الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
The most common multi-joint pain presentation is ankle and knee pain. The foot plays an important role in painful knee conditions. There are several mechanisms by which foot pain could be linked to the subsequent onset of knee symptoms in people at risk of knee osteoarthritis (KOA). Heel pain (HP) is a common symptom in the general population; the posterior heel is the second most common location of mechanically induced HP. KOA is the most common joint disease and is associated with significant pain and disability. There is an increasing awareness on the importance in identifying early phases of the KOA.
The aim of the current study is to investigate the prevalence of PHP, related disability, and associated factors in patients with early knee osteoarthritis (EKOA) as well as the laterality of HP to the most affected knee (index knee) (bilateral, ipsilateral, and contralateral).
One hundred female patients diagnosed with EKOA were enrolled in the current study from those attending the Outpatient Clinic of Physical Medicine, Rheumatology and Rehabilitation Department at Alexandria University Hospitals. Participants with history of heel, foot or ankle joint trauma or surgery, participants with secondary KOA, advanced KOA and knee pain related to other musculoskeletal conditions (rheumatoid arthritis) were excluded.
Patients were categorized into 2 groups according to MFPDI, group 1 with non-disabling HP and group 2 with disabling HP. Further HP was categorized into 3 groups according to laterality to the index knee (bilateral, ipsilateral and contralateral HP) which was the most painful knee according to VAS.
The findings of our study highlight that the heel is a common location of pain in people with EKOA, and bilateral HP to the index knee was found to be the most prevalent HP presentation.
Our finding also showed that 54% of the female patients with EKOA complaining of PHP age 31-50 years, 34% of those with HP were disabled by their pain. Disabling HP was associated with significant functional limitation including worse HAQ-DI score and knee‐specific measure (WOMAC) score, particularly those with diabetes mellitus, manual occupations, and those with valgus foot alignment and it was significantly less common in those having previously worn high heels (2-3 cm).
Disabling HP was associated with significant X-ray finding on lateral heel view as half the patients with disabling HP had more than one finding (Planter, Insertion calcaneal-spur) or those had an insertion calcaneal spur size (>10mm).
There was a high negative statistically significant correlation between MFPDI and Quad angle of the affected knee, while there was a positive statistically significant correlation between MFPDI and serum uric acid level.
Also our finding showed that people with bilateral HP to the index knee have reduced measures of health and physical function; including worse HAQ-DI. Bilateral HP was associated with significant older age, and those with diabetes mellitus. In our study patients with ipsilateral HP showed a tendency for lower KL score while patients with bilateral HP and contralateral HP had a tendency for a higher KL score.