Analysis of Data on the Prevalence and Pharmacologic Treatment of Plantar Fasciitis Pain

An analysis of data from a large, national survey provides insights into factors associated with the type of foot pain known as plantar fasciitis and its pharmaceutical treatment. Although data from the survey show that less than one percent of U.S. adults experienced plantar fasciitis pain in the previous month, as many as 41 percent of plantar fasciitis respondents used prescription pain medications during that time (but only 6 percent reported using them specifically for plantar fasciitis pain). The analysis was conducted by the National Center for Complementary and Integrative Health (NCCIH) and was published in The Journal of Pain.

Plantar fasciitis is a progressive degenerative condition affecting the thick band of tissue that covers the bones on the bottom of the foot (plantar fascia), and has been associated with heel pain, falls, poor quality of life, and disability. The data for this analysis come from the 2013 National Health and Wellness Survey, a self-administered, Internet-based questionnaire completed by 75,000 participants identified through a Web-based consumer panel. Participants were asked if they experienced any pain within the last year and the last month and were asked to select specific types of diagnoses for their pain from a list that included plantar fasciitis.

Among the findings of the analysis on prevalence:

• Approximately one percent of U.S. adults reported a diagnosis of plantar fasciitis in the last year, and more than three-quarters of them reported having plantar fasciitis pain in the previous month.
• Overall prevalence of diagnosed plantar fasciitis with pain was 0.85 percent.
• The prevalence of plantar fasciitis was lowest in those aged 18-44 (0.53 percent) and highest in those aged 45-64 (1.33 percent).
• Females (1.19 percent) were 2.5 times more likely to report plantar fasciitis than males (0.47 percent).
• Hispanic whites had the highest prevalence of plantar fasciitis (0.95 percent), followed by non-Hispanic whites (0.93 percent). Non-Hispanic blacks were substantially more likely to use prescription pain medicine for plantar fasciitis than non-Hispanic whites.
• Body mass index (BMI) was strongly associated with plantar fasciitis; those with a BMI of 30 or more (1.48 percent) were 5 times more likely to have plantar fasciitis than those with a BMI less than 25 (0.29 percent).

Among the findings of the analysis on characteristics of plantar fasciitis pain:

• 25 percent reported having severe plantar fasciitis pain, 45 percent reported moderate pain, and 28 percent had mild pain.
• More than 61 percent reported having pain every day, and almost 54 percent reported that their pain interfered with normal work activities at least moderately. Nearly one-third reported severe (“quite a bit” or “extreme”) pain-related interference.

Among the findings of the analysis on medication use by those with plantar fasciitis pain:

• Non-Hispanic blacks were three times more likely to use prescription pain medications specifically for this condition than non-Hispanic whites.

• Although approximately one-quarter of respondents with plantar fasciitis pain used opioids (27.97 percent) and prescription nonsteroidal anti-inflammatory drugs (NSAIDs) (23.73 percent) for any pain, far fewer used these medications specifically to treat their plantar fasciitis pain.
• More than two-thirds with plantar fasciitis used over-the-counter (OTC) products for pain management; the most common OTC products were NSAIDs (49.48 percent) and acetaminophen (26.93 percent); only 1.37 percent used herbal products or other nonvitamin, nonmineral dietary supplement.
• Those diagnosed with plantar fasciitis by a medical specialist were twice as likely to use prescription medication for their plantar fasciitis pain than those diagnosed by a nonspecialist.

The author of the study concluded that these data provide additional insights into an often-disabling disorder, as well as the drug treatments used to manage it, despite a lack of evidence from clinical trials supporting their use. The extent of use of nonpharmacologic approaches for those with plantar fasciitis pain remains unknown.