PAIN CATASTROPHIZING AND NEUROPATHIC SYMPTOMS PREDICT POOR RECOVERY IN INDIVIDUALS WITH CHRONIC PLANTAR HEEL PAIN: A PROSPECTIVE COHORT STUDY

Abstract

Background

Chronic plantar heel pain (CPHP) is one of the most common musculoskeletal foot disorders and is frequently associated with persistent pain, reduced physical function, and impaired quality of life. Although biomechanical factors have traditionally been emphasized in the management of CPHP, increasing evidence suggests that psychological and neuropathic mechanisms may contribute to prolonged symptom persistence and poor recovery outcomes.

Objective

To investigate whether pain catastrophizing beliefs and neuropathic symptoms predict poorer long-term recovery outcomes in individuals with chronic plantar heel pain over a 12-month follow-up period.

Methods

A prospective cohort study was conducted involving 220 participants with clinically diagnosed chronic plantar heel pain. Baseline assessments included demographic, physical, psychological, and behavioral variables. Pain catastrophizing was assessed using the Pain Catastrophizing Scale (PCS), neuropathic symptoms were evaluated using the painDETECT questionnaire, and depressive symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9). Pain severity, foot function, and health-related quality of life were assessed using the Foot Health Status Questionnaire (FHSQ) and EQ-5D questionnaire at baseline and 12-month follow-up. Linear mixed-effects regression models were used to determine longitudinal predictors of recovery outcomes.

Results

A total of 208 participants completed the 12-month follow-up assessment. Higher baseline pain catastrophizing scores were significantly associated with persistent pain severity and poorer recovery trajectories over time (β = 0.41, 95% CI 0.24 to 0.58, p < 0.001). Greater neuropathic symptom involvement was also significantly associated with delayed pain reduction and persistent symptoms during follow-up (β = 0.37, 95% CI 0.19 to 0.54, p < 0.001). Increased sedentary behavior was associated with poorer functional and quality-of-life outcomes, whereas higher daily step counts demonstrated favorable associations with recovery. Traditional biomechanical variables including body mass index, ankle plantarflexor strength, and first metatarsophalangeal joint dorsiflexion mobility did not demonstrate significant predictive value for long-term recovery outcomes. Pain catastrophizing and neuropathic symptoms remained significant independent predictors after adjustment for demographic and clinical covariates.

Conclusion

Pain catastrophizing beliefs and neuropathic symptom involvement were significant predictors of poorer long-term recovery outcomes in individuals with chronic plantar heel pain. Psychological and neuropathic factors demonstrated stronger prognostic associations than traditional biomechanical measures. These findings highlight the importance of incorporating biopsychosocial assessment into rehabilitation strategies for chronic plantar heel pain.