PFPS-Defined Plantar Heel Pain Among Women Aged 40-60 Years Engaged in Prolonged Standing in Kerala, India: A Descriptive Cross-Sectional Online Survey
A descriptive cross-sectional survey of 100 women aged 40–60 engaged in prolonged standing in Kerala, India, found that approximately 69% met the Plantar Fasciitis Pain/Disability Scale (PFPS) criterion (>35) for heel pain, indicating a high symptom burden of predominantly moderate pain in this self-selected sample, though the results do not represent the population prevalence of clinically confirmed plantar fasciitis.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
For many adults, the simple act of taking the first step in the morning can be met with a sharp, stinging pain in the bottom of the foot. This discomfort, often called plantar heel pain, is a widespread complaint that can make walking feel like a chore. While the medical term for the most common cause is plantar fasciitis, the condition is actually a broad category of foot trouble that can stem from various issues, including fat pad problems or nerve irritation. To sort through this confusion, researchers use a specific questionnaire called the Plantar Fasciitis Pain/Disability Scale. This tool is not a magic wand that instantly diagnoses a disease; rather, it is a graded ruler designed to measure how much pain and daily struggle a person is experiencing. It helps quantify the burden of symptoms, distinguishing between those who are merely uncomfortable and those whose lives are significantly disrupted by the pain.
The question of who suffers most from this condition is particularly relevant for people whose jobs require them to stand for long periods. In the southern Indian state of Kerala, a group of researchers set out to understand the scale of this problem among women aged forty to sixty who spend their workdays on their feet. These women, often working in roles that demand prolonged standing, represent a group that is frequently overlooked in medical studies. The researchers wanted to know how many of these women were experiencing significant heel pain and how that pain affected their ability to move and function. They did not set out to diagnose a specific disease in every participant, but rather to map the landscape of suffering within this specific community.
To gather this information, the team conducted an online survey during 2023, reaching out to women in the districts of Kannur and Kozhikode. They invited participants to fill out a digital form that asked about their work habits and their pain levels. The survey was shared through messaging apps and email, relying on the women to choose to participate. Out of the 142 women who received the invitation, 100 completed the questionnaire. The researchers defined "prolonged standing" as being on one's feet for more than four hours a day or standing continuously for over an hour without a break. Every woman who took the survey met this definition, ensuring the group shared a common occupational experience.
The results revealed a striking pattern. When the researchers looked at the scores from the pain and disability questionnaire, they found that nearly seven out of ten women in the group met the specific threshold used to define significant heel pain. In total, 69 percent of the participants scored high enough to indicate they were dealing with substantial discomfort and limitations in their daily lives. The average pain score for the group was moderate, suggesting that while not everyone was in agony, the majority were dealing with a level of pain that was noticeable and persistent. When asked to rate their pain on a standard scale from zero to one hundred, most women fell into the moderate category, with a smaller portion reporting severe pain and very few saying they felt no pain at all.
The nature of the pain described by these women offered further clues. Most reported that the pain felt deep rather than superficial, and it was most commonly located at the very bottom of the heel. The survey also asked about specific activities that triggered the pain. Many women found that standing on their toes, walking down stairs, or standing for long periods after a break made the pain worse, often reaching a moderate or severe level. This pattern of symptoms aligns with what is typically expected when the tissues supporting the heel are under constant strain. The researchers also noted a strong link between the overall disability score and the intensity of the pain reported, confirming that as the pain increased, the ability to perform daily tasks decreased.
It is important to understand what these numbers do and do not mean. The study did not involve a doctor examining the women's feet or using imaging technology to confirm a diagnosis of plantar fasciitis. Because of this, the finding that 69 percent of the women met the pain criteria cannot be taken as proof that 69 percent of all standing women in Kerala have the specific medical condition known as plantar fasciitis. Instead, the result represents the heavy burden of symptoms in this specific group of self-selected women. The researchers were careful to note that the women who chose to participate might have been more likely to have pain than those who did not, which could make the problem appear larger than it is in the general population.
Despite these limitations, the study provides a clear picture of the reality faced by middle-aged women in prolonged-standing roles in this region. The high proportion of women reporting significant pain suggests that this is a serious occupational health issue that deserves attention. The findings point to a need for better workplace strategies, such as improved footwear, opportunities to rest, and load management, to protect the feet of these workers. While the survey does not offer a cure or a definitive diagnosis, it successfully highlights a hidden layer of discomfort that affects a large number of women, urging clinicians and employers to look closer at the feet of those who stand all day.
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