Chronic plantar heel pain severity is associated with lipid biomarkers

To describe associations between systemic metabolic biomarkers and chronic plantar heel pain (CPHP).

Adults with clinically diagnosed CPHP (n = 197) and age- and sex-matched controls (n = 100) provided fasting blood samples for analysis of glucose, total cholesterol, triglycerides, high- and low-density lipoprotein (HDL, LDL) cholesterol, non-HDL cholesterol, and total cholesterol/HDL cholesterol ratio. Data on medication use, body mass index (BMI), waist circumference, ankle plantarflexor strength, and painDETECT scores were also collected. Associations with CPHP presence were analysed using logistic regression. Among cases, linear regression assessed associations with pain severity (100 mm visual analogue scale), and pain duration (number of months with heel pain). Models were adjusted for age and sex, and then BMI (primary model). Sensitivity analyses tested whether medication use affected outcomes. Additional interaction analyses considered BMI, waist circumference, ankle plantarflexor strength, and painDETECT score.

Total cholesterol (β = 5.0points per mmol/L), non-HDL cholesterol (β = 5.1points per mmol/L), LDL cholesterol (β = 4.9points per mmol/L), and total cholesterol/HDL cholesterol ratio (β = 4.2points per one-unit increase), but not fasting glucose, triglycerides, or HDL cholesterol, were positively associated with pain severity. This association persisted for total cholesterol after further adjusting for lipid-lowering medication. Metabolic biomarkers were not associated with CPHP presence, and no overall association with pain duration was observed; however, waist circumference modified the LDL-pain duration association (β = 0.02).

Several lipid biomarkers were associated with pain severity, supporting a potential metabolic contribution in established disease, but not with CPHP presence or duration. Longitudinal studies are needed to clarify temporality and the role of lipid-related mechanisms in symptom modulation.