Plantar fasciitis is one of the most common causes of foot pain, affecting millions of people worldwide, particularly those who are middle-aged or engage in regular physical activity. It is a condition characterized by inflammation of the plantar fascia, a thick band of tissue that runs across the bottom of the foot and connects the heel bone to the toes. The hallmark symptom of plantar fasciitis is stabbing pain in the heel, especially upon taking the first steps in the morning or after prolonged periods of inactivity. This condition can significantly impair mobility, making even simple tasks like walking or standing painful. Despite its prevalence, awareness and understanding of plantar fasciitis and general foot pain remain limited, especially in rural and semi-urban populations where access to healthcare and health education is often restricted [1-4].

Globally, the incidence of plantar fasciitis is increasing, driven by a combination of factors such as rising obesity rates, increased participation in physical activities and aging populations. The condition is also closely associated with occupations that require long periods of standing or walking, making it a significant concern for both athletes and individuals engaged in manual labor. However, plantar fasciitis is not solely limited to these groups; it can affect anyone, including those with sedentary lifestyles, due to factors such as poor footwear, improper walking gait, or inadequate foot support [5-8].

In India, particularly in rural areas like District Kangra in Himachal Pradesh, the burden of plantar fasciitis may be underrecognized. The region, known for its diverse population engaged in agriculture, construction and service industries, presents a unique opportunity to study public knowledge and awareness of plantar fasciitis and general foot pain. The combination of physically demanding jobs, often conducted without ergonomic support or proper footwear and a general lack of access to specialized healthcare services may contribute to the prevalence of this condition. Yet, awareness about plantar fasciitis, its risk factors, preventive measures and treatment options remains low, potentially leading to chronic pain and disability that could otherwise be managed or prevented with timely intervention [7-10].

Understanding public awareness of plantar fasciitis and general foot pain in District Kangra is crucial for developing effective public health strategies. Early diagnosis and appropriate management are key to reducing the impact of this condition on individuals' quality of life. However, misconceptions and a lack of knowledge about the causes, symptoms and treatment of plantar fasciitis often hinder effective management. This highlights the need for educational interventions that can empower individuals to take proactive steps in preventing and managing foot pain [9,10].

The primary objective of this study is to assess the awareness and knowledge of plantar fasciitis and foot pain among adults in District Kangra, Himachal Pradesh. By conducting a comprehensive cross-sectional survey, this research aims to identify gaps in understanding and provide insights into the public's perception of this condition. The findings from this study will contribute to the development of targeted public health strategies and educational initiatives that can improve foot health and prevent the long-term complications associated with plantar fasciitis. Through this research, we hope to bridge the knowledge gap, promote better health outcomes and enhance the overall well-being of the population in District Kangra and similar rural regions.

Objectives of the Study

The primary objective is to gauge awareness and knowledge about Plantar Fasciitis and Foot Pain among general public of District Kangra, Himachal Pradesh.

• Research Approach: Descriptive

• Research Design: Cross-sectional survey design

• Study area: District Kangra, Himachal Pradesh

• Study duration: Between January 2024 to May 2024

• Study population: The study's target population encompassed all adults aged 18 and above who had been residents of District Kangra Himachal Pradesh for a minimum of 12 months

• Sample size: A robust sample size of 400 adults was determined using a 95% confidence level, an estimated knowledge level of 50% regarding Plantar Fasciitis and Foot Pain, a precise 5% absolute error margin and a conservative 5% non-response rate

• Study tool: A google form questionnaire consisting of questions regarding socio-demography and knowledge regarding Plantar Fasciitis and Foot Pain was created. The questionnaire was initially pre-tested on a small number of participants to identify any difficulty in understanding by the respondents

Description of Tool 

• Demographic data survey instrument: The demographic form elicited information on participants’ background: age, gender, marital status, religion, employment, education and many more

• Questionnaire: The questionnaire contains 20 structured knowledge related questions regarding Plantar Fasciitis and Foot Pain. One mark was given for each correct answer and zero for incorrect answer. The maximum score was 20 and minimum score was zero. Scoring was done on the basis of marks as >80% (16-20) = very good, 60-79% (12-15) = Good, 41-59% (8-11) = Fair, <40% (<8) = poor

• Validity of: By the experts in this field

• Data collection: Data was collected under the guidance of supervisors. The google form questionnaire was circulated among the residents of District Kangra Himachal Pradesh for responses using online modes like e-mail and social media platforms like Whatsapp groups, Facebook, Instagram and Linkedin till the 400 responses were collected 

• Data analysis: Data was collected and entered in Microsoft excel spread sheet, cleaned for errors and analyzed with Epi Info V7 Software with appropriate statistical test in terms of frequencies and percentage

• Ethical Considerations: Participants confidentiality and anonymity was maintained

The study involved 400 participants from District Kangra, Himachal Pradesh and provided a detailed analysis of their socio-demographic characteristics and knowledge regarding plantar fasciitis and foot pain. The socio-demographic data (Table 1) showed that the participants were fairly well-distributed across different age groups, with 30.5% aged 18-30 years, 24.8% aged 31-40 years, 22.3% aged 41-50 years and 22.5% aged above 50 years. The gender distribution was relatively balanced, with 48.0% males and 52.0% females. Regarding marital status, the majority of participants were married 57.5%, while 39.3% were single and 3.3% fell into the "others" category. The religious composition revealed that most participants were Hindu 82.8%, followed by Muslims 7.5% and Sikhs 7.8%. Employment status indicated that 49.3% of the participants were employed, 26.5% were unemployed and 24.3% were students. Educational levels varied, with 33.8% of participants being graduates, 27.0% having completed high school, 25.3% holding postgraduate or higher degrees and 14.0% having education below high school.

In terms of knowledge about the symptoms of plantar fasciitis and foot pain (Table 2), a significant 78.8% of participants had heard of plantar fasciitis, indicating a good level of general awareness. Additionally, 72.0% were aware that plantar fasciitis can cause heel pain, while 69.0% knew that it can lead to stiffness in the foot. However, fewer participants recognized that foot pain is often worse in the morning with plantar fasciitis 66.3% and 64.3% knew that it can cause difficulty in walking. These findings suggest that while the general concept of plantar fasciitis is well-known, there is room for improving awareness, particularly regarding the full range of symptoms.

Knowledge about the causes and risk factors of plantar fasciitis and foot pain (Table 3) revealed moderate awareness among participants. About 60.5% of participants understood that prolonged standing increases the risk of plantar fasciitis and 59.0% recognized that wearing improper footwear can contribute to foot pain. Furthermore, 57.5% were aware that obesity is a risk factor for plantar fasciitis and 55.3% knew that high-impact activities can contribute to foot pain. However, knowledge about the role of foot structure, such as flat feet or high arches, was slightly lower, with only 53.0% being aware of this risk factor. These results highlight areas where public health education could be enhanced, particularly in educating individuals about modifiable risk factors.

Regarding prevention (Table 4), knowledge levels were relatively low. While 53.8% of participants knew that wearing proper footwear can help prevent foot pain, only 52.0% recognized the importance of stretching exercises in preventing plantar fasciitis.

Table 1: Socio-Demographic Characteristics of Study Participants (N = 400)

Table 2: Knowledge Regarding Symptoms of Plantar Fasciitis and Foot Pain (N = 400)

Table 3: Knowledge Regarding Causes and Risk Factors of Plantar Fasciitis and Foot Pain (N = 400)

Table 4: Knowledge Regarding Prevention of Plantar Fasciitis and Foot Pain (N = 400)

Table 5: Knowledge Regarding Treatment and Management of Plantar Fasciitis and Foot Pain (N = 400)

Table 6: Overall Knowledge Score Categories for Plantar Fasciitis and Foot Pain (N = 400)

Additionally, 50.8% understood that maintaining a healthy weight can help prevent foot pain, but awareness of other preventive measures was lower. For example, only 48.3% were aware that avoiding high-impact activities can help prevent foot pain and 45.0% knew that taking breaks during prolonged standing could be beneficial. These findings suggest a need for targeted educational interventions focusing on practical strategies to prevent plantar fasciitis and related foot pain.

Participants' knowledge regarding the treatment and management of plantar fasciitis and foot pain (Table 5) was relatively limited. Less than half of the participants were aware that rest and ice 47.5% and stretching exercises 45.5% could help manage plantar fasciitis. Awareness of other treatment options was even lower, with only 43.3% recognizing the benefits of wearing orthotics, 40.3% knowing that over-the-counter pain relievers could help and just 37.5% being aware that physical therapy might be required for severe cases. These findings indicate a significant need for better dissemination of information regarding both conservative and medical treatment options for managing plantar fasciitis and foot pain.

Finally, the overall knowledge scores (Table 6) revealed a varied distribution among participants. About 25.5% demonstrated very good knowledge, scoring between 16-20 points. A slightly larger proportion 29.8% had good knowledge, scoring 12-15 points. A notable 26.8% had fair knowledge, scoring 8-11 points, while 18.0% fell into the poor knowledge category, scoring below 8 points. This distribution suggests that while a portion of the population possesses a solid understanding of plantar fasciitis and foot pain, a significant percentage still requires better education and awareness regarding this common condition. These results highlight the need for public health initiatives that can effectively bridge these knowledge gaps.

This study provides a comprehensive assessment of the awareness and knowledge regarding plantar fasciitis and foot pain among the general population of District Kangra, Himachal Pradesh. The findings reveal significant insights into the public's understanding of this common condition, highlighting both areas of strength and gaps that require targeted educational interventions. Given the impact of plantar fasciitis on mobility and quality of life, particularly in populations engaged in physically demanding occupations, these results have important implications for public health strategies in similar rural regions.

The socio-demographic data indicate that the study sample was well-distributed across various age groups, with a balanced representation of both genders. This diversity enhances the generalizability of the findings to the broader population of District Kangra. The age distribution is particularly relevant, as plantar fasciitis is often associated with middle-aged individuals, a group well-represented in this study. Additionally, the relatively high educational attainment among participants 33.8% being graduates and 25.3% holding postgraduate or higher degrees suggests that the population has a reasonable baseline capacity for health literacy. However, despite this educational background, gaps in knowledge about plantar fasciitis were still evident, underscoring the need for targeted health education that reaches beyond general educational qualifications [3,4].

The study reveals that while a significant majority 78.8% of participants had heard of plantar fasciitis, detailed knowledge of its symptoms varied. Although 72.0% were aware that plantar fasciitis can cause heel pain, fewer participants recognized other key symptoms, such as stiffness in the foot 69.0% and morning pain 66.3%. This disparity suggests that while the general concept of plantar fasciitis is known, the specific symptoms that could lead to early diagnosis and effective management are less understood. The lower awareness of symptoms like difficulty in walking 64.3% is particularly concerning, as it indicates that individuals may not associate their mobility issues with this condition, leading to delayed diagnosis and treatment. Public health initiatives should focus on enhancing awareness of the full spectrum of symptoms associated with plantar fasciitis to promote early recognition and intervention [5-7].

Knowledge regarding the causes and risk factors of plantar fasciitis was moderate, with some critical gaps. While 60.5% of participants understood that prolonged standing increases the risk of developing plantar fasciitis, awareness of other significant risk factors was somewhat lower. For instance, only 59.0% recognized that improper footwear could contribute to foot pain and 57.5% were aware of the risk posed by obesity. The fact that only 53.0% of participants knew that plantar fasciitis could be caused by foot structural issues, such as flat feet or high arches, highlights a significant area for improvement in public education. These findings underscore the need for health education campaigns that emphasize the role of modifiable risk factors, such as weight management, appropriate footwear and the impact of occupational activities, in the prevention of plantar fasciitis [7-9]

The study also identified significant gaps in participants' knowledge about the prevention of plantar fasciitis and foot pain. While just over half of the participants 53.8% knew that wearing proper footwear can help prevent foot pain, knowledge of other preventive measures was relatively low. Only 52.0% recognized the importance of stretching exercises and even fewer participants were aware that maintaining a healthy weight 50.8% and avoiding high-impact activities 48.3% could help prevent foot pain. The lowest awareness was related to the importance of taking breaks during prolonged standing 45.0%. These findings suggest that while some preventive strategies are known, there is a need for broader education on the full range of measures that can help prevent plantar fasciitis. Public health campaigns should focus on providing practical, actionable advice that individuals can incorporate into their daily routines to reduce their risk of developing this condition [8,10].

Participants' knowledge regarding the treatment and management of plantar fasciitis and foot pain was relatively limited, highlighting another area for public health intervention. Less than half of the participants were aware that rest and ice 47.5% and stretching exercises 45.5% could help manage plantar fasciitis. Awareness of other treatment options was even lower, with only 43.3% recognizing the benefits of wearing orthotics, 40.3% knowing that over-the-counter pain relievers could help and just 37.5% being aware that physical therapy might be required for severe cases. This lack of knowledge about treatment options could lead to inadequate self-management and prolonged pain, further impacting individuals' quality of life. It is essential to disseminate information about the full range of treatment options, from conservative measures like rest and stretching to more involved interventions like physical therapy, to ensure that individuals are empowered to manage their condition effectively [7,9].

The overall knowledge scores revealed a wide distribution among participants, with 25.5% demonstrating very good knowledge and 29.8% showing good knowledge. However, a significant portion of the population still fell into the fair 26.8% and poor 18.0% knowledge categories. This variability underscores the fact that while some individuals possess a strong understanding of plantar fasciitis and foot pain, a considerable percentage of the population still lacks adequate knowledge. This disparity points to the need for targeted educational interventions that address specific gaps in knowledge, particularly among those with lower overall awareness. Ensuring that all segments of the population are well-informed is crucial for preventing and managing plantar fasciitis effectively [8,10].

The findings of this study have important implications for public health strategies in District Kangra and similar regions. There is a clear need for comprehensive educational campaigns that address both the general awareness of plantar fasciitis and the specific knowledge gaps identified in this study. Public health initiatives should prioritize the dissemination of information on modifiable risk factors, prevention strategies and treatment options, with a focus on practical, actionable advice that can be easily implemented by the general public. Additionally, healthcare providers in the region should be equipped with the tools and resources to educate their patients about plantar fasciitis, emphasizing early diagnosis and effective management. Community-based interventions, such as workshops, health camps and workplace ergonomic assessments, could be effective in raising awareness and promoting healthy practices that prevent and manage plantar fasciitis and foot pain.

In conclusion, this study underscores the significant need for improved public awareness and education regarding plantar fasciitis and foot pain in District Kangra, Himachal Pradesh. While there is a foundational level of awareness about the condition, particularly regarding its basic symptoms, substantial gaps remain in the public's understanding of the causes, risk factors, preventive measures and treatment options. These deficiencies highlight the urgency of targeted public health interventions that can effectively address these knowledge gaps and empower individuals to take proactive steps in preventing and managing plantar fasciitis. By enhancing educational efforts and equipping healthcare providers with the necessary resources to educate the public, it is possible to reduce the prevalence and impact of this common yet often debilitating condition. Ultimately, improving knowledge and awareness will not only help individuals manage their symptoms more effectively but also contribute to better overall foot health and quality of life in the community.

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