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Foot type and injury risk

Discussion in 'Biomechanics, Sports and Foot orthoses' started by NewsBot, Sep 5, 2006.

  1. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1

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    Foot morphology and foot/ankle injury in indoor football.
    J Sci Med Sport. 2006 Aug 31;
    Cain LE, Nicholson LL, Adams RD, Burns J
     
  2. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    Yet another study showing that pronated feet are not a risk factor for overuse injury ... when will we get it?
     
  3. Josh Burns

    Josh Burns Active Member

    Yes the pronated feet are spared from injury again! But they do not 'perform' well.

    The results of this study pave the way for a new research direction in foot type biomechanics i.e. athletic performance. We may be able to modify foot function through orthoses, footwear, stretching, strengthening, etc. to enhance sporting performance at both the recreational and elite level.

    Joshua Burns PhD, B App Sc (Pod) Hons
    NHMRC Australian Clinical Research Fellow
    Institute for Neuromuscular Research, The Children's Hospital at Westmead
    Conjoint Senior Lecturer, Discipline of Paediatrics and Child Health
    Faculty of Medicine, The University of Sydney, Australia
     
  4. Hylton Menz

    Hylton Menz Guest

    Pronated foot type may be associated with exercise-related leg pain:

    Exercise-Related Leg Pain in Female Collegiate Athletes. The Influence of Intrinsic and Extrinsic Factors

    Mark F. Reinking

    American Journal of Sports Medicine

    Background: Exercise-related leg pain is a common complaint among athletes, but there is little evidence regarding risk factors for this condition in female collegiate athletes.

    Purpose: To examine prospectively the effect of selected extrinsic and intrinsic factors on the development of exercise-related leg pain in female collegiate athletes.

    Study Design: Cohort study; Level of evidence, 2.

    Methods: Subjects were 76 female collegiate athletes participating in fall season sports, including cross-country running, field hockey, soccer, and volleyball. Athletes were seen for a preseason examination that included measures of height, weight, foot pronation, and calf muscle length as well as a questionnaire for disordered eating behaviors. Body mass index was calculated from height and weight (kg/m2). Those athletes who developed exercise-related leg pain during the season were seen for follow-up. All athletes who developed the condition and a matched group without such leg pain underwent bone mineral density and body composition testing. Statistical analyses of differences and relationships were conducted.

    Results: Of the 76 athletes, 58 (76%) reported a history of exercise-related leg pain, and 20 (26%) reported occurrence of exercise-related leg pain during the season. A history of this condition was strongly associated with its occurrence during the season (odds ratio, 13.2). Exercise-related leg pain was most common among field hockey and cross-country athletes and least common among soccer players. There were no differences between athletes with and without such leg pain regarding age, muscle length, self-reported eating behaviors, body mass index, menstrual function, or bone mineral density. Athletes with exercise-related leg pain had significantly (P < .05) greater navicular drop compared with those without.
    Conclusion: Exercise-related leg pain was common among this group of female athletes. The results suggest that there are certain factors, including foot pronation, sport, and a history of this condition, that are associated with an increased risk of exercise-related leg pain. ​
     
  5. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    OK :eek: .... that makes it two studies that show a pronated foot is a risk factor for injury .... all the rest show that its not :p
     
  6. Josh Burns

    Josh Burns Active Member

    The similarities between these two studies are uncanny:

    Reinking (2006) "76 female collegiate athletes......Athletes with exercise-related leg pain had significantly (P < .05) greater navicular drop compared with those without."

    Cain et al (2006) "76 adolescent male indoor football (Futsal) players..... supinated and under-pronated feet, were found to be associated with a significant increase in the risk of overuse injury (p=0.008)"

    Could it be that gender determines the relationship between foot type and injury?

    Joshua Burns PhD, B App Sc (Pod) Hons
    NHMRC Australian Clinical Research Fellow
    Institute for Neuromuscular Research, The Children's Hospital at Westmead
    Conjoint Senior Lecturer, Discipline of Paediatrics and Child Health
    Faculty of Medicine, The University of Sydney, Australia
     
  7. John Spina

    John Spina Active Member

    Gender can be a factor,especially with very lean young women-amennorhea can be related as well as very lean women with amennorhea seem to also have less bone density.
     
  8. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    A prospective study on gait-related intrinsic risk factors for lower leg overuse injuries.
    Ghani Zadeh Hesar N, Van Ginckel A, Cools AM, Peersman W, Roosen P, Declercq D, Witvrouw E.
    Br J Sports Med. 2009 Feb 18. [Epub ahead of print]
     
  9. Rod Wishart

    Rod Wishart Member

    All quiet on this thread... Interesting.
     
  10. drsha

    drsha Banned

    Dr. Payne Wrote:
    Yet another study showing that pronated feet are not a risk factor for overuse injury ... when will we get it?

    Craig: With all of the sophistication of this Arena, how can you comfortably accept a term like "pronated foot" in this day and age??

    What is a Pronated Foot?
    Does having a rigid rearfoot functional rearfoot type prevent that foot from collapsing and being injury prone?
    Does it matter whether collapse is rearfoot (CIA) associated or First Ray (FHL) to cause injury?

    With all your new words and a closed mind to new words that are not of your creation, my opinion is reinforced by this thread that you remain rearfoot focused, lacking in understanding forefoot function and therefore weak in your treatment accumen.

    1. When utilizing functional foot typing, the majority of rearfeet are rigid or stable. They are not flexible (pronated).
    This means that just by shear numbers, the majority of injuries (like the majority of feet) will occur in the "supinated" rearfeet.
    2. I predict that the flexible rearfoot functional foot type is a poor performer that unless vaulted and compensated, has a much higher injury rate when comparing equal numbered populations with the rigid rearfoot functional foot type.
    3. The most common foot type on the competitive athletic field is the rigid rearfoot, flexible forefoot functional foot type and depending on the muscularity and morphing ability to take the forefoot from its mobile adaptor functional tasking to its rigid lever and supportive functional tasking with power and in phase, will determine the injury rate of that individual. Successful treatment will depend on ones ability to prevent the vault of the foot from collapsing and the ability to stabilize and power the forefoot so that it can perform to its highest potential.
    4. Rearfoot treatment (Posts, Skives, Inverted Casts, STJ Axis location) in these cases plays a relatively small component of the biomechanical problem by your own definition and hence plays only a small role in the cure.

    These rules change with each of the functional foot types and therefore with each patient in a very custom way. To generalize feet and injuries into "pronated or not pronated rearfeet" as a group is so short minded when one can profile all feet ito functional foot types and then treat them foot type-specific.

    "When will we get it"?
    Craig Payne
    Dennis
     
  11. drsha

    drsha Banned

    Dr Menz Wrote and Quoted:
    Athletes with exercise-related leg pain had significantly (P < .05) greater navicular drop compared with those without.
    Conclusion: Exercise-related leg pain was common among this group of female athletes. The results suggest that there are certain factors, including foot pronation, sport, and a history of this condition, that are associated with an increased risk of exercise-related leg pain.

    Can Navicular Collapse come from only rearfoot collapse?
    Can Navicular Collapse come from forefoot collapse?

    So maybe these "pronated feet" had supinated rearfeet and collapsed forefeet making Dr. Crain right again!! Pronated feet are not related to injury???

    We should coin yet another term "Forefoot Pronation" to make it its own distanct entity.

    Then Rearfoot Pronation + Forefoot Pronation = Total Pronation

    This should relieve Dr. Payne because now we all get it! Pronated feet cause injury

    Secondly, in Architecture, when two arches are connected by a curved roof, that is called a Vault. Navicular sag or collapse is a relative measure of the height of The Vault of The Foot.
    So if we created a Centring underneath The Vault to prevent its collapse, balanced the rear pillar, balanced the fore pillar and balanced one foot to the other, foot type and case specific, we would be practicing Neoteric Biomechanics.
    Dennis
     
  12. drsha

    drsha Banned

    Dr. Burns Concludes:
    Could it be that gender determines the relationship between foot type and injury?

    ????????????????????

    If this is where research (Ph.D's) take us.
    Sex change operations will prolong the athletic life and performance of some of our great athletes even better than orthotics.


    Sorry, sorry, sorry. I could'nt control myself from this post!!

    Dennis
     
  13. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    How familiar are you with the published research evidence on this:

    No relationship between foot pronation and overuse injuries (Cowan et al, 1992; Cowan et al, 1996; Brusseuil et al, 1998; Wen et al, 1998; Twellaar et al, 1997; Kaufmann, Brodine & Shaffer, 1999; Michelson, Durant & McFarland, 2002; Giladi et al, 1985; Burns et al, 2005; Hetrsroni et al, 2006)
    Weak relationship between foot pronation and overuse injuries (White & Yates, 2002; Reinking 2006, Willems et al, 2007)

    Not one prospective study has shown a strong relationship between foot "pronation" and injury (each study used a different definition and technique to measure "pronation")
     
  14. drsha

    drsha Banned

    DrSha Wrote:
    Craig: With all of the sophistication of this Arena, how can you comfortably accept a term like "pronated foot" in this day and age??
    Dr. Payne Replied:
    How familiar are you with the published research evidence on this:
    No relationship between foot pronation and overuse injuries (Cowan et al, 1992;

    I asked why a generalized term like “pronated foot” from random studies could be used in order to form a scientific conclusion?

    Dr. Payne Replied with reference to Twelve Studies
    Cowan et al, 1996; Brusseuil et al, 1998; Wen et al, 1998; Twellaar et al, 1997; Kaufmann, Brodine & Shaffer, 1999; Michelson, Durant & McFarland, 2002; Giladi et al, 1985; Burns et al, 2005; Hetrsroni et al, 2006)
    Weak relationship between foot pronation and overuse injuries (White & Yates, 2002; Reinking 2006, Willems et al, 2007)
    and then added:
    “each study used a different definition and technique to measure "pronation"

    Dr Sha States:
    I am assuming that Dr. Payne is pointing out that if there are twelve definitions for a pronated foot and twelve different methods of measuring it in the twelve referenced papers, you are in agreement with me that the term “foot pronation’” needs defining (if not, please explain) and that any bundling of these studies to reach a conclusion that “foot pronation” does or doesn’t do anything lacks power.

    Could I be provided with one (or more) definition of “foot pronation” and one (or more) methods of measuring it so that we can make this discussion and the literature more meaningful?

    I am in agreement that rearfoot pronation (STJ) is not a leading cause of injury (in a total population, I believe that Vault Collapse and Forefoot Pathology are the leading causes.

    I hypothesized that if investigators followed 100 rearfoot pronated feet and 100 non rearfoot pronated feet, the pronated group would have a higher injury rate.

    I then suggested that if a profiling system that subdivided all feet into types was added to the mix of any of these studies, their results would be more meaningful.

    Dr. Payne implies (I agree) that we should be searching for a different solution to injury than treating “foot pronation”.

    IDr Sha Previous Post:
    Successful treatment will depend on ones ability to prevent the vault of the foot from collapsing and the ability to stabilize and power the forefoot so that it can perform to its highest potential.

    Dr Sha States:
    I have suggested a different solution and would welcome his critique (edits) of my solution.

    I have raised questions, suggested a different solutions and had hoped that instead of a repeat of the "search the literature refrain", Dr. Payne would answer and reply to my posting.
    Dennis
     
  15. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    That has been done many times (see the references I gave above) and the injury rate is NOT higher in the rearfoot pronated group. One study even showed that a 'rearfoot pronated' foot type was less likely to get an injury. A couple did show a small increased risk. The vast majority show that the injury rate is not higher in 'pronated' feet (regardless of how you might like to define it).


    It did not matter what measure of rearfoot 'pronation' was used - arch height; 3d rearfoot motion; navicular drop; foot posture index; etc --- the results are pretty consistent.
     
    Last edited: Mar 9, 2009
  16. Lawrence Bevan

    Lawrence Bevan Active Member

    If we dont measure rearfoot pronation what do we measure?Are we saying that how much a rearfoot pronates is completely irrelevant to why patients have symptoms and how orthotics relieve them?

    Is the answer that rearfoot motion is irrelevant and rearfoot moment is the key factor?

    Anybody ever come up with a usable grading system for the "Supination resistance test"?
     
  17. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    That is the direction things are pointing in - at least considering things in those terms is consistent with the evidence. A reduction in the rearfoot inversion moment and the hallux dorsiflexion moment (or lowering the dorsiflexion stiffness curve) could be the 'holy grail' of foot orthotic function ?
    In our reliability study we used a scale of 0/5 to 5/5; we now use low, medium and high.
     
  18. Rod Wishart

    Rod Wishart Member

    Is the rearfoot itself largely irrelevant?
    Anybody looked at a cadaveric specimen of a human foot lately?
    Seems to me the STJ is a pretty rigid old joint, while the calcaneal - talonavicular joint, with a hyaline cartilage lined spring ligament completing the structure allows a hell of a lot more movement. Can we ditch supination resistance etc and whip up comfortable arch supports for what ails you? Me wonders sometimes.

    Rod
     
  19. Griff

    Griff Moderator

    Craig,
    Out of interest what cut off point/boundaries (in Newtons) do you use to delineate between the low, medium and high groups?

    Thanks

    Ian
     
    Last edited: Mar 10, 2009
  20. drsha

    drsha Banned

    Dr. Payne States:
    It did not matter what measure of rearfoot 'pronation' was used - arch height; 3d rearfoot motion; navicular drop; foot posture index; etc --- the results are pretty consistent. Is the rearfoot itself largely irrelevant?

    Dr Sha States:
    Rearfoot Pronation, as an isolated entity is rather easy to treat.
    So are “Vault Pronation” and Forefoot Pronation”. That is to say, as isolated entities, they are easy to treat.
    Problems occur that slow down progress:
    1. When you try to treat one of them (ie Rearfoot Pronation) to cure the others (Modern Rootian Biomechanics).
    2. When you try to treat all feet alike (the need for a profiling system like FFT)
    3. When your focus is in making the same diagnosis using more sophisticated language and technique but not making upgrades in care.
    4. When you weigh research too heavily, manipulate its meaning and cast aside new theories with “show me the research”.
    The facts are that each patient has a specific type of foot (rearfoot, vault and forefoot) that once diagnosed, allows for foot type specific treatment incorporating corrections for the rearfoot, vault and forefoot.
    Do you need another study showing that pronation is not the root of injury or do you need to research alternative theories for new answers?

    Rod Wishart States:
    Anybody looked at a cadaveric specimen of a human foot lately?
    Seems to me the STJ is a pretty rigid old joint, while the calcaneal - talonavicular joint, with a hyaline cartilage lined spring ligament completing the structure allows a hell of a lot more movement. Can we ditch supination resistance etc and whip up comfortable arch supports for what ails you? Me wonders sometimes.
    Dr Sha States:
    We shouldn’t ditch anything. The stable and flexible rearfoot types need their supination resistance to be controlled. The rigid and flat rearfoot types don’t.
    The fstable and flexible forefoot types need their hallux dorsiflexion stiffness moment lowered, the rigid and flat forefoot types don’t.
    The stable and flexible rearfoot types need support under The Vault of the Foot, the rigid and flat rearfoot types don’t.
    The stable and flexible forefoot types need support under The Vault of the Foot, the rigid and flat forefoot types don’t.
    All feet need some type of forefoot treatment in order to maximize performance and reduce injury and the development of overuse syndromes and deformity.

    If you apply these rules to casting, posting and modifying orthotic shells, foot type specific, outcomes are better, failure rates are reduced and complications become less of an issue.

    Current concept should not be buried but instead expanded and upgraded in ways that provide better and more complete care for the foot suffering public (isn’t that our common goal?).
    Dennis
     
  21. efuller

    efuller MVP

    You've got to make the connection between one thing and another. This is the point of the tissue stress approach to biomechanical treatment of the foot. For example, sinus tarsi syndrome can be modeled as pain caused by the structures that stop further pronation of the STJ when the STJ reaches the end of range of motion. Specifically the lateral process of the talus hits the floor of the sinus tarsi of the calcaneus at the end or range of motion. I've seen this in cadaver specimens. So, I would say that STJ position is relevant for sinus tarsi syndrome.

    On the other hand, 1st MPJ pathology is a little harder to explain in relation to the STJ, but it can. It can be explained by examining the anatomical structures of the windlass mechanism.
    Fuller, E.A. The Windlass Mechanism Of The Foot: A Mechanical Model To Explain Pathology J Am Podiatr Med Assoc 2000 Jan; 90(1) p 35-46

    I feel that it makes more sense to do mechanical analysis on the anatomical structures than to rely on hypothetical constructs like "locking of the MTJ" that treat the midtarsal joint as a black box where you cannot see the inner workings. We can examine the anatomy of the midtarsal joint ans be able to explain any phenomenon that we observe in relation to the midtarsal joint.

    Also, through the use of mechanical analysis we can attempt to describe how an "arch support" will alter the stresses in specific anatomical structures. We can just dispense arch supports and see if they work, or we can try and figure out how they do work so that we can be successful a greater percentage of the time.

    Regards,

    Eric
     
  22. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    No. As each device used to measure the force will have a different value (eg can depend on angle of pull of the strap etc). See this discussion.
     
  23. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    The device we use to quantify supination resistance and the version of the clinical test we use, is to apply the force to the medial side of the talonavicular region --- this elevates the arch as well as supinates the rearfoot.
     
  24. Rod Wishart

    Rod Wishart Member

    Is the supination resistance test valid as a measure of rearfoot motion/moments/etc if we're actually applying force directly under the midfoot? confused, but thinking...

    Rod
     
  25. efuller

    efuller MVP

    I believe that Craig may have said that there was a correlation between STJ axis position and supination resistance test. This would make sense in terms of moments about the STJ. All other things being equal a foot with a medial deviated STJ axis will more likely have its center of pressure further lateral to the STJ axis when compared to a foot with an average position of the STJ axis. Following this logic there will be a greater pronation moment from the ground in the medially deviated axis foot. That would explain why a medially deviated STJ axis foot would have a more difficult supination resistance test. So, there is some theoretical validity to the correlation of supination resitance to moments acting on the STJ.

    Regards,

    Eric
     
  26. Rod Wishart

    Rod Wishart Member

    Good explanation.

    Thanks,
     
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