Why Running Shoes Don't Fix Injuries
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Dr. Nicholas A. Campitelli discussing running shoes and injuries at the 2014 American Podiatric Medical Association National Convention in Hawaii.
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Why Running Shoes Don't Fix Injuries
- 2. Nicholas A. Campitelli, DPM, FACFAS feet@me.com Unity Health Network 2660 Akron, OH 44333 330-926-3232 Consultant for Medline Foot & Ankle Reconstruction Consultant for Valeant Dermatology
- 4. 1. Shoes 2. Form / Biomechanics 3. Injury
- 5. Shoes
- 6. "Shoes do no more for the foot than a hat does for the brain." —Dr. Mercer Rang, legendary orthopedic surgeon and researcher in pediatric development
- 7. "I need a shoe with good support" - our society
- 9. "The Running Shoe Theory" • Cushion • Support • Motion Control Gallant JL, Pierrynowski MR. A theoretical perspective on running- related injuries. J Am Podiatr Med Assoc. 2014 Mar;104(2):211- 20.
- 10. PCECH • P ronation • C ontrol • E levated • C ushioned • H eel Gallant JL, Pierrynowski MR. A theoretical perspective on running-related injuries. J Am Podiatr Med Assoc. 2014 Mar;104(2):211-20.
- 11. Feet are weak • Protection • Cushioning • Support • Pronation Control Robbins SE, Hanna AM. Running-related injury prevention through barefoot adaptations. Med Sci Sports Exerc. 1987 Apr;19(2):148-56. The injuries are considered "pseudo- neuropathic" in nature. 1987
- 12. Evidence Based Richards CE, Magin PJ, Callister R: Is your prescription of distance running shoes evidence-based? Br J Sports Med 43: 159, 2009.
- 13. CONCLUSION: This prospective study demonstrated that assigning shoes based on the shape of the plantar foot surface had little influence on injuries even after considering other injury risk factors. Knapik JJ, Trone DW, Swedler DI, Villasenor A, Bullock SH, Schmied E, Bockelman T, Han P, Jones BH. Injury reduction effectiveness of assigning running shoes based on plantar shape in Marine Corps basic training. Am J Sports Med. 2010 Sep;38(9):1759-67. 722 Runners
- 14. Yeung SS, Yeung EW, Gillespie LD. Interventions for preventing lower limb soft-tissue running injuries. Cochrane Database Syst Rev. 2011 Jul 6;(7) Overall, the evidence base for the effectiveness of interventions to reduce soft-tissue injury after intensive running is very weak, with few trials at low risk of bias. More well-designed and reported RCTs are needed that test interventions in recreational and competitive runners. 25 Trials 30,252 Runners
- 15. 1: Yeung SS, Yeung EW, Gillespie LD. Interventions for preventing lower limb soft-tissue running injuries. Cochrane Database Syst Rev. 2011 Jul 6;(7) Found no evidence in military recruits that wearing running shoes based on foot shape, rather than standard running shoes, significantly reduced rate of running injuries (2 trials; 5795 participants; Rate Ratio 1.03, 95% CI 0.93 to 1.14). Shoe Paradigm Outdated? 5795 Runners
- 16. Cushion
- 18. Between 250 and 500 miles the shoes retained less than 60% of their initial shock absorption capacity. No differences in shock absorption characteristics were apparent based upon either shoe price or the manufacturer model. Cook SD, Kester MA, Brunet ME. Shock absorption characteristics of running shoes. Am J Sports Med. 1985 Jul-Aug;13(4):248-53.
- 19. “foot control seems to improve as cushioning is lost and foot control accounts for at least half of running shoe related injuries” Hamill J, Bates BT. A kinetic evaluation of the effects of in vivo loading on running shoes. J Orthop Sports Phys Ther. 1988;10(2):47-53
- 20. As shoe cushioning capability decreases, runners modify their patterns to maintain constant external loads. The adaptation strategies to shoe degradation were unaffected by different cushioning technologies, suggesting runners should choose shoes for reasons other than cushioning technology. Kong PW, Candelaria NG, Smith DR. Running in new and worn shoes: a comparison of three types of cushioning footwear. Br J Sports Med. 2009 Oct;43(10):745-9.
- 21. As a result of perceived protection and comfort in running shoes, runners will not institute shock absorbing behaviors and will become more susceptible to injury Robbins SE, Gouw GJ. Athletic footwear: unsafe due to perceptual illusions. Med Sci Sports Exerc. 1991 Feb;23(2):217-24. Robbins SE, Gouw GJ. Athletic footwear and chronic overloading. A brief review. Sports Med. 1990 Feb;9(2):76-85. Robbins S, Waked E. Hazard of deceptive advertising of athletic footwear. Br J Sports Med. 1997 Dec;31(4):299-303.
- 22. Trainers vs Flats? Logan S, Hunter I, J Ty Hopkins JT, Feland JB, Parcell AC. Ground reaction force differences between running shoes, racing flats, and distance spikes in runners. J Sports Sci Med. 2010 Mar 1;9(1):147-53 “….recommendation that runners transition gradually”
- 23. Surfaces "Our feet weren't designed to run on concrete"
- 24. Surfaces Feehery FJ. The biomechanics of running on different surfaces. Clin Podiatr Med Surg 1986;3(4) 649-59. Nigg B, Wakeling J. Impact forces and muscle tuning: a new paradigm. Exerc Sport Sci Rev 2001;29(1) 37-41. Van Gent RN, Siem D, Van Middelkoop M et al. Incidence and determinants of lower extremity running injuries in long distance runners: A systematic review. BrJ Sports Med 2007;41(8):469-480. The evidence that running on hard surfaces causes either an increase in impact forces or an increase in injury rates is weak 1986 2001 2007
- 25. Surfaces Nigg B, Wakeling J. Impact forces and muscle tuning: a new paradigm. Exerc Sport Sci Rev 2001;29(1):37-41. The capacity of cushioning to reduce either impact forces or injury rates is also being called into question.
- 26. Surfaces Robbins S, Waked E. Foot position awareness: The effect of footwear on instability, excessive impact, and ankle spraining. Critical Reviews in Physical and Rehabilitation Medicine. 1997;9(1):53-74. Diminished proprioception has been identified as a significant side effect of heavily cushioned shoes.
- 27. An asphalt running surface decreased mid-portion tendinopathy risk (RR 0.47, p = 0.02). In contrast, sand increased the relative risk for mid-portion Achilles tendinopathy tenfold (RR 10, CI 1.12 to 92.8, p = 0.01). Knobloch K, Yoon U, Vogt PM. Acute and overuse injuries correlated to hours of training in master running athletes. Foot Ankle Int. 2008 Jul;29(7):671-6.
- 29. Biomechanics
- 30. “Generally abnormal pronation during static stance does not produce major symptomatology.” Root ML, Orien WP, Weed JH. Normal and Abnormal Function of the Foot -Volume 2. Clinical Biomechanics Corp., Los Angeles, CA, 1977.
- 31. “Even during locomotion, however, abnormal pronation rarely produces symptomatology that is acute enough to prevent weight bearing” Root ML, Orien WP, Weed JH. Normal and Abnormal Function of the Foot -Volume 2. Clinical Biomechanics Corp., Los Angeles, CA, 1977.
- 33. Ankle Equinus A structural limitation of ankle joint dorsiflexion. (Less then 10 degrees of DF) Root ML, Orien WP, Weed JH. Normal and Abnormal Function of the Foot -Volume 2. Clinical Biomechanics Corp., Los Angeles, CA, 1977.
- 34. Subtalar Joint Neutral Care should be taken not to plantarflex the foot. This will move the narrow end of the talus into the ankle joint mortise increase the range of motion of the subtalar joint. Root ML, Orien WP, Weed JH. Normal and Abnormal Function of the Foot -Volume 2. Clinical Biomechanics Corp., Los Angeles, CA, 1977.
- 38. Elevated Heel Jarvinen T, Kannus P, Maffulli N et al. Achilles tendon disorders: etiology and epidemiology. Foot Ankle Clin 2005;10(2):255-66. “…since the introduction of the PECH design there has actually been an increase, not a decrease in Achilles tendon injuries.” 2005
- 39. Elevated Heel Sekizawa K, Sandrey MA, Ingersoll CD et al. Effects of shoe sole thickness on joint position sense. Gait Posture 2001;13(3):221-228. “…heel elevation during stance places the ankle joint in a position where proprioception is inherently poor.” 2001
- 40. Elevated Heel Baycroft CM, Culp V. Running shoes - Design facts and functional fantasies. Chiropractic Sports Medicine 1993;7(1):6-8. “The capacity of existing levels of heel elevation to increase pronation has also been noted.” 1993
- 41. Elevated Heel Van Gent RN, Siem D, Van Middelkoop M et al. Incidence and determinants of lower extremity running injuries in long distance runners: A systematic review. BrJ Sports Med 2007;41(8):469-480. “…the overall impact on injury rates of running in a shoe with an elevated heel remains untested in clinical trials.” 2007
- 42. Achilles Tendon Wearing SC, Reed L, Hooper SL, Bartold S, Smeathers JE, Brauner T. Running Shoes Increase Achilles Tendon Load in Walking: an Acoustic Propagation Study. Med Sci Sports Exerc. 2014 Feb 4. Peak acoustic velocity in the Achilles tendon was higher with footwear, suggesting that standard running shoes with a 10-mm heel offset increase tensile load in the Achilles tendon. Although further research is required, these findings question the therapeutic role of standard running shoes in Achilles tendinopathy. 2014
- 43. Wearing shoes inhibits normal foot joint ROM forefoot to rear foot Morio C, Lake MJ, Gueguen N, Rao G, Baly L. The influence of footwear on foot motion during walking and running. J Biomech. 2009 Sep 18;42(13):2081-8. Wolf S, Simon J, Patikas D, Schuster W, Armbrust P, Döderlein L. Foot motion in children shoes: a comparison of barefoot walking with shod walking in conventional and flexible shoes. Gait Posture. 2008 Jan;27(1):51-9. 2008 2009
- 44. The barefoot has the ability to vary gait and joint position thus reduce repetitive forces seen in shod foot that leads to overuse injuries. Kurz MJ, Stergiou N, Blanke D. Spanning set defines variability in locomotive patterns. Med Biol Eng Comput. 2003 Mar;41(2):211-4. 2003
- 46. Soccer Game 7.0 - 9.5 Miles per game
- 48. Hreljac A, Marshall RN, Hume PA. Evaluation of lower extremity overuse injury potential in runners. Med Sci Sports Exerc. 2000 Sep;32(9):1635-41. Hreljac A. Etiology, prevention, and early intervention of overuse injuries in runners: a biomechanical perspective. Phys Med Rehabil Clin N Am. 2005 Aug;16(3):651-67, vi. Review. There has been no consistent association between subtalar motion and running related injuries. Gallant JL, Pierrynowski MR. A theoretical perspective on running-related injuries. J Am Podiatr Med Assoc. 2014 Mar;104(2):211-20. 2000 2005
- 49. Findings support the idea that the ML-GRF have less to do with pronation than previous research suggested. Morley JB, Decker LM, Dierks T, Blanke D, French JA, Stergiou N. Effects of varying amounts of pronation on the mediolateral ground reaction forces during barefoot versus shod running. J Appl Biomech. 2010 May;26(2):205-14. 2010
- 50. Our study does not support the hypothesis that anterior knee pain is related to excessive foot pronation. Hetsroni I, Finestone A, Milgrom C, Sira DB, Nyska M, Radeva-Petrova D, Ayalon M. A prospective biomechanical study of the association between foot pronation and the incidence of anterior knee pain among military recruits. J Bone Joint Surg Br. 2006 Jul;88(7):905-8. 405 Soldier 61 (15%) keen pain 2006
- 51. Patellofemoral Pain Kinetic analysis revealed several significant discriminators whereas rearfoot movement variables were not good discriminators between the groups. Messier SP, Davis SE, Curl WW, Lowery RB, Pack RJ. Etiologic factors associated with patellofemoral pain in runners. Med Sci Sports Exerc. 1991 Sep;23(9):1008-15. Erratum in: Med Sci Sports Exerc 1991 Nov;23(11):1233. 1991
- 52. We conclude that lower-extremity alignment is not a major risk factor for running injuries. Wen DY, Puffer JC, Schmalzried TP. Lower extremity alignment and risk of overuse injuries in runners. Med Sci Sports Exerc. 1997 Oct;29(10):1291-8. 304 Runners Marathon training over 12 months
- 53. The results of the present study contradict the widespread belief that moderate foot pronation is associated with an increased risk of injury among novice runners taking up running in a neutral running shoe. Nielsen RO, Buist I, Parner ET, Nohr EA, Sørensen H, Lind M, Rasmussen S. Foot pronation is not associated with increased injury risk in novice runners wearing a neutral shoe: a 1-year prospective cohort study. Br J Sports Med. 2014 Mar;48(6):440-7. 927 runners 2014
- 54. Based on the review of literature, there is no definitive link between atypical foot mechanics and running injury mechanisms. Ferber R, Hreljac A, Kendall KD. Suspected mechanisms in the cause of overuse running injuries: a clinical review. Sports Health. 2009 May;1(3):242-6. 2009
- 56. Strike Patterns
- 57. 19 Subjects who ran 49 ft. 0.29% of 5k 0.04% of a Marathon Hatala KG, Dingwall HL, Wunderlich RE, Richmond BG. Variation in foot strike patterns during running among habitually barefoot populations. PLoS One. 2013;8(1):e52548. doi: 10.1371/journal.pone.0052548. Epub 2013 Jan 9. This study did find that there was an increase in impact forces in those who were heel strikers compared to midfoot and forefoot striking PLOS ONE Journal 72% were Heel strikers Habitually barefoot population from northern Kenya that does not run very much, and which lives in a very sandy habitat. 1 2
- 58. Runners who habitually rearfoot strike have significantly higher rates of repetitive stress injury than those who mostly forefoot strike. Daoud AI, Geissler GJ, Wang F, Saretsky J, Daoud YA, Lieberman DE. Foot strike and injury rates in endurance runners: a retrospective study. Med Sci Sports Exerc. 2012 Jul;44(7):1325-34. 53 collegiate athletes 2012
- 59. Tarahumara population (35 individuals-46% more then 19) 70% of them were either forefoot or mid foot strikers. The remaining 30% that were heel striking were Tarahumaras who have adopted western running shoes with cushioned, elevated heels, stiff soles, and toe springs. Lieberman DE, Strike type variation among Tarahumara Indians in minimal sandals versus conventional running shoes, Journal of Sport and Health Science (2014), http://dx.doi.org/10.1016/j.jshs.2014.03.009 46% 1
- 60. Spring Theory Girard O, Millet GP, Slawinski J, Racinais S, Micallef JP. Changes in running mechanics and spring- mass behaviour during a 5-km time trial. Int J Sports Med. 2013 Sep;34(9):832-40 Taylor MJ, Beneke R. Spring mass characteristics of the fastest men on Earth. Int J Sports Med. 2012 Aug;33(8):667-70. doi: 10.1055/s-0032-1306283. Epub 2012 Apr 17. Erratum in: Int J Sports Med. 2012 Aug;33(8):670. Blickhan R. The spring-mass model for running and hopping. J Biomech. 1989;22(11-12):1217-27.
- 65. Injury
- 66. Injury Rates NIELSEN RO, BUIST I, SORENSEN H, ET AL: Training errors and running related injuries: a systematic review. Int J Sports Phys Ther 7: 58, 2012. 30-85% year 85% 15%
- 67. Injury Rates 0 17.5 35 52.5 70 1980 1990 2000 2010 JENKINS DW, CAUTHON DJ: Barefoot running claims and controversies: a review of the literature. JAPMA 101: 231, 2011.
- 68. Stress Fractures
- 69. Giuliani J, Masini B, Alitz C, Owens BD. Barefoot-simulating footwear associated with metatarsal stress injury in 2 runners. Orthopedics. 2011 Jul 7;34(7):e320-3.
- 72. Plantar Fasciitis Is it Inflammatory? Lemont H, Ammirati KM, Usen N. Plantar fasciitis: a degenerative process (fasciosis) without inflammation. J Am Podiatr Med Assoc. 2003 May-Jun;93(3):234-7.
- 73. 17 shod runners Converted to barefoot running Improved arch Robbins, S., Hanna, A.M. (1987). Running-related injury prevention through barefoot adaptations. Medicine and Science in Sports and Exercise. Vol 19, No 2, 148–156. 1987
- 74. These results suggest that endurance running in minimal support footwear with 4 mm offset or less makes greater use of the spring-like function of the longitudinal arch, thus leading to greater demands on the intrinsic muscles that support the arch, thereby strengthening the foot. Elizabeth E. Miller, Katherine K. Whitcome, Daniel E. Lieberman, Heather L. Norton, Rachael E. Dyer, The effect of minimal shoes on arch structure and intrinsic foot muscle strength, Journal of Sport and Health Science, Volume 3, Issue 2, June 2014, Pages 74-85,
- 76. Summary
- 77. Shoes How one runs is probably more important than what is on one’s feet, but what is on ones feet may effect how one runs.
- 78. ACSM
- 80. Biomechanics
- 81. Injury
- 83. Thank you.
Editor's Notes
- thanks for inviting this is a topic that is very dear to me
- something I want to stress.. I am a surgeon and I then became interested in this area… I do not have an underlying interest in biomechanics. No Disclosures Despite what you may hear about vibram. I have no financial ties to them and never did
- Too many variables to account for. I’ve made an attempt at some research and we will discuss it later.
- Need to discuss that I have not produced any peer reviewed studies. Fascinating thing about blogging is it attracts people. You can pull a research article with 10 subjects and it's considered scientific. I can find 1,000 people on my blog with improvement from minimalist shoes and its anecdotal Explain anecdotally what I have done, and how I use literature to support what I do and there is no literature to support the use of traditional running shoes or orthotics. I have submitted a research for peer reviewed publication and present it.
- 15 minutes Too many variables Get you to THINK DIFFERENT Have to explain that there is not enough time in 15 minutes to review every article. Something i want to stress is that you can find studies that show orthotics help injuries, but they're not scientific. What I mean by this is there are way too many variables to control. It's not as if these studies are saying x number of people have this injury and this injury is due to excessive pronation and by controlling this excessive pronation, we fix the injury. It just isn't out there. It's a haphazardness way of treating a foot injury.
- To understand barefoot running, you have to understand shoe gear. One of the first things I teach runners in my practice is to not rely on shoes.
- STIGMA Why has the shoe become what it has become
- Comment that heel began to become popular and it metamorphosed into what we know today as running shoes with thick cushioned heels.
- PODIATRIST ARE PRESCRIBING SHOES BASED ON FOOT TYPE NOT TRUE ANYMORE. One of the most common methods of prevention of injury is the prescription of running shoes based on foot type This is a great synopsis in japma
- This is important and basically can get a ton of info regarding this from the paper. introduces the concept of the shoe
- THIS SLIDE SHOWS THAT WE KNEW THIS 27 years ago According to Robbins and Hanna,7 the assump- tions underlying the design of modern running shoes contend that feet are evolutionarily unsuccessful and inherently fragile; therefore, the only way to prevent RRIs is to protect the foot by packaging it in footwear that provides cushioning, support, and pronation control Point of this slide is that this is not new. We looked at this years ago and saw what fundamentals were being placed into shoes, and that it wasn’t scientific. Robbins advocated barefoot strengthening then.
- The prescription of this shoe type to distance runners is not evidence-based. My GOAL TODAY IS TO MOVE THIS ENTIRE ROOM AWAY FROM THIS THEORY To determine whether the current practice of prescribing distance running shoes featuring elevated cushioned heels and pronation control systems tailored to the individual's foot type is evidence-based.
- It’s pretty clear that what we have been doing for the past 40 years is not working. POINT IS THAT WHAT WE HAVE BEEN DOING IS NOT WORKING
- So this particular slide show the data at looking at shoes only.
- I'm sure many of you tell your patients that if they have more then 300-500 miles on there shoes, they need new ones right?
- Points to make are… 1. One study and we are still referencing this from 1985
- True, but what does that have to do with pronation? If concrete is hard then we use more pronation to absorb shock right? Don't control it. We have seen studies that show controlling pronation does not prevent injuryHowever, the evidence to support this assumption is weak.5 In fact, Ferris et al15 report that when running on hard surfaces, humans tend to land with less leg stiffness and, therefore, maintain the same peak ground reaction force despite a change in surface stiffness. Nigg and Wakeling16 agree and suggest that the mechanism behind this adjustment involves muscle tuning in the locomotor system, which occurs shortly before ground contact to prepare the body for landing. These findings put the Running Shoe Theory into question because it seems that the body is capable of attenuating the high-impact forces experienced on hard surfaces and, therefore, may not need any additional protection to avoid injury.
- And we all know what happens when proprioception is reduced… INJURY!
- Will see increase stress placed on the achilles tendon when running on sand.
- Why does a cushioned elevated heel exist? No one knows and there is no literature to demonstrate this
- The purpose of root is to introduce that he only discussed walking and that it has been transformed into running. Discuss my theory on the propulsion phase Is excessive pronation even pathologic? It is my opinion that we have for years over treated this deformity with orthotic devices in an unnecessary manner. I believe that there are pathologic situations of abnormally pronated feet when severe deformities present but this a rare circumstance and almost never encountered in those who are able to run. Root himself made the statement, "Generally abnormal pronation during static stance does not produce major symptomatology." He also goes on to say that," even during locomotion, however, abnormal pronation rarely produces symptomatology that is acute enough to prevent weight bearing." Root also mentions that using a functional foot orthoses to control abnormal foot geometry reduces the need for muscles to compensate. My feelings are to treat the muscles and strengthen them and reduce the abnormal motion by 1.) creating a stronger foot, and 2.) naturally improving the gait which will decrease the etiology of the abnormal forces. And example of this is to remove the high cushioned heel which places the foot into a plantarflexed position. Root has even suggested that a slight plantarflexed ankle will create the need for the subtalar joint to increase in pronation to compensate for the lack of dorsiflexion. So remove the heel and reduce the slight equinus it is creating. Is there literature that exists to advocate a specific heel height of a running shoe for a foot with no existing injury? There is less strain on the Achilles' tendon with a higher heel which in cases of achilles tendonitis could aid in recovery. The theory has been described that the heel was implemented in running shoes to prevent this achilles strain but is it necessary? I believe it is not.
- We have to discuss root, when all this started I went back and read Roots books and you know what's fascinating, is he doesn't discuss running. Yet I'll bet that many of you out there use roots mechanics on walking and morph them into running.
- So root says its RARE to produce symptomatology.
- sometimes you just have to try it!
- So some will say that I’m just posting pictures of this online. Yeah. I am because the research has already been done but no one is listening. This is nothing new. INTRO TO SLIDE on HEEL HEIGHT AND ACHILLES
- The point of this study was that running shoes with a 10mm heel actually increased the tensile load on the Achilles' tendon. The findings question the therapeutic role of standard running shoes in Achilles tendinopathy.
- These are two studies cited in a JAPMA paper this spring Consistent. You just can’t say controlling pronation will fix running injuries. AND so many podiatrists are focused on controlling pronation.
- THE GROUND REACTIVE FORCES DID NOT CHANGED REGARDLESS OF THE AMOUNT OF PRONATION Despite extensive research on running mechanics, there is still a knowledge gap with respect to the degree of relationship between mediolateral ground reaction forces (ML-GRF) and foot pronation. Our goal was to investigate whether differences exist in ML-GRF among runners that exhibit different degrees of pronation. Seventeen male and 13 female recreational runners ran with and without shoes while ML-GRF and frontal kinematics were collected simultaneously. Subjects were divided into groups based upon their peak eversion (low pronation, middle pronation, high pronation). Discrete parameters from the ML-GRF were peak forces, respective times of occurrence, and impulses. No significant differences were found between groups regarding the magnitude of ML-GRF. Based upon the relative times of occurrence, the peak medial GRF occurred closer to the peak eversion than the peak lateral GRF. Findings support the idea that the ML-GRF have less to do with pronation than previous research suggested.
- Excessive foot pronation has been considered to be related to anterior knee pain. We undertook a prospective study to test the hypothesis that exertional anterior knee pain is related to the static and dynamic parameters of foot pronation. Two weeks before beginning basic training lasting for 14 weeks, 473 infantry recruits were enrolled into the study and underwent two-dimensional measurement of their subtalar joint displacement angle during walking on a treadmill. Of the 405 soldiers who finished the training 61 (15%) developed exertional anterior knee pain. No consistent association was found between the incidence of anterior knee pain and any of the parameters of foot pronation. While a statistically significant association was found between anterior knee pain and pronation velocity (left foot, p = 0.05; right foot, p = 0.007), the relationship was contradictory for the right and left foot. Our study does not support the hypothesis that anterior knee pain is related to excessive foot pronation.
- The purpose of this study was to extend our knowledge of running related injuries by determining whether relationships exist between selected anthropometric, biomechanical, muscular strength and endurance, and training variables and runners afflicted with patellofemoral pain (PFP). Specifically, the objectives of this study were to examine differences in selected measures between a non-injured control group (C) of runners (N = 20) and a group of injured runners (INJ) diagnosed by an orthopedic surgeon as having PFP (N = 16). High speed photography, a force platform, and isokinetic dynamometry were used to determine rearfoot motion, ground reaction forces, and knee muscular strength and endurance. Stepwise discriminant function analyses were performed on the anthropometric, biomechanical, and muscular strength and endurance variables. Q angle was a significant discriminator (P less than 0.01) between the INJ and C groups. The muscular endurance data revealed several significant discriminators with the INJ subjects being weaker in knee extension endurance. Kinetic analysis revealed several significant discriminators whereas rearfoot movement variables were not good discriminators between the groups. The training data revealed that the INJ group ran significantly less (P less than 0.01) miles.wk-1 than the C group. Our results suggest that Q angle is a strong discriminator between runners afflicted with PFP and non-injured runners. In addition, several muscular endurance and kinetic variables may also be important components of the etiology of PFP.
- Something to point out is the impact factor. Make sure to mention this. A group of 304 runners enrolling in a marathon training program had alignment measurements performed and completed a questionnaire on training practices and injuries over the previous 12 months. The alignment measures consisted of arch index (AI), heel valgus (HV), knee tubercle-sulcus angle (TSA), knee varus (KV), and leg-length difference (LLD). Results indicated few consistent statistical associations between these alignment measures and risk of injuries, either bivariately or multivariately: left AI with hamstring injuries; right AI with shin injuries; right HV with back injuries; left TSA with ankle injuries; KV with hip injuries; and LLD with back, ankle, and foot injuries. A few statistically significant relationships were also found between other training and anthropometric factors and injuries: mileage with hamstring injuries; interval training with shin injuries; hard surfaces with back and thigh injuries; shoe use patterns with foot and overall injuries; and body mass index with heel injuries. We conclude that lower-extremity alignment is not a major risk factor for running injuries in our relatively low mileage cohort; however, prospective studies are necessary to confirm or refute these findings.
- To investigate if running distance to first running-related injury varies between foot postures in novice runners wearing neutral shoes. DESIGN: A 1-year epidemiological observational prospective cohort study. SETTING: Denmark. PARTICIPANTS: A total of 927 novice runners equivalent to 1854 feet were included. At baseline, foot posture on each foot was evaluated using the foot-posture index and categorised into highly supinated (n=53), supinated (n=369), neutral (n=1292), pronated (n=122) or highly pronated (n=18). Participants then had to start running in a neutral running shoe and to use global positioning system watch to quantify the running distance in every training session. MAIN OUTCOME MEASURE: A running-related injury was defined as any musculoskeletal complaint of the lower extremity or back caused by running, which restricted the amount of running for at least 1 week. RESULTS: During 1 year of follow-up, the 1854 feet included in the analyses ran a total of 326 803 km until injury or censoring. A total of 252 participants sustained a running-related injury. Of these, 63 were bilateral injuries. Compared with a neutral foot posture, no significant body mass index-adjusted cumulative risk differences (RD) were found after 250 km of running for highly supinated feet (RD=11.0% (-10% to 32.1%), p=0.30), supinated feet (RD=-1.4% (-8.4% to 5.5%), p=0.69), pronated feet (RD=-8.1% (-17.6% to 1.3%), p=0.09) and highly pronated feet (RD=9.8% (-19.3% to 38.8%), p=0.51). In addition, the incidence-rate difference/1000 km of running, revealed that pronators had a significantly lower number of injuries/1000 km of running of -0.37 (-0.03 to -0.70), p=0.03 than neutrals. CONCLUSIONS: The results of the present study contradict the widespread belief that moderate foot pronation is associated with an increased risk of injury among novice runners taking up running in a neutral running shoe. More work is needed to ascertain if highly pronated feet face a higher risk of injury than neutral feet.
- Abstract CONTEXT: Various epidemiological studies have estimated that up to 70% of runners sustain an overuse running injury each year. Although few overuse running injuries have an established cause, more than 80% of running-related injuries occur at or below the knee, which suggests that some common mechanisms may be at work. The question then becomes, are there common mechanisms related to overuse running injuries? EVIDENCE ACQUISITION: RESEARCH STUDIES WERE IDENTIFIED VIA THE FOLLOWING ELECTRONIC DATABASES: MEDLINE, EMBASE PsycInfo, and CINAHL (1980-July 2008). Inclusion was based on evaluation of risk factors for overuse running injuries. RESULTS: A majority of the risk factors that have been researched over the past few years can be generally categorized into 2 groups: atypical foot pronation mechanics and inadequate hip muscle stabilization. CONCLUSION: Based on the review of literature, there is no definitive link between atypical foot mechanics and running injury mechanisms. The lack of normative data and a definition of typical foot structure has hampered progress. In contrast, a large and growing body of literature suggests that weakness of hip-stabilizing muscles leads to atypical lower extremity mechanics and increased forces within the lower extremity while running.
- Something to point out is the impact factor. Make sure to mention this. IN SUMMARY, THE POINT IM’ TRYING TO MAKE WITH THESE SLIDES IS THAT MANY DOCS WILL HEAR INJURY, LOOK AT THE FOOT, LOOK AT THE SHOE AND SAY YOU NEED AND ORTHOTIC, YOU’RE IN THE WRONG SHOE AND YOU ARE OVERPRONATION… WITHOUT ASKING ABOUT TRAINING PATTERNS ETC
- Kirby's Response to midfoot/forefoot strike patterns Other studies say this as well 95% shoes being sold have elevated heels Introduce this as Kirby stating that barefoot runners heel strike Kirby cites this in Podiatry Today as proof that even the barefoot individuals heel strike. Show that they really don't
- This study looked at 53 collegiate athletes and compared injuries to strike pattern.
- This is a 2014 study that looked at the Tarahumara’s. Point is that they typical run with a mid foot or forefoot strike pattern, and this study showed that the 30% that don’t have adopted a western running shoe style.
- Discuss three part spring Ankle joint, knee joint, hip joint// You can conserve the torque during a step cycle by adding a joint.
- In fact, if you follow this curve, they’re increasing!! Despite advancements in running shoes, no change in injury rates I don't know about you, but as much propaganda as we see on running shoes, injuries aren't getting better. Shoes clearly aren't solving the problem.
- This study shows NO INFLAMMATION.
- To investigate if running distance to first running-related injury varies between foot postures in novice runners wearing neutral shoes. DESIGN: A 1-year epidemiological observational prospective cohort study. SETTING: Denmark. PARTICIPANTS: A total of 927 novice runners equivalent to 1854 feet were included. At baseline, foot posture on each foot was evaluated using the foot-posture index and categorised into highly supinated (n=53), supinated (n=369), neutral (n=1292), pronated (n=122) or highly pronated (n=18). Participants then had to start running in a neutral running shoe and to use global positioning system watch to quantify the running distance in every training session. MAIN OUTCOME MEASURE: A running-related injury was defined as any musculoskeletal complaint of the lower extremity or back caused by running, which restricted the amount of running for at least 1 week. RESULTS: During 1 year of follow-up, the 1854 feet included in the analyses ran a total of 326 803 km until injury or censoring. A total of 252 participants sustained a running-related injury. Of these, 63 were bilateral injuries. Compared with a neutral foot posture, no significant body mass index-adjusted cumulative risk differences (RD) were found after 250 km of running for highly supinated feet (RD=11.0% (-10% to 32.1%), p=0.30), supinated feet (RD=-1.4% (-8.4% to 5.5%), p=0.69), pronated feet (RD=-8.1% (-17.6% to 1.3%), p=0.09) and highly pronated feet (RD=9.8% (-19.3% to 38.8%), p=0.51). In addition, the incidence-rate difference/1000 km of running, revealed that pronators had a significantly lower number of injuries/1000 km of running of -0.37 (-0.03 to -0.70), p=0.03 than neutrals. CONCLUSIONS: The results of the present study contradict the widespread belief that moderate foot pronation is associated with an increased risk of injury among novice runners taking up running in a neutral running shoe. More work is needed to ascertain if highly pronated feet face a higher risk of injury than neutral feet.
- To investigate if running distance to first running-related injury varies between foot postures in novice runners wearing neutral shoes. DESIGN: A 1-year epidemiological observational prospective cohort study. SETTING: Denmark. PARTICIPANTS: A total of 927 novice runners equivalent to 1854 feet were included. At baseline, foot posture on each foot was evaluated using the foot-posture index and categorised into highly supinated (n=53), supinated (n=369), neutral (n=1292), pronated (n=122) or highly pronated (n=18). Participants then had to start running in a neutral running shoe and to use global positioning system watch to quantify the running distance in every training session. MAIN OUTCOME MEASURE: A running-related injury was defined as any musculoskeletal complaint of the lower extremity or back caused by running, which restricted the amount of running for at least 1 week. RESULTS: During 1 year of follow-up, the 1854 feet included in the analyses ran a total of 326 803 km until injury or censoring. A total of 252 participants sustained a running-related injury. Of these, 63 were bilateral injuries. Compared with a neutral foot posture, no significant body mass index-adjusted cumulative risk differences (RD) were found after 250 km of running for highly supinated feet (RD=11.0% (-10% to 32.1%), p=0.30), supinated feet (RD=-1.4% (-8.4% to 5.5%), p=0.69), pronated feet (RD=-8.1% (-17.6% to 1.3%), p=0.09) and highly pronated feet (RD=9.8% (-19.3% to 38.8%), p=0.51). In addition, the incidence-rate difference/1000 km of running, revealed that pronators had a significantly lower number of injuries/1000 km of running of -0.37 (-0.03 to -0.70), p=0.03 than neutrals. CONCLUSIONS: The results of the present study contradict the widespread belief that moderate foot pronation is associated with an increased risk of injury among novice runners taking up running in a neutral running shoe. More work is needed to ascertain if highly pronated feet face a higher risk of injury than neutral feet.
- Need to add studies if I'm going to show you can't treat Pf this way No high level evidence supported the use of foot orthoses for flexible pes planus. There is good to moderate level evidence that foot orthoses improve physical function (medial-lateral sway in standing (level II) and energy cost during walking (level III)). There is low level evidence (level IV) that foot orthoses improve pain, reduce rearfoot eversion, alter loading and impact forces; and reduce rearfoot inversion and eversion moments in flexible pes planus. Well-designed randomised controlled trials that include appropriate sample sizes, clinical cohorts and involve a measure of symptom change are required to determine the efficacy of foot orthoses to manage adult flexible pes planus. Kirby Thoughts In fact, a foot orthosis does very little to limit motion of any joints of the foot. Stand on an orthosis and see if you can still move your foot just as much as if you were barefoot on the ground. You will see, a foot orthosis does very little, if any, to limit motion of the foot. Kirby Thoughts What then does a foot orthosis do? It alters the locations, temporal patterns and magnitudes of ground reaction force acting on the plantar foot during weightbearing activities, nothing more, nothing less. Thousands upon thousands of runners have worn and currently wear both over-the-counter and custom foot orthoses regularly to run in with no ill-side effects and with no evidence of “weak feet” as some of the barefoot/minimalist running zealots suggest.
- Demonstrates increase in muscle strength from wearing and running in minimalist shoes.
- Pronation is good. Not as crucial as we used to think. Not concerned with foot type as much