Inservice by Kellie Adams Objectives Review ankle anatomy and biomechanics in order to understand motions involved at each joint during pronation Apply running requirements for active duty soldiers to the prevalence of ankle and foot injuries in active duty soldiers ID: 908896
Download Presentation The PPT/PDF document "In runners, does excessive STJ pronation..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
In runners, does excessive STJ pronation compared to normal STJ pronation increase risk of lower extremity musculoskeletal injury?
Inservice by Kellie Adams
Slide2Objectives
Review ankle anatomy and biomechanics in order to understand motions involved at each joint during pronation
Apply running requirements for active duty soldiers to the prevalence of ankle and foot injuries in active duty soldiers
List the main causes of excessive pronation in order to understand the mechanism of foot posture
Associate/dissociate pronation and running injury based on available research in order to treat patients with up-to-date evidence based practice
Slide3Question:
In runners, does excessive STJ pronation compared to normal STJ pronation increase risk of lower extremity musculoskeletal injury?
Slide4Ankle Anatomy: Bones of the foot
Slide5Ankle Anatomy: Regions of the foot
Slide6Ankle Anatomy: Talocrural Joint
Slide7Ankle Anatomy: Subtalar Joint
Slide8Ankle Anatomy: Transverse Tarsal Joint
Slide9Ankle Anatomy: Metatarso-phalangeal joints
Slide10Ankle Anatomy: Ligaments
Slide11Ankle Biomechanics: Planes and Axis
Slide12Ankle Biomechanics: Pronation & Supination
Pronation
: Dorsiflexion, eversion, abduction
Supination
: Plantarflexion, inversion, adduction
Slide13Common causes of excessive pronation1:
Tight Calf Muscles
Proximal Control
Posterior Tibialis Weakness
Forefoot Varus
Slide14Running Requirements in United States Army
Physical Fitness Test requirements involve a timed 2-mile run
Time limits are based on gender and age group
Typical Physical Training (PT) involves a 4 mile run, 3 times per week
Slide15Rates of Ankle and Foot Injuries in Active-Duty U.S. Army Soldiers, 2000-20062
Purpose:
to quantify acute ankle and foot injuries over time and identify high risk categories of ankle and foot injuries
Data obtained from Total Army Injury and Health Outcomes Database (TAIHOD) to identify number of soldiers in the army from 2000-2006 and Patient Administration Systems and Biostatic Activity agency for clinical encounters in military medical care facilities
Rates were stratified by sex, age, military rank classification, educational attainment, marital status, length of active duty service, existence of at least 1 ankle foot injury in the previous 2 years, race
Slide16Rates of Ankle and Foot Injuries in Active-Duty U.S. Army Soldiers, 2000-20062
During 2000-2006, 221,393 soldiers were seen for at least 1 ankle foot injury
71% ankle injuries
42% foot injuries
Higher prevalence of ankle foot injuries:
Female
<30 years old
Enlisted
Less than a high school education
Shorter length of active duty service
Strongest risk factor = record of ankle foot injury within the previous 2 years
Slide17Foot Posture Index (FPI)3
Clinical tool aimed at classifying foot posture into pronated, neutral, and supinated
Used by many studies due to simplicity and single quantifiable result
Positive values indicate a pronated foot posture
Negative values indicate a supinated foot posture
Neutral foot = 0
Slide18Foot Posture Index (FPI)3
Patient stands in double leg stance position for measurements
Clinical criteria:
Talar Head Palpation
Supra- and infra- lateral malleolar curvature
Calcaneal frontal position
Bulging in region of talonavicular joint
Height and congruence of medial longitudinal angle
Abduction/Adduction of the forefoot on the rearfoot
Total score will be a number between -12 and +12
Slide19Foot pronation is not associated with increased injury risk in novice runners wearing a neutral shoe4
1 year prospective cohort study
927 healthy adults age 18-65 (1854 feet)
Purpose:
to investigate if running distance to first running related injury varied between foot postures in novice runners wearing neutral shoes
Hypothesis:
the running distance at first injury will not vary across different foot postures in a neutral running shoe
Classifications included highly supinated, supinated, neutral, pronated, highly pronated based on foot posture profiles created for each runner based on Foot Posture Index
Slide20Foot pronation is not associated with increased injury risk in novice runners wearing a neutral shoe4
Participants were required to wear the same neutral shoe for running and a GPS watch
Participants uploaded their training data to an online personal training diary to track running distance
Participants decided when and where to run with no restrictions on distance, duration, and intensity
Slide21Slide22Foot pronation is not associated with increased injury risk in novice runners wearing a neutral shoe4
Results
Pronated feet sustained significantly
fewer
injuries per 1000 km of running than neutral feet
Runners with excessive pronation or supination were not significantly more likely to get hurt than runners with neutral foot motion
Among runners who ran at least 600 miles over the first year, injury rates were slightly higher among runners with neutral feet than those with excessive pronation
Injury frequency was lowest for the foot position between 7-10° pronated
Slide23Foot pronation is not associated with increased injury risk in novice runners wearing a neutral shoe4
Strengths:
Prospective study
Large sample size (n= 927)
All participants wore the same neutral running shoe
Weaknesses:
Relatively low number of participants in the highly pronated group (18) and highly supinated group (53)
In this study, neutral foot posture defined as 0-7 on FPI, pronated group was defined as 7-10, highly pronated defined as >10
FPI value 0-4 is generally considered a reasonable normal range and >4 is considered pronated
This study eliminated participants that were wearing inserts or orthotics from participating
Slide24Association between foot type and lower extremity injuries: Systematic Literature Review with Meta-analysis5
Purpose:
provide an evidence based summary on whether foot type is associated with the incidence of lower extremity injuries
Secondary purpose:
to identify the most appropriate method of assessing foot type
Included cross-sectional, case-control, and prospective study designs (29 studies used)
Quality of each study was assessed by two reviewers and scored 0-6. Only studies >3 were included in the meta-analysis
Slide25Association between foot type and lower extremity injuries: Systematic Literature Review with Meta-analysis5
Results
High arch or flat foot classification, when compared to a neutral foot classification, is associated with increased lower extremity injuries
OR= 1.23
95% CI: 1.11-1.37
p <0.001
Review favored the use of the Foot Posture Index
Slide26Association between foot type and lower extremity injuries: Systematic Literature Review with Meta-analysis5
Strengths:
Meta-analysis
Significance was set at p <0.05 for all analyses
Weaknesses:
Databases were searched by a single reviewer, leading to possible bias
Demographics of a lot of subjects were highly active participants- active duty military personnel and competitive/amateur athletes
No search limits were used for the year of publication- some studies were outdated
Slide27Impact of foot type on cost of lower extremity injury6
Cross sectional prospective study
Purpose:
determine relationship between Foot Posture Index and medical costs associated with lower extremity musculoskeletal injury
668 active duty service members participated
Foot posture was determined by using the Foot Posture Index
Data about medical costs, diagnostic codes, and RVUs were obtained from the military healthcare database
Slide28Impact of Foot Type on Cost of Lower Extremity Injury6
Results
336 out of 668 subjects sought medical care for lower extremities during the study period of 31 months, with 243 seeking care for injuries at or distal to the knee
Greater rate of knee injuries for those with a highly pronated foot type (p= 0.017) or those with a pronated or highly pronated foot type (p=0.011) compared to those with a neutral foot type
Individuals with pronated feet resulted in significantly more healthcare visits
Slide29Impact of foot type on cost of lower extremity injury6
Strengths:
Large sample size
Prospective study
Weaknesses:
Sample size in highly supinated and highly pronated was relatively low
Slide30Conclusion
Based on the studies presented here and other studies of poor quality that I came across in my research, as well as my own previous knowledge, my conclusion is that ankle pronation
may
increase risk of running injury
More quality, up-to-date research is required in order to form a more definitive conclusion
Slide31Questions?
Slide32References
Payne C. The nonsensical understanding of 'overpronation'.
Running Research Junkie
. February 2013. http://www.runresearchjunkie.com/the-nonsensical-understanding-of-overpronation/. Accessed June 7, 2018.
Wallace RF, Wahi MM, Hill OT, Kay AB. Rates of Ankle and Foot Injuries in Active-Duty U.S. Army Soldiers, 2000–2006.
Military Medicine
. 2011;176(3):283-290. doi:10.7205/milmed-d-10-00098.
Redmond AC., Crosbie J., Ouvrier RA. Development and validation of a novel rating system for scoring foot posture: the Foot Posture Index. Clinical Biomechanics 2006, 21:1; 89-98
Slide33References
Nielsen RO, Buist I, Parner ET, et al. Foot pronation is not associated with increased injury risk in novice runners wearing a neutral shoe: a 1-year prospective cohort study.
British Journal of Sports Medicine
. 2013;48(6):440-447. doi:10.1136/bjsports-2013-092202.
Tong JW, Kong PW. Association Between Foot Type and Lower Extremity Injuries: Systematic Literature Review With Meta-analysis.
Journal of Orthopaedic & Sports Physical Therapy
. 2013;43(10):700-714. doi:10.2519/jospt.2013.4225.
Teyhen, D.S., Nelson, L.A., Koppenhaver, S.L., Honan, L.K., McKay, A.E., Young, A.R., & Christie, D.S. (2013). Impact of foot type on cost of lower extremity injury. NATO Science and Technology Symposium, Milan, Italy.