Dynamic foot function as a risk factor for lower limb overuse injury: a systematic review

Abstract

BackgroundDynamic foot function is considered a risk factor for lower limb overuse injuries including Achilles tendinopathy, shin pain, patellofemoral pain and stress fractures. However, no single source has systematically appraised and summarised the literature to evaluate this proposed relationship. The aim of this systematic review was to investigate dynamic foot function as a risk factor for lower limb overuse injury.MethodsA systematic search was performed using Medline, CINAHL, Embase and SportDiscus in April 2014 to identify prospective cohort studies that utilised dynamic methods of foot assessment. Included studies underwent methodological quality appraisal by two independent reviewers using an adapted version of the Epidemiological Appraisal Instrument (EAI). Effects were expressed as standardised mean differences (SMD) for continuous scaled data, and risk ratios (RR) for nominal scaled data.ResultsTwelve studies were included (total n = 3,773; EAI 0.44 to 1.20 out of 2.00, representing low to moderate quality). There was limited to very limited evidence for forefoot, midfoot and rearfoot plantar loading variables (SMD 0.47 to 0.85) and rearfoot kinematic variables (RR 2.67 to 3.43) as risk factors for patellofemoral pain; and plantar loading variables (forefoot, midfoot, rearfoot) as risk factors for Achilles tendinopathy (SMD 0.81 to 1.08). While there were significant findings from individual studies for plantar loading variables (SMD 0.3 to 0.84) and rearfoot kinematic variables (SMD 0.29 to 0.62) as risk factors for ‘non-specific lower limb overuse injuries’, these were often conflicting regarding different anatomical regions of the foot. Findings from three studies indicated no evidence that dynamic foot function is a risk factor for iliotibial band syndrome or lower limb stress fractures.ConclusionThis systematic review identified very limited evidence that dynamic foot function during walking and running is a risk factor for patellofemoral pain, Achilles tendinopathy, and non-specific lower limb overuse injuries. It is unclear whether these risk factors can be identified clinically (without sophisticated equipment), or modified to prevent or manage these injuries. Future prospective cohort studies should address methodological limitations, avoid grouping different lower limb overuse injuries, and explore clinically meaningful representations of dynamic foot function.Electronic supplementary materialThe online version of this article (doi:10.1186/s13047-014-0053-6) contains supplementary material, which is available to authorized users.

Biomechanical Risk Factors Associated with Running-Related Injuries: A Systematic Review

“…This means it is unclear whether differences between groups preceded the onset of injury or were a consequence of the injury. Previous systematic reviews on this topic have identified biomechanical risk factors for specific injuries (e.g., patellofemoral pain [23] or iliotibial band syndrome [24]), focused on biomechanics at one anatomic region (e.g., the foot [25]), had no specific focus on running biomechanics [25] or a running population [25], and/or included a combination of prospective and retrospective studies [23,24].…”

External rotation elastic bands at the lower limb decrease rearfoot eversion during walking: a preliminary proof of concept

“…This coupling has been considered in multifactorial approaches to musculoskeletal painful conditions 3 , 4 , such as foot-ankle and knee disorders possibly related to abnormal pronation and supination 5 - 9 . Although influenced by transverse-plane motion at the knee 10 , coupling of rearfoot eversion-inversion with lower limb internal-external rotation during walking 1 , 2 may enable forces at the foot to change both rearfoot and lower limb kinematics 10 , 11 in a distal to proximal direction.…”

The effect of orthotics on intersegmental foot kinematics and the EMG activity of select lower leg muscles

“…[4] Alterations in rear-and midfoot motion are often implicated 52 as contributing factors in the cause of symptoms in these individuals. [5][6][7][8] 53…”