The effect of changing foot progression angle using real-time visual feedback on rearfoot eversion during running

Abstract

Atypical rearfoot in/eversion may be an important risk factor for running-related injuries. Prominent interventions for atypical rearfoot eversion include foot orthoses, footwear, and taping but a modification derived from gait retraining to correct atypical rearfoot in/eversion is lacking. We aimed to investigate changes in rearfoot in/eversion, subtalar pronation, medial longitudinal arch angle, and selected lower limb joint biomechanics while performing toe-in/toe-out running using real-time visual feedback. Fifteen female runners participated in this study. Subjects performed toe-in/toe-out running using real-time visual feedback on foot progression angle, which was set ±5° from habitual foot progression angle. 3D kinematics of rearfoot in/eversion, subtalar supination/pronation, medial longitudinal arch angle, foot progression angle, hip flexion, ab/adduction and internal/external rotation, knee flexion, ankle dorsiflexion, and ankle power were analyzed. A repeated-measures ANOVA followed by pairwise comparisons was used to analyze changes between three conditions. Toe-in running compared to normal and toe-out running reduced peak rearfoot eversion (mean difference (MD) with normal = 2.1°; p<0.001, MD with toe-out = 3.5°; p<0.001), peak pronation (MD with normal = -2.0°; p<0.001, MD with toe-out = -3.4; p = <0.001), and peak medial longitudinal arch angle (MD with normal = -0.7°; p = 0.022, MD with toe-out = -0.9; p = 0.005). Toe-out running significantly increased these kinematic factors compared to normal and toe-in running. Toe-in running compared to normal running increased peak hip internal rotation (MD = 2.3; p<0.001), and reduced peak knee flexion (MD = 1.3; p = 0.014). Toe-out running compared to normal running reduced peak hip internal rotation (MD = 2.5; p<0.001), peak hip ab/adduction (MD = 2.5; p<0.001), peak knee flexion (MD = 1.5; p = 0.003), peak ankle dorsiflexion (MD = 1.6; p<0.001), and peak ankle power (MD = 1.3; p = 0.001). Runners were able to change their foot progression angle when receiving real-time visual feedback for foot progression angle. Toe-in/toe-out running altered rearfoot kinematics and medial longitudinal arch angle, therefore supporting the potential value of gait retraining focused on foot progression angle using real-time visual feedback when atypical rearfoot in/eversion needs to be modified. It should be considered that changes in foot progression angle when running is accompanied by changes in lower limb joint biomechanics.

Subgroups of Foot-Ankle Movement Patterns Can Influence the Responsiveness to a Foot-Core Exercise Program: A Hierarchical Cluster Analysis

“…These differences in movements in the transverse plane could also be related to the foot progression angle. A toe-out (foot abduction) placement during the stance phase of gait has been shown to increase the forefoot abduction angles ( Schallig et al, 2020 ) and can lead to increased foot pronation during running ( Mousavi et al, 2021 ). However, we did not directly measure the foot progression angle in our study, therefore we cannot confirm this association, and the lack of discriminating features in frontal plane movement between clusters suggests that it is unlikely that inter-cluster differences are solely related to that parameter.…”

Gait retraining targeting foot pronation: A systematic review and meta-analysis

“…MLAA and increased internal longitudinal arch compared to normal and toe-out running. These 2 studies showed that the foot is more supinated when toeing-in [55,62]. Thus, in individuals with over-pronation, toeing-in not only may reduce foot pronation, it may contribute to foot stabilization at touchdown and late stance phase of walking.…”

“…Two studies assessed the effect of changing foot progression angle on rearfoot kinematics [62,63]. In the study by Mousavi et al [62] subjects performed toe-in/toe-out running using Toe-in running decreased peak rearfoot eversion, peak pronation, and peak medial longitudinal arch angle (MLAA) in healthy runners [17].…”

“…Two studies assessed the effect of changing foot progression angle on rearfoot kinematics [62,63]. In the study by Mousavi et al [62] subjects performed toe-in/toe-out running using Toe-in running decreased peak rearfoot eversion, peak pronation, and peak medial longitudinal arch angle (MLAA) in healthy runners [17]. In patients with osteoarthritis, toe-in walking reduced peak rearfoot eversion and increased rearfoot inversion at initial contact, rearfoot excursion in frontal plane, peak external ankle inversion moments.…”

A Deep Learning Method for Foot Progression Angle Detection in Plantar Pressure Images

“…Furthermore, externally rotated FPA and increased medial loading play important roles in flatfoot [ 21 , 22 ]. Moreover, foot placement angle was the best single predictor of total rearfoot motion, and the FPA may be useful to correct atypical rearfoot kinematics [ 23 , 24 ]. Classifying the left foot and the right before measuring the FPA may play an important role in providing information on the postural changes [ 25 ].…”