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Foot pronation is not associated with increased injury risk in novice runners wearing a neutral shoe

Discussion in 'Biomechanics, Sports and Foot orthoses' started by NewsBot, Jun 14, 2013.

  1. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1

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    Foot pronation is not associated with increased injury risk in novice runners wearing a neutral shoe: a 1-year prospective cohort study
    Rasmus Oestergaard Nielsen, Ida Buist, Erik Thorlund Parner, Ellen Aagaard Nohr, Henrik Sørensen, Martin Lind, Sten Rasmussen
    Br J Sports Med doi:10.1136/bjsports-2013-092202
     
  2. After reading just the abstract: did they all wear the same type of shoe? Reliability of foot posture index "in their hands"? Other than that, seems to be the study we've been waiting for...
     
  3. HansJohnson

    HansJohnson Welcome New Poster

    Indeed an interesting study. @Simon: all runners used the same neutral shoe.

    At first the study does seem very interesting but there a few odds things about their methodology. They used 5 different raters for the rating of Foot Posture Index (and not a single rater as you would expect). They did not perform a reliability analysis for the raters ability to agree on the FPI score. From first hand experience and some of the papers on FPI reliability, it seems to have questionable interrater reliability in some cases. It would have been great to see a reliability analysis.

    Further more they use an odd categorization of the FPI. 1-7 is defined as neutral? The newest version (FPI-6) uses 0-5 as neutral? When they state that 1-7 is defined as neutral they reference a paper from Redmond et al (Normative values for the Foot Posture Index, J Foot Ankle). But this paper does not state that FPI 1-7 should be regarded as neutral. From my point of view (and from my experience with the FPI), their category of "neutral feet" is comprised of both neutral and pronated feet which obviously would cause bias towards the null-hypothesis of no difference between "neutral" and "pronated" in their analysis.

    "Foot pronation"...I think they should have changed the title to "Static pronated foot posture is not...".

    Cheers,
    HJ
     
  4. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Press Release:
    Researchers explode the myth about running injuries
     
  5. The media will love this one. This is yet another study that had very narrow result applications, using a static measure of foot posture that produced very limited evidence but that which the news media will blow out of proportion to what the study actually showed. Ho hum......yawn....:morning:
     
  6. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    Its already started:
    Researchers explode the myth about running shoes, injuries
    Ordinary running shoes do not risk foot pronation for novice runners

    "Corrective Running Shoes Are Based On A Myth" <-- this one was on the Popular Science website, but they have deleted it!
     
  7. Craig Payne

    Craig Payne Moderator

    Articles:
    8
  8. If the above is correct, I think that someone should write a letter to the editor regarding this misuse of the FPI within the study.
     
  9. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    Its right. they classified the "neutral" foot as a FPI of 0-7 !!!!!! :craig::craig::craig::craig:
     
  10. Is there any precedent in the literature to adopt this approach though?

    Wonder what the result would have been if they used a shoe with moderate "pronation control"?
     
  11. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    Nope. They quoted Tony's normative values paper in JFAR :http://www.jfootankleres.com/content/1/1/6 ... but I do not see what they are claiming in that paper.
    Exactly! ...hence the silly overhyped press release that the media are lapping up.
     
  12. CraigT

    CraigT Well-Known Member

    Apart from what has already been stated, I think the thing that bothers me is the title-
    'Foot pronation is not associated with increased injury risk in novice runners wearing a neutral shoe: a 1-year prospective cohort study'
    Pronation is dynamic. This was not a dynamic study.
    The title should be 'A pronated static foot posture is not associated with increased injury risk in novice runners...'
    Which is another nail in the coffin of the wet footprint test, but should not be interpreted beyond that...
     
  13. HansJohnson

    HansJohnson Welcome New Poster

    I strongly agree with CraigT. They do NOT measure foot pronation and the media (and all the uncritical readers) have just read the title/abstract.

    I just had a look of what the authors previously have published. The first author have previously published papers showing that the FPI (or navicular drop test) can not be used to predict dynamic foot movement. It is very poor methodological practice that he avoids referencing his own previous work but instead references the paper by Chuter who is one of the few studies that indicate that FPI has a strong association to dynamic foot pronation.

    They have also published several papers from this cohort. Once again it is very odd that they avoid referencing their own previous work done on the same subjects.

    Together with the previous issues I hope that someone would write a paper to the journal and explain the methodological concerns.


    1. Video based analysis of dynamic midfoot function and its relationship with Foot Posture Index scores. Nielsen RG, Rathleff MS, Moelgaard CM, Simonsen O, Kaalund S, Olesen CG, Christensen FB, Kersting UG. Gait Posture. 2010 Jan;31(1):126-30
     
  14. SeasonsChange

    SeasonsChange Member

    I've noticed many athletes can get away almost any type of footware when they are running less than 30mpw. Problems start to occur at the higher mileage training, regardless of a thoughtful build up. There is only so much stress certain stress certain structures can adapt to. Modifying a runners kinetics via shoe and/or orthotic invention seems to allow athletes to make huge breakthroughs in training volume.
     
  15. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    I have been all over twitter this AM re this study!!!!!

    Has anyone got a picture of a foot with an FPI around 7 so I can show people just how pronated a 7 really is?
     
  16. toomoon

    toomoon Well-Known Member

    here you go.. FPI 7
     

    Attached Files:

  17. efuller

    efuller MVP

    Two comments:
    Wow, I wonder how much of the eversion of the heel bisection is because the fat pad is pulled so far laterally relataive to the calcaneus.

    Now, that is a nice frontal plane view of a STJ axis that is medially deviated in the transverse plane. It looks like the entire, (well almost all), weigth bearing surface of the foot is lateral the center of the ankle joint.

    Eric
     
  18. toomoon

    toomoon Well-Known Member

    Eric.. the truly amazing thing about this fellow is that he was a dual Olympian.. in basketball!!
    He came to see me because he wanted to recommence running and he was getting global foot pain. Given his navicular was essentially dragging in the dirt that is entirely unsurprising. He is one of the very few people I have ever, in my career, advised that running was not for them...
     
  19. User7

    User7 Active Member

    Was he playing basketball on those feet, or those feet before they had plastically deformed to the degree shown in the photo?
     
  20. Dr Rich Blake

    Dr Rich Blake Active Member

    One of the only things I would like to say about this study, like many others, is that how a patient runs can be so different than their foot type since influenced by so many factors. One example of thousands would be the terrible cavus foot with walking lateral instability and severe pronation once they begin to run. I think if this study was to be done over you would make sure that each foot fit its category both in stance and running which is easily to do. Then you are going to find out some things. But if 3 highly pronated feet run, and one runs highly pronated, and next neutral and the next supinated, you are not going to learn anything. Rich
     
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