Foot type and tibial stress injuries

NewsBot · Feb 6, 2008

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Association between foot type and tibial stress injuries: a systematic review
A Barnes, J Wheat, C Milner
British Journal of Sports Medicine 2008;42:93-98

Objectives: To systematically review published articles investigating the association between structural foot characteristics and tibial stress injuries, and to suggest possible future avenues of research in this area.

Methods: Literature was identified, selected and appraised in accordance with the methods of a systematic review. Articles potentially relevant to the research question were identified by searching the following electronic databases: Amed, Cinahl, Index to UK theses, Medline, PubMed, Scopus, Sports discus and Web of science. Duplicates were removed and, based on the title and abstract, the full text of relevant studies were retrieved. Two reviewers independently assessed papers; this formed the basis for the inclusion of the most appropriate trials.

Results: From the 479 articles originally identified, nine were deemed appropriate for inclusion in the review. In general, specific data relating to this relationship was limited. Outcomes of the nine investigations were difficult to compare due to differing methods used across studies. Results have proved conflicting, with limited evidence found to implicate any specific foot type as a potential risk factor for tibial stress injuries.

Conclusions: No definitive conclusions can be drawn relating foot structure or function to an increased risk of tibial stress injuries. Extremes of foot types are likely to pose an increased risk of tibial stress injuries compared to normal arched feet.
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Admin2 · Feb 6, 2008

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NewsBot · Mar 4, 2008

Foot medial longitudinal-arch deformation during quiet standing and gait in subjects with medial tibial stress syndrome.
Bandholm T, Boysen L, Haugaard S, Zebis MK, Bencke J.
J Foot Ankle Surg. 2008 Mar-Apr;47(2):89-95.

The objective of this study was to investigate (1) if subjects with medial tibial stress syndrome demonstrate increased navicular drop and medial longitudinal-arch deformation during quiet standing and gait compared with healthy subjects, and (2) the relationship between medial longitudinal-arch deformation during quiet standing and gait. Thirty subjects aged 20 to 32 years were included (15 with medial tibial stress syndrome and 15 controls). Navicular drop and medial longitudinal-arch deformation were measured during quiet standing with neutral and loaded foot using a ruler and digital photography. Medial longitudinal-arch deformation was measured during walking gait using 3-dimensional gait analysis. Subjects with medial tibial stress syndrome demonstrated a significantly larger navicular drop (mean +/- 1 SD, 7.7 +/- 3.1 mm) and medial longitudinal-arch deformation (5.9 +/- 3.2 degrees) during quiet standing compared with controls (5.0 +/- 2.2 mm and 3.5 +/- 2.6 degrees, P < .05). Subjects with medial tibial stress syndrome also demonstrated significantly larger medial longitudinal-arch deformation (8.8 +/- 1.8 degrees) during gait compared with controls (7.1 +/- 1.7 degrees, P = .015). There was no correlation between medial longitudinal-arch deformation during quiet standing and gait in either of the 2 groups (r < 0.127, P > .653). The subjects with medial tibial stress syndrome in this study demonstrated increased navicular drop and medial longitudinal-arch deformation during quiet standing and increased medial longitudinal-arch deformation during gait compared to healthy subjects. Medial longitudinal-arch deformation during quiet standing did not correlate with medial longitudinal-arch deformation during gait in either of the 2 groups
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NewsBot · Nov 18, 2008

Biomechanical Risk Factors in the Development of Medial Tibial Stress Syndrome in Distance Runners
Jo L. Tweed, Jackie A. Campbell and Steven J. Avil
Journal of the American Podiatric Medical Association; Volume 98 Number 6 436-444 2008

Background: We investigated the relationship between functional and static foot posture and medial tibial stress syndrome in distance runners.

Methods: Twenty-eight runners with a clinical diagnosis of medial tibial stress syndrome and 12 asymptomatic runners were assessed with the Foot Posture Index to measure static overpronation. Range of motion was measured at the talocrural joint, with the knee extended and flexed as was range of motion at the first metatarsophalangeal joint and the angular difference between the neutral and relaxed calcaneal stance positions. Each participant was then videotaped while running on a treadmill shod and unshod. This videotape was analyzed using freeze frame to identify abnormal or mistimed pronation at each phase of gait. The results were analyzed using logistic regression to give the probability that a runner is likely to experience medial tibial stress syndrome, predicted from the static measurements and dynamic observations.

Results: Variables identified as being significant predictors of medial tibial stress syndrome were the difference between the neutral and relaxed calcaneal stance positions, range of motion of the talocrural joint with the knee extended, early heel lift and abductory twist during gait, and apropulsive gait.

Conclusion: Runners with suspected symptoms of medial tibial stress syndrome should be assessed dynamically and statically for abnormal or mistimed pronation
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NewsBot · May 23, 2018

Factors Contributing to Medial Tibial Stress Syndrome in Runners: A Prospective Study
Becker, James et al
Medicine & Science in Sports & Exercise: May 22, 2018 - Volume Publish Ahead of Print - Issue - p

Purpose Medial tibial stress syndrome (MTSS) is one of the most common overuse injuries sustained by runners. Despite the prevalence of this injury, risk factors for developing MTSS remain unclear. The purpose of this study was to prospectively evaluate differences in passive range of motion, muscle strength, plantar pressure distributions, and running kinematics between runners who developed MTSS and those who did not.

Methods 24 NCAA Division 1 cross country runners participated in this study. Participants underwent a clinical exam documenting passive range of motion and muscle strength at the hips and ankles. Plantar pressure analysis was used to quantify mediolateral pressure balances while walking and 3D motion capture was used to quantify running kinematics. Participants were followed for a two year period during which time any runners who developed MTSS were identified by the team’s certified athletic trainer.

Results Runners who developed MTSS demonstrated tighter iliotibial bands (p=.046, ES=1.07), weaker hip abductors (p=.008, ES=1.51), more pressure under the medial aspect of their foot at initial foot contact(p=.001, ES=1.97), foot flat(p<.001, ES=3.25), and heel off (p=.034, ES=1.30), greater contralateral pelvic drop (p=0.021, ES=1.06), and greater peak amounts (p=0.017, ES=1.42) and durations (p<.001, ES=2.52) of rearfoot eversion during stance phase. A logistic regression (χ2=21.31, p<.001) indicated that every 1% increase in eversion duration increased odds of developing MTSS by 1.38 (p=0.015).

Conclusions These findings demonstrate that the development of MTSS is multifactorial, with passive range of motion, muscle strength, plantar pressure distributions, and both proximal and distal kinematics all playing a role. We suggest that coaches or sports medicine professionals screening runners for injury risk consider adopting a comprehensive evaluation which includes all these areas.
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NewsBot · Apr 2, 2019

Alignment of the rearfoot and foot pressure patterns of individuals with medial tibial stress syndrome: A cross-sectional study
KazuoKinoshita et al
Physical Therapy in Sport; 27 March 2019

Highlights
the current study enrolling 18 athletes participating in daily sports exercise with Grade 1 or 2 MTSS showed the rear foot eversion on walking in the stance phase until heel off, although the LHA on standing is normal.

This eversion results in high foot pressure of the medial metatarsal areas and narrow and straight figure of COP path.

We should notice that rear foot malalignment in individuals with MTSS can be detected on walking, even if the alignment on standing is normal.
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Objective
To compare the rearfoot alignment (leg-heel angle, LHA) during standing and walking, and foot pressure during walking between individuals with medial tibial stress syndrome (MTSS) and asymptomatic individuals participating in daily sports.

Design
A cross-sectional study.

Setting
Research laboratory.

Participants
MTSS (18 legs) and control (15 legs) participants.

Main outcome measures
The LHA in the frontal plane during walking and standing; partial foot pressures expressed as the percentage of body weight (%PFP); and transverse width of the center of pressure (COP) path expressed as the percentage of foot width (%Trans) on walking.

Results
The LHA while walking was significantly higher in MTSS individuals, whereas the LHA while standing was not significantly different. The %PFPs of medial metatarsal areas were significantly higher in MTSS patients, whereas the %Trans was significantly lower.

Conclusions
In individuals with MTSS, the LHA is similar to controls while standing but higher (more everted) while walking while there is higher pressure under the medial metatarsal areas and the COP is more medial. Rearfoot malalignment in individuals with mild to moderate MTSS can be detected on walking, even if the alignment on standing is normal.
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