Static and dynamic risk factors for overuse injury

NewsBot · Dec 19, 2014

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Static foot posture as a risk factor for lower limb overuse injury: a systematic review and meta-analysis
Neal BS, Griffiths IB, Dowling GJ, Murley GS, Munteanu SE, Franettovich Smith MM, Collins NJ and Barton CJ
Journal of Foot and Ankle Research 2014, 7:55 (19 December 2014)

BackgroundStatic measures of foot posture are regularly used as part of a clinical examination to determine the need for foot level interventions. This is based on the premise that pronated and supinated foot postures may be risk factors for or associated with lower limb injury. This systematic review and meta-analysis investigates foot posture (measured statically) as a potential risk factor for lower limb overuse injuries.

MethodsA systematic search was performed using Medline, CINAHL, Embase, SportDiscus in April 2014, to identify prospective cohort studies that investigated foot posture and function as a risk factor for lower limb overuse injury. Eligible studies were classified based on the method of foot assessment: (i) static foot posture assessment; and/or (ii) dynamic foot function assessment. This review presents studies evaluating static foot posture. The methodological quality of included studies was evaluated by two independent reviewers, using an adapted version of the Epidemiological Appraisal Instrument (EAI). Where possible, effects were expressed as standardised mean differences (SMD) for continuous scaled data, and risk ratios (RR) for nominal scaled data. Meta-analysis was performed where injuries and outcomes were considered homogenous.

ResultsTwenty-one studies were included (total n = 6,228; EAI 0.8 to 1.7 out of 2.0). There was moderate evidence that a pronated foot posture was a risk factor for medial tibial stress syndrome (MTSS) development and very limited evidence that a pronated foot posture was a risk factor for patellofemoral pain development, although associated effect sizes were small (0.28 to 0.33). No relationship was identified between a pronated foot posture and any other evaluated pathology (i.e. foot/ankle injury, bone stress reactions and non-specific lower limb overuse injury).

ConclusionThis systematic review identified moderate and very limited evidence of small effect that a pronated foot posture is a risk factor for MTSS and patellofemoral pain respectively. Evaluation of static foot posture should form part of a multifactorial assessment for both MTSS and patellofemoral pain, although only as a part of the potential injury risk profile. Whilst the included measures are clinically applicable, further studies are required to determine their relationship with dynamic foot function.
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Dynamic foot function as a risk factor for lower limb overuse injury: a systematic review
Geoffrey J Dowling, George S Murley, Shannon E Munteanu, Melinda M Franettovich Smith, Bradley S Neal, Ian B Griffiths, Christian Barton and Natalie J Collins
Journal of Foot and Ankle Research 2014, 7:53 doi:10.1186/s13047-014-0053-6

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.
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NewsBot · Dec 25, 2014

Mal-Alignment as a Risk Factor for Lower Extremity
Overuse Injuries in Young Adults in Unorganised
Sports Activities.
Ajai Singh; Sabir Ali; Vineet Kumar; Rajeshwar N. Srivastava
International Journal of Physical Education, Sports and Health 2014; 1(2): 25-2

Overuse injuries in young adults present a unique challenge to the treating clinician. In this study, we
studied the association of male-alignment as a risk factor for overuse injuries of the lower extremity in
young adults. This prospective cohort study examined all the adult patients presented with various lower
extremity overuses injuries. Only those engaged in unorganised sports activity were studied. After
making a clinical impression, all patients were subjected to relevant X-rays to diagnose the malalignment,
if present or not. A total of 252 cases with overuse injuries was included, in which seventythree
per cent were male patients. The sprain ankle was the commonest overuse injury to both genders. In
our study, the mal-alignment was seen in 64.3% of the total overuse cases, of which the commonest malalignment
in both genders was internal tibial torsion. In conclusions overuse injuries in young adults are
frequently associated with mal-alignments. Better understanding of these mal-alignments are better for
the management of these injuries.
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Griff · Dec 25, 2014

NewsBot said: ↑

Mal-Alignment as a Risk Factor for Lower Extremity
Overuse Injuries in Young Adults in Unorganised
Sports Activities.
Ajai Singh; Sabir Ali; Vineet Kumar; Rajeshwar N. Srivastava
International Journal of Physical Education, Sports and Health 2014; 1(2): 25-2
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Perhaps I'm missing something but if all the subjects presented with overuse injuries then how can this be considered a prospective study?

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