Relationships between static foot alignment and dynamic plantar loads in runners with acute and chronic stages of plantar fasciitis: a cross-sectional study.

Ana P. Ribeiro,Silvia M. A. João,Roberto C. Dinato,Isabel C. N. Sacco

doi:10.1590/bjpt-rbf.2014.0136

Abstract

BACKGROUND:The risk factors for the development of plantar fasciitis (PF) have been associated with the medial longitudinal arch (MLA), rearfoot alignment and calcaneal overload. However, the relationships between the biomechanical variables have yet to be determined.OBJECTIVE: The goal of this study was to investigate the relationships between the MLA, rearfoot alignment, and dynamic plantar loads in runners with unilateral PF in acute and chronic phases.METHOD: Cross-sectional study which thirty-five runners with unilateral PF were evaluated: 20 in the acute phase (with pain) and 15 with previous chronic PF (without pain). The MLA index and rearfoot alignment were calculated using digital images. The contact area, maximum force, peak pressure, and force-time integral over three plantar areas were acquired with Pedar X insoles while running at 12 km/h, and the loading rates were calculated from the vertical forces.RESULTS: The multiple regression analyses indicated that both the force-time integral (R 2=0.15 for acute phase PF; R 2=0.17 for chronic PF) and maximum force (R 2=0.35 for chronic PF) over the forefoot were predicted by an elevated MLA index. The rearfoot valgus alignment predicted the maximum force over the rearfoot in both PF groups: acute (R 2=0.18) and chronic (R 2=0.45). The rearfoot valgus alignment also predicted higher loading rates in the PF groups: acute (R 2=0.19) and chronic (R 2=0.40). CONCLUSION: The MLA index and the rearfoot alignment were good predictors of plantar loads over the forefoot and rearfoot areas in runners with PF. However, rearfoot valgus was demonstrated to be an important clinical measure, since it was able to predict the maximum force and both loading rates over the rearfoot.

Highlights

Foot types and repetitive plantar loads have been commonly associated with lower limb injuries, especially running-related injuries[1], such as medial tibial stress syndrome[2], patellofemoral pain syndrome[3], and plantar fasciitis (PF)[4,5,6]
High intra-examiner and inter-examiner reliability levels were found for the medial longitudinal arch (MLA) index
The rearfoot alignment reliability levels were high for the intra‐examiner and inter‐examiner measurements

Summary

Introduction

Foot types and repetitive plantar loads have been commonly associated with lower limb injuries, especially running-related injuries[1], such as medial tibial stress syndrome[2], patellofemoral pain syndrome[3], and plantar fasciitis (PF)[4,5,6]. PF is considered to be the third most prevalent injury in runners[8,9,10]. Specific intrinsic and extrinsic risk factors related to the foot-ankle structures have been explored in the literature[11]. The main intrinsic factors for the development of PF in runners have been explained as foot-type changes[12], rearfoot valgus posture[4,13,14], and elevated plantar arch structures[5,8,13].

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