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.
Highlights
Running-related injuries (RRIs) are very common in athletes; sports clinicians are frequently consulted about these injuries [1]
In a recent systematic review [2] we showed that peak rearfoot eversion may be associated with iliotibial band syndrome, patellar tendinopathy, and posterior tibial tendon dysfunction in runners
Female runners with atypical rearfoot eversion may be more prone to RRIs, female runners with tibial stress fracture showed greater peak rearfoot eversion [11] and female runners with iliotibial band syndrome showed lower peak rearfoot eversion compared to non-injured runners [2, 12]
Summary
Running-related injuries (RRIs) are very common in athletes; sports clinicians are frequently consulted about these injuries [1]. Rearfoot eversion is among the most commonly reported kinematic factors in the studies investigating foot function and/or risk factors for lower-limb injuries [2,3,4]. Much debate exists on whether atypical rearfoot eversion contributes to injury [4, 7]. This is mainly because most studies investigating rearfoot eversion for RRIs have either a case-control or a cross-sectional design that cannot prove causality; the results of prospective studies are mainly based on a small sample size [8]. There are several studies reporting that rearfoot eversion may be a potential risk factor for RRIs [2, 9, 10]. Female runners with atypical rearfoot eversion may be more prone to RRIs, female runners with tibial stress fracture showed greater peak rearfoot eversion [11] and female runners with iliotibial band syndrome showed lower peak rearfoot eversion compared to non-injured runners [2, 12]
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