Ankle Involvement Research Articles

Ultrasound prevalence of wrist, hand, ankle and foot synovitis and tenosynovitis in systemic sclerosis, and relationship with disease features and hand disability

In systemic sclerosis, few studies have shown that hand and wrist ultrasound is more sensitive than clinical examination in the detection of synovitis and tenosynovitis. Even fewer studies have investigated ankle and foot involvement with ultrasound. Our objectives were to investigate ultrasound prevalence of wrist, hand, ankle and foot synovitis and tenosynovitis in patients with systemic sclerosis classified with ACR/EULAR 2013 criteria, and to study their relationship with disease features and hand disability. Consecutive patients with systemic sclerosis, classified with ACR/EULAR 2013 criteria, were included in a monocentric cross-sectional study. They underwent standardized musculoskeletal clinical examination and hand, wrist, ankle and foot ultrasound. Clinical, biological and imaging data were also collected. Fifty-five patients were included. Ultrasound was more sensitive than clinical examination to detect at least one synovitis (respectively 52% versus 25%, P=0.025) and at least one tenosynovitis (respectively 16% versus 4%, P=0.009); 18% of patients had ankle tenosynovitis and 29% had ankle and/or foot synovitis, mostly located at metatarsophalangeal joints (25.5%). Having at least one ultrasound hand synovitis was associated with higher Cochin hand functional disability scale (mean 25±3 versus 12±2, P=0.003) and diffuse cutaneous subset (P=0.038). Our study shows that ultrasound is more sensitive than clinical examination to detect synovitis and tenosynovitis in systemic sclerosis. The foot involvement is less frequent than hand involvement, mainly localized at metatarsophalangeal joint. Finally, having at least one synovitis of the hand is associated with diffuse cutaneous subset and higher hand disability.

Validation of prediction models of severe disease course and non-achievement of remission in juvenile idiopathic arthritis part 2: results of the Nordic model in the Canadian cohort

BackgroundValidated clinical prediction models to identify children with poor prognosis at the time of juvenile idiopathic arthritis (JIA) diagnosis would be very helpful for tailoring treatments, and avoiding under- or over-treatment. Our objective was to externally validate Nordic clinical prediction models in Canadian patients with JIA.MethodsWe used data from 513 subjects at the 3-year follow-up from the Research in Arthritis in Canadian Children emphasizing Outcomes (ReACCh-Out) cohort. The predicted outcomes were non-achievement of remission, severe disease course, and functional disability. The Nordic models were evaluated exactly as published and after fine-tuning the logistic regression coefficients using multiple data splits of the Canadian cohort. Missing data was handled with multiple imputation, and prediction ability was assessed with C-indices. C-index values > 0.7 were deemed to reflect helpful prediction.ResultsOverall, 81% of evaluable patients did not achieve remission off medications, 15% experienced a severe disease course, and 38% reported disability (CHAQ score > 0). The Nordic model for predicting non-achievement of remission had a C-index of 0.68 (95% CI 0.62–0.74), and 0.74 (0.67–0.80) after fine-tuning. For prediction of severe disease course, it had a C-index of 0.69 (0.61–0.78), and 0.79 (0.68–0.91) after fine-tuning. The fine-tuned Nordic model identified 85% of the cohort as low risk for a severe disease course (< 20% chance) and 7% as high risk (> 60% chance). The Nordic model to predict functional disability had a C-index of 0.57 (0.50–0.63), and 0.51 (0.39–0.63) after fine-tuning.ConclusionsFine-tuned Nordic models, combining active joint count, physician global assessment of disease activity, morning stiffness, and ankle involvement, predicted well non-achievement of remission and severe disease course in Canadian patients with JIA. The Nordic model for predicting disability could not predict functional disability in Canadian patients.

Focal Pigmented Villonodular Synovitis in the Hip Joint – A Rare Case Report

Pigmented villonodular synovitis is characterized by villous/nodular proliferation of the synovial membrane affecting commonly the knee joint. Involvement of the hip ankle, shoulder, and elbow joint is distinctly uncommon. Young adults are mainly affected and present with localized pain with/without joint stiffness and swelling. Etiology thought to be due to synovial hyperplasia following chronic inflammation. The role of trauma is controversial. Radiography and computed tomography scan are not diagnostic in the early stages. MRI is useful in the diagnosis and follow-up. Histology reveals nodular proliferation lined by hyperplastic synovium beneath which are sheets of histiocytes, hemosiderin laden macrophages and osteoclast-like giant cells. Colony-stimulating factor 1 gene overexpression is seen in histiocytic cells. Syniovectomy is the mode of treatment. Total hip arthroplasty may be required for extensive disease. A high index of clinical suspicion is required to diagnose this rare disease to prevent the limitation of joint mobility and destruction.

PO 18254 - Synovial giant cell tumor of the ankle

Introduction: Synovial giant cell tumor is a benign neoplasm that is rarely reported in the form of malignant metastasis. Synovial giant cell tumor most frequently occurs in the hand, hip and knee and rarely occurs in the ankle and foot. The present study describes 2 rare cases of synovial giant cell tumor located in the hindfoot (one with diffuse disease with tibiotarsal and subtalar joint involvement and the other with signs of periarticular ankle involvement) and describes the chosen treatment. Methods: Two consecutive patients were evaluated, and a brief literature review was performed. Results: Open synovectomy was performed in both cases, with complete tumor resection and satisfactory patient progression. Conclusion: Open synovectomy was found to be a good method for the treatment of these lesions because it enabled a satisfactory approach, with good visualization of the ankle compartments and underlying joints and the ability to efficiently provide marginal excision, total synovectomy and complete tumor resection for arthrotomy, without postoperative complications.

Talus Arthritis Pattern in Juvenile Idiopathic Arthritis (JIA)

Category:Ankle ArthritisIntroduction/Purpose:Juvenile idiopathic arthritis is a broad term that describes a clinically heterogeneous group of arthritides of unknown cause, which begin before 16 years of age persist for more than 6 weeks.It is one of the main diseases affecting Paediatric age group Joints in a form of a chronic, long standing and debilitating disease. It is estimated that 1 in 1000 children present with JIA in the UK alone.Radiographic progression of the disease occurs early, and if not addressed may result in permanent joint destruction and poor functional outcomes.The ankle is frequently involved, but it is unclear whether this is due to synovitis, tenosynovitis.To date, no evidence of combined therapies or integrated care for juvenile idiopathic arthritis patients with F&A problems exists.Methods:JIA patients with ankle involvement presented to orthopedic foot and ankle services between 2012-2017 were include. All patients had weight bearing x-rays ankle measuring Tibio talar angle, also underwent Ankle MRI following standard hospital MRI protocols.The MRI scans were used to measure the affected areas in talus. Talus was divided into 4 anatomical regions (Anterio-medial, Anterio-lateral, posterior-medial, posterolateral). lesion involving wider areas were recorded as two or more regions accordingly, i.e.: AM and PM involvement at the same time were given yes for area of involvement in both region and recorded separately.Bilateral Ankles involvement were also recorded. Tibial growth plate involvement in these patients on the MRI scan was recorded. Demographic data was collected along with side, disease pattern, age at diagnosis and age at presentation to F&A speciality and patients requiring surgical intervention. Measurements were carried out by two in dependent orthopaedics F&A surgeons.Results:14 patients were included in this study with a total of 17 ankles. 12 were females (N=12, 85.7%). Mean age was between 8-21 years (15.0 ± 4.08, M±SD). Time to presentation was 2.9 to 8.4 years (5.1 ± 1.4 years). 5 had Oligo-articular involvement (37.5%),9 patients had polyA (64.2%).11/17 Right Ankles (64.7%), 3 left (21.4%). 3 bilateral (21.4%). 11/17 Ankles in Varus (64.7%), 1/17 valgus (5.8%), 5/17 neutral (29.4%).Mean Tibiotalar angle was 80° ± 13.5° (Range 49° - 100°).12/17(70.5%) had involvement of the antero-medial part of the talus,1/17(5.8%)antero-lateral, 8/17 postero-medial(47.06%), 3/17(17.6%) postero-lateral .All the patients with postero-lateral involvement, they also had postero-medial involvement. (p=0.043). 13/17 ankles (76.4%) had tibial growth plate involvement.5 patients (35.7%) had subsequent operations.Conclusion:This study shows a pattern of involvement in the talus and the effect this disease has on Tibiotalar alignment. This needs to be confirmed on a larger number of patients. And highlights the need for an earlier presentation of these patients to F&A surgeon to prevent the disease sequela. Further research is required to study the tibial growth plate involvement for its contribution to the varus / valgus deformity in a chronological method. Further research is also required to quantify the time frame for disease and deformity progression in the Tibiotalar Joint.

Predicting disease severity and remission in juvenile idiopathic arthritis: are we getting closer?

To summarize current research on the prediction of severe disease or remission in children with juvenile arthritis, and define further steps needed towards developing prediction tools with sufficient accuracy for clinical use. High disease activity, poor patient-reported outcomes, ankle or wrist involvement, and a longer time from onset to the start of treatment herald a severe disease course and a low chance of remission. Other studies confirmed that age less than 7 years and positive ANA are the strongest predictors of uveitis development. Preliminary evidence suggests ultrasound findings may predict flare in patients with clinically inactive disease, and several new biomarkers show promise. A few prediction tools that combine predictors to estimate the chance of remission or a severe disease course in the medium-term to long-term have shown good accuracy when internally validated in the population in which they were developed. Promising candidate tools for predicting disease severity and long-term remission in juvenile arthritis are now available. These tools need external validation in other populations, and ideally formal trials to assess whether their use in practice improves patient outcomes. We are definitively getting closer, but we are not there yet.

Ankle involvement in rheumatoid arthritis – a comparison of inflammatory signs on musculoskeletal ultrasound and magnetic resonance imaging

To evaluate the frequency of tibiotalar and subtalar joints together with extensor, flexor and peroneal tendons inflammatory lesions in rheumatoid arthritis (RA) patients by using ultrasound (US) and magnetic resonance imaging (MRI). Fifty RA patients and 25 healthy subjects were prospectively included. All patients and controlsunderwent clinical examination (to screen for swollen and/or tender ankles) and ankle US and MRI (to screen for synovialhypertrophy - SH, tenosynovitis and power Doppler - PD signals). The imaging tests were compared using overall agreement, positive agreement, Cohen's κ, sensitivity, specificity and positive likelihood ratio. The subtalar joint had the highest frequency of US-detected SH (30%), as well as positive PD signals (10%). Regarding US joint effusion, the tibiotalar joint recorded the highest frequency (44%). The most frequent US tenosynovitis was detected in the tibialis posterior tendon (40%). Compared to MRI, US evaluation of tibiotalar joints had very good agreement and large effect on detection probability for both SH and effusion (kappa 0.84, positive likelihood ratio 21.1). Compared to MRI, the sensitivity and specificity for US joint involvement ranged between 72.0-88.5% and 82.4-95.8%, and for tenosynovitis were 33.3-78.6% and 85.2-100%, respectively. Compared to asymptomatic RA patients (n=25), those with at least one symptomatic ankle (n=25) had significantly higher frequencies of both SH and effusion in all the evaluated structures. US has high sensitivity and specificity in detecting RA inflammatory lesions in the ankle and rearfoot, in very good agreement with MRI. The high frequency of ankle inflammatory lesions in RA should result in increased interest in the imaging evaluation of these structures.

Clinical and ultrasound ankle involvement in rheumatoid arthritis in remission

Clinical and ultrasound ankle involvement in rheumatoid arthritis in remission

The relevance of ultrasound examination of the foot and ankle in patients with rheumatoid arthritis - a review of the literature.

Rheumatoid arthritis (RA) is an inflammatory disease characterized by symmetrical involvement of the joints and tendons,especially of the hands and wrists, but also of the feet and ankles from the very beginning of the disease. For the patient, thefoot and ankle involvement is equally important as the other joints, since it affects the functionality of the feet and the qualityof life of the patients. It is already known that subclinical involvement of the ankles and feet occurs even in patients that areconsidered in clinical remission, thus they do not need for changes of therapy, but still might benefit from it. In spite of this, theclinicians do not give enough care to the ankle and foot in RA patients, especially if asymptomatic, resulting future deformities,joint damage and feet disability. In order to show the importance of the feet and ankles in RA patients and to demonstratethe indispensable role of ultrasonography (US) for that purpose, at the same time displaying the US abnormalities that shoulddraw our attention, we performed this review of the literature.

Lower extremity function in patients with early rheumatoid arthritis during the first five years, and relation to other disease parameters

Objective: The objective of this study was to investigate lower extremity function in early rheumatoid arthritis (RA) and assess its relation to other disease parameters.Methods: An inception cohort (recruited in 1995–2005) of patients with early RA was followed according to a structured protocol. Lower extremity function was investigated at inclusion and after 1, 2, and 5 years using the Index of Muscle Function (IMF; total score 0–40). Self-reported disability was estimated using the Health Assessment Questionnaire (HAQ). The same rheumatologist assessed patients for swollen joints and joint tenderness.Results: In total, 106 patients were included. Lower extremity function improved from baseline to the 1 year visit [IMF total median 10, interquartile range (IQR) 4–16 vs 7, IQR 3–12; p = 0.01]. This was followed by a decline in lower extremity function. Throughout the study, there were significant correlations between IMF and HAQ scores (r = 0.38–0.58; p < 0.001 at all time-points). Patients with knee and/or ankle synovitis at inclusion had significantly higher IMF scores than those without such joint involvement, with similar associations for joint tenderness. In multivariate linear regression analysis, ankle synovitis was significantly associated with higher IMF scores (β = 2.91, 95% confidence interval 0.28–5.54), whereas there was no such association for metatarsophalangeal (MTP) arthritis.Conclusion: Lower extremity function in early RA improved during the first year, followed by a gradual decline. Ankle involvement had a greater impact than MTP involvement on lower extremity function. This highlights the importance of treating large-joint disease in RA.

Clinical Ankle Involvement and Ultrasound Synovial Hypertrophy are Significant Predictors of DAS28-Defined Rheumatoid Arthritis Disease Activity

Abstract Objective. The study aimed to investigate the relationship between ankle involvement and disease activity in rheumatoid arthritis (RA), from clinical and ultrasound perspectives. Methods. RA patients were recruited in 2018 in the random order of presentation from the out-patient clinic. On the same day of inclusion, all patients underwent clinical examination, laboratory tests (inflammatory markers), ankle ultrasound and patient-reported outcomes. Results. The study included 183 patients with established RA, mostly women (86.3%), with mean age of 57.3 years. Clinical examination revealed 101 (55.2%) patients with at least one tender ankle and 56 (30.6%) patients with at least one swollen ankle. Regression analysis revealed that both clinically tender and swollen ankles were 2.8 and respectively 3.4 times more likely to reveal ultrasound ankle joint synovial hypertrophy (SH). The presence of ankle SH was associated with higher disease activity: for example, compared to patients without ankle SH, patients with ultrasound-detected SH in any ankle joint had significantly higher median DAS28CRP (4.60 compared to 2.73, p&lt;0.001). Power Doppler (PD) activity of ankle SH produced similar results: PD signal presence (p&lt;0.001) and PD grade (p = 0.009) were associated with higher median DAS28CRP. Ankle joint involvement had an independent effect on DAS28CRP-defined disease activity: for example, the absence of ankle SH independently and significantly decreased DAS28CRP with 0.985 points (p&lt;0.001). Conclusion. Clinical ankle involvement and ultrasound-detected ankle SH have a directly proportional relationship with disease activity in RA.

Upright standing after stroke: How loading-unloading mechanism participates to the postural stabilization

Postural strategies employed by hemiparetic stroke patients need to be better understood to guide rehabilitation. Of the two complementary mechanisms used to stabilize the standing posture, loading-unloading (LU) and pressure distribution (PD), it is hypothesized that the former would be predominantly used. To this aim, posturographic assessments, through a dual force-platform, were performed in 30 Hemiparetics tested 3 months after a unilateral stroke, and 30 matched healthy Controls. Original indices (from 0 to 1) were calculated to assess LU and PD contributions. The results show that along the mediolateral axis, the LU contribution was very high and similar in Hemiparetics and in Controls (0.80 ± 0.07 vs 0.76 ± 0.09 a.u; p > 0.05), indicating a predominant hip involvement. Along the anteroposterior axis, the PD contribution was very close to 1 in controls (0.96 ± 0.03 a.u.) indicating an exclusive ankle involvement. Despite a lower contribution in Hemiparetics (0.88 ± 0.11 a.u.; p < 0.01), the indices were surprisingly always above 0.5, meaning that ankle movements remain predominant for controlling postural sways along the anteroposterior axis in all patients even those with severe clinical deficits. However the PD contribution appeared larger in patients with light or moderate deficits of the sensitivity (r = −0.532; p < 0.01) or the motor command (r = −0.513; p < 0.01). These results indicate that postural stabilization of hemiparetic persons remains controlled by a PD mechanism along the anteroposterior axis, even in those combining poor distal motor command and deep sensory loss. This ankle control, piloted by the more-loaded non-paretic limb, would therefore be preferred to a hip control through lateral trunk motion. This should be considered when defining the objectives of the postural rehabilitation after stroke.

Enthesitis-related arthritis: current perspectives.

In this narrative review, we overview the recent literature on enthesitis-related arthritis (ERA). For the purpose of our review, we searched Scopus for recent articles on this subject from 2013 onward, including some classic older articles for perspective. ERA is a juvenile idiopathic arthritis (JIA) subtype more common in males, associated in a majority with human leucocyte antigen B27. Such children generally present with asymmetric oligoarthritis or polyarthritis, predominantly of lower limb joints, associated with enthesitis or sacroiliitis. While diagnosis remains clinical, ultrasound is being increasingly used to detect subclinical enthesitis and for guiding entheseal site injections. Spine MRI can help detect sacroiliitis, inflammatory spinal changes, and pelvic sites of enthesitis in such patients. The recent juvenile spondyloarthropathy disease activity index recognizes the key clinical features of ERA, viz enthesitis and inflammatory back pain, which other disease activity indices used in JIA did not include. Management includes NSAIDs with physical therapy. Conventional disease-modifying agents like sulfasalazine and methotrexate may be used to minimize duration of NSAID use and in those with high inflammatory burden. In patients refractory to these drugs, biologics such as antitumor necrosis factor alpha agents have proven useful, based on evidences from randomized controlled trials and retrospective registry analyses. Factors predicting a poorer outcome in such children include hip or ankle involvement or restricted spinal mobility. Considering that children with ERA have overall poorer long-term outcomes than other subtypes of JIA, there is a need to further optimize therapeutic strategies for such patients.

O 104 - MRI-based musculoskeletal models for the quantification of gait in children with Juvenile Idiopathic Arthritis

Juvenile Idiopathic Arthritis (JIA) is a paediatric disease of unknown aetiology potentially leading to biomechanical alterations due to local damage of joints. After assessing its reliability, a patient-specific musculoskeletal model of the lower limb was used to investigate the link between joint loading and disease activity in a cohort of JIA children with ankle involvement. We observed a common strategy aiming at protecting the affected ankles with consequent overloading of hip and knee. When quantified at patient specific level, this strategy might allow to identify those cases where a localised steroid injection might not be sufficient to induce remission.

Juvenile idiopathic arthritis in the biologic era: predictors of the disease progression and need for early introduction of biologic treatment.

To assess longitudinally the course and outcome of juvenile idiopathic arthritis (JIA) in patients diagnosed and followed-up exclusively in the biologic era; also, to define possible predictors of the disease progression and need for early implementation of biologicals. Prospective and retrospective, monocentric cohort study of 120 JIA patients, diagnosed between 2001 and 2010, and followed-up for ≥ 4years (median 8.04). Disease activity, cumulative articular/extra-articular damage and quality of life were evaluated by the assessment tools Juvenile Arthritis Disease Activity Score (JADAS71), Juvenile Arthritis Damage Index (JADI) and Childhood Health Assessment Questionnaire (CHAQ), respectively. Moreover, potential predictors of the disease progression and their relation to biologic therapy were investigated. High JADAS71 score (> 9) at diagnosis was indicative of progression to polyarticular course and the need for early introduction of biologic treatment. Other independent predictors of progression to polyarthritis, were: involvement of upper limb, hip and ankle within 6months following JIA diagnosis and percentage of cumulative time with active disease > 35% within the first year. At the end of the study, both the median JADAS71 score and the Disability Index were significantly lower than the initial (p < 0.001) and remission off medication was achieved in 25% of the patients. Articular and extra-articular (only ocular) cumulative damage was demonstrated only in 5 and 7.5% of patients, respectively. Physical functional ability was found normal/mildly restricted in 93.3% and moderately restricted in 6.7% of the patients. We believe that these findings, fit in with a picture of JIA course and outcome under current conditions of objective "disease status" evaluation and of tightly controlled follow-up. Predictors emerged from our study could contribute to the identification of patients who will need early implementation of biologic treatment.

Limb girdle muscular dystrophy 2G in a religious minority of Bulgarian Muslims homozygous for the c.75G>A, p.Trp25X mutation

Mutations in TCAP gene cause autosomal recessive limb-girdle muscular dystrophy type 2G (LGMD2G), congenital muscular dystrophy and autosomal dominant dilated and hypertrophic cardiomyopathy. We studied 18 affected individuals from 12 pedigrees, belonging to a Bulgarian Muslim minority from the South-West of Bulgaria, homozygous for the c.75G>A, p.Trp25X mutation in TCAP gene. The heterozygous carrier rate of p.Trp25X among 100 newborns in this region was found to be 2%. The clinical features in the Bulgarian TCAP group include disease onset in the first to the third decade of life, proximal muscle weakness in the lower limbs, followed or accompanied by difficulties in ankle dorsiflexion and involvement of the proximal muscles of the upper limbs 5–9 years after the disease onset. Asymmetry between left and right was present in more than 20% of the affected. Respiratory and cardiac functions were not affected. On the MRI the muscles of the posterior pelvic area, thigh and anterior leg were predominantly affected, while sartorius, gracilis and biceps femoris muscles remained relatively spared.In conclusion, LGMD2G appears to be a common form among Bulgarian Muslims. Homozygosity for c.75G>A, p.Trp25X is associated with a homogeneous clinical presentation, but the clinical course and severity of the disease show inter- and intra-familial variation.

CLINICAL AND IMMUNOLOGICAL PECULIARITIES OF THE YUVENILY IDIOPATHIC ARTHRITIS INCREASE IN CHILDREN AND ADOLESCENTS

Clinical and immunological features of the juvenile idiopathic arthritis in children and adolescents have been studied. It was revealed that most often juvenile idiopathic arthritis was found in females. In articular syndrome the polyarthritis predominated with knee and ankle involvement was prominent. The pain syndrome in the articular apparatus was more intense in girls. The most frequent radiologic sign was a moderately expressed epiphyseal osteoporosis. The inherent sign of juvenile idiopathic arthritis was a persistent increase in the level of interleukin.

Rare case of multiple symmetric lipomatosis – Madelung's disease

Multiple symmetric lipomatosis is a rare disease characterized by a symmetrical accumulation of massive adipose tissue on the neck, superior part of the trunk, and limbs1. We report an exclusively rare for our practice case of multiple symmetric lipomatosis in a 51-year old male, who presented with diffuse lipomatosis – face and neck engagement, bilateral breast enlargement, upper parts of the arms and ankle involvement was seen too – typical engagement for Madelung’s disease. There was no serious deviations in his blood tests. No family history was found also. During gathering information alcohol abuse was discovered.

Managing Gout Flares in the Elderly: Practical Considerations.

Gout is common in the elderly, affecting an estimated 4.7 million people aged >60years in the USA alone. The incidence and prevalence of gout increases, and male predisposition to gout reduces, with increasing age. The elderly have more comorbidities, and gout manifests differently, with more frequent involvement of knees, ankles, and wrists at disease onset, systemic upset, and tophi. Comorbidities and polypharmacy make the management of gout flares challenging in this population. Intra-articular corticosteroid injection remains the treatment of choice for accessible joints, oral prednisolone is preferred over low-dose colchicine, and non-steroidal anti-inflammatory drugs (NSAIDs) are best avoided. Xanthine oxidase inhibitors (XOI) remain the first-line treatment for hyperuricemia in the elderly. Arhalofenate, an emerging uricosuric anti-inflammatory drug, prevents gout flares while reducing serum urate. It may be particularly relevant in the treatment of gout in the elderly as they are unable to tolerate long-term colchicine for flare prophylaxis and frequently have contraindications to corticosteroids and NSAIDs. However, given its modest urate-lowering effect, it can only be used in combination with an XOI, and the safety and efficacy of this drug has not been examined in the elderly or in those with chronic kidney disease. Diuretics and beta-blockers should be discontinued where feasible, whereas low-dose aspirin can be continued if otherwise indicated.

Running Injuries in the Participants of Ljubljana Marathon.

IntroductionThe aim of our study was to determine the self-reported incidence and prevalence of running-related injuries among participants of the 18th Ljubljana Marathon, and to identify risk factors for their occurrence.MethodsA customized questionnaire was distributed over registration. Independent samples of t-test and chi-square test were used to calculate the differences in risk factors occurrence in the injured and non-injured group. Factors which appeared significantly more frequently in the injured group were included further into multiple logistic regression analysis.ResultsThe reported lifetime running injury (absence >2 weeks) incidence was: 46% none, 47% rarely, 4% occasionally, and 2% often. Most commonly injured body regions were: knee (30%), ankle and Achilles’ tendon (24%), foot (15%), and calf (12%). Male gender, running history of 1-3 years, and history of previous injuries were risk factors for life-time running injury. In the season preceding the event, 65% of participants had not experienced any running injuries, 19% of them reported minor problems (max 2 weeks absenteeism), but 10% and 7% suffered from moderate (absence 3-4 weeks) or major (more than 4 weeks pause) injuries. BMI was identified as the solely risk factor.ConclusionsThis self-reported study revealed a 53% lifetime prevalence of running-related injuries, with the predominate involvement of knee, ankle and Achilles’ tendon. One out of three recreational runners experienced at least one minor running injury per season. It seems that male gender, short running experience, previous injury, and BMI do increase the probability for running-related injuries.