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The online version of this article (doi:10.1186/s13047-014-0053-6) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
GSM, MMFS, BSN, IBG, CB, SEM and NJC conceived the idea for this review. GSM, MMFS, BSN, IBG designed and piloted the search strategy. GJD undertook the search. Title and abstracts were reviewed by GJD and GSM. Quality appraisal was undertaken by GJD and NJC. Study information and data was extracted by GJD and GSM. The manuscript was drafted by GJD, GSM, MMFS, BSN, IBG, CB, SEM, and NJC. All authors have read and approved the final manuscript.
Dynamic 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.
A 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.
Twelve 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.
This 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.
Additional file 1: Search strategy. (DOCX 25 KB)13047_2014_53_MOESM1_ESM.docx
Additional file 2: Epidemiological Appraisal Instrument used to rate the quality of the 12 included studies. (PDF 278 KB)13047_2014_53_MOESM2_ESM.pdf
Additional file 3: Results from quality assessment using the Epidemiological Appraisal. Instrument (12 included studies). (PDF 205 KB)13047_2014_53_MOESM3_ESM.pdf
Additional file 4: Presentation of plantar loading variables across the 12 studies. (DOCX 216 KB)13047_2014_53_MOESM4_ESM.docx
Additional file 5: Presentation of kinematic and kinetic variables across the 12 studies. (DOCX 36 KB)13047_2014_53_MOESM5_ESM.docx
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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 J Barton
Natalie J Collins
- BioMed Central