The relationship between the height of the medial longitudinal arch (MLA) and the ankle and knee injuries in professional runners

doi:10.1016/j.foot.2008.01.004

The Foot

Volume 18, Issue 2, June 2008, Pages 84-90

https://doi.org/10.1016/j.foot.2008.01.004 Get rights and content

Abstract

Background

Usually the rate of lower extremity's injuries in sports such as running is known to be correlated with the height of foot arches. Foot pressure measurement studies have shown controversial results in this issue, mainly due to the complexity of the foot structure. This study aimed to investigate if any relationship exists between the MLA height and the ankle/knee injuries in professional runners. It was also aimed to find out any association between the foot pressure patterns and the clinical navicular drop test in the subjects.

Materials and methods

Forty-seven professional runners were participated in this study and using the clinical navicular drop test, they were categorized into normal, low and high arch foot subjects. Using an Emed pedography platform (Novel, Germany), the maximum force, peak pressure and the contact area of their feet were studied in both static (single limb support) and dynamic conditions.

Results

The results of this study showed no strong correlation between the height of MLA and the rate of the ankle/knee injuries (P = 0.58). The correlation between the clinical navicular drop test and the modified arch index (MAI) was between 0.32 in static and 0.57 in dynamic tests.

Conclusion

The results of this study conveyed that having a lower or higher than a normal MLA is not a definite risk factor for sports-related injuries. This might be due to the complexity of the foot structure and its ability to accommodate with new situations routinely occurs in sport. Furthermore, although a high correlation was not found between the clinical navicular drop test and the foot pressure indices, due to the clinical entity of this test, the obtained association is relatively good. A significant correlation was found between the foot pressure distribution in single limb support (static) and the dynamic conditions, which provides an extrapolation of the results of this type static condition tests to the dynamic conditions.

Introduction

The capability of foot shock absorption as well as providing good body stability is mainly due to the fact that the foot structure is very complex [1]. Existence of too many small joints and three medial, lateral and transverse foot arches have granted the foot to be a very unique segment of the body. Different type of foot structures has shown to be an important factor in plantar pressure distribution pattern [2]. Any inappropriate foot plantar pressure distribution may increase the risk of tissue injuries leading to be as a source of pain. Increased walking speed results in increased plantar pressures but not vice versa and running is associated with overuse injuries rather than a direct relationship with plantar pressures and overuse injuries [3], [4]. In closed kinematic chain activities such as running, the interaction between the foot and the ground determines the probability of occurring injuries in this area [5]. Despite having many common structural features, the shape and the biomechanical reactions of the foot differ greatly among individuals. The medial longitudinal arch (MLA) has been known as the source of many of these differences [6] and the existence of any relationship between the MLA height and the lower limb injuries has been studied in some research with controversial results [4], [7], [8]. The most common technique of foot type classification is categorizing them through its MLA heights using the clinical navicular drop test [6]. Due to the fact that this is a static test and a dynamic test is required to classify the feet during movements (walking/running) to measure the foot plantar pressure during both standing (single/double) and moving (walking/running) both indoor and outdoor activities. Using foot plantar pressure measurement systems is more common for this reason and as previous studies have shown [6], [9] the modified arch index (MAI) is a good indicator of foot type to be a valid clinical means [6], [9].

The primary purpose of this survey was to study the relationship between the height of the MLA and the rate of occurrence of the ankle and knee injuries in professional runners. In addition, studying the correlation between the clinical navicular drop test and the MLA, and finding any relationships between the indices obtained in both static and dynamic conditions were also the other aims of this study.

Section snippets

Materials and methods

The study included 47 professional¹ male runners from Shaheed Shiroodi Stadium, 2006, Tehran, Iran. Before conducting the test, a pilot study was carried out to prove the repeatability and reliability of the system with 10 normal subjects. Each test was repeated for six times and the average of the results was used in data analysis. The subjects were excluded if they were using any medical insoles, suffering from any malalignment of lower limbs or the spinal

Repeatability of the Emed pedograph platform system

Before starting the test, 10 healthy subjects with normal arch height were asked to walk over the platform using the previously described method, as a pilot study. The whole test was repeated again in the afternoon of the same day and a week later. Intraclass correlation (ICC) of the indices including peak pressure, maximum force and contact area was calculated as shown in Table 1. The ICC between 0.85 and 0.91 is known as a good repeatability of the test and convinced the researchers to start

Discussion

Despite the meaningful difference between the average of navicular drop values in the injured and healthy groups, the main hypothesis of this study was not confirmed and no relationship was found between the rate of the ankle and knee injuries and the height of the subject's MLA. The results also showed that the most injured subjects were in the group with normal arch height and not in low or high arch subjects. In other words, most high arch subjects were in the healthy and not in injured

Conclusion

The results of this study did not support the idea of existence any relationship between the structure of the MLA and the prevalence of the ankle and knee injuries in professional runners. It seems that various factors such as different foot wears, training surfaces, experiencing previous injuries, the intensity and frequency of training sessions and also the type of trainings all might determine the probability of injury occurrence in athletes. This also indicates that using prophylactic ankle

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The relationship between foot arch flexibility and medial-lateral ground reaction force distribution
2019, Gait and Posture
Overuse running injury susceptibility has previously been associated with the magnitude and slope of ground reaction force profiles, most often in the vertical axis. However, despite the implications of excessive pronation and supination on injury susceptibility, very little research has examined the factors that might affect distribution of force in the medial-lateral directions.
The purpose of this study was to consider how foot structure, specifically arch flexibility, affects the distribution of ground reaction force between the medial-lateral and vertical planes of motion.
Twenty-five participants were classified as having stiff or flexible arches, and three dimensional kinetic data were gathered while the volunteers ran at 7 mph on an instrumented treadmill. A mixed-effects ANOVA was used to analyze the effect of arch flexibility type on distribution of ground reaction force impulse in the medial and lateral directions.
The results suggest that individuals with relatively stiff arches experience a greater proportion of ground reaction force in the medial-lateral plane of motion, as compared with those with more flexible arches (p = 0.03). Further, the results suggest that most individuals, regardless of foot structure, experience greater impulse of force in the lateral than in the medial direction (p < 0.01).
Considering previously explored relationships between ground reaction force, foot pronation/supination, and chronic running injuries, the results of this study suggest that arch flexibility could be used as a criterion for assessing injury susceptibility. Further, conclusions drawn from this study add to the discussion on the pros and cons of training or using devices to increase or restrict arch flexibility while running.
Medial Longitudinal Arch: Accuracy, Reliability, and Correlation Between Navicular Drop Test and Footprint Parameters
2018, Journal of Manipulative and Physiological Therapeutics
Citation Excerpt :
High NDT values are associated with subtalar pronation and lower MLA, and low NDT values are associated with subtalar supination and high MLA.32 The correlation between the NDT and the AI was evaluated, identifying small correlations in bipedal (r = 0.317) and single leg stance (r = 0.320)34 and moderate correlation for the static AI (r = 0.44) and the dynamic AI (r = 0.570).35 The AI is a measurement dependent on the contact area of the foot.
The purpose of this study was to evaluate the correlation among the navicular drop test, the arch angle, the Staheli index and the Chippaux-Smirak index. The reliability and the correlation among the footprint parameters were also estimated.
A cross-sectional study (n = 86; 59.3% women; 27.8 years, standard deviation: 4.8 years) was carried out. The navicular drop test was evaluated and footprint parameters using a plantar pressure platform were recorded in the dominant foot. Pearson correlation coefficients, intraclass correlation coefficient, standard error of measurement, and minimum detectable change were calculated.
Both intrarater and interrater reliability were excellent for all the parameters evaluated (intraclass correlation coefficients > 0.880). Statistically significant correlations existed between the navicular drop test and footprints parameters (arch angle = 0,643; Staheli index = 0.633; Chippaux-Smirak index = 0.614). The footprint parameters had excellent correlation with each other (0.838-0.881). The navicular drop test and the footprint parameters studied were reproducible and thus had excellent reliability.
The correlations obtained between the navicular drop test and the footprint parameters evaluated were good. The navicular drop test appears to be a reproducible, valid, and simple test for evaluating medial longitudinal arch height, having fewer disadvantages than using footprint parameters.
O 032 - Investigating the gender-related response of muscle fatigue of the medial longitudinal arch height in healthy young
2018, Gait and Posture
How (not) to interpret a non-causal association in sports injury science
2018, Physical Therapy in Sport
Citation Excerpt :
A review of the literature revealed conflicting evidence across several studies investigating the association between ND and the risk of lower extremity injuries. In some investigations, a large ND has been associated with increased risk of patellofemoral pain (Boling et al., 2009) and medial tibial stress syndrome (Neal et al., 2014; Newman, Witchalls, Waddington, & Adams, 2013), whilst other studies reported no association (Hubbard, Carpenter, & Cordova, 2009; Nakhaee, Rahimi, Abaee, Rezasoltani, & Kalantari, 2008; Yagi, Muneta, & Sekiya, 2013). A prospective study found female novice runners with a ND > 10 mm (mm) to be more prone to RRIs (Buist, Bredeweg, Lemmink, van Mechelen, & Diercks, 2010), but this is in contrast to another study, revealing ND below and above 10 mm to be similar between injured and non-injured participants (Reinking, Austin, & Hayes, 2007).
To discuss the interpretability of non-causal associations to sports injury development exemplified via the relationship between navicular drop (ND) and running-related injury (RRI) in novice runners using neutral shoes.
1-year prospective cohort study.
Denmark.
926 novice runners, representing 1852 feet, were included.
The outcome was “a musculoskeletal complaint of the lower extremity or back caused by running, which restricted the amount of running for at least a week”.
Fewer feet with small ND than those feet with a reference ND sustained injuries at 50 (risk difference (RD) = −4.1% [95%CI = −7.9%;-0.4%]) and 100 km (RD = −5.3% [95%CI = −9.9%;-0.7%]). Similarly, fewer feet with a large ND sustained injuries than the feet with a reference drop at 250 (RD = −7.6% [95%CI = −14.9%;-0.3%]) and 500 km (RD = −9.8% [95%CI = −19.1%;-0.4%]).
Non-causal associations can help to identify sub-groups of athletes at an increased or decreased risk of sports injury. Based on the current results, those with a small or large navicular drop sustain fewer injuries than those with a reference drop. Importantly, navicular drop does not cause RRIs, but influences the relationship between training load and RRI. This illustrates that non-causal associations are unsuitable to respond to the question: Why do sports injury develop?
Relationship between the mobility of medial longitudinal arch and postural control
2017, Acta Orthopaedica et Traumatologica Turcica
The aim of this study was to analyze the relationship between the medial longitudinal arch mobility and static and dynamic balance.
A total of 50 subjects (25 female, and 25 male; Mean age: 22.2 ± 1.3 years; BMI: 22.8 ± 3.8 kg/m²) were included in this study. The relative arch deformity (RAD) was calculated with both 10% and 90% weight bearing (WB). Static balance was evaluated with Single Leg Stance Test and dynamic balance with TechnoBody PK 200WL computerized balance device. Subjects were evaluated for goniometric measurements of lower extremity joints, leg dominance and leg-length discrepancy.
Bipedal dynamic balance was correlated with both feet length at 10% WB and 90% WB. There was a correlation between the dynamic balance on dominant foot and RAD value on the aspect of Medium Speed (r = −0.32, p = 0.02), Perimeter Length (r = −0.32, p = 0.02) and Anterior–Posterior Sway (r = 0.36, p = 0.01). Static balance was unaffected by RAD value when the visual system was eliminated.
Our results suggest that decrease of arch mobility on the dominant foot is associated with posterior sway by causing knee or hip strategy and preventing ankle strategy even in small perturbations. The rate of deviation from the equilibrium point and the degree of total swaying increase when arch mobility decreases.
Prevalence of myofascial trigger points and diagnostic criteria of different muscles in function of the medial longitudinal arch
2015, Archives of Physical Medicine and Rehabilitation
Citation Excerpt :
The project observed the principles outlined in the Declaration of Helsinki of 1975 and was approved by the Research Ethics Committee of the Centro de Estudios Universitarios San Pablo University. Inclusion criteria include an NDT≥10mm in the lower MLA group and an NDT ranging from 5 to 9mm23,47,48 in the control group. To avoid other factors that could be related to the prevalence of LTrPs, the following exclusion criteria were established: undergone lower extremity surgery, suffered from acute injuries, presented lower limb deformities, suffered from systemic or neurological diseases that could affect pain perception, and presented a reduced normal range of movement in the lower limb.
To evaluate the reliability of the used diagnostic criteria of latent trigger points (LTrPs) and pressure pain thresholds and to evaluate the prevalence of LTrPs in several muscles of the lower limb in subjects with a lower medial longitudinal arch (MLA) compared with controls.
Cross-sectional study.
University campus.
Subjects with a lower limb MLA (n=82) and controls (n=82) (N=164).
Not applicable.
The navicular drop test was used to classify subjects with a lower MLA (≥10mm) and controls (5–9mm). The Simons et al recommended specific diagnostic criteria and pressure pain thresholds were used to evaluate the prevalence of LTrPs in several muscles of the lower limb, which was compared between the 2 groups. The reliability was evaluated using Cohen's kappa and intraclass correlation coefficient. The unpaired Student t test and chi-square test were used to evaluate the difference in the LTrP prevalence between the 2 groups.
The intrarater reliability of the navicular drop test and the diagnosis of LTrPs was excellent, with the taut band and tender spot being the most reliable diagnostic criteria. In the lower MLA group, 60 subjects (73%) presented at least 1 LTrP whereas 57 controls (70%) presented at least 1 LTrP. The lower MLA group showed more LTrPs (4.46±4.10) than did controls (3.32±3.24) (P<.05). There were significantly (P<.05) more subjects with LTrPs in the flexor digitorum longus, tibialis anterior, and vastus medialis in the lower MLA group than in the control group.
LTrPs are common in the lower limb muscles in both controls and subjects with a lower MLA. A lower MLA is associated with a higher prevalence of LTrPs, which are significant in the flexor digitorum longus, tibialis anterior, and vastus medialis.

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The relationship between the height of the medial longitudinal arch (MLA) and the ankle and knee injuries in professional runners

Abstract

Background

Materials and methods

Results

Conclusion

Introduction

Section snippets

Materials and methods

Repeatability of the Emed pedograph platform system

Discussion

Conclusion

Gait Posture

Clin Biomech

Gait Posture

Gait Posture

J Biomech

Orthop Clin North Am

Gait Posture

J Biomech

Clin Biomech

Gait Posture

Aust J Physiother

Foot type and overuse injury in triathletes

J Am Podiatr Med Assoc

Evaluation of lower extremity overuse injury potential in runners

Med Sci Sports Exerc

Factors contributing to the development of medial tibial stress syndrome in the high school runners

J Orthop Sports Phys Ther

The effect of the pronated and supinated foot postures on static and dynamic postural stability

J Athlet Train