The effect of foot type on in-shoe plantar pressure during walking and running
Introduction
Many factors such as over training, low bone density, running on uneven surfaces, lower extremity malalignment as well as foot type have previously been associated with an increased risk of overuse injuries, specifically stress fractures [1]. In examining foot type, previous literature has indicated that individuals with a flat foot may be at increased risk for the development of many lower extremity overuse injuries including metatarsal stress fractures, iliotibial band syndrome, and patellofemoral pain syndrome [2]. A study by Simkin et al. focused on stress fracture injury risk as it is related to foot type and reported that individuals with a high arch were at increased risk for femoral and tibial stress fractures, while individuals with a low arch were at increased risk for the development of metatarsal stress fractures without specifying the location [3]. A study by Williams et al. focused specifically on stress fractures in runners and identified that runners with high arches were at increased risk for developing fifth metatarsal stress fractures, while runners with low arches were at increased risk for developing second and third metatarsal stress fractures [4]. Williams et al. stated that these differences in stress fracture injury risk were the result of altered lower extremity biomechanics in these two groups of individuals. The runners with low arches had an increase in rearfoot eversion velocity and eversion excursion [4]. In contrast, other authors have stated that no association exists between arch height and the risk for lower extremity injuries including stress fractures [2], [5], [6], [7].
Substantial work has been done examining plantar pressure during walking both barefoot and in shoes as well as different speeds [8], [9], [10], [11], [12], [13]. Increasing walking speed has been shown to result in increased plantar pressure in each of the foot regions that have been examined [8], [12]. Walking speed has been shown to linearly influence the loading patterns beneath the hallux as well as the rearfoot [8], [12], [13], [14], however, increases in walking speed had less of an effect on forefoot loading patterns [8]. Medial and middle forefoot loading initially increased at the slower walking speeds however remained constant or decreased as the subjects began to walk faster, which was attributed to a decrease in contact time as walking speed increased [8]. While changes in loading patterns were observed in the rearfoot, hallux and forefoot, the forces beneath the medial and lateral midfoot were not significantly altered with increased walking speed [12]. In addition to examining the influence of walking speed, previous literature has examined the effect of different footwear on plantar pressure patterns indicating that when subjects walked in running shoes the plantar pressure was significantly reduced when compared to barefoot walking [12], [15].
In contrast to the information that is available examining plantar pressure distribution patterns during walking, very few studies have been completed that examine plantar pressure distribution patterns during running. Sneyers et al. examined the differences in plantar pressure patterns in pes planus, pes cavus, and normal foot types during barefoot running [16]. The results of this study indicated that the relative loads under the midfoot were decreased in the pes cavus foot type due to the lack of foot deformation that exists in the rigid pes cavus foot [16]. In addition, Sneyers et al. reported that in patients with a pes planus foot no significant medial shift existed in forefoot loading [16]. Sneyers et al. also demonstrated differences in loading patterns between running barefoot and in shoes indicating that more statistically significant differences existed between different foot types when examining the barefoot condition as compared to examining the shod running condition [16].
In addition to examining foot type in running, previous studies have examined the differences between running and walking at different speeds. Ground reaction forces rather than plantar loading patterns were analyzed [17], [18]. However, one previous study by Burnfield et al. examined the differences in plantar loading at different walking speeds [12]. Their results indicated that with increased walking speed there was an increase in plantar loading [12]. To our knowledge, no current literature exists examining the differences in plantar pressure distribution patterns when comparing walking and running and when examining different foot types. Therefore, the purpose of this study was to investigate the differences in plantar pressure between walking and running and between subjects with a normal and a low arch foot. We hypothesized that an increase in plantar pressure, maximum force and contact area would exist during running when compared to walking. In addition, the loading patterns would shift medially in the subjects with a low arch compared to a normal arch.
Section snippets
Materials and methods
A total of 50 healthy active adults were recruited from the university and surrounding community. Demographic information for all subjects can be found in Table 1. All subjects were tested bilaterally; however, the right foot of each subject was used during statistical analysis. Inclusion criteria included a history of no lower extremity injuries within the past year and no history of foot and ankle surgery. All subjects read and signed an informed consent approved by the institutional review
Results
Thirty-four feet (68%) were classified as having a normal arch, while 16 feet (32%) were classified as having a low arch. No significant differences in age (p = 0.9), weight (p = 0.32) or height (p = 0.73) were found between the normal and low arch groups (Table 1).
Only one significant interaction existed between movement type (walking and running) and foot type (normal and flat). The normalized maximum force in the medial midfoot was significantly increased in the low arch foot when compared to the
Discussion
The results of this study indicate that during running the contact area, maximum force, and peak pressure were significantly increased when compared to walking. The only foot region that did not show an increase in contact area during running was the rearfoot. The decrease in contact area in the rearfoot during running was not statistically significant; however, it could be the result of different foot strike patterns during running. Previous research has examined the influence of foot strike
Conflict of interest
None.
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