Elsevier

Gait & Posture

Volume 29, Issue 3, April 2009, Pages 387-391
Gait & Posture

Full length article
Intrinsic gait-related risk factors for Achilles tendinopathy in novice runners: A prospective study

https://doi.org/10.1016/j.gaitpost.2008.10.058Get rights and content

Abstract

The purpose of this prospective cohort study was to identify dynamic gait-related risk factors for Achilles tendinopathy (AT) in a population of novice runners. Prior to a 10-week running program, force distribution patterns underneath the feet of 129 subjects were registered using a footscan® pressure plate while the subjects jogged barefoot at a comfortable self-selected pace. Throughout the program 10 subjects sustained Achilles tendinopathy of which three reported bilateral complaints. Sixty-six subjects were excluded from the statistical analysis. Therefore the statistical analysis was performed on the remaining sample of 63 subjects. Logistic regression analysis revealed a significant decrease in the total posterior–anterior displacement of the Centre Of Force (COF) (P = 0.015) and a laterally directed force distribution underneath the forefoot at ‘forefoot flat’ (P = 0.016) as intrinsic gait-related risk factors for Achilles tendinopathy in novice runners. These results suggest that, in contrast to the frequently described functional hyperpronation following a more inverted touchdown, a lateral foot roll-over following heel strike and diminished forward force transfer underneath the foot should be considered in the prevention of Achilles tendinopathy.

Introduction

The development of Achilles tendinopathy (AT) is a multi-factorial process influenced by both extrinsic (environmental) and intrinsic (person-related) risk factors [1], [2], [3], [4], [5], [6]. Although it has been stated that overuse injuries are resulting from training errors, underlying anatomical or biomechanical features would prevent a runner from training as long or intensely as another runner before incurring an overuse injury [7].

The most prominent hypothesis concerning running patterns suggests that rapid and repeated transitions from pronation to supination cause the Achilles tendon to undergo a ‘whipping’ or ‘bow-string’ action [2], [6], [8], [18]. In hyperpronation, resulting either in delayed resupination [8], [10] or excessive motion in the frontal plane especially in a lateral heel strike [5], the Achilles tendon is even more subjected to whipping [8]. This whipping action creates shear forces across the Achilles tendon exerting particularly high eccentric stresses on the medial side of the tendon [9]. Cross-sectional studies have reported more inversion at touchdown, significant greater maximum pronation velocity, more pronation and a shorter time to maximum pronation in runners afflicted with AT [8], [11], [12].

It should be noted, however, that prospective studies are still lacking hampering a clear cause–effect relationship especially when the importance of foot roll-over characteristics (e.g., hyperpronation) in the onset of AT is considered.

The purpose of this prospective cohort study was to determine intrinsic dynamic gait-related risk factors for AT in a population of novice runners. It was hypothesized that novice runners developing AT show an altered roll-over pattern of the foot in force distribution measured with a pressure plate.

Section snippets

Subjects

Healthy, able-bodied novice runners (N = 129) participated voluntarily. All were recruited from the participants of three Start To Run programs (STRs) organised in April 2006 and April 2007 if they met the criteria of a novice runner. A novice runner was defined as an individual having no former experience in running or jogging and taking part in a STR for the first time. All subjects were injury-free at the time of enrolment and did not sustain any injury to the lower extremities and back during

Results

During the 10 weeks, 69 running injuries of the lower extremity and lower back related to running were reported (Table 1). Group 1 comprised a total of 10 subjects (2 men, 8 women) who sustained clinically diagnosed AT of which 3 reported bilateral complaints (2 men, 1 woman). Group 2 consisted of 53 subjects (8 men, 45 women) who did not develop any injury to either leg during the 10-week program. None reported a previous history of ankle sprains or AT. Subjects who sustained acute injuries

Discussion

The main goal of this study was to establish gait-related risk factors for AT in a population of novice runners in a prospective design. The results identify a diminished total anterior displacement of the COF and a more laterally directed force distribution at FFF as risk factors in the development of AT.

In the past, case–control studies have described the role of hyperpronation in inducing a whipping or bow-string action of the Achilles tendon [8], [9], [11]. However, no prospective studies

Conclusion

Diminished anterior displacement of the Center Of Force suggesting less forward force transfer underneath the foot and a more lateral foot roll-over at forefoot flat deserve attention while screening the novice runner for preventative measures. This is the first study focusing on dynamic gait-related risk factors for Achilles tendinopathy in a prospective design. Therefore further research is warranted to confirm these findings.
Conflict of interest statement

None declared.

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