The influence of motion control shoes on the running gait of mature and young females
Highlights
► The running gait of mature females gait could predispose to injuries. ► We examined effect of motion control shoes on running gait of mature females. ► Motion control shoes reduce rearfoot eversion and knee internal rotation. ► Motion control shoes do not affect knee external adductor moment. ► Mature females should run with insoles with both medial and lateral support.
Introduction
It is widely acknowledged that participation in running as a recreational or competitive activity contributes positively to health and fitness outcomes [1]. However, this activity is also associated with high rates of musculoskeletal injury, evidenced by a study reporting one running injury to occur every 100 training hours [2]. Among the twenty-six most common conditions to affect runners, women have been shown to have higher incidences of patella femoral pain syndrome, iliotibial band friction syndrome, plantar fasciitis, meniscal damage and pathology of the patella, Achilles tendinopathy and osteoarthritis of the knee compared to men [3]. Increased age, specifically >50 years, has also been found to be associated with a higher incidence of overuse running injuries [3]. The higher incidence of running related overuse injuries in women compared to men, and in runners over the age of 50 years indicates that mature female runners are particularly susceptible to injury occurrence.
Mature female runners have been found to yield significantly greater magnitudes of rearfoot eversion, knee internal rotation, knee external adductor moment and peak loading rate (of vertical ground reaction force) compared to younger runners [4]. While this study did not control for footwear, these age-related changes in female running gait may indicate biomechanical risk factors for overuse injury development and progression of degenerative conditions. Footwear provides an accessible method for changing patterns of running gait [5]. Thus investigation of the influence of footwear manipulation on mature female running gait is important in order to investigate the potential for reducing biomechanical risk factors associated with overuse injury and degenerative conditions that may be exacerbated by regular participation in running.
Motion control aspects of a shoe aim to reduce excessive rearfoot motion and subsequent internal rotation of the lower leg and knee valgus, through altering deformation rates and geometry between the medial and lateral sides of the shoe [6]. Although a magnitude of rearfoot eversion is essential to produce a flexible forefoot to enhance shock absorbency and allow adaptation to irregularities in the running surface [7], excessive movement has been frequently associated with certain running-related overuse injuries [8]. Excessive rearfoot motion is suggested to increase knee pain and overuse injury risk via elevated levels of lower limb strain [9], increased knee internal rotation and a forefoot loading [10], [11], [12]. Studies investigating the ability of greater medial support in footwear to reduce rearfoot eversion and lower leg internal rotation during running, have found promising results [13].
However, a negative effect of motion control shoes has been an increase in knee external adductor moment during running [14]. High values of this moment are related to increased loading of the medial knee [15], and are primarily contributed to by the frontal plane moment arm length of the ground reaction force about the knee joint centre [15]. This moment arm length may increase due to a varus position of the knees, or a medial shift in the location of the centre of pressure of the ground reaction force. Increased medial support in shoes can potentially move the line of action of the ground reaction force medially, thereby increasing the moment arm at the knee [16]. This is in contrast to the alternative method often prescribed to reduce knee external adductor moments, and subsequent loading of the medial knee, which involves wedging the lateral sole [17]. It is therefore important to assess whether medial support has any negative influence on the knee external adductor moment for the population of mature female runners.
The first aim of this study was to test the conclusions of the previous study comparing running gait in mature and young females [4] by repeating this comparison but with a consistent neutral trainer. The second aim was to investigate the influence of a motion control shoe on lower limb biomechanics of both study groups. It was hypothesised that (a) a neutral shoe would result in higher peak rearfoot eversion, knee internal rotation angle and knee external adductor moment for mature compared to younger females; (b) the motion control shoe would yield reduced magnitudes of rearfoot eversion and knee internal rotation in both groups compared to a neutral shoe and (c) the motion control shoe would increase knee external adductor moment.
Section snippets
Participants
Fifteen young (age range 18–25 years, mean 21.2 years, SD 1.3) and fifteen mature females (age range 40–60 years, mean 49.7 years, SD 4.1) volunteered to participate in this study. The young females were from the Sport and Health Sciences student cohort of the University of Exeter, while the mature participants volunteered from a local women's running club (Women's Running Network). All females had a minimum of three years running experience and attended a running club three nights a week. Best
Results
In the neutral shoe, mature females exhibited significantly higher peak ankle eversion angles, knee internal rotation angles and external adductor moments, than the younger females (p < 0.05) (Table 3). For the mature and young females, the motion control shoe resulted in a significant decrease in the peak ankle eversion angle (mature 15.6–9.1°; young 7.4–6.5°) and the peak knee internal rotation angle (mature 15.5–13.6°; young 9.7–8.3°) compared to a neutral shoe (p < 0.05). No significant
Discussion
This study compared the running gait of young and mature females while wearing a neutral shoe, and investigated the influence of a motion control shoe on running gait. In support of the first hypothesis, when running in the neutral shoe, rearfoot eversion, knee internal rotation, and knee external adductor moment were significantly higher in mature (40–60 years) compared to young females (18–25 years). The change in rearfoot eversion is similar to the results from Nigg et al., who showed a 6.1°
Conclusions
In support of a previous study where shoe model was not controlled, trials in a consistent neutral shoe in the current study showed mature females to exhibit significantly greater rearfoot eversion, knee internal rotation and knee external adductor moment compared to younger females. Among mature and young females, the motion control shoe significantly reduced peak rearfoot eversion and knee internal rotation; while there was no evidence of an increase in peak knee external adductor moment.
Conflict of interests
The study has been independently undertaken by researchers at the University of Exeter without external funding. There is no conflict of interest.
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