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Pronation in Runners

Implications for Injuries

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Abstract

In spite of some significant progress in the understanding of the biomechanics of the ankle joint complex, especially the coupling mechanism between foot and leg, various mechanisms causing overuse injuries in the lower extremities are still poorly understood. Some increased pronation of the foot is often physiological, but excessive pronation is potentially harmful. Compensatory overpronation may occur for anatomical reasons. However, not only the amount of foot eversion, but also the way this eversion is transferred into tibial rotation may be crucial to the overloading stress on the knee. In other words, the individual transfer mechanism of foot eversion into internal tibial rotation may be of some predictable value for lower extremity overloading and related injuries.

Further research is necessary to improve the functional understanding of anatomical and biomechanical abnormalities and their pathological value in predicting overuse injuries.

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References

  1. MacIntyre JG, Taunton JE, Clement DB, et al. Running injuries: a clinical study of 4173 cases. Clin J Sports Med 1991; 1: 81–7

    Article  Google Scholar 

  2. Orava S. Exertion injuries due to sports and physical exercise: a clinical and statistical study of nontraumatic overuse injuries of the musculoskeletal system of athletes and keep-fit athletes [thesis]. Oulu: University of Oulu, 1980

    Google Scholar 

  3. Renström P, Johnson RJ. Overuse injuries in sports: a review. Sports Med 1985; 2: 316–33

    Article  PubMed  Google Scholar 

  4. Clanton TO. Etiology of injury to the foot and ankle. In. Drez D, DeLee JC, editors. Orthopaedic sports medicine. Philadelphia (PA): W.B. Saunders, 1992: 29–52

    Google Scholar 

  5. Hintermann B, Nigg BM. Epidemiology of foot and ankle disorders. In. Nordin M, Andersson GBJ, Pope MH, editors. Musculoskeletal disorders in the workplace: principles and practice. St Louis (MO): Mosby, 1996: 536–49

    Google Scholar 

  6. Lysholm J, Wilander J. Injuries in running. Am J Sports Med 1987; 15: 168–71

    Article  PubMed  CAS  Google Scholar 

  7. Slocum DB, James SL. Biomechanics of running. JAMA 1968; 205: 720–8

    Article  Google Scholar 

  8. Renstroem PA. Prevention of sports injuries. In. Kannus P, Krauss RH, editors. Sports medicine. Philadelphia (PA): W.B. Saunders, 1991: 53–72

    Google Scholar 

  9. Stanish WD. Overuse injuries in athletes: a prospective study. Med Sci Sports Exerc 1989; 16 (1): 1–7

    Google Scholar 

  10. Walther SD, Hart LE, McIntosh JM. The Ontario cohort study of running-related injuries. Arch Intern Med 1989; 149: 2561–4

    Article  Google Scholar 

  11. Hamilton WG. Foot and ankle injuries in dancers. Clin Sports Med 1988; 7: 143–73

    PubMed  CAS  Google Scholar 

  12. Howse J. Disorders of the great toe in dancers. Clin Sports Med 1983; 2: 499–505

    PubMed  CAS  Google Scholar 

  13. Marshall P. The rehabilitation of overuse foot injuries in athletes and dancers. Clin Sports Med 1988; 7: 64–70

    Google Scholar 

  14. McNeal AP, Watkins A, Clarkson PM, et al. Lower extremity alignment and injury in young, professional, college and professional ballet dancers: II. Dancer-reported injuries. Med Probl Perform 1990; 5: 83–8

    Google Scholar 

  15. Solomon RL, Trepman E, Nicheli LJ. Foot morphology and injury patterns in ballet and modern dancers. Kinesiol Med Dancers 1989; 12: 20–40

    Google Scholar 

  16. Clement DB, Taunton JE, Smart GW, et al. A survey of overuse running injuries. Phys Sports Med 1981; 9: 47–58

    Google Scholar 

  17. Hintermann B, Holzach PJ. Die Bursitis subachillea - eine biomechanische Analyse und klinische Studie. Z Orthop 1992; 130: 114–9

    Article  PubMed  CAS  Google Scholar 

  18. James B, Bates B, Osterning L. Injuries in running. Am J Sports Med 1978; 6: 40–50

    Article  PubMed  CAS  Google Scholar 

  19. Smart GW, Taunton JE, Clement DB. Achilles tendon disorders in runners: a review. Med Sci Sports Exerc 1980; 12 (4): 231–43

    PubMed  CAS  Google Scholar 

  20. Clanton TO. Sport shoes, insoles and orthoses. In. Drez D, DeLee JC, editors. Orthopaedic sports medicine. Philadelphia (PA): W.B. Saunders, 1992: 322–46

    Google Scholar 

  21. Hintermann B. Einlagen und Schuhkorrekturen bei Leistungssportlern - eine 3-Jahresstudie bei jugendlichen Skilangläufern. Schweiz Rundsch Med Prax 1992; 81: 389–94

    PubMed  CAS  Google Scholar 

  22. McKenzie DC, Clement DB, Taunton JE. Running shoes, orthotics and injuries. Sports Med 1985; 2: 324–7

    Article  Google Scholar 

  23. Levens AS, Berkeley CE, Inman VT, et al. Transverse rotation of the segments of the lower extremity in locomotion. J Bone Joint Surg 1948; 30A: 859–72

    PubMed  CAS  Google Scholar 

  24. Mann RA. Biomechanics of running. In. Frankel VH, editor. Foot problems in adults: I. Biomechanics of the foot. Vol 31. St Louis (MO): Mosby, 1982: 167–80

    Google Scholar 

  25. Nigg BM, Hintermann B. Biomechanics of the ankle joint complex and the shoe. In. Nordin M, Andersson GBJ, Pope MH, editors. Muskuloskeletal disorders in the workplace: principles and practice. St Louis (MO): Mosby, 1996: 558–69

    Google Scholar 

  26. Sutherland DN, Hagy JL. Measurement of gait movements from motion picture films. J Bone Joint Surg Am 1972; 54: 787–99

    PubMed  CAS  Google Scholar 

  27. Mann RA, Baxter DF, Lutter L. Running symposium. Foot Ankle 1981; 1: 190–224

    PubMed  CAS  Google Scholar 

  28. Hintermann B, Nigg BM, Sommer C. Foot movement and tendon excursion: an in vitro study. Foot Ankle 1994; 15 (7): 386–95

    PubMed  CAS  Google Scholar 

  29. Allinger TL, Engsberg JR. A method to determine the range of motion of the ankle joint complex, in vivo. J Biomech 1993; 26: 69–76

    Article  PubMed  CAS  Google Scholar 

  30. Hicks JH. The mechanics of the foot: I. The joints. J Anat 1953; 87: 345–57

    PubMed  CAS  Google Scholar 

  31. Wright DG, Desai SM, Henderson WH. Action of the subtalar and ankle-joint complex during the stance phase of walking. J Bone Joint Surg 1964; 46A: 361–82

    Google Scholar 

  32. Inman VT. The ankle joint. In. Stiel JB, editor. The joints of the ankle. 2nd ed. Baltimore (MD): Wiliams & Wilkins, 1991: 31–8

    Google Scholar 

  33. Lundberg A. Kinematics of the ankle and foot: in vitro stereophotogrammetry. Acta Orthop Scand 1989; 60 Suppl. 233: 1–24

    Google Scholar 

  34. Manter JT. Movements of the subtalar and transverse tarsal joints. Anat Rec 1941; 80: 397–400

    Article  Google Scholar 

  35. Isman RE, Inman VT. Anthropometric studies of the human foot and ankle [technical report 58]. San Francisco: Biomechanics Laboratory, University of California, 1968: 1–12

    Google Scholar 

  36. Langelaan van EJ. A kinematic analysis of the tarsal joints. Acta Orthop Scand 1983; 54 Suppl. 204: 15–49

    Google Scholar 

  37. Siegler S, Chen J, Schneck CD. The three dimensional kinematics and flexibility characteristics of the human ankle and subtalar joint. J Biomech Eng 1988; 110: 364–73

    Article  PubMed  CAS  Google Scholar 

  38. Engsberg JR. A biomechanical analysis of the talocalcaneal joint: in vitro. J Biomech 1987; 20: 429–42

    Article  PubMed  CAS  Google Scholar 

  39. Hintermann B, Nigg BM, Sommer C, et al. Transfer of movement between calcaneus and tibia in vitro. Clin Biomech 1994; 9: 349–55

    Article  Google Scholar 

  40. Hintermann B, Nigg BM. Die Bewegungsübertragung zwischen Fuss und Unterschenkel in vitro. Sportverletz Sportschaden 1994; 2: 60–6

    Article  Google Scholar 

  41. Hintermann B, Nigg BM. Pronation aus der Sicht der Bewegungsübertragung zwischen Kalkaneus und Tibia. Schweiz Z Sportmed 1993; 41: 151–6

    PubMed  CAS  Google Scholar 

  42. Hintermann B, Nigg BM, Cole GK. Influence of selective arthrodesis on the movement transfer between calcaneus and tibia in vitro. Clin Biomech 1994; 9: 356–61

    Article  Google Scholar 

  43. Hintermann B, Nigg BM. Influence of arthrodeses on kinematics of the axially loaded ankle complex during dorsiflexion/ plantarflexion. Foot Ankle 1995; 16 (10): 633–6

    PubMed  CAS  Google Scholar 

  44. Hintermann B, Sommer C, Nigg BM. The influence of ligament transection on tibial and calcaneal rotation with loading and dorsi-plantarflexion. Foot Ankle 1995; 16 (9): 567–71

    PubMed  CAS  Google Scholar 

  45. Sommer C, Hintermann B, Nigg BM, et al. Influence of ankle ligaments on tibial rotation: an in vitro study. Foot Ankle 1996; 17 (2): 79–84

    PubMed  CAS  Google Scholar 

  46. Olerud C, Rosendahl Y. Torsion transmitting properties of the hindfoot. Clin Orthop 1987; 214: 285–95

    PubMed  Google Scholar 

  47. Lapidus PW. Kinesology and mechanical anatomy of the tarsal joints. Clin Orthop 1963; 30: 20–36

    PubMed  CAS  Google Scholar 

  48. Huson A. Biomechanics of the subtalar joint: a reappraisal. Chir Piede 1973; 9: 389–98

    Google Scholar 

  49. Cavanagh PR, Kram R. Stride length in distance running. Med Sci Sports Exerc 1990; 21 (4): 467–79

    Google Scholar 

  50. Frederick EC, Hagy JL, Mann RA. Prediction of vertical impact forces during running. J Biomech 1981; 14: 498–505

    Article  Google Scholar 

  51. Nigg BM, Bahlsen AH, Lüthi SM, et al. The influence of running velocity and midsole hardness on external impact forces in heel-toe running. J Biomech 1987; 20: 951–9

    Article  PubMed  CAS  Google Scholar 

  52. Cole GK, Nigg BM, Ronsky JL, et al. Application of the joint coordinate system to three-dimensional joint attitude and movement representation: a standardization proposal. J Biomech Eng 1993; 115: 344–9

    Article  PubMed  CAS  Google Scholar 

  53. Bogert van den AJ, Smith GD, Nigg BM. In vivo determination of the anatomical axes of the ankle joint complex: an optimization approach. J Biomech 1994; 27 (12): 1477–88

    Article  PubMed  Google Scholar 

  54. Sports-induced inflammation. Clancy WG, Leadbetter WB, Buckwalter JA, et al. editors. Tendon trauma and overuse injuries. Park Ridge: American Academy of Orthopaedic Surgeons, 1990: 609–18

  55. Leach RE. Running injuries of the knee. In. D’Ambrosia R, Drez D, editors. Prevention and treatment of running injuries. Thorefare (NJ): Slade, 1982: 55–75

    Google Scholar 

  56. Bahlsen AH. The etiology of running injuries: a longitudinal, prospective study [thesis]. Calgary: University of Calgary, 1993: 23–67

    Google Scholar 

  57. Benink RJ. The constraint mechanism of the human tarsus. Acta Orthop Scand 1985; 56 Suppl. 215: 1–32

    Google Scholar 

  58. Nigg BM, Cole GK, Nachbauer W. Effects of arch height of the foot angular motion of the lower extremities in running. J Biomech 1993; 26: 909–16

    Article  PubMed  CAS  Google Scholar 

  59. Nigg BM, Bahlsen AH, Denoth J, et al. Factors influencing kinetic and kinematic variables in running. In. Nigg BM, editor. Biomechanics of running shoes. Champaign (IL): Human Kinetics Publishers, 1986: 139–59

    Google Scholar 

  60. Bates BT, Osterning LR, Mason BR, et al. Foot orthotic devices to modify selected aspects of lower extremity mechanics. Am J Sports Med 1979; 7 (6): 338–42

    Article  PubMed  CAS  Google Scholar 

  61. Subotnick SI. Orthotic foot control and the overuse syndrome. Phys Sportsmed 1993; 3 (1): 75–9

    Google Scholar 

  62. Segesser B, Nigg BM. Insertionstendinosen am Schienbein, Achillodynie und Ueberlastungsfolgen am Fuss - Aetiologie, Biomechanik, Therapeutische Möglichkeiten. Orthopade 1980; 11: 834–7

    Google Scholar 

  63. Hintermann B. Tibialis posterior dysfunction: a review of the problems and personal experience. Foot Ankle Surg 1997; 3: 61–70

    Article  Google Scholar 

  64. Clement DB, Taunton JE, Smart GW. Achilles tendinitis and peritendinitis: etiology and treatment. Am J Sports Med 1984; 12: 179–84

    Article  PubMed  CAS  Google Scholar 

  65. James SL, Jones DC. Biomechanical aspects of distance running injuries. In. Cavanagh P, editor. Biomechanics of distance running. Champaign (IL): Human Kinetics Publishers, 1990: 249–69

    Google Scholar 

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Authors and Affiliations

  1. Orthopaedic Department, University of Basel, Basel, Switzerland

    Beat Hintermann

  2. Human Performance Laboratory, The University of Calgary, Calgary, Alberta, Canada

    Benno M. Nigg

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  1. Beat Hintermann
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  2. Benno M. Nigg
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Hintermann, B., Nigg, B.M. Pronation in Runners. Sports Med 26, 169–176 (1998). https://doi.org/10.2165/00007256-199826030-00003

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