Dynamic foot function as a risk factor for lower limb overuse injury : A systematic review

Journal article


Dowling, Geoffrey, Murley, George, Munteanu, Shannon, Franettovich Smith, Melinda, Neal, Bradley, Griffiths, Ian, Barton, Christian and Collins, Natalie. (2014) Dynamic foot function as a risk factor for lower limb overuse injury : A systematic review. Journal of Foot and Ankle Research. 7(53), pp. 1 - 13. https://doi.org/10.1186/s13047-014-0053-6
AuthorsDowling, Geoffrey, Murley, George, Munteanu, Shannon, Franettovich Smith, Melinda, Neal, Bradley, Griffiths, Ian, Barton, Christian and Collins, Natalie
Abstract

Background

Dynamic foot function is considered a risk factor for lower limb overuse injuries including Achilles tendinopathy, shin pain, patellofemoral pain and stress fractures. However, no single source has systematically appraised and summarised the literature to evaluate this proposed relationship. The aim of this systematic review was to investigate dynamic foot function as a risk factor for lower limb overuse injury. Methods

A systematic search was performed using Medline, CINAHL, Embase and SportDiscus in April 2014 to identify prospective cohort studies that utilised dynamic methods of foot assessment. Included studies underwent methodological quality appraisal by two independent reviewers using an adapted version of the Epidemiological Appraisal Instrument (EAI). Effects were expressed as standardised mean differences (SMD) for continuous scaled data, and risk ratios (RR) for nominal scaled data. Results

Twelve studies were included (total n = 3,773; EAI 0.44 to 1.20 out of 2.00, representing low to moderate quality). There was limited to very limited evidence for forefoot, midfoot and rearfoot plantar loading variables (SMD 0.47 to 0.85) and rearfoot kinematic variables (RR 2.67 to 3.43) as risk factors for patellofemoral pain; and plantar loading variables (forefoot, midfoot, rearfoot) as risk factors for Achilles tendinopathy (SMD 0.81 to 1.08). While there were significant findings from individual studies for plantar loading variables (SMD 0.3 to 0.84) and rearfoot kinematic variables (SMD 0.29 to 0.62) as risk factors for ‘non-specific lower limb overuse injuries’, these were often conflicting regarding different anatomical regions of the foot. Findings from three studies indicated no evidence that dynamic foot function is a risk factor for iliotibial band syndrome or lower limb stress fractures. Conclusion

This systematic review identified very limited evidence that dynamic foot function during walking and running is a risk factor for patellofemoral pain, Achilles tendinopathy, and non-specific lower limb overuse injuries. It is unclear whether these risk factors can be identified clinically (without sophisticated equipment), or modified to prevent or manage these injuries. Future prospective cohort studies should address methodological limitations, avoid grouping different lower limb overuse injuries, and explore clinically meaningful representations of dynamic foot function.

KeywordsBiomechanics; Plantar pressures; Kinematics; Prospective studies; Musculoskeletal diseases; Review
Year2014
JournalJournal of Foot and Ankle Research
Journal citation7 (53), pp. 1 - 13
PublisherSpringer Nature
ISSN1757-1146
Digital Object Identifier (DOI)https://doi.org/10.1186/s13047-014-0053-6
Scopus EID2-s2.0-84930946061
Open accessOpen access
Page range1 - 13
Research GroupSchool of Allied Health
Publisher's version
License
Place of publicationUnited States of America
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