Elsevier

Gait & Posture

Volume 72, July 2019, Pages 109-122
Gait & Posture

The relationship between static and dynamic foot posture and running biomechanics: A systematic review and meta-analysis

https://doi.org/10.1016/j.gaitpost.2019.05.031Get rights and content

Highlights

  • Some evidence was found for a relationship between foot arch and running biomechanics.

  • High-arched runners exhibited increased leg stiffness.

  • Low-arched runners exhibited increased rearfoot eversion excursion.

  • Future research would benefit from a consensus in foot arch assessments.

Abstract

Background

Medial longitudinal arch characteristics are thought to be a contributing factor to lower limb running injuries. Running biomechanics associated with different foot types have been proposed as one of the potential underlying mechanisms. However, no systematic review has investigated this relationship.

Research question

The aim of this study was to conduct a systematic literature search and synthesize the evidence about the relationship between foot posture and running biomechanics.

Methods

For this systematic review and meta-analysis different electronic databases (Pubmed, Web of Science, Cochrane, SportDiscus) were searched to identify studies investigating the relationship between medial longitudinal arch characteristics and running biomechanics. After identification of relevant articles, two independent researchers determined the risk of bias of included studies. For homogenous outcomes, data pooling and meta-analysis (random effects model) was performed, and levels of evidence determined.

Results

Of the 4088 studies initially identified, a total of 25 studies were included in the qualitative review and seven in the quantitative analysis. Most studies had moderate and three studies a low risk of bias. Moderate evidence was found for a relationship between foot posture and subtalar joint kinematics (small pooled effects: −0.59; 95%CI −1.14 to − 0.003) and leg stiffness (small pooled effect: 0.59; 95%CI 0.18 to 0.99). Limited or very limited evidence was found for a relationship with forefoot kinematics, tibial/leg rotation, tibial acceleration/shock, plantar pressure distribution, plantar fascia tension and ankle kinetics as well as an interaction of foot type and footwear regarding tibial rotation.

Significance

While there is evidence for an association between foot posture and subtalar joint kinematics and leg stiffness, no clear relationship was found for other biomechanical outcomes. Since a comprehensive meta-analysis was limited by the heterogeneity of included studies future research would benefit from consensus in foot assessment and more homogenous study designs.

Introduction

Foot and medial longitudinal arch characteristics have frequently been discussed as potential contributing factors to overuse injuries of the lower extremities [1,2]. Although the evidence is not conclusive [1,3,4], high arched feet are thought to be more rigid with less capacity for shock absorption [5,6]. This may lead to a higher incidence of ankle injuries, bony injuries (especially to the tibia or femur), and injuries to the lateral aspect of the lower limb [1]. Low arched feet in contrast appear to be related to more knee injuries, soft tissue injuries, and injuries to the medial aspect of the lower limb [1]. A recent systematic review aimed to identify this relationship and showed a slightly increased pooled odds ratio (OR = 1.23; 95% CI: 1.11, 1.37) for lower extremity injuries, when either high and low arch feet were present [4]. Some lower limb alignment characteristics have already been identified as being associated with running-related injuries [4,7].

Altered biomechanics are also assumed to provide the link between medial longitudinal arch alignment and increased injury risk [1], and foot arch characteristics have been shown to influence kinematics and kinetics of running [[8], [9], [10]]. The flexibility of different medial longitudinal arch types has been suggested to contribute to differences in running biomechanics [11], i.e. influence the shock attenuation and plantar pressure distribution during running [1,12].

The relationship between foot posture and lower limb biomechanics in walking has already been investigated using a systematic approach by Buldt et al. [13]. A low level of evidence was found for a relationship between low foot arches and increased frontal plane motion of the rearfoot [13]. In contrast, the relationship between foot posture and running biomechanics has not been investigated using a systematic review approach. Therefore, the aim of this systematic review was to evaluate the relationship between different foot postures and running biomechanics.

Section snippets

Methods

This study was conducted and reported according to the PRISMA guidelines for reporting systematic reviews and meta-analysis [14] and as suggested by Harris et al. [15]. Prior to the start of the study, the review protocol was registered at the University of York, Centre for Reviews and Dissemination PROSPERO database: Registration number CRD42017069530 (http://www.crd.york.ac.uk/prospero/).

A systematic literature search was conducted in July 2017 and repeated in February 2018. Inclusion and

Search results

The initial search resulted in 4088 studies, of which 787 duplicates were excluded. Additionally, eight studies were identified through other sources (forward and backward search). A total of 42 studies were assessed for eligibility, of which 17 needed to be excluded for various reasons (no investigation of running condition, no classification of foot type, no full-text found, no comparison group). Finally 25 studies were included in the qualitative analysis and seven studies in the

Discussion

The aim of this study was to systematically synthesize the relationship between medial longitudinal arch characteristics and running biomechanics. Overall, some evidence was found for a relationship between the medial longitudinal arch and rearfoot kinematics, leg stiffness, mid- and forefoot kinematics, tibial rotation, tibial acceleration/shock, plantar pressure distribution (peak pressures, center of pressure course) and ankle kinetics (net work, propulsive work, dynamic joint stiffness

Conclusion

There is evidence for a relationship between medial longitudinal arch characteristics and running biomechanics, especially for subtalar joint kinematics, leg stiffness, ankle kinetics and tibial shock. Even though this relationship has been discussed as an underlying mechanism for running-related injuries, it is difficult to draw conclusive practical or clinical guidance from the current literature. Future research would benefit from higher internal validity and a consensus on medial

Conflict of interest statement

There are no conflicts of interest among any of the authors of this article.

Acknowledgements

This project (Barefoot LIFE) was funded by the Ministry for Science and Research in Hamburg, Germany (grant number LFF-FV13). The research visit to the Oxford Gait Laboratory, Oxford University Hospitals, of the first author (KH) was funded by the European Society of Movement Analysis for Adults and Children (ESMAC). All authors were fully involved in the study and preparation of the manuscript. The material within this manuscript has not been and will not be submitted for publication elsewhere.

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