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

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


Author Dowling, Geoffrey J.
Murley, George S.
Munteanu, Shannon E.
Smith, Melinda M. Franettovich
Neal, Bradley S.
Griffiths, Ian B.
Barton, Christian J.
Collins, Natalie J.
Title Dynamic foot function as a risk factor for lower limb overuse injury: A systematic review
Journal name Journal of Foot and Ankle Research   Check publisher's open access policy
ISSN 1757-1146
Publication date 2014-12-19
Year available 2014
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1186/s13047-014-0053-6
Open Access Status Not Open Access
Volume 7
Issue 53
Total pages 13
Place of publication London, United Kingdom
Publisher BioMed Central
Language eng
Formatted 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.
Keyword Biomechanics
Plantar pressures
Kinematics
Prospective studies
Musculoskeletal diseases
Review
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collection: School of Health and Rehabilitation Sciences Publications
 
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