• 1

    USA Triathlon Web site. Available at: http://www.usatriathlon.org. Accessed April 8. ,2004. .

  • 2

    Korkia PK, Tunstall-Pedoe DS, Maffulli N: An epidemiological investigation of training and injury patterns in British triathletes. .Br J Sports Med 28::191. ,1994. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Manninen JS, Kallinen M: Low back pain and other overuse injuries in a group of Japanese triathletes. .Br J Sports Med 30::134. ,1996. .

  • 4

    Vleck VE, Garbutt G: Injury and training characteristics of male elite, development squad, and club triathletes. .Int J Sports Med 19::38. ,1998. .

  • 5

    Wilk BR, Fisher KL, Rangelli D: The incidence of musculoskeletal injuries in an amateur triathlon racing club. .J Orthop Sports Phys Ther 22::108. ,1995. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Collins K, Wagner M, Peterson K, et al: Overuse injuries in triathletes. .Am J Sports Med 17::675. ,1989. .

  • 7

    Ireland ML, Micheli LJ: Triathletes: biographic data, training, and injury patterns. .Ann Sports Med 3::117. ,1987. .

  • 8

    O’Toole ML, Hiller WD, Smith RA, et al: Overuse injuries in ultraendurance triathletes. .Am J Sports Med 17::514. ,1989. .

  • 9

    Massimino FA, Armstrong MA, O’Toole ML, et al: Common triathlon injuries: special considerations for multisport training. .Ann Sports Med 4::82. ,1988. .

    • Search Google Scholar
    • Export Citation
  • 10

    James SL, Bates BT, Osternig LR: Injuries to runners. .Am J Sports Med 6::40. ,1978. .

  • 11

    Williams DS III, McClay IS, Hamill J: Arch structure and injury patterns in runners. .Clin Biomech 16::341. ,2001. .

  • 12

    Busseuil C, Freychat P, Guedj EB, et al: Rearfoot-forefoot orientation and traumatic risk for runners. .Foot Ankle Int 19::32. ,1998. .

  • 13

    Kaufman KR, Brodine SK, Shaffer RA, et al: The effect of foot structure and range of motion on musculoskeletal overuse injuries. .Am J Sports Med 27::585. ,1999. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Bennett JE, Reinking MF, Pluemer B, et al: Factors contributing to the development of medical tibial stress syndrome in high school runners. .J Orthop Sports Phys Ther 31::504. ,2001. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Razeghi M, Batt ME: Foot type classification: a critical review of current methods. .Gait Posture 15::282. ,2002. .

  • 16

    Menz HB: Alternative techniques for the clinical assessment of foot pronation. .JAPMA 88::119. ,1998. .

  • 17

    Redmond A, Burns J, Ouvrier R, et al: An initial appraisal of the validity of a criterion based, observational clinical rating system for foot posture. .J Orthop Sports Phys Ther 31::160. ,2001. .

    • Search Google Scholar
    • Export Citation
  • 18

    Rose GK, Welton EA, Marshall T: The diagnosis of flat foot in the child. .J Bone Joint Surg Br 67::71. ,1985. .

  • 19

    Noakes H, Payne C: The reliability of the manual supination resistance test. .JAPMA 93::185. ,2003. .

  • 20

    Thomson CE: An investigation into the reliability of the valgus index and its validity as a clinical measurement. .The Foot 4::191. ,1994. .

    • Search Google Scholar
    • Export Citation
  • 21

    Song J, Hillstrom HJ, Secord D, et al: Foot type biomechanics: comparison of planus and rectus foot types. .JAPMA 86::16. ,1996. .

  • 22

    Pope RP, Herbert RD, Kirwan JD, et al: A randomized trial of preexercise stretching for prevention of lower-limb injury. .Med Sci Sports Exerc 32::271. ,2000. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Bennell KL, Crossley K: Musculoskeletal injuries in track and field: incidence, distribution and risk factors. .Aust J Sci Sport 28::69. ,1996. .

    • Search Google Scholar
    • Export Citation
  • 24

    Cohen ME: Analysis of ordinal dental data: evaluation of conflicting recommendations. .J Dent Res 80::309. ,2001. .

  • 25

    Walters SJ, Campbell MJ, Lall R: Design and analysis of trials with quality of life as an outcome: a practical guide. .J Biopharm Stat 11::155. ,2001. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    Menz HB: Two feet, or one person? problems associated with statistical analysis of paired data in foot and ankle medicine. .The Foot 14::2. ,2004. .

    • Search Google Scholar
    • Export Citation
  • 27

    Sutton AJ, Muir KR, Jones AC: Two knees or one person: data analysis strategies for paired joints or organs. .Ann Rheum Dis 56::401. ,1997. .

  • 28

    Michelson JD, Durant DM, McFarland E: The injury risk associated with pes planus in athletes. .Foot Ankle Int 23::629. ,2002. .

  • 29

    Williams DS, McClay IS, Hamill J, et al: Lower extremity kinematics and kinetic differences in runners with high and low arches. .J Appl Biomech 17::153. ,2001. .

    • Search Google Scholar
    • Export Citation
  • 30

    Tareco JM, Miller NH, MacWilliams BA, et al: Defining flatfoot. .Foot Ankle Int 20::456. ,1999. .

  • 31

    Kuzma JW: Basic Statistics for the Health Sciences, Mayfield, Mountain View, CA. ,1998. .

  • 32

    Williams MM, Hawley JA, Black R, et al: Injuries amongst competitive triathletes. .N Z J Sports Med 16::2. ,1988. .

  • 33

    Dahle LK, Mueller M, Delitto A, et al: Visual assessment of foot type and relationship of foot type to lower extremity injury. .J Orthop Sports Phys Ther 14::70. ,1991. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34

    Korpelainen R, Orava S, Karpakka J, et al: Risk factors for recurrent stress fractures in athletes. .Am J Sports Med 29::304. ,2001. .

  • 35

    Cowan DN, Jones BH, Robinson JR: Foot morphologic characteristics and risk of exercise related injury. .Arch Fam Med 2::773. ,1993. .

  • 36

    Giladi M, Milgrom C, Stein M, et al: The low arch, a protective factor in stress fractures. .Orthop Rev 14::81. ,1985. .

  • 37

    Ekenman I, Tsai-Fellander L, Westblad P, et al: A study of intrinsic factors in patients with stress fractures of the tibia. .Foot Ankle Int 17::477. ,1996. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38

    Sneyers CJ, Lysens R, Feys H, et al: Influence of malalignment of feet on the plantar pressure pattern in running. .Foot Ankle Int 16::624. ,1995. .

  • 39

    McPoil TG, Cornwall MW: The relationship between static lower extremity measurements and rearfoot motion during walking. .J Orthop Sports Phys Ther 24::309. ,1996. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40

    Hamil J, Bates BT, Knutzen KM, et al: Relationship between selected static and dynamic lower extremity measures. .Clin Biomech 4::217. ,1989. .

    • Search Google Scholar
    • Export Citation

Foot Type and Overuse Injury in Triathletes

Joshua Burns School of Exercise and Health Sciences, University of Western Sydney, Sydney, Australia.

Search for other papers by Joshua Burns in
Current site
Google Scholar
PubMed
Close
 BAppSc(Pod)Hons
,
Anne-Maree Keenan Academic Unit of Musculoskeletal Disease, School of Medicine, University of Leeds, Leeds, England.

Search for other papers by Anne-Maree Keenan in
Current site
Google Scholar
PubMed
Close
 BAppSc(Pod), MAppSc
, and
Anthony Redmond Academic Unit of Musculoskeletal Disease, School of Medicine, University of Leeds, Leeds, England.

Search for other papers by Anthony Redmond in
Current site
Google Scholar
PubMed
Close
 PhD, MSc, DPodM
View More View Less

Abnormal foot morphology has been suggested to contribute to overuse injuries in athletes. This study investigated the relationship between foot type and injury incidence in a large sample of competitive triathletes not wearing foot orthoses during a 6-month retrospective analysis and a 10-week prospective cohort study. Foot alignment was measured using the Foot Posture Index and the Valgus Index, and participants were assigned to supinated, pronated, and normal foot-type groups. Overall, 131 triathletes sustained 155 injuries during the study. Generally, foot type was not a major risk factor for injury; however, there was a fourfold increased risk of overuse injury during the competition season in athletes with a supinated foot type. The results of this study show that triathletes with a supinated foot type are more likely to sustain an overuse injury. (J Am Podiatr Med Assoc 95(3): 235–241, 2005)

Corresponding author: Joshua Burns, BAppSc(Pod)Hons, PO Box 799, Neutral Bay, New South Wales 2089, Australia.