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- Author or Editor: Gabriel Gijon-Nogueron x
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Risk Factors and Protective Factors for Lower-Extremity Running Injuries
A Systematic Review
A review of the scientific literature was performed 1) to identify studies describing the most common running injuries and their relation to the risk factors that produce them and 2) to search for potential and specific protective factors. Spanish and English biomedical search engines and databases (MEDLINE/PubMed, Database Enfermería Fisioterapia Podología [ENFISPO], Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature) were queried (February 1 to November 30, 2013). A critical reading and assessment was then performed by the Critical Appraisal Skills Programme Spanish tool. In total, 276 abstracts that contained the selected key words were found. Of those, 25 identified and analyzed articles were included in the results. Injuries result from inadequate interaction between the runner's biomechanics and external factors. This leads to an excessive accumulation of impact peak forces in certain structures that tends to cause overuse injuries. The main reasons are inadequate muscle stabilization and pronation. These vary depending on the runner's foot strike pattern, foot arch morphology, and sex. Specific measures of modification and control through running footwear are proposed.
Background:
Diabetic foot care management is directed at patients with a history of complications, especially those with rising levels of hemoglobin A1c, and those who have had diabetes for several years. The aim of this study was to cross-culturally adapt a French-language version of the Diabetic Foot Self-care Questionnaire of the University of Malaga (DFSQ-UMA) for use in France.
Methods:
Cross-cultural adaptation was performed according to relevant international guidelines (International Society for Pharmacoeconomics and Outcomes Research), and the factor structure was determined. Internal consistency was measured using the Cronbach α. Item-total and inter-item correlations were assessed.
Results:
The French data set comprised 146 patients. The mean ± SD patient age was 62.60 ± 15.47 years. There were 47 women and 99 men. The structure matrix (with three factors) was tested by confirmatory factor analysis. The 16-item questionnaire had a Cronbach α of 0.92. The mean value for inter-item correlations was 0.48 (range, 0.17–0.86). The rotated solution revealed a three-factor structure that accounted for 48.10% of the variance observed. A significant inverse correlation was observed between questionnaire scores and hemoglobin A1c levels (r = –0.17; P < .01).
Conclusions:
This study validates the French-language version of the DFSQ-UMA, which can be used as a self-reported outcome measure for French-speaking patients in France.
Structural Changes in the Lower Extremities in Boys Aged 7 to 12 Years Who Engage in Moderate Physical Activity
An Observational Longitudinal Study
Background:
Physical activity in children may provide health benefits. We sought to consider the practice of soccer as a possible major factor in the development of the lower limb. The study is based on 3-year data for a group of children who practice this sport.
Methods:
For 3 years we monitored 53 children who practiced soccer 3 times a week and had engaged in 2 years of continuous sports activity. Their mean ± SD age was 8.49 ± 2.01 years in the first year. Each year, Foot Posture Index, valgus index, subtalar joint axis, and Q angle for the knee were analyzed.
Results:
The mean ± SD Foot Posture Index scores ranged from 5.38 ± 1.79 in the right foot and 4.49 ± 1.67 in the left foot in the first year to 4.64 ± 2.51 and 4.34 ± 2.26, respectively, in the third year. The valgus index for the same period ranged from 14.05° ± 1.51° (right) and 13.88° ± 1.46° (left) to 13.09° ± 1.28° and 13.07° ± 1.07°, respectively. In the knee, the Q angle ranged from 12.83° ± 1.98° (right) and 12.74° ± 1.68° (left) to 13.17° ± 1.45° and 13.26° ± 1.46°, respectively. In the subtalar joint, the changes were 37.73% right and 30.19% left between the first and third years toward a neutral subtalar joint axis.
Conclusions:
These results show that although playing soccer might cause structural changes in the lower limb, these alterations should not be considered harmful because they may be influenced by age as well.
Background: Running can be considered a high-impact practice, and most people practicing continuous running experience lower-limb injuries. The aim of this study was to determine the influence of 45 min of running on foot posture and plantar pressures.
Methods: The sample comprised 116 healthy adults (92 men and 24 women) with no foot-related injuries. The mean ± SD age of the participants was 28.31 ± 6.01 years; body mass index, 23.45 ± 1.96; and training time, 11.02 ± 4.22 h/wk. Outcome measures were collected before and after 45 min of running at an average speed of 12 km/h, and included the Foot Posture Index (FPI) and a baropodometric analysis.
Results: The results show that foot posture can be modified after 45 min of running. The mean ± SD FPI changed from 6.15 ± 2.61 to 4.86 ± 2.65 (P < .001). Significant decreases in mean plantar pressures in the external, internal, rearfoot, and forefoot edges were found after 45 min of running. Peak plantar pressures in the forefoot decreased after running. The pressure-time integral decreased during the heel strike phase in the internal edge of the foot. In addition, a decrease was found in the pressure-time integral during the heel-off phase in the internal and rearfoot edges.
Conclusions: The findings suggest that after 45 min of running, a pronated foot tends to change into a more neutral position, and decreased plantar pressures were found after the run.
Background:
The aim of this study was to observe the pressure changes in the felt padding used to off-load pressure from the first metatarsal head, the effects obtained by different designs, and the loss of effectiveness over time.
Method:
With a study population of 17 persons, two types of 5-mm semicompressed felt padding were tested: one was C-shaped, with an aperture cutout at the first metatarsophalangeal joint, and the other was U-shaped. Pressures on the sole of the foot were evaluated with a platform pressure measurement system at three time points: before fitting the felt padding, immediately afterward, and 3 days later.
Results:
In terms of decreased mean pressure on the first metatarsal, significant differences were obtained in all of the participants (P < .001). For plantar pressures on the central metatarsals, the differences between all states and time points were significant for the C-shaped padding in both feet (P < .001), but with the U-shaped padding the only significant differences were between no padding and padding and at day 3 (P = .01 and P = .02).
Conclusions:
In healthy individuals, the U-shaped design, with a padding thickness of 5 mm, achieved a more effective and longer-lasting reduction in plantar pressure than the C-shaped design.
Background:
Ligamentous or joint laxity is a clinical entity characterized by increased joint mobility beyond the range of motion regarded as normal, and joint mobility is an effective indicator of the degree of laxity. We examined the influence of ligamentous laxity on the range of ankle dorsiflexion with the knee flexed and extended, comparing lax adults with a control (nonlax) group.
Methods:
The sample comprised 400 individuals: 200 in the control group (mean ± SD age, 32.49 ± 11.06 years) and 200 in the lax group (mean ± SD age, 29.82 ± 9.40 years). The Beighton criteria were applied to each participant to diagnose laxity or nonlaxity, and sex, age, and angle range of bilateral dorsiflexion with the knee extended and flexed were recorded.
Results:
The mean ± SD dorsiflexion range with the knee straight was 16.14° ± 5.29° left ankle and 21.21° ± 4.93° right ankle in the lax group and 12.94° ± 4.17° left ankle and 17.08° ± 4.40° right ankle in the control group. The respective values with the knee flexed were 15.84° ± 5.31° and 21.21° ± 4.80° in the lax group and 12.95° ± 3.95 and 17.23° ± 4.25° in the control group.
Conclusions:
In this sample, ankle dorsiflexion range in the lax group was 4° bigger than that in the control group in both knee positions.
Background
The technical gestures characteristic of certain sports may lead to one type of foot being more prevalent than the others. The Foot Posture Index (FPI) has been used as a diagnostic tool for support postures in various sports, but the differences in these postures between sports of distinct gestures in their actions are far from completely understood.
Methods
The overall FPI, obtained as the sum of the scores of its six individual criteria, was determined in 90 male athletes (30 runners, 30 basketball players, and 30 handball players) in static bipedal stance and relaxed position. Analysis of variance was used to find significant differences among the three sports in the total FPI and its six criteria.
Results
The mean ± SD FPI was 2.9 ± 2.8 in runners, 3.9 ± 4.1 in basketball players, and −0.4 ± 6.9 in handball players, with significant differences among these groups (P = .008). Significant differences were also found in the talar head position and talonavicular prominence values between handball players and runners (P = .001 and P = .004, respectively) and between handball and basketball players (P = .002 and P = .006, respectively).
Conclusions
Runners and basketball players had neutral feet, whereas handball players had supinated feet. The differences in foot posture seem to be mainly determined by two of the FPI criteria: talar head position and talonavicular prominence.
Background
The foot of a newborn is a structure that is under formation and is susceptible to presenting pathologic disorders from the moment of birth. Evidence of the prevalence of clinodactyly in newborns is scarce. Therefore, the objective of this study was to determine that prevalence and its interrelationship with gestational and neonatal factors.
Methods
In a sample of 305 newborns (147 boys and 158 girls), the commonest podiatric medical alterations with either a genetic or a postural component present at the moment of birth were explored physically. The prevalence found in the sample was then related to different anthropometric, gestational, and racial/ethnic parameters of the newborn.
Results
The sex of the newborn was unrelated to any podiatric medical pathology found. Clinodactyly was present in approximately 90% of the fifth toes studied. Breech or transverse fetal presentation and the width of the forefoot affected the appearance of clinodactyly of the fourth and fifth toes. The anthropometric differences between the feet of boys and girls were verified.
Conclusions
The presence of clinodactyly of the fourth and fifth toes in newborns is a frequent clinical finding and should, therefore, be considered in the podopediatric examination. In the neonatal population studied, the pathologic disorders explored did not depend on sex. The prevalence of fourth and fifth toe clinodactyly was significantly influenced by breech or transverse presentation and by forefoot width, but not by the mother's race/ethnicity.
Normal Values of the Foot Posture Index in a Young Adult Spanish Population
A Cross-Sectional Study
Background
Although the appearance of foot or lower-limb pathologies is etiologically multifactorial, foot postures in pronation or supination have been related to certain diseases such as patellofemoral syndrome and plantar fasciitis. The objective of the present study was to determine the normal values of foot posture in a healthy young adult Spanish sample, and to identify individuals at risk of developing some foot pathology.
Methods
The Foot Posture Index (FPI) was determined in a sample of 635 (304 men, 331 women) healthy young adults (ages 18–30 years). The FPI raw score was transformed into a logit score, and a new classification was obtained with the mean ± 2 SD to identify the 5% of the sample with potentially pathologic feet.
Results
The normal range of the FPI was −1 to +6, and FPI values from +10 to +12 and −6 to −12 could be classified as indicating potentially pathologic feet. The women's logit FPI (0.50 ± 1.4, raw FPI +3) was higher than the men's (0.25 ± 1.6, raw FPI +2), with the difference being significant (P = 0.038). No statistically significant differences were found between body mass index groups (P = 0.141).
Conclusions
The normal FPI range goes from just one point of supination to a certain degree of pronation (+6). The identification of 35 individuals with potentially pathologic feet may help in the implementation of a preventive plan to avoid the appearance of foot disorders.
Anthropometric Foot Changes During Pregnancy
A Pilot Study
Background:
Women’s feet change during pregnancy owing to hormonal and anatomical changes, thus having a strong influence on the decrease in their quality of life during pregnancy. This preliminary study aimed to value the anthropometric and positional changes that affect their feet.
Methods:
Ten pregnant women were measured during their gestational period to analyze the anthropometric changes in their feet from the 12th week of pregnancy. We examined the changes that occured in foot length, forefoot width, arch of the foot height, and the fixed position of the foot by using the Foot Posture Index, and we analyzed three intervals corresponding to pregnancy weeks 12, 24, and 34.
Results:
The most significant finding, with a reliability rate of 95%, is the decrease in internal arch height, which descends 0.65 mm (0.0394 inches) on average at the final stage of the pregnancy period. This change happened in 18 of the feet analyzed, tending toward pronation according to the measure provided by the Foot Posture Index, with a change of 3.78 points on this scale.
Conclusions:
The foot of the pregnant woman tends to flatten during gestational weeks 12 to 34, taking a more pronated posture, and the anthropometric changes in late pregnancy result in increases in foot length and forefoot width, changes that seem to be moderate. (J Am Podiatr Med Assoc 103(4): 314–321, 2013)
