Biomechanics: Wearing footwear with toe springs requires less muscle work

News Release:

Wearing footwear with an upward curvature at the front of the shoe – known as the toe spring – requires less work from the muscles of the feet to walk than shoes with a flatter sole, according to an experimental study published in Scientific Reports.

Toe springs keep the toes continually elevated above the ground in a flexed upwards position to help the front part of the foot roll forward when walking or running and are present in most modern athletic shoes, but their effect on natural foot function and vulnerability of the feet to injury has not been widely studied.

Freddy Sichting and colleagues from Harvard University, the Chemnitz University of Technology and Buffalo University investigated the effects of toe springs on foot biomechanics using a controlled experiment in which 13 participants walked barefoot on a treadmill at a comfortable walking pace. The participants were then asked to repeat the process wearing four different pairs of specially designed sandals with varying upward curvature of the toe region in order to simulate the curvature of modern athletic footwear. 3D motion data were captured using markers placed on each subject’s knee, ankle and foot.

The authors found that toe springs decrease the work of the muscles around the joints that connect the toes to the foot bones. The higher the upwards curve of the toes in respect to the rest of the foot, the less work the foot muscles had to perform to support the joints when walking.

The findings explain why toe springs are so comfortable and popular but suggest that shoes with toe springs may contribute to weakening of the foot muscles with long-term use. This may increase susceptibility to common pathological conditions such as plantar fasciitis, inflammation of the foot that connects the heel bone to the toes, according to the authors.

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The Dangers of Running in the Cold

There are some dangers that are associated with exercising in the cold, even though it can be an exhilarating and rewarding experience. Cold injury is common in some of those extreme type sports, but not always necessarily in running, but it does have its dangers. Precautions do need to be taken and you do need to be aware of the signs of an impending problem with your body in the cold and you do need to know what to do.

Hypothermia is probably the greatest and most serious problem and most well known, due to the potential to become fatal if not addressed quickly and properly. You are at greater risk if it is cold, windy, and wet; if you are young, tall and thin; and if you run at a slower pace. The classic signs of hypothermia are shivering, slurred speech, a lethargy, a slow and shallow breathing, a weak pulse and a clumsiness or lack of coordination. If any of this starts to happen there is an urgency to getting the runner warmed up and get more help.

At the other extreme of the spectrum are the relatively minor issue of chilblains. This an inflammatory response of the small blood vessels in the toes (and sometimes the fingers) that can be quite painful. These do not happen in the extreme cold, but are more common in the colder climates, but are unheard of in the warm climates. They initially appear as a reddish colored painful and itchy patches on the toes, but can sometimes affect the fingers, nose and ears. If the chilblains do become chronic and keep occurring, they take on a dark blue color. They normally heal up reasonably quickly unless they keep recurring, which points to the importance of preventing them by use of warm socks and shoes. When one occurs, then soothing chilblain creams to stimulate the circulation is usually very helpful.

To avoid a cold injury, wearing several layers of clothing that designed for exercise are recommended. Take into account the direction of the wind when beginning your run and choose a route that is in a well populated area so you are not far from help if you need it. It is often a good idea to also wear a warm hat and gloves for further protection from the cold. If you have any real doubts, then don’t go for a run. You could have a rest day or use a treadmill that is indoors.

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Which Running Shoes for Severs Disease?

Sever’s disease, or more appropriately called calcaneal apophysitis is a common problem with the growth plate at the back of the heel bone in kids. The growth plate combines with the rest of the heel bone at around the early to mid-teenage years, so it is no longer a problem after that time. The pain is typically at the back of the heel bone or if you squeeze the sides. The cause of the problem is typically too much load on the growing area, especially in a short period of time if there has not been time for the kids body to adapt to those higher loads.

Biomechanically the problem with Sever’s disease is the growth plate is the part of the heel bone that contacts the ground when heel striking and running, so that can add to the loads on the bone. Also the Achilles tendon attaches to the heel bone, so the pull from the calf muscles while running can also increase the load on the growth plate.

Typical the management of Sever’s disease is to reduce the loads by cutting back on the levels of activity. ICE can be used after activity if the pain is bad enough. A cushioned heel raise is often used to give some protection to the growth plate.

What Running Shoes can help Sever’s disease?

Looking at the nature of the biomechanics associated with Sever’s disease, then any running shoe that has a high drop (like the Brooks Adrenaline) is going to be helpful. Also running shoes with good cushioning are going to also help (like the Asic’s gel models). So look for shoes with a higher drop (heel raise) and good cushioning.

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Running Shoes for Bunions

Running Shoes for Bunions

When I decided to write this post, I did a quick google search to see what is available. It was really embarrassing. Almost all the advice being given for this was from websites that earn a commission if you click on link of the running shoes to buy them. Most of the shoes being recommended would not help you at all if you had bunions.

There is plenty of good information on bunions online, so there is no point litigating what they are and what causes them here, except to say that the only way to get rid of them is with surgery and the best you can do to prevent them getting worse or being so painful is to get the shoe fitting correct.

The running shoes that are best if you have bunions are those that are wider in the forefoot to accommodate the enlarged joint. Your typical running shoe made on a wider last is often not wide enough (though you will read commonly that they are from those who make money selling those shoes). You could try on the wider last models of each of the brands to see how they feel on you. In all honestly, there is only one brand that is any good here and they are the Altra running shoes. They are massively wide in the forefoot compared to other brands and they have the width to accommodate the enlarged joint associated with the bunion. If you have a bunion, then try a pair.

What else could you do for bunions?

Apart from surgery, there are other options. What is important is to keep the joint mobile and flexible with exercises as it does have a tendency to become stiffer. A bunion corrector can also be used to help with that. If you can not get the shoes right, then there are donut shaped pads that can be worn to keep the pressure off the joint.

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Healing Yoga: Proven Postures to Treat Twenty Common Ailments?from Backache to Bone Loss, Shoulder Pain to Bunions, and More
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Which Running Shoes for Anterior Compartment Syndrome?

Anterior compartment syndrome or chronic exertional compartment syndrome is a problem with the muscle on the front of the leg (the anterior tibial muscle or tibialis anterior muscle) trying to expand during exercise when the fascia around the muscle is too tight and the muscle can not expand. This can become painful and is one of the causes of that term, “shin splints”.

The treatment options in the past were often limited and a surgical release of the tight fascia around the muscle was usually the better definitive treatment.

However, we now have this study on anterior compartment syndrome that shows it is good option to change from heel striking to forefoot striking to help this condition. From all reports it works pretty well and the rationale for it is sound. While this might be a good idea for anterior compartment syndrome, it would not be a good idea for other types of running injuries such as achilles tendon issues. The transition from rearfoot or heel striking to a midfoot or forefoot strike pattern needs to be slow to allow for the tissues to adapt to the loads.

What running shoes should be used for anterior compartment syndrome?

There is no specific shoes for runners with anterior compartment syndrome. There will be many personal preferences here, but it comes down to does the shoe allow or facilitate forefoot striking? A lower drop shoe will help with that. Less cushioning under the heel will help do that. The type or model of shoe is not particularly important in this case, its the running technique and the touch down angle that is important. That can be achieved in any type of running shoe.

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Injury-Free Running: How to Build Strength, Improve Form, and Treat/Prevent Injuries
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Causes of Higher Risk of Stress Fractures in Female Runners

Press Release:

PHILADELPHIA – Running is one of the most popular forms of exercise, enjoyed by a broad range of age groups and skill levels.  More women are running recreationally compared to men; specifically 54% of runners are female as indicated by a 2018 National Runner Survey. Women, however, are at least twice as likely as men to develop stress fractures, an injury that impacts around 20% of runners. However, information is still lacking on how to best prevent and treat stress fractures in women. New pilot research from Jefferson suggests physiological factors that could be included in routine screening for stress fracture risk, as well as changes in training approach to aid in prevention.

The researchers examined physiological differences that might contribute to increased risk of stress fractures in a study published in Sports Healthand also surveyed women’s perception of risk and behaviors that contribute to stress fractures in a separate study published in Physical Therapy in Sport

“Most of the literature focuses on elite runners or athletes,” says Therese Johnston, PT, PhD, MBA, Professor in the Department of Physical Therapy and first author of both studies. “It was important for us to capture the regular or average female runner in these studies, and the main goal was to see how we can prevent a first or subsequent fracture.”

Both studies surveyed the same group of 40 female recreational runners, age 18-65 years. 20 women had a history of running-related stress fractures, and they were matched according to age and running abilities with 20 women with no history of stress fractures. The two studies aimed to assess what contributed to risk of stress fractures, from the physiological, such as – bone structure and density, muscle mass, hormonal status, to ones influenced by training routine, such as training intensity, nutrition, insufficient strengthening, and ignoring pain.

“This mixed methods approach provides a richer context and a more detailed picture of the practices and risks that contribute to stress fractures in every-day women runners,” says Jeremy Close, MD, associate professor in family and sports medicine and one of the lead authors on the research. “It also tells us how perceived risk informs physiological risk.”

For the study focused on physiological factors, the subjects underwent a comprehensive blood panel that examined levels of hormones like estradiol and testosterone, vitamins and minerals important for bone health such as vitamin D and calcium, and bone markers. They also underwent dual energy x-ray absorptiometry (DXA) to test for bone mineral density. The researchers found that while there was no difference in estradiol hormone levels between the two groups, women who had a stress fracture history reported menstrual changes or irregular periods as a result of their training, or during peak training times. The blood panel also examined markers for bone formation and resorption, and pointed to increased bone turnover in the group of women with stress fractures. They also found through the DXA testing that women with a history of stress fractures had lower hip bone mineral density compared to women with no history of stress fractures, indicating decreased bone strength that could increase risk of injury.

“DXA for bone density and blood testing for bone markers are not routinely performed in this population – they are usually reserved for post-menopausal women – so we may be missing important clinical indicators for stress fractures in these women,” says Dr. Johnston. “While the link between menstrual changes and bone strength is unclear, our findings also indicate that asking female runners about any menstrual irregularities during heavier training times is important during routine screening.”

For the study investigating women’s self-perception of risk, interviews were conducted with the goals of finding out which factors women thought were associated with stress fractures or maintaining bone health while running. Several themes emerged from these interviews. Specifically, compared to women without stress fractures, women with histories of stress fractures had increased their training load more quickly. Also, while they knew of the importance of nutrition and strengthening exercises, women with a history of stress fracture more often reported not having or making the time for a balanced diet and proper cross-training to complement their running regimen.

Finally, women in this group reported pushing through the pain and running despite an injury more often than those without stress fracture. “In the interviews, it sounded like these women had trouble knowing which pain was normal, and which pain was abnormal. They also reported not always receiving appropriate guidance from healthcare providers on how to progress running safely,” says Dr. Johnston.

“It is clear that there needs to be more guidance from healthcare providers for woman runners on how to prevent stress fractures” says Dr. Close. “It can be very frustrating for these women who are on a path to wellness, but are impeded by an injury that can take several months to heal. If they don’t have the proper guidance on how to return to running safely, they risk a second injury.”

“We hope that our findings will encourage more thorough and routine screening in women runners for bone density and strength,” says Dr. Johnston, “as well as a comprehensive education plan on how to balance running with cross-training, and how to interpret pain cues from the body, to help women differentiate between normal aches and pains and indicators of a serious injury.”

Dr. Johnston plans to continue this research by studying women with acute stress fractures as they start running again, in order to identify factors related to successful or unsuccessful return to running following a stress fracture. The study will include Dr. Close as well as Marc Harwood, MD, service chief in the department of non-operative sports medicine at Rothman Orthopaedic Institute.

The work was funded by the Thomas Jefferson University Office of the Provost. The authors report no conflict of interest

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Why runner’s addiction is adding to your injury woes

Press Release:

Each week, millions of runners around the world lace up their running shoes, spurred on by the psychological, health and social benefits that running delivers.

The birth of Parkrun in 2004 – now an international activity with more than 20 countries involved – is credited with a sharp rise in the popularity of running in the past decade, but with benefits come downsides.

A new research paper by University of South Australia Adjunct Professor Jan de Jonge and his team reveals the price that runners (and society) pay when the sport becomes an obsession.

Prof de Jonge, based in the Netherlands at Eindhoven University of Technology and Utrecht University, surveyed 246 recreational runners aged 19 to 77 years to investigate how a person’s mental outlook (mental recovery and passion for running) affects their risk of running-related injuries.

Not surprisingly, the more “obsessively passionate” runners – where the sport fully controlled their life to the detriment of partners, friends and relatives – reported far more running-related injuries than those who were more “harmoniously passionate” and laid back in their approach to running.

The latter group, who are in full control of their running and integrate the sport into their life and other activities, reported faster mental recovery after a run and sustained fewer running-related injuries. They were more likely to heed the early warning signs of injuries and take both physical and mental breaks from running whenever necessary.

Obsessively passionate runners disregarded the need to recover after training and failed to mentally detach from the sport, even when running became harmful. Their approach to running delivered short-term gains such as faster times but resulted in more running-related injuries.

Age and gender played a part. The older runners were able to mentally detach and recover a lot faster after a run than those in the 20-34 age group – especially females – who were more prone to running-related injuries.

“Most running-related injuries are sustained as a result of overtraining and overuse or failing to adequately recover, merely due to an obsessive passion for running,” Prof de Jonge says.

“The majority of research focuses on the physical aspects of overtraining and lack of recovery time, but the mental aspects of running-related injuries have been ignored to date.

“When running becomes obsessive, it leads to problems. It controls the person’s life at the expense of other people and activities and leads to more running-related injuries. This behaviour has also been reported in other sports, including professional dancing and cycling.”

In the Netherlands, where the study was undertaken, running-related injuries costs the economy approximately €10 million a year (A$16 million) in medical costs, work absences and reduced productivity. Next to soccer, running is the Dutch sport with the highest number of injuries.

While there are no comparative figures available for Australia, a study by Medibank Private lists running as the 4th most injury-prone sport in Australia after Aussie Rules, basketball and netball, with sporting injuries overall costing the economy more than $2 billion a year.

The paper, “Mental Recovery and Running-Related Injuries in Recreational Runners: the Moderating Role of Passion for Running”, is published open access in the International Journal of Environmental Research and Public Health.

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Do running shoes prevent running injury?

There is no clear answer to this. They may help prevent injury or they may not. Check out this PodChatLive video in which the hosts discussed this issue with Michael Nitschke who is a runner, coach and a Podiatrist.

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Maximal running shoes may increase injury risk to some runners

Press Release:

BEND, Ore. – Lower leg pain and injuries have long been a problem for runners, but research at Oregon State University-Cascades has shown that one type of running shoe may increase such risks for some runners.

Researchers in the Functional Orthopedic Research Center of Excellence (FORCE) Lab compared the biomechanics associated with “maximal” and “neutral” running shoes in tests with 15 female runners. The study concluded that runners experienced a higher impact peak and increased loading rate with the “maximal” shoes. Increases in both factors are associated with a greater likelihood of injury, such as plantar fasciitis and tibial stress fractures.

The study was published in The Orthopaedic Journal of Sports Medicine and is believed to be the first rigorous analysis of impacts associated with maximal shoes.

Maximal running shoes feature increased cushioning, particularly in the forefoot region of the midsole, and have gained popularity since being introduced in 2010. More than 20 varieties of maximal shoes are on the market.

Runners wearing maximal shoes, the researchers wrote, have reported feeling the extra cushion after running two to three miles. As a result, the researchers did not expect to find increases in impact peak or loading rate in runners wearing maximal shoes.

In the FORCE Lab study, researchers evaluated the impacts on runners’ feet and legs before and after a simulated 5,000 meter (about 3 miles) run on a treadmill. Each subject wore a neutral running shoe (New Balance 880) for one test and then, after a seven to 10-day waiting period, repeated the procedure with a maximal shoe (Hoke One One Bondi 4). In each test, 3D movements and forces were measured by monitoring reflective markers placed on the runners’ shoes and legs and by having the subjects run over a “force plate” that recorded the forces being applied as the runner’s foot hit the surface.

“We were surprised by these results,” said Christine Pollard, director of the FORCE Lab and an associate professor of kinesiology. “We thought we would see the opposite. Typically, increased cushioning results in a reduction in the impact peak and loading rate of the vertical ground reaction force. We suspect that the large amount of cushioning across the entire midsole caused the runners to rely more on the shoe than on their own internal structures to attenuate these forces.”

The study also evaluated the degree of “peak eversion,” the outward turning of the foot, a factor associated with injury risk. The researchers found no difference between the maximal and neutral shoes.

The research is a first step in gathering evidence on the effects of maximal running shoes on runners’ injury risks, said Pollard, who is also a licensed physical therapist. Maximal shoes are becoming very popular, but without controlled studies, clinicians have been unable to make science-based recommendations to runners.

Pollard said she expects that a study with male runners might produce different results. “We know that gender differences in running biomechanics do exist,” she added.

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‘Minimal’ shoes may reduce running injuries

Press Release:

Runners who wear trainers with no cushioning and land on the ball of their foot rather than the heel put significantly less demand on their bodies, new research suggests.

Researchers compared how quickly the force acts when runners’ feet hit the ground — known as the loading rate — which has been shown to influence running injury risk.

The study of 29 runners found significantly lower loading rates for those who wore so-called minimal trainers and landed on the ball of their foot, compared to people in normal running shoes, regardless of whether the latter landed on the heel or ball of the foot.

Lead author Dr Hannah Rice, of the University of Exeter, said: “So many people use running as a means of reducing the risk of chronic diseases, but about three quarters of runners typically get injured in a year.

“Footwear is easily modifiable but many runners are misguided when it comes to buying new trainers. “This research shows that running in minimal shoes and landing on the balls of your feet reduces loading rates and may therefore reduce the risk of injury.”

Running continues to grow in popularity, and research aimed at reducing the high incidence of running-related injuries has been ongoing for decades — but injury rates have not fallen.

Modern-day runners in cushioned footwear tend to land on their heel — known as a “rearfoot strike” — while those who run in the natural barefoot state are more likely to land on the ball of their foot – a “forefoot strike”.

Rearfoot strike runners experience an abrupt vertical impact force each time the foot lands on the ground. This impact force is often missing when running with a forefoot strike, but previous research has shown that forward/backwards and sideways forces can be higher with a forefoot strike, meaning the total force is similar.

Total force seems to be similar between foot strikes if wearing modern, cushioned trainers.

Dr Rice said: “This seems to suggest that, for runners in traditional, cushioned running shoes, foot strike pattern may not matter for injury risk.

“However, we suspected that the same may not be true of runners who regularly use minimal shoes, which don’t have the cushioning provided by traditional running shoes.

“Our research tells us that becoming accustomed to running with a forefoot strike in shoes that lack cushioning promotes a landing with the lowest loading rates, and this may be beneficial in reducing the risk of injury”

Any transition to new footwear or to a different foot strike pattern should be undertaken gradually, and with guidance.

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