Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Department of Health and Sport Medicine, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran.
PLoS One. 2021 Feb 10;16(2):e0246425. doi: 10.1371/journal.pone.0246425. eCollection 2021.
Atypical rearfoot in/eversion may be an important risk factor for running-related injuries. Prominent interventions for atypical rearfoot eversion include foot orthoses, footwear, and taping but a modification derived from gait retraining to correct atypical rearfoot in/eversion is lacking. We aimed to investigate changes in rearfoot in/eversion, subtalar pronation, medial longitudinal arch angle, and selected lower limb joint biomechanics while performing toe-in/toe-out running using real-time visual feedback. Fifteen female runners participated in this study. Subjects performed toe-in/toe-out running using real-time visual feedback on foot progression angle, which was set ±5° from habitual foot progression angle. 3D kinematics of rearfoot in/eversion, subtalar supination/pronation, medial longitudinal arch angle, foot progression angle, hip flexion, ab/adduction and internal/external rotation, knee flexion, ankle dorsiflexion, and ankle power were analyzed. A repeated-measures ANOVA followed by pairwise comparisons was used to analyze changes between three conditions. Toe-in running compared to normal and toe-out running reduced peak rearfoot eversion (mean difference (MD) with normal = 2.1°; p<0.001, MD with toe-out = 3.5°; p<0.001), peak pronation (MD with normal = -2.0°; p<0.001, MD with toe-out = -3.4; p = <0.001), and peak medial longitudinal arch angle (MD with normal = -0.7°; p = 0.022, MD with toe-out = -0.9; p = 0.005). Toe-out running significantly increased these kinematic factors compared to normal and toe-in running. Toe-in running compared to normal running increased peak hip internal rotation (MD = 2.3; p<0.001), and reduced peak knee flexion (MD = 1.3; p = 0.014). Toe-out running compared to normal running reduced peak hip internal rotation (MD = 2.5; p<0.001), peak hip ab/adduction (MD = 2.5; p<0.001), peak knee flexion (MD = 1.5; p = 0.003), peak ankle dorsiflexion (MD = 1.6; p<0.001), and peak ankle power (MD = 1.3; p = 0.001). Runners were able to change their foot progression angle when receiving real-time visual feedback for foot progression angle. Toe-in/toe-out running altered rearfoot kinematics and medial longitudinal arch angle, therefore supporting the potential value of gait retraining focused on foot progression angle using real-time visual feedback when atypical rearfoot in/eversion needs to be modified. It should be considered that changes in foot progression angle when running is accompanied by changes in lower limb joint biomechanics.
非典型的后足内翻/外翻可能是与跑步相关损伤的一个重要危险因素。纠正非典型后足外翻的显著干预措施包括足矫形器、鞋类和贴扎，但缺乏一种源自步态再训练的、可纠正非典型后足内翻/外翻的改良方法。我们旨在研究在使用实时视觉反馈进行足内/外翻跑步时，后足内/外翻、距下关节内翻/外翻、内侧纵弓角度和选定的下肢关节生物力学的变化情况。15 名女性跑步者参与了这项研究。研究对象使用实时视觉反馈进行足内/外翻跑步，其足行进角度设置为习惯足行进角度的±5°。分析了后足内/外翻、距下关节内翻/外翻、内侧纵弓角度、足行进角度、髋关节屈曲、内收/外展和内旋/外旋、膝关节屈曲、踝关节背屈和踝关节功率的三维运动学。使用重复测量方差分析（ANOVA）和两两比较分析三种状态下的变化情况。与正常跑步和足外展跑步相比，足内展跑步减少了后足最大外翻（与正常跑步相比的平均差异（MD）=2.1°；p<0.001，与足外展跑步相比的 MD=3.5°；p<0.001）、最大内翻（与正常跑步相比的 MD=-2.0°；p<0.001，与足外展跑步相比的 MD=-3.4°；p=0.001）和最大内侧纵弓角度（与正常跑步相比的 MD=-0.7°；p=0.022，与足外展跑步相比的 MD=-0.9°；p=0.005）。与正常跑步和足内展跑步相比，足外展跑步显著增加了这些运动学因素。与正常跑步相比，足内展跑步增加了最大髋关节内旋（MD=2.3°；p<0.001），并减少了最大膝关节屈曲（MD=1.3°；p=0.014）。与正常跑步相比，足外展跑步减少了最大髋关节内旋（MD=2.5°；p<0.001）、最大髋关节内收/外展（MD=2.5°；p<0.001）、最大膝关节屈曲（MD=1.5°；p=0.003）、最大踝关节背屈（MD=1.6°；p<0.001）和最大踝关节功率（MD=1.3°；p=0.001）。跑步者能够在接收实时视觉反馈以调整足行进角度时改变其足行进角度。足内/外翻跑步改变了后足运动学和内侧纵弓角度，因此支持当需要纠正非典型后足内/外翻时，使用实时视觉反馈进行以足行进角度为焦点的步态再训练的潜在价值。应该考虑到跑步时足行进角度的变化伴随着下肢关节生物力学的变化。
