Wilzman Andrew R, Tenforde Adam S, Troy Karen L, Hunt Kenneth, Fogel Nathaniel, Roche Megan Deakins, Kraus Emily, Trikha Rishi, Delp Scott, Fredericson Michael
Worcester Polytechnic Institute, Worcester, Massachusetts, USA.
Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA.
Orthop J Sports Med. 2022 Jun 15;10(6):23259671221104793. doi: 10.1177/23259671221104793. eCollection 2022 Jun.
Bone stress injury (BSI) is a common reason for missed practices and competitions in elite track and field runners.
It was hypothesized that, after accounting for medical risk factors, higher plantar loading during running, walking, and athletic movements would predict the risk of future BSI in elite collegiate runners.
Cohort study; Level of evidence, 2.
A total of 39 elite collegiate runners (24 male, 15 female) were evaluated during the 2014-2015 academic year to determine the degree to which plantar pressure data and medical history (including Female and Male Athlete Triad risk factors) could predict subsequent BSI. Runners completed athletic movements while plantar pressures and contact areas in 7 key areas of the foot were recorded, and the measurements were reported overall and by specific foot area. Regression models were constructed to determine factors related to incident BSI.
Twenty-one runners (12 male, 9 female) sustained ≥1 incident BSI during the study period. Four regression models incorporating both plantar pressure measurements and medical risk factors were able to predict the subsequent occurrence of (A) BSIs in female runners, (B) BSIs in male runners, (C) multiple BSIs in either male or female runners, and (D) foot BSIs in female runners. Model A used maximum mean pressure (MMP) under the first metatarsal during a jump takeoff and only misclassified 1 female with no BSI. Model B used increased impulses under the hindfoot and second through fifth distal metatarsals while walking, and under the lesser toes during a cutting task, correctly categorizing 83.3% of male runners. Model C used higher medial midfoot peak pressure during a shuttle run and triad cumulative risk scores and correctly categorized 93.3% of runners who did not incur multiple BSIs and 66.7% of those who did. Model D included lower hindfoot impulses in the shuttle run and higher first metatarsal MMP during treadmill walking to correctly predict the subsequent occurrence of a foot BSI for 75% of women and 100% without.
The models collectively suggested that higher plantar pressure may contribute to risk for BSI.
骨应力损伤（BSI）是精英田径运动员训练和比赛缺赛的常见原因。
研究假设，在考虑医学风险因素后，跑步、行走及运动时较高的足底负荷可预测精英大学生运动员未来发生BSI的风险。
队列研究；证据等级，2级。
在2014 - 2015学年对39名精英大学生运动员（24名男性，15名女性）进行评估，以确定足底压力数据和病史（包括女运动员三联征和男运动员三联征风险因素）预测后续BSI的程度。运动员完成运动动作时，记录足部7个关键区域的足底压力和接触面积，并按整体及特定足部区域报告测量结果。构建回归模型以确定与新发BSI相关的因素。
在研究期间，21名运动员（12名男性，9名女性）发生了≥1次BSI事件。四个结合了足底压力测量和医学风险因素的回归模型能够预测：（A）女运动员的BSI；（B）男运动员的BSI；（C）男或女运动员的多次BSI；（D）女运动员的足部BSI。模型A使用起跳时第一跖骨下方的最大平均压力（MMP），仅将1名无BSI的女性误分类。模型B使用行走时后足及第二至第五跖骨远端下方增加的冲量，以及变向任务时小脚趾下方增加的冲量，正确分类了83.3%的男运动员。模型C使用往返跑时较高的足内侧中足峰值压力和三联征累积风险评分，正确分类了93.3%未发生多次BSI的运动员和66.7%发生多次BSI的运动员。模型D包括往返跑时较低的后足冲量和跑步机行走时较高的第一跖骨MMP，正确预测了75%有足部BSI的女性和100%无足部BSI的女性后续足部BSI的发生情况。
这些模型共同表明较高的足底压力可能会增加BSI的风险。
