Evidence for running shoes and orthoses Orthopaedic Summit 2018 - - PowerPoint PPT Presentation

Movement Science Laboratory

Evidence for running shoes and orthoses

Orthopaedic Summit 2018 Las Vegas, NV Dec. 8th, 2018

Richard Willy, PhD, PT, OCS

Assistant Professor Motion Analysis Laboratory Physical Therapy University of Montana

The presenter has no financial relationships or product endorsements to disclose

Movement Science Laboratory

The presenter has no financial relationships

• r product endorsements to disclose

Movement Science Laboratory

Why do shoes garner such attention?

Fashion statement Endorsements We love bandwagons! Emphasis on engineering Gear obsession? Attribute performances Inexpensive “treatment” and “prevention”

Msnbc.com

Photo credit: Derek Oxley

Ampla.com

Nike.com Runfoot.com

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Assigning shoes based on foot type

Knapik et al., 2010

Sportspodiatryinfo.com

1042 Air Force basic trainees (913 males, 346 female) Level II study: Injury risk unaffected by shoe assignment Predictors of injury: Smoking habit and low aerobic fitness

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Baseline assessment Foot posture assessment and shoe randomization, n=105 13 Week Half marathon program Injury incidence: 32%

Evidence for footwear prescription

Ryan 2011

Neutral foot (n=51)

Pegasus (n=17) Structure Triax (n=18) Nucleus (n=16)

Pronated foot (n=36)

Pegasus (n=12) Structure Triax (n=12) Nucleus (n=12)

Highly Pronated (n=18)

Pegasus (n=6) Structure Triax (n=5) Nucleus (n=7)

Motion control shoes: highest risk of injury, regardless of foot type Neutral foot in the neutral shoe= more injuries than in stability shoe!

Movement Science Laboratory

• 927 runners: Tracked running volume via GPS for 12-months
• Foot posture index measured

– Highly supinated (n=53) – Supinated (n=369) – Pronated (n=122) – Highly pronated (n=18)

• 252 sustained injury

Runners classified as “pronators”: Lowest injury rate per 1000 km

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2011-2012 peak

Hokaoneone.com Vibram.com

Movement Science Laboratory Healthy runners (n=61) Minimalist shoe (n=31)

Asics Piranha

Standard shoe (n=30)

Asics Cumulus

26 week transition period: Increased use of issued shoe, decreased use of their own shoe a) No overall difference in injury incidence, BUT b) High mileage, heavy runners (>71.4 kg): minimalist injuries

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Measurement of stack height and shoe drop

Stack height heel - stack height forefoot= Shoe drop

Runningwarehouse.com Runningwarehouse.com

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What about zero drop shoes?

32 mm heel 32 mm forefoot 27 mm heel 17 mm forefoot

Brooks Launch Altra Torin

10 mm drop 0 mm drop

Zero drop shoes: Purported to encourage “natural, more efficient running”

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Randomized 577 runners, 18-65 years of age, running for at least 12 months without interruption due to injury

Does shoe drop affect injury rates?

Malisoux 2016

10 cm Drop Shoe (n=190) 6 cm Drop Shoe (n=194) Zero Drop Shoe (n=193) Lost to follow-up (n=14) Lost to follow-up (n=4) Lost to follow-up (n=6) Injury incidence: 21.6% Injury incidence: 27.4% Injury incidence: 24.6% 6 months running 10.33 injuries per 1000 hours of running

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Shoe fitting recommendations

No evidence for shoe prescription Knapik 2010, 2014, Ryan 2011 Rotating shoes: 39% reduced risk of running injury Malisoux 2015

“Comfort filter”: Comfortable shoes result in reduced metabolic demand, optimize gait Nigg 2015

?

“Pick a shoe that seems to need no break-in period”

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Foot orthoses: 41% reduction in risk of stress fracture Median PEDro: 5/10, range: 3-8

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Orthoses for treatment of PFP

Only 1 Level I study Collins 2009 Results: Foot orthoses + PT better at 6- and 12- weeks vs. PT alone >10.96mm change in midfoot width: clinical prediction rule Vicenzino 2010 Barton et al., 2011: If single leg squat pain decreases w/ orthoses, use in early rehab

McPoil 2009

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Recommendation: OTC orthoses, mainly in 1st 6 months of treatment

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Summary

Shoe prescription based on foot shape or mechanics does not reduce injury incidence Shoe drop does not influence injury incidence Minimalist shoes may place less fit, higher BMI runners at elevated risk Rotating shoes reduces risk considerably Foot orthoses reduce risk of bone stress injuries Orthoses beneficial in treatment of plantar fasciopathy and patellofemoral pain, mainly in 1st 3-6 months treatment

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1. Bonanno DR, Landorf KB, Munteanu SE, Murley GS, Menz HB. Effectiveness of foot orthoses and shock-absorbing insoles for the prevention of injury: a systematic review and meta-analysis. Br J Sports Med. 2017;51:86-96. 2. Collins N, Crossley K, Beller E, Darnell R, McPoil T, Vicenzino B. Foot orthoses and physiotherapy in the treatment of patellofemoral pain syndrome: randomised clinical trial. British Journal of Sports Medicine. 2009;43:163-168. 3. Knapik JJ, Trone DW, Swedler DI, et al. Injury reduction effectiveness of assigning running shoes based on plantar shape in Marine Corps basic training. Am J Sports Med. 2010;38:1759-1767. 4. Malisoux L, Chambon N, Urhausen A, Theisen D. Influence of the Heel-to-Toe Drop of Standard Cushioned Running Shoes on Injury Risk in Leisure-Time Runners: A Randomized Controlled Trial With 6-Month Follow-up. Am J Sports Med. 2016;44:2933-2940. 5. Malisoux L, Ramesh J, Mann R, Seil R, Urhausen A, Theisen D. Can parallel use of different running shoes decrease running- related injury risk? Scandinavian journal of medicine & science in sports. 2015;25:110-115. 6. Martin RL, Davenport TE, Reischl SF, et al. Heel pain-plantar fasciitis: revision 2014. J Orthop Sports Phys Ther. 2014;44:A1- 33. 7. Molloy JM, Christie DS, Teyhen DS, et al. Effect of running shoe type on the distribution and magnitude of plantar pressures in individuals with low- or high-arched feet. J Am Podiatr Med Assoc. 2009;99:330-338. 8. Mundermann A, Stefanyshyn DJ, Nigg BM. Relationship between footwear comfort of shoe inserts and anthropometric and sensory factors. Med Sci Sports Exerc. 2001;33:1939-1945. 9. Nielsen RO, Buist I, Parner ET, et al. Foot pronation is not associated with increased injury risk in novice runners wearing a neutral shoe: a 1-year prospective cohort study. Br J Sports Med. 2014;48:440-447. 10. Nielsen RO, Parner ET, Nohr EA, Sorensen H, Lind M, Rasmussen S. Excessive Progression in Weekly Running Distance and Risk of Running-related Injuries: An Association Modified by Type of Injury. J Orthop Sports Phys Ther. 2014;1-25. 11. Nigg BM, Baltich J, Hoerzer S, Enders H. Running shoes and running injuries: mythbusting and a proposal for two new paradigms: 'preferred movement path' and 'comfort filter'. Br J Sports Med. 2015;49:1290-1294. 12. Nigg BM, Wakeling JM. Impact forces and muscle tuning: a new paradigm. Exerc Sport Sci Rev. 2001;29:37-41. 13. Ridge ST, Johnson AW, Mitchell UH, et al. Foot bone marrow edema after a 10-wk transition to minimalist running shoes. Med Sci Sports Exerc. 2013;45:1363-1368. 14. Ryan MB, Valiant GA, McDonald K, Taunton JE. The effect of three different levels of footwear stability on pain outcomes in women runners: a randomised control trial. Br J Sports Med. 2011;45:715-721. 15. Vicenzino B, Collins N, Crossley K, Beller E, Darnell R, McPoil T. Foot orthoses and physiotherapy in the treatment of patellofemoral pain syndrome: a randomised clinical trial. BMC musculoskeletal disorders. 2008;9:27. 16. Whittaker GA, Munteanu SE, Menz HB, Tan JM, Rabusin CL, Landorf KB. Foot orthoses for plantar heel pain: a systematic review and meta-analysis. Br J Sports Med. 2017; 17. Willson JD, Bjorhus JS, Williams DS, 3rd, Butler RJ, Porcari JP, Kernozek TW. Short-term changes in running mechanics and foot strike pattern after introduction to minimalistic footwear. PM R. 2014;6:34-43; quiz 43.

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Acknowledgements

OSET Organizing Committee Collaborators: John Willson, PT, PHD; Stacey Meardon, PT, PhD; Paul DeVita, PhD, Ryan Mizner, PT, PhD, Christian Barton, PT, PhD Rich.willy@umontana.edu @rwilly2003

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Focus on the individual: Shoe prescription

24 year-old female marathoner Left repeat proximal 5th metatarsal stress fracture

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Rocker bottom sole

Sobhani 2013

Reduced Achilles tendon loads

Sobhani 2013, 2015

Reduced forefoot pressures

Sobhani 2014

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Effect of training in minimalist shoes

Willson 2014 Training phase Rearfoot strikers Non-rearfoot strikers At enrollment (Standard shoes) 19 Baseline (Vibrams) 12 5 Post-training (Vibrams) 9 8

Vibram.com

6 x 20 min training in minimalist shoes “Some runners shift off their heels with these shoes” 10/19 runners demonstrated bone marrow edema Ridge 2013

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Foot orthoses: Injury prevention

Absolute Risk Reduction: 0.49 (p<0.001): Favoring orthoses

Foot orthoses: Effective at reducing primarily bone stress injuries Median PEDro: 5/10, range: 3-8