The forefoot (FF) running pattern has been recently advocated to improve running economy and prevent overuse injuries compared to the rearfoot (RF) pattern. However, these claims have not been supported by empirical evidence. The purpose of this dissertation was to investigate the potential advantages of RF and FF patterns to improve running economy and reduce injury risk in 20 natural RF and 20 natural FF runners. The first study found that the RF group was more economical when performing the RF pattern at a slow, medium, and fast speed vs. FF running. Only running at the fast speed resulted in a difference in economy between footfall patterns in the FF group in which RF running was more economical. Therefore, there is no advantage of FF running for improving running economy. The results of the second study indicated that there was a weak to moderate relationship between Achilles tendon (AT) moment arm length and running with either RF or FF patterns. AT force was greater during FF running, which may increase the risk of developing tendon injury. The third study used a modeling approach to find that FF running resulted in greater elastic energy recoil in the gastrocnemius (GA) and the soleus (SO). However, greater mechanical work overall with FF running resulted in no difference in metabolic cost of the GA between footfall patterns but greater metabolic cost of the SO compared to RF running. The fourth study found that shock attenuation was greater during RF running compared to FF running. Greater shock attenuation during RF running was a result of an increased load imposed on the system. Decomposing the vertical ground reaction force in the frequency domain revealed that RF running may have a greater reliance on passive shock attenuation mechanism whereas the FF pattern may have a greater reliance on active shock attenuation mechanisms. These results suggest that previous speculation that the FF running pattern is more economical was not substantiated. It is likely that each footfall pattern exposes a runner to different types of injuries, rather than one footfall pattern being more injurious than another.

INTRODUÇÃO: As alterações do comprimento relativo dos metatarsais no plano axial são consideradas por muitos autores uma causa de distribuição inadequada da carga durante a marcha, sobrecarregando as estruturas plantares do antepé, culminando com a metatarsalgia. A meta do tratamento cirúrgico dessa síndrome é estabelecer o alinhamento da fórmula metatarsal. Porém, muitos estudos evidenciam uma taxa de 15% de recidiva da metatarsalgia após a reconstrução do formato preconizado no plano axial, conduzindo a um questionamento sobre a importância do alinhamento das cabeças dos metatarsais no plano coronal. OBJETIVO: Esse estudo tem como objetivo avaliar o padrão de alinhamento das cabeças dos metatarsais no plano coronal com carga, em indivíduos sem e com metatarsalgia. MÉTODO: Estudo transversal, avaliou 106 indivíduos entre 30 a 65 anos, dividindo-os em dois grupos de 106 pés cada, um sem dor, deformidades e calosidades nos pés e outro grupo com metatarsalgia entre os 2º, 3º e 4º metatarsais. O recrutamento dos indivíduaos foi realizado no Pronto Socorro do IOT e no ambulatório do IOT HC FMUSP, respeitando os critérios de inclusão, exclusão e aplicando o Termo de Consentimento Livre e Esclarecido. Indivíduos com deformidades no mediopé, retropé e tornozelo, pacientes com cirurgias ou fraturas prévias no pé, doenças reumatológicas e síndromes osteoneuromusculares, não foram incluídos. Após a seleção, os indivíduos foram submetidos a duas radiografias, uma axial do antepé com carga, avaliando o plano coronal de modo a aferir as alturas das cabeças dos metatarsais, e uma anteroposterior dos pés com carga, determinando o comprimento de cada raio. A análise estatística foi realizada, comparando as medidas entre os grupos. RESULTADOS: Foram avaliados 106 indivíduos, divididos em dois grupos com 106 pés cada. No grupo com metatarsalgia, 34 pés (32%) eram de pacientes do sexo masculino, apresentando uma média de idade de 49,5 anos. Foram identificados 33 pés com hálux valgo no grupo com metatarsalgia. No grupo sem patologia 54 pés (51%) eram de pacientes do sexo masculino, apresentando uma média de idade de 44,6 anos. As variáveis antropométricas como tamanho do pé, peso, altura e IMC, entre os grupos, não apresentaram diferença estatística. As cabeças dos metatarsais em ambos grupos se distribuíram em formato não retilíneo no plano coronal, seguindo a fórmula M1 M3 > M4=M5. O apoio distal do 1º raio apresentou uma posição mais plantar no grupo com metatarsalgia (p=0,000). CONCLUSÃO: As cabeças dos metatarsais em indivíduos com metatarsalgia e sem deformidade em valgo do 1º dedo, se alinharam no plano coronal de modo que M1 M3 > M4=M5, sendo M1 < M3, M1 < M4 e o M1 < M5. As cabeças dos metatarsais em indivíduos sem dor, calosidades e deformidades no antepé, se alinharam no plano coronal de modo que M1 M3 > M4=M5, sendo M1 < M3 e M1=M4=M5. No plano coronal o ponto de apoio do M1 se posicionou mais plantar nos pés de indivíduos com metatarsalgia / INTRODUCTION: Many authors consider the differences in the relative length of metatarsals in the axial plane, the cause of inadequate load distribution during the gait, overloading the forefoot plantar structures, culminating with metatarsalgia. The realignment of the metatarsal formula is the goal of surgical treatment of this syndrome. However, many studies have shown a 15% rate of metatarsalgia recurrence after the reconstruction in the axial plane, questioning the importance of the metatarsal heads alignment in the coronal plane. OBJECTIVE: This study aims to evaluate the alignment pattern of metatarsal heads in the coronal plane in individuals with and without metatarsalgia. METHODS: A cross-sectional study evaluated 106 individuals between 30 and 65 years old. They were divided in two groups of 106 feet each, one without foot pathologies and another group with metatarsalgia between the 2nd, 3rd and 4th metatarsals. The recruitment was performed at the IOT HC FMUSP for both groups, respecting the criteria of inclusion, exclusion and applying the Informed Consent Term. Individuals with midfoot, hindfoot and ankle deformities, patients with previous surgeries or fractures in the foot, rheumatologic diseases and osteoneuromuscular syndromes were not included. After the selection, the subjects were submitted to one weightbearing forefoot axial radiograph, evaluating the coronal plane in order to verify the heights of the metatarsals heads, and other weightbearing anteroposterior foot radiograph, determining the length of each ray. Statistical analysis was performed comparing the measurements between groups. RESULTS: A hundred six individuals were evaluated, forming two groups with 106 feet each. The group with metatarsalgia presented 34 male patients feet (32%), with a mean age of 49.5 years. Thirty-three feet with hallux valgus were identified in the metatarsalgia group. In the non-pathological group were found 54 male patients feet (51%), with a mean age of 44.6 years. Anthropometric variables such as foot size, body weight, height and BMI between the groups did not present statistical difference. The metatarsal heads in both groups were distributed in curved line in the coronal plane, following the formula M1 M3 > M4 = M5. The distal support of the 1st ray was positioned more plantar in the metatarsalgia group (p = 0.000). CONCLUSION: The metatarsal heads in individuals with metatarsalgia and no hallux valgus, were aligned in the coronal plane following this formula M1 M3 > M4 = M5, with M1 < M3, M1 < M4 and M1 < M5. The metatarsal heads in individuals without pain, callosities and forefoot deformities, were aligned in the coronal plane following the position M1 M3 > M4 = M5, with M1 < M3 and M1 = M4 = M5. In the coronal plane, the M1 weightbearing point was more plantar in the feet of individuals with metatarsalgia

INTRODUÇÃO: As alterações do comprimento relativo dos metatarsais no plano axial são consideradas por muitos autores uma causa de distribuição inadequada da carga durante a marcha, sobrecarregando as estruturas plantares do antepé, culminando com a metatarsalgia. A meta do tratamento cirúrgico dessa síndrome é estabelecer o alinhamento da fórmula metatarsal. Porém, muitos estudos evidenciam uma taxa de 15% de recidiva da metatarsalgia após a reconstrução do formato preconizado no plano axial, conduzindo a um questionamento sobre a importância do alinhamento das cabeças dos metatarsais no plano coronal. OBJETIVO: Esse estudo tem como objetivo avaliar o padrão de alinhamento das cabeças dos metatarsais no plano coronal com carga, em indivíduos sem e com metatarsalgia. MÉTODO: Estudo transversal, avaliou 106 indivíduos entre 30 a 65 anos, dividindo-os em dois grupos de 106 pés cada, um sem dor, deformidades e calosidades nos pés e outro grupo com metatarsalgia entre os 2º, 3º e 4º metatarsais. O recrutamento dos indivíduaos foi realizado no Pronto Socorro do IOT e no ambulatório do IOT HC FMUSP, respeitando os critérios de inclusão, exclusão e aplicando o Termo de Consentimento Livre e Esclarecido. Indivíduos com deformidades no mediopé, retropé e tornozelo, pacientes com cirurgias ou fraturas prévias no pé, doenças reumatológicas e síndromes osteoneuromusculares, não foram incluídos. Após a seleção, os indivíduos foram submetidos a duas radiografias, uma axial do antepé com carga, avaliando o plano coronal de modo a aferir as alturas das cabeças dos metatarsais, e uma anteroposterior dos pés com carga, determinando o comprimento de cada raio. A análise estatística foi realizada, comparando as medidas entre os grupos. RESULTADOS: Foram avaliados 106 indivíduos, divididos em dois grupos com 106 pés cada. No grupo com metatarsalgia, 34 pés (32%) eram de pacientes do sexo masculino, apresentando uma média de idade de 49,5 anos. Foram identificados 33 pés com hálux valgo no grupo com metatarsalgia. No grupo sem patologia 54 pés (51%) eram de pacientes do sexo masculino, apresentando uma média de idade de 44,6 anos. As variáveis antropométricas como tamanho do pé, peso, altura e IMC, entre os grupos, não apresentaram diferença estatística. As cabeças dos metatarsais em ambos grupos se distribuíram em formato não retilíneo no plano coronal, seguindo a fórmula M1 M3 > M4=M5. O apoio distal do 1º raio apresentou uma posição mais plantar no grupo com metatarsalgia (p=0,000). CONCLUSÃO: As cabeças dos metatarsais em indivíduos com metatarsalgia e sem deformidade em valgo do 1º dedo, se alinharam no plano coronal de modo que M1 M3 > M4=M5, sendo M1 < M3, M1 < M4 e o M1 < M5. As cabeças dos metatarsais em indivíduos sem dor, calosidades e deformidades no antepé, se alinharam no plano coronal de modo que M1 M3 > M4=M5, sendo M1 < M3 e M1=M4=M5. No plano coronal o ponto de apoio do M1 se posicionou mais plantar nos pés de indivíduos com metatarsalgia / INTRODUCTION: Many authors consider the differences in the relative length of metatarsals in the axial plane, the cause of inadequate load distribution during the gait, overloading the forefoot plantar structures, culminating with metatarsalgia. The realignment of the metatarsal formula is the goal of surgical treatment of this syndrome. However, many studies have shown a 15% rate of metatarsalgia recurrence after the reconstruction in the axial plane, questioning the importance of the metatarsal heads alignment in the coronal plane. OBJECTIVE: This study aims to evaluate the alignment pattern of metatarsal heads in the coronal plane in individuals with and without metatarsalgia. METHODS: A cross-sectional study evaluated 106 individuals between 30 and 65 years old. They were divided in two groups of 106 feet each, one without foot pathologies and another group with metatarsalgia between the 2nd, 3rd and 4th metatarsals. The recruitment was performed at the IOT HC FMUSP for both groups, respecting the criteria of inclusion, exclusion and applying the Informed Consent Term. Individuals with midfoot, hindfoot and ankle deformities, patients with previous surgeries or fractures in the foot, rheumatologic diseases and osteoneuromuscular syndromes were not included. After the selection, the subjects were submitted to one weightbearing forefoot axial radiograph, evaluating the coronal plane in order to verify the heights of the metatarsals heads, and other weightbearing anteroposterior foot radiograph, determining the length of each ray. Statistical analysis was performed comparing the measurements between groups. RESULTS: A hundred six individuals were evaluated, forming two groups with 106 feet each. The group with metatarsalgia presented 34 male patients feet (32%), with a mean age of 49.5 years. Thirty-three feet with hallux valgus were identified in the metatarsalgia group. In the non-pathological group were found 54 male patients feet (51%), with a mean age of 44.6 years. Anthropometric variables such as foot size, body weight, height and BMI between the groups did not present statistical difference. The metatarsal heads in both groups were distributed in curved line in the coronal plane, following the formula M1 M3 > M4 = M5. The distal support of the 1st ray was positioned more plantar in the metatarsalgia group (p = 0.000). CONCLUSION: The metatarsal heads in individuals with metatarsalgia and no hallux valgus, were aligned in the coronal plane following this formula M1 M3 > M4 = M5, with M1 < M3, M1 < M4 and M1 < M5. The metatarsal heads in individuals without pain, callosities and forefoot deformities, were aligned in the coronal plane following the position M1 M3 > M4 = M5, with M1 < M3 and M1 = M4 = M5. In the coronal plane, the M1 weightbearing point was more plantar in the feet of individuals with metatarsalgia

Objectives: The aim of the study was to evaluate how lower limbs injuries are related to footstrike pattern in 800 m women runners aged 16 - 22 in the Czech Republic and around the world. Methods: Due to the current epidemiological situation, the original field investigation of 48 runners was not possible to complete. Literature research on the topic and the series of ten case studies were performed instead. The research was performed in following databases: Medline, ScienceDirect, SPORTDiscus and Bibliographia medica Čechoslovaca. Results showed seven studies that met inclusion criteria. After that footstrike pattern was evaluated and compared with injury history in 10 women runners in 800 meters, who took part in the Czech Republic championship. Results: Two studies out of seven confirmed a higher incidence of injuries in RFS than in FFS, 4/7 did not show a significant difference, 1/7 did not evaluate the higher incidence in one or the other type of the footstrike. Three studies out of seven confirmed the relationship between RFS and knee injuries. Furthermore, two of them showed relationship between RFS and hip pain. 2/7 did not confirm any relationship between footstrike pattern and specific injury and 2/7 did not evaluated this relationship at all. Based on the series of ten case studies, it...

Title: Effect of mechanical correction and active exercise in the treatment of deformity of the fifth toe - Tailor's bunion Objectives: The aim of this thesis is to identify the effect of mechanical correction and active physiotherapeutic intervention in the treatment of deformity Tailor's bunion. Methods: This is a quantitative-qualitative experimental study involving 10 probands aged 19 to 25 with flexible Tailor's bunion deformity, 6 out of 10 probands had bilateral deformity and the remaining probands unilateral deformity. In this thesis, passive intervention in the form of mechanical axial correction of V. MTP joint by strapping tape was used and active intervention in the form of selected active exercise aimed at evaluating (identifying) the effect on selected foot parameters. The participants were randomly divided into two groups of five. Group 1 was subjected to active therapeutic intervention and Group 2 was subjected to passive therapeutic intervention for 4 weeks. Before and after the therapeutic intervention, the probands were examined clinically, followed by a postural stability test in static standing on the tensometric plate RS Footscan ® Balance and pressure distribution testing of individual foot segments while walking on a Footscan Gait plate. At the end of the examination we did...

Title: Evaluation of the effect of exercise according to the Propriofoot concept and the methodology of Sensorimotor Training by Janda and Vávrová on foot pressure distribution Objectives: In this thesis the following three goals were set: First, to find out if and how does the percentual foot pressure distribution between the left and right foot in standing change after a four-week long exercise according to either the methodology of Sensorimotor training by Janda and Vávrová or the Propriofoot concept. Second, if and how will the segmental foot load change. Third, if the prospective changes of foot load will agree or differ between the two groups. Methods: A pilot study for quantitative research using experimental scientific method was conducted, with two groups consisting of ten members each, aged thirty to fifty and diagnosed with flat foot. At the beginning, all probands underwent diagnostic measurement using the "Plantograf V10" device. Then they attended a four-week long individual therapy with an exercise plan created according to one of the two methods in consideration. At the end the probands were again measured by the same device. Entrance and control measurements obtained for each participant and both groups were evaluated, compared and statistically analyzed. Results: Analysis of the...

The overall aim of this thesis on congenital clubfoot was to estimate the incidence with a national perspective, analyse residual deformities and their management, and evaluate patient reported long-term quality of life and foot function. Paper I was a prospective, nationwide sampling of 280 children with congenital clubfoot during 1995-96. The average incidence was 1.4‰. There was regional heterogeneity but no seasonal variation. Paper II evaluated ultrasonography on 54 newborn, prospectively followed up to 12 months of age. Significant increase of medial malleolus to navicular distance (MM-N-distance) and of soft tissue thickness with increasing age was seen and with acceptable reliability. Paper III assessed 35 children (47 feet) after previous posterior release, mean age of 4.5 years, and the MM-N-distance was shorter in unilateral clubfeet (21 patients) than in contralateral normal feet. No association between navicular position and forefoot adduction (FFA) was determined. Smaller FFA yielded better subjective and functional outcome. Paper IV reviewed distraction treatment with Ilizarov External Fixator in seven patients (10 feet), 6-15 years of age, with relapsed deformities. All patients, except one, reported satisfaction with the overall result but less stiffness was experienced in only 4/10 feet. Paper V evaluated self-estimated outcome in 83 patients (63 males, 20 females), mean age of 64 years, through SF-36 and EQ-5D, and through AAOS foot and ankle score. Age and gender adjusted norm groups were used. Female patients scored worse than male patients did. Both males and females reported negative influence on foot and ankle function. Conclusion: The incidence of congenital clubfoot in Sweden is higher than in previous Scandinavian studies. Ultrasonography is reliable for describing pathoanatomy of the talo-navicular joint in clubfeet and can detect "spurious" (false) correction. Distraction treatment with the Ilizarov External Fixator yields subjective improvement but stiffness remains. Long-term influence on daily life activities is limited to foot and ankle function for both genders, but only female patients report negative influence on physical aspects of quality of life.

Accelerometers and gyroscopes are used to detect foot strike (FS), i.e., the moment when the foot first touches the ground. However, it is unclear whether different conditions (footwear hardness or foot strike pattern) influence the accuracy and precision of different FS detection methods when using such micro-electromechanical sensors (MEMS). This study compared the accuracy of four published MEMS-based FS detection methods with each other and the gold standard (force plate) to establish the most accurate method with regard to different foot strike patterns and footwear conditions. Twenty-three recreational runners (12 rearfoot and 11 forefoot strikers) ran on a 15-m indoor track at their individual running speed in three footwear conditions (low to high hardness). MEMS and a force plate were sampled at a rate of 3750 Hz. Individual accuracy and precision of FS detection methods were found which were dependent on running styles and footwear conditions. Most of the methods were characterized by a delay which generally increased from rearfoot to forefoot strike pattern and from high to low midsole hardness. It can be concluded that only one of the four methods can accurately determine FS in a variety of conditions.

Made available in DSpace on 2016-06-02T20:19:23Z (GMT). No. of bitstreams: 1 5753.pdf: 2217344 bytes, checksum: 0fb3595b520f776853349e4095faa810 (MD5) Previous issue date: 2014-02-21 / Universidade Federal de Sao Carlos / In Brazil, it is estimated a 30-fold increase in the number of runners in the last 15 years. This growing number of practitioners has been noticed all over the world. It is known that most of the injuries that occur during this activity involves the knee joint (42,1%) and, the Patellofemoral Pain (PFP) is the commonest. Recently, it has been hypothesized that running technique modification (such as, landing with the forefoot on the ground [FFOOT], increasing 10% of the step rate [10% SR] and increasing the trunk flexion [TFLEX]) has the potential to reduce the demand on the knee joint. However, no study evaluated the effects of these running techniques on the lower limb and trunk three-dimensional joint kinematics and on comfort reported by runners. Thus, this study aimed to evaluate the immediate effects FFOOT, 10% SR and TFLEX on the trunk, hip, knee and ankle kinematics and on the subjective assessment of comfort during running. Thirty-one healthy rearfoot strike-landing runners (20 males, 11 females) were evaluated. For such, the Qualisys Motion Capture System was used to collect data during Usual Running (USRUN) and the other three running techniques and, a visual analogue scale was used to evaluate comfort in each condition. The variables of interest were collected during initial foot contact on the treadmill. For statistical analysis, it was used the multivariate analysis of variance (MANOVA) with repeated measures (alpha level of 0.05). During the FFOOT, it was shown reduction in the knee external rotation (P < 0.001), hip flexion (P < 0.001), adduction (P = 0.001), internal rotation (P < 0.001), greater knee adduction (P = 0.016), knee flexion (P < 0.001) and plantar flexion (P < 0.001). The 10% SR demonstrated diminished knee external rotation (P = 0.001), hip internal rotation (P = 0.008) and, hip flexion (P = 0.001), however, there was greater knee flexion (P = 0,042). The TFLEX increased knee adduction (P = 0.001), hip flexion (P < 0.001), trunk flexion (P < 0.001), but decreased plantar flexion (P = 0.003). The USRUN was the most comfortable technique (P = 0.033 0.002). Therefore, we were to conclude that the three running technique modifications can minimized the knee and hip movements in the frontal and transverse planes that are associated with greater stress on the patellofemoral joint. In addition, the FFOOT and 10% SR techniques resulted in increased knee flexion that could improve the impact forces absorption. It is believed that a gradual transition to these running techniques may improve comfort. / No Brasil, estima-se um aumento de 30 vezes no número de corredores nos últimos 15 anos. Esse crescente número de praticantes é observado em todo o mundo. Sabe-se que o maior número de lesões nesta atividade envolve a articulação do joelho (42,1%) sendo a Dor Patelofemoral (DPF) a disfunção mais comum nessa articulação. Recentemente, têm sido hipotetizado que a modificação da técnica de corrida (tal como a aterrissagem com o antepé no solo [CAA], o aumento de 10% na frequência da passada [CFP10] e o aumento da flexão do tronco [CFT]) apresenta potencial de reduzir a demanda na articulação do joelho. Entretanto, não há estudos que avaliaram a influência dessas técnicas de corrida na cinemática articular tridimensional do membro inferior e do tronco e no conforto relatado por corredores. Dessa forma, o objetivo do presente estudo foi avaliar os efeitos imediatos da CAA, CFP10 e CFT na cinemática do tronco, quadril, joelho e tornozelo e na percepção de conforto durante a corrida. Foram avaliados 31 corredores sadios, com padrão de aterrissagem iniciado pelo retropé (20 homens, 11 mulheres). Para tal, a corrida habitual (CHAB) e as 3 técnicas de corrida foram coletadas utilizando o sistema de captura e análise do movimento Qualisys Motion Capture System e, uma escala visual analógica foi utilizada para a avaliação do conforto em cada condição. As variáveis de interesse foram obtidas no contato inicial do pé na esteira ergométrica. Para análise estatística foi utilizado o teste de análise de variância multivariada (MANOVA) com medidas repetidas (nível de significância de 5%). Durante a execução da CAA, foi observada diminuição da rotação lateral do joelho (P<0,001), da flexão (P<0,001), da adução (P=0,001), e da rotação medial do quadril (P<0,001) e, aumento da adução (P=0,016) e da flexão de joelho (P<0,001) e da flexão plantar do tornozelo (P<0,001). A CFP10 diminuiu a rotação lateral do joelho (P=0,001) e a rotação medial (P=0,008) e a flexão do quadril (P=0,001), porém aumentou a flexão do joelho (P=0,042). A CFT aumentou a adução do joelho (P=0,001), a flexão do quadril (P<0,001) e a flexão do tronco (P<0,001), mas diminuiu a flexão plantar do tornozelo (P=0,003). A CHAB foi a técnica mais confortável (P=0,033 P=0,002). Assim, é possível concluir que as 3 modificações da técnica de corrida são capazes de minimizar os movimentos do joelho e quadril nos planos frontal e transversal relacionados ao aumento do estresse patelofemoral. Além disso, a CAA e a CFP10 resultaram em aumento da flexão do joelho, o que pode contribuir com uma melhor absorção das forças de impacto. Acredita-se que após uma adaptação gradual com as modificações da técnica de corrida, o conforto relatado possa ser aumentado.

Accelerometers and gyroscopes are used to detect foot strike (FS), i.e., the moment when the foot first touches the ground. However, it is unclear whether different conditions (footwear hardness or foot strike pattern) influence the accuracy and precision of different FS detection methods when using such micro-electromechanical sensors (MEMS). This study compared the accuracy of four published MEMS-based FS detection methods with each other and the gold standard (force plate) to establish the most accurate method with regard to different foot strike patterns and footwear conditions. Twenty-three recreational runners (12 rearfoot and 11 forefoot strikers) ran on a 15-m indoor track at their individual running speed in three footwear conditions (low to high hardness). MEMS and a force plate were sampled at a rate of 3750 Hz. Individual accuracy and precision of FS detection methods were found which were dependent on running styles and footwear conditions. Most of the methods were characterized by a delay which generally increased from rearfoot to forefoot strike pattern and from high to low midsole hardness. It can be concluded that only one of the four methods can accurately determine FS in a variety of conditions.