A prospective biomechanical study of the association between foot pronation and the incidence of anterior knee pain among military recruits

Abstract

Excessive foot pronation has been considered to be related to anterior knee pain. We undertook a prospective study to test the hypothesis that exertional anterior knee pain is related to the static and dynamic parameters of foot pronation. Two weeks before beginning basic training lasting for 14 weeks, 473 infantry recruits were enrolled into the study and underwent two-dimensional measurement of their subtalar joint displacement angle during walking on a treadmill. Of the 405 soldiers who finished the training 61 (15%) developed exertional anterior knee pain. No consistent association was found between the incidence of anterior knee pain and any of the parameters of foot pronation. While a statistically significant association was found between anterior knee pain and pronation velocity (left foot, p = 0.05; right foot, p = 0.007), the relationship was contradictory for the right and left foot. Our study does not support the hypothesis that anterior knee pain is related to excessive foot pronation.

Dynamic foot function as a risk factor for lower limb overuse injury: A systematic review

“…Following the sequential review of titles, abstracts and full texts, as well as removing studies that were not prospective cohort studies, 80 studies were eligible ( Figure 1). Of these, 12 studies investigated dynamic foot function variables, and were included in this part of the review [27,29,35,[38][39][40][41][42][43][44][45][46]. Due to inconsistencies in outcomes measured, pooling of data was not possible.…”

“…With the exception of one moderate quality study [43], all studies were rated as low quality [27,29,35,[37][38][39][40][41][42][44][45][46]. In terms of inter-rater reliability across 35 items included in the quality assessment, 24 items had perfect or near perfect agreement between raters.…”

“…All studies clearly reported the aim and objective (item 1) and that foot posture was measured prospectively before longer-term follow up of injury (item 28) [27,29,35,[38][39][40][41][42][43][44][45][46]. Eleven studies clearly defined the assessment of foot function (item 2) [27,29,35,[38][39][40][41][42][43][44][45] and eight studies clearly defined the lower limb overuse injury of interest (item 3) [29,35,39,[41][42][43][44][45].…”

Relação do valgo dinâmico do joelho com a força muscular do quadril e tronco em indivíduos com síndrome patelofemoral

“…Com estas alterações biomecânicas na marcha, para alcançar a extensão total do joelho, o fêmur deverá realizar excessiva rotação medial (32,34) , aumentando a força de contato do côndilo femoral lateral com a face lateral da patela (35,36) . Porém, estudos prospectivos não encontraram uma relação que suportasse a hipótese que a dor anterior do joelho possa estar relacionada com uma pronação excessiva do pé (37)(38)(39) .…”

“…Com estas alterações biomecânicas na marcha, para alcançar a extensão total do joelho, o fêmur deverá realizar excessiva rotação medial (32,34) , aumentando a força de contato do côndilo femoral lateral com a face lateral da patela (35,36) . Porém, estudos prospectivos não encontraram uma relação que suportasse a hipótese que a dor anterior do joelho possa estar relacionada com uma pronação excessiva do pé (37)(38)(39) .Quanto à estabilização local, a força e/ou a ativação alterada do músculo vasto medial oblíquo (VMO) em relação ao vasto lateral (VL) tem sido relacionada com o início da SDP (21,22,(40)(41)(42)(43)(44) .As fibras oblíquas do vasto medial inserem-se na face superior e medial da patela formando um ângulo médio de 45º a 55º, sendo o principal responsável para evitar o excessivo deslocamento lateral da patela. Devido ao alinhamento estrutural em valgo dos membros inferiores, a patela tem uma tendência natural ao deslocamento lateral (42) .…”