Intrinsic gait-related risk factors for Achilles tendinopathy in novice runners: A prospective study

Ginckel, Ans Van; Thijs, Youri; Hesar, Narmin Ghani Zadeh; Mahieu, Nele; Clercq, Dirk De; Roosen, Philip; Witvrouw, Erik

doi:10.1016/j.gaitpost.2008.10.058

Cited by 116 publications

(183 citation statements)

References 26 publications

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“…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.…”

Section: Search Resultsmentioning

confidence: 99%

“…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.…”

Section: Quality Assessmentmentioning

confidence: 99%

“…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].…”

Section: Quality Assessmentmentioning

confidence: 99%

“…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]. None of the included studies provided an adequate description of all intrinsic or extrinsic covariates or how these were adjusted for in the analysis (items 11, 12, 13, 36 and 37) (e.g.…”

Section: Quality Assessmentmentioning

confidence: 99%

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

Dowling

Murley

Smith

et al. 2014

Journal of Science and Medicine in Sport

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Background: Dynamic foot function is considered a risk factor for lower limb overuse injuries including Achilles tendinopathy, shin pain, patellofemoral pain and stress fractures. However, no single source has systematically appraised and summarised the literature to evaluate this proposed relationship. The aim of this systematic review was to investigate dynamic foot function as a risk factor for lower limb overuse injury. Methods: A systematic search was performed using Medline, CINAHL, Embase and SportDiscus in April 2014 to identify prospective cohort studies that utilised dynamic methods of foot assessment. Included studies underwent methodological quality appraisal by two independent reviewers using an adapted version of the Epidemiological Appraisal Instrument (EAI). Effects were expressed as standardised mean differences (SMD) for continuous scaled data, and risk ratios (RR) for nominal scaled data. Results: Twelve studies were included (total n = 3,773; EAI 0.44 to 1.20 out of 2.00, representing low to moderate quality). There was limited to very limited evidence for forefoot, midfoot and rearfoot plantar loading variables (SMD 0.47 to 0.85) and rearfoot kinematic variables (RR 2.67 to 3.43) as risk factors for patellofemoral pain; and plantar loading variables (forefoot, midfoot, rearfoot) as risk factors for Achilles tendinopathy (SMD 0.81 to 1.08). While there were significant findings from individual studies for plantar loading variables (SMD 0.3 to 0.84) and rearfoot kinematic variables (SMD 0.29 to 0.62) as risk factors for 'non-specific lower limb overuse injuries', these were often conflicting regarding different anatomical regions of the foot. Findings from three studies indicated no evidence that dynamic foot function is a risk factor for iliotibial band syndrome or lower limb stress fractures. Conclusion: This systematic review identified very limited evidence that dynamic foot function during walking and running is a risk factor for patellofemoral pain, Achilles tendinopathy, and non-specific lower limb overuse injuries. It is unclear whether these risk factors can be identified clinically (without sophisticated equipment), or modified to prevent or manage these injuries. Future prospective cohort studies should address methodological limitations, avoid grouping different lower limb overuse injuries, and explore clinically meaningful representations of dynamic foot function.

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Section: Search Resultsmentioning

confidence: 99%

Section: Quality Assessmentmentioning

confidence: 99%

Section: Quality Assessmentmentioning

confidence: 99%

Section: Quality Assessmentmentioning

confidence: 99%

See 2 more Smart Citations

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

Dowling

Murley

Smith

et al. 2014

Journal of Science and Medicine in Sport

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“…Out of desperation to run and attempts to avoid potential injury, he began to experiment and tested a walk/sprint rotation which reduced the Achilles pain but created hip pain and thus it was stopped. Changing one's gait may help to prevent and reduce symptoms from Achilles tendinopathy [22,31] and it is possible the walk/sprint altered IP's gait to the point of decreasing mid-portion pain.…”

Section: Introductionmentioning

confidence: 99%

Achilles Tendinopathy and the 100-Pound Punching Bag

Collen¹

2017

J Nov Physiother

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Cyclic mechanical stimulation rescues achilles tendon from degeneration in a bioreactor system

Wang

Lin

et al. 2015

Journal Orthopaedic Research

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Physiotherapy is one of the effective treatments for tendinopathy, whereby symptoms are relieved by changing the biomechanical environment of the pathological tendon. However, the underlying mechanism remains unclear. In this study, we first established a model of progressive tendinopathy-like degeneration in the rabbit Achilles. Following ex vivo loading deprivation culture in a bioreactor system for 6 and 12 days, tendons exhibited progressive degenerative changes, abnormal collagen type III production, increased cell apoptosis, and weakened mechanical properties. When intervention was applied at day 7 for another 6 days by using cyclic tensile mechanical stimulation (6% strain, 0.25 Hz, 8 h/day) in a bioreactor, the pathological changes and mechanical properties were almost restored to levels seen in healthy tendon. Our results indicated that a proper biomechanical environment was able to rescue early-stage pathological changes by increased collagen type I production, decreased collagen degradation and cell apoptosis. The ex vivo model developed in this study allows systematic study on the effect of mechanical stimulation on tendon biology. Keywords: bioreactor; degeneration; ex vivo; tendon; mechanical stimulationTendons are force-transmitting tissues connecting muscle to bone, which have the ability to sense and respond to different mechanical loading. [1][2][3][4][5] Because of this physiological function, biomechanics play an essential role in maintaining tendon homeostasis. [2][3][4][5] Normal healthy tenocytes are long spindle-shaped cells that bind to extracellular matrix proteins including collagen. 6 When tendon is subjected to physiological loading in vivo, the deformation of the cytoskeleton and cellular membrane attached to the collagen fibers can be sensed by cells, which initiate signaling cascades. 6-9 Accumulated evidence shows that in order to maintain normal tendon homeostasis, mechanical stimulation is required. 10-14 Yang et al. have reported that mechanical stretching can modulate proliferation of human tendon fibroblasts in the absence of serum and increase the cellular production of collagen type I, which is at least in part mediated via TGF-b. 15 Zeichen et al. reported that mechanical stress promotes tendon fibroblasts proliferation depending on the stress time. 16 These studies have demonstrated that mechanical loading can increase the diameter of the healed tendons by stimulating tenocyte proliferation and collagen synthesis, and so increase tensile strength. However, the precise physiological levels of strain, frequency, and duration to affect such a response are not well understood.Tendinopathy is a degenerative condition of uncertain etiology, although it is generally considered to be the result of tendon overuse. 17 However, there is increasing evidence that microtearing of tendon caused by general overuse might in fact lead to local understimulation of tenocytes and trigger the degenerative cascade of the tendon. 13,18,19 Clinical findings of tendon degeneration and c...

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Intrinsic gait-related risk factors for Achilles tendinopathy in novice runners: A prospective study

Cited by 116 publications

References 26 publications

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

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

Achilles Tendinopathy and the 100-Pound Punching Bag

Cyclic mechanical stimulation rescues achilles tendon from degeneration in a bioreactor system

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