Stress Fractures of the Tarsal Navicular in Long-Distance Runners

Ting, Arthur J.; King, W. D.; Yocum, Lewis A.; Antonelli, Daniel; Moynes, Diane Radovich; Kerlan, Robert K.; Jobe, Frank W.; Wong, Louise; Bertolli, J

doi:10.1016/s0278-5919(20)30961-3

Cited by 43 publications

(9 citation statements)

References 7 publications

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“…The only previous study examining biomechanics in runners who had sustained an NSF was reported by Ting et al 41 Similar to the findings in the current study, Ting et al 41 reported that there were no differences in the vertical loading rate between participants with an NSF and controls. Observing a 2-dimensional frontal-plane view while runners with an NSF ran on a treadmill, Ting et al 41 suggested that 4 of their 5 patients with an NSF demonstrated higher amounts and velocities of rearfoot eversion compared with control participants. However, this was based on a qualitative analysis and not tested statistically.…”

Section: Discussionsupporting

confidence: 87%

“…However, this was based on a qualitative analysis and not tested statistically. Thus, to our knowledge, the current study is the first to provide quantitative data confirming the qualitative observations of Ting et al 41 This is also the first study to use a multisegmented foot model to study biomechanical factors related to an NSF and thus is the first to show reduced forefoot abduction excursion in runners with NSFs. This combination of higher rearfoot eversion and reduced forefoot abduction is especially relevant in relation to the hypothesis on how altered foot biomechanics may lead to an NSF in the first place.…”

Section: Discussionsupporting

confidence: 85%

“…However, to date, none of these studies have reported statistically significant differences between patients who have and have not sustained an NSF. Similarly, Ting et al 41 did not find any differences in radiographic measures of calcaneal pitch angle, metatarsal pitch angle, or talus-metatarsal angle between patients with an NSF and uninjured controls. NSFs have also been reported in patients with rectus, planus, and cavus feet, 11,18,35,38 suggesting that foot type may not play a large role in this injury.…”

Section: Discussionmentioning

confidence: 85%

“…11,18,35,38 There are even fewer studies examining how an NSF influences foot biomechanics. The most comprehensive of these is a study by Ting et al, 41 which examined rearfoot kinematics and ground-reaction forces in 10 competitive distance runners: 5 who had sustained an NSF and 5 control participants. No differences in the loading rate from the vertical ground-reaction force were observed, and while the runners with NSFs appeared to have higher amounts and velocities of foot pronation, these variables were not evaluated statistically, nor were any mean values provided.…”

mentioning

confidence: 99%

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Foot Kinematics Differ Between Runners With and Without a History of Navicular Stress Fractures

Becker

James

Osternig

et al. 2018

Orthopaedic Journal of Sports Medicine

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Background:A navicular stress fracture (NSF) is a common and high-risk injury in distance runners. It is not clear whether there are differences in foot structure and function between runners who have and those who have not sustained an NSF.Purpose/Hypothesis:This study compared foot structure, range of motion, and biomechanics between runners with a history of unilateral NSFs and runners who had never sustained this injury. The hypothesis was that runners with a history of NSFs will have less dorsiflexion and subtalar range of motion in a clinical examination and greater rearfoot eversion and higher eversion velocity while running than either the noninvolved feet or healthy controls.Study Design:Cross-sectional study; Level of evidence, 3.Methods:Seven runners who sustained an NSF were matched with 7 controls without this injury history. Participants underwent a clinical orthopaedic examination, followed by a 3-dimensional running gait analysis. Clinical examination variables, foot kinematics, and ground-reaction forces were compared between injured and noninjured feet within the NSF group and between the NSF group and control group.Results:The NSF group demonstrated less plantar flexion on the clinical examination than the control group (P = .034, effect size [ES] = 0.69). The involved feet of the NSF group demonstrated greater rearfoot eversion excursion, greater eversion velocity, and reduced forefoot abduction excursion than either the noninvolved feet of the NSF group (P = .015, ES = 1.73; P = .015, ES = 1.86; and P = .015, ES = 0.96, respectively) or the control group (P = .012, ES = 1.40; P = .016, ES = 0.49; and P = .005, ES = 1.60, respectively).Conclusion:There are differences in foot kinematics but not ground-reaction forces, foot structure, or passive range of motion between runners who have and those who have not sustained an NSF. Runners who demonstrate increased rearfoot eversion and reduced forefoot abduction during stance may be more at risk for developing NSFs.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 85%

mentioning

confidence: 99%

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Foot Kinematics Differ Between Runners With and Without a History of Navicular Stress Fractures

Becker

James

Osternig

et al. 2018

Orthopaedic Journal of Sports Medicine

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show abstract

“…This adds credibility to the correlations noted between a "relatively" short first metatarsal or long second metatarsal and navicular stress fractures. 42 Although shoewear may affect the relationship between running and stress fractures by altering force transmission through the foot, 40 no clinical or mechanical study has investigated the effects of shoewear on the occurrence of navicular or other tarsal stress fractures in athletes.…”

Section: Pathology and Etiologymentioning

confidence: 99%