The effect of foot landing position on biomechanical risk factors associated with anterior cruciate ligament injury

Abstract

BackgroundIdentification of biomechanical risk factors associated with anterior cruciate ligament (ACL) injury can facilitate injury prevention. The purpose of this study is to investigate the effects of three foot landing positions, “toe-in”, “toe-out” and “neutral”, on biomechanical risk factors for ACL injury in males and females. The authors hypothesize that 1) relative to neutral, the toe-in position increases the biomechanical risk factors for ACL injury, 2) the toe-out position decreases these biomechanical risk factors, and 3) compared to males, females demonstrate greater changes in lower extremity biomechanics with changes in foot landing position.MethodsMotion capture data on ten male and ten female volunteers aged 20–30 years (26.4 ± 2.50) were collected during double-leg jump landing activities. Subjects were asked to land on force plates and target one of three pre-templated foot landing positions: 0° (“neutral”), 30° internal rotation (“toe-in”), and 30° external rotation (“toe-out”) along the axis of the anatomical sagittal plane. A mixed-effects ANOVA and pairwise Tukey post-hoc comparison were used to detect differences in kinematic and kinetic variables associated with biomechanical risk factors of ACL injury between the three foot landing positions.ResultsRelative to neutral, landing in the toe-in position increased peak hip adduction, knee internal rotation angles and moments (p < 0.01), and peak knee abduction angle (p < 0.001). Landing in the toe-in position also decreased peak hip flexion angle (p < 0.001) and knee flexion angle (p = 0.023). Landing in the toe-out position decreased peak hip adduction, knee abduction, and knee internal rotation angles (all p < 0.001). Male sex was associated with a smaller increase in hip adduction moment (p = 0.043) and knee internal rotation moment (p = 0.032) with toe-in landing position compared with female sex.ConclusionsToe-in landing position exacerbates biomechanical risk factors associated with ACL injury, while toe-out landing position decreases these factors.

The analysis of knee joint loading during drop landing from different heights and under different instruction sets in healthy males

“…The aforementioned biomechanical measures all increase to attenuate impact forces during landing phase. While average frontal and transverse plane moment, which were consistent with previously reported values [39, 40], were found to be statistically different between heights with moderate and small effect size, respectively, the values were smaller than those experienced by young adults in sport setting (abduction moment 1.3 Nm/kg and external rotation moment 0.2 Nm/kg) [41, 42]; and likely not clinically relevant.…”

A Comparison of the Hamstring to Quadriceps Activation Ratio in the Toe-in or Neutral Toe Position After Triple Jump Spikes in Female Volleyball Players

“…According to previous kinematic studies, landing with the toe-in position due to increased hip adduction, internal knee rotation, knee abduction and knee valgus may increase the risk of ACL injuries, and athletes have been recommended not to do jump-landing with this pattern (13).…”

“…Previous studies have shown that landing with the toein position may be accompanied by an increase in the in- ternal torsion of the tibia and knee valgus (12), and increased hip adduction, internal rotation and knee abduction may predispose the knee to ACL injuries (13,14) and may therefore be considered a risk factor for ACL injuries (15).…”

Effects of Foot Rotation on ACL Injury Risk Variables During Drop Landing

“…Foot progression angle (FPA), or the angular difference between the long axis of the foot and the mid-sagittal plane of an individual at initial contact during drop landing, is a modifiable variable of ACL injury risk [26,34] that can affect lower extremity kinematics and kinetics. Padua et al [26] included landing with an FPA greater than 30° toe-in or toe-out as a "high risk" position in the Landing Error Scoring System (LESS).…”

“…Other research has stated that just excessive toe-out landing leads to increased knee abduction and external rotation angle, thus having the potential to impinge the ACL against the lateral wall of the femoral intercondylar notch, causing injury [10]. Tran et al [34] has shown that landing with a toe-in position of 30° from neutral (0° FPA) increases peak hip adduction, knee internal rotation angles and moments, as well as peak knee abduction angle, and decreases peak hip flexion angle. Conversely, they demonstrated that landing with a toe-out position decreased these variables resulting in a safer landing position and potentially reducing the risk of ACL injury [34].…”