The foot in multistage ultra-marathon runners: experience in a cohort study of 22 participants of the Trans Europe Footrace Project with mobile MRI

Abstract

Objectives67 runners participated in the Trans Europe FootRace 2009 (TEFR09), a 4487 km (2789 mi) multistage ultra-marathon covering the south of Europe (Bari, Italy) to the North Cape. Reports on ultra-marathons are lacking, but the literature reports overuse injuries in athletes, especially to the Achilles tendon (AT), ankle or hind foot. Bone oedema may be related to exposure and is present in fatigue fractures. Therefore, the aim of this study was to determine prospectively if sustained maximal load during an ultra-marathon leads to damage to the foot.Design and participantsIn a cohort study, repeated scanning of the 22 athletes participating in the study was performed before and during (approximately every 1000 km) the race. Using the obtained fat saturated inversion recovery sequence, two experienced readers blinded to the clinical data rated the images regarding foot lesions. Statistical analysis included regression analysis and computation of the inter-rater reliability.SettingThe TEFR09 course. MRI scanning was performed according to prearranged schedules for every participant, using a mobile 1.5 Tesla MRI unit on a trailer following the race.Primary outcome measuresMRI data such as AT diameter, bone or tendon lesions, subcutaneous, plantar fascia or intraosseous oedema.ResultsThe 22 study participants did not differ significantly from the total of the 67 TEFR09 runners regarding height, weight and age. The AT diameter increased significantly from 6.8 to 7.8 mm as did intraosseous signal, bone lesions and subcutaneous oedema. However, finishers differed only regarding plantar aponeurosis and subcutaneous oedema from participants aborting the TEFR09. Inter-rater reliability was 0.88–0.98.ConclusionUnder the extreme stress of the TEFR09, an increase of the AT diameter as well as bone signal are thought to be adaptive since only subcutaneous oedema and plantar fascia oedema were related to abortion of the race.Trial registration numberUniversity of Ulm, Germany Ethics Committee Number 78/08-UBB/se.

Evaluation of MR Images of the Ankle and Foot in Response to Long-Distance Running: A Systematic Review

“…Four studies [32][33][34][35] investigating the effect of long-distance running on the ankle and foot complex using MRI were included in this systematic review. All the studies compared MRI results between baseline and follow-up within the same participants.…”

“…None of these studies performed a single long-distance running. Two studies [33,35] performed an ultra-marathon race (4486 km-4487 km) for about consecutive 64 days and one study [32] conducted 30 min outdoor run per day for consecutive seven days. The remaining study [34] conducted seven-month intensive training, consisting of six training sessions per week and two major international races.…”

“…Follow-up study was conducted 10-20 h following exertion [32] or one month after the completion of the training season [34]. Another two studies [33,35] performed MRI examination repetitively (five times in total), before and during long-distance running, approximately every 900 km-1000 km. Two studies used a dedicated foot coil with 8 channels [33,35], while one study adopted a head coil [32] and the remaining study [34] did not describe their technique.…”

Ultramarathon Running: Medical Issues

“…In the 'Trans Europe FootRace' 2009, a 4,487 km multistage ultra-marathon covering the south of Europe (Bari, Italy) to the North Cape an increase in the diameter of the Achilles tendon, intraosseous signals, bone lesions and subcutaneous oedema were found [104]. Interestingly, an increase of diameter of the Achilles tendon and bone signals were thought to be adaptive; subcutaneous oedema and plantar fascia oedema were related to abortion of the race [104].…”

“…Ultra-running can cause minor problems to the skeletal muscle such as muscle soreness but also major problems to tendons and joints [103][104][105]. Different recent studies using MRI (magnetic resonance imagining) provided detailed analyses of the problems of the locomotor system such as bursal or presumed peritendineal fluid and/or edematous tissue, cartilage defects or tibiotalar bone edema-like lesions [106].…”