Evidence for running shoes and orthoses Orthopaedic Summit 2018 - PowerPoint PPT Presentation

Evidence for running shoes and orthoses Orthopaedic Summit 2018 Las Vegas, NV Dec. 8 th , 2018 Richard Willy, PhD, PT, OCS Assistant Professor The presenter has no financial relationships or Motion Analysis Laboratory product endorsements to disclose Physical Therapy University of Montana Movement Science Laboratory

The presenter has no financial relationships or product endorsements to disclose Movement Science Laboratory

Why do shoes garner such attention? Fashion statement Endorsements We love bandwagons! Emphasis on engineering Gear obsession? Nike.com Attribute performances Inexpensive “treatment” and Ampla.com “prevention” Runfoot.com Photo credit: Derek Oxley Msnbc.com Movement Science Laboratory

Assigning shoes based on foot type Knapik et al., 2010 1042 Air Force basic trainees (913 males, 346 female) Sportspodiatryinfo.com Level II study: Injury risk unaffected by shoe assignment Predictors of injury: Smoking habit and low aerobic fitness Movement Science Laboratory

Evidence for footwear prescription Ryan 2011 Baseline assessment Foot posture assessment and shoe randomization, n=105 Neutral foot Pronated foot Highly Pronated (n=51) (n=36) (n=18) Nucleus Pegasus Structure Pegasus Structure Nucleus Nucleus Pegasus Structure Triax (n=16) (n=17) Triax (n=12) (n=12) Triax (n=7) (n=6) (n=18) (n=12) (n=5) 13 Week Half marathon program Injury incidence: 32% Motion control shoes: highest risk of injury, regardless of foot type Neutral foot in the neutral shoe= more injuries than in stability shoe! Movement Science Laboratory

• 927 runners: Tracked running volume via GPS for 12-months • Foot posture index measured – Highly supinated (n=53) Runners classified as – Supinated (n=369) “pronators”: – Pronated (n=122) Lowest injury rate per – Highly pronated (n=18) 1000 km • 252 sustained injury Movement Science Laboratory

Hokaoneone.com 2011-2012 peak Vibram.com Movement Science Laboratory

Healthy runners (n=61) Minimalist shoe (n=31) Standard shoe (n=30) Asics Piranha Asics Cumulus 26 week transition period: Increased use of issued shoe, decreased use of their own shoe a) No overall difference in injury incidence, BUT b) High mileage, heavy runners (>71.4 kg): minimalist injuries Movement Science Laboratory

Measurement of stack height and shoe drop Runningwarehouse.com Runningwarehouse.com Stack height heel - stack height forefoot= Shoe drop Movement Science Laboratory

What about zero drop shoes? Brooks Launch Altra Torin 27 mm heel 32 mm heel 10 mm drop 0 mm drop 17 mm forefoot 32 mm forefoot Zero drop shoes: Purported to encourage “natural, more efficient running” Movement Science Laboratory

Does shoe drop affect injury rates? Malisoux 2016 Randomized 577 runners, 18-65 years of age, running for at least 12 months without interruption due to injury 10 cm Drop Shoe 6 cm Drop Shoe Zero Drop Shoe (n=190) (n=194) (n=193) 6 months running Lost to follow-up Lost to follow-up Lost to follow-up (n=14) (n=4) (n=6) Injury incidence: Injury incidence: Injury incidence: 21.6% 24.6% 27.4% 10.33 injuries per 1000 hours of running Movement Science Laboratory

Shoe fitting recommendations ? No evidence for shoe prescription Knapik 2010, 2014, Ryan 2011 Rotating shoes: 39% reduced risk of running injury Malisoux 2015 “Comfort filter”: Comfortable shoes result in reduced metabolic demand, optimize gait Nigg 2015 “Pick a shoe that seems to need no break-in period” Movement Science Laboratory

Foot orthoses: 41% reduction in risk of stress fracture Median PEDro: 5/10, range: 3-8 Movement Science Laboratory

Orthoses for treatment of PFP Only 1 Level I study Collins 2009 Results: Foot orthoses + PT better at 6- and 12- weeks vs. PT alone >10.96mm change in midfoot width: clinical prediction rule Vicenzino 2010 Barton et al., 2011: If single leg squat pain decreases w/ orthoses, McPoil 2009 use in early rehab Movement Science Laboratory

Recommendation: OTC orthoses, mainly in 1 st 6 months of treatment Movement Science Laboratory

Summary Shoe prescription based on foot shape or mechanics does not reduce injury incidence Shoe drop does not influence injury incidence Minimalist shoes may place less fit, higher BMI runners at elevated risk Rotating shoes reduces risk considerably Foot orthoses reduce risk of bone stress injuries Orthoses beneficial in treatment of plantar fasciopathy and patellofemoral pain, mainly in 1 st 3-6 months treatment Movement Science Laboratory

1. Bonanno DR, Landorf KB, Munteanu SE, Murley GS, Menz HB. Effectiveness of foot orthoses and shock-absorbing insoles for the prevention of injury: a systematic review and meta-analysis. Br J Sports Med. 2017;51:86-96. 2. Collins N, Crossley K, Beller E, Darnell R, McPoil T, Vicenzino B. Foot orthoses and physiotherapy in the treatment of patellofemoral pain syndrome: randomised clinical trial. British Journal of Sports Medicine. 2009;43:163-168. 3. Knapik JJ, Trone DW, Swedler DI, et al. Injury reduction effectiveness of assigning running shoes based on plantar shape in Marine Corps basic training. Am J Sports Med. 2010;38:1759-1767. 4. Malisoux L, Chambon N, Urhausen A, Theisen D. Influence of the Heel-to-Toe Drop of Standard Cushioned Running Shoes on Injury Risk in Leisure-Time Runners: A Randomized Controlled Trial With 6-Month Follow-up. Am J Sports Med. 2016;44:2933-2940. 5. Malisoux L, Ramesh J, Mann R, Seil R, Urhausen A, Theisen D. Can parallel use of different running shoes decrease running- related injury risk? Scandinavian journal of medicine & science in sports. 2015;25:110-115. 6. Martin RL, Davenport TE, Reischl SF, et al. Heel pain-plantar fasciitis: revision 2014. J Orthop Sports Phys Ther. 2014;44:A1- 33. 7. Molloy JM, Christie DS, Teyhen DS, et al. Effect of running shoe type on the distribution and magnitude of plantar pressures in individuals with low- or high-arched feet. J Am Podiatr Med Assoc. 2009;99:330-338. 8. Mundermann A, Stefanyshyn DJ, Nigg BM. Relationship between footwear comfort of shoe inserts and anthropometric and sensory factors. Med Sci Sports Exerc. 2001;33:1939-1945. 9. Nielsen RO, Buist I, Parner ET, et al. Foot pronation is not associated with increased injury risk in novice runners wearing a neutral shoe: a 1-year prospective cohort study. Br J Sports Med. 2014;48:440-447. 10. Nielsen RO, Parner ET, Nohr EA, Sorensen H, Lind M, Rasmussen S. Excessive Progression in Weekly Running Distance and Risk of Running-related Injuries: An Association Modified by Type of Injury. J Orthop Sports Phys Ther. 2014;1-25. 11. Nigg BM, Baltich J, Hoerzer S, Enders H. Running shoes and running injuries: mythbusting and a proposal for two new paradigms: 'preferred movement path' and 'comfort filter'. Br J Sports Med. 2015;49:1290-1294. 12. Nigg BM, Wakeling JM. Impact forces and muscle tuning: a new paradigm. Exerc Sport Sci Rev. 2001;29:37-41. 13. Ridge ST, Johnson AW, Mitchell UH, et al. Foot bone marrow edema after a 10-wk transition to minimalist running shoes. Med Sci Sports Exerc. 2013;45:1363-1368. 14. Ryan MB, Valiant GA, McDonald K, Taunton JE. The effect of three different levels of footwear stability on pain outcomes in women runners: a randomised control trial. Br J Sports Med. 2011;45:715-721. 15. Vicenzino B, Collins N, Crossley K, Beller E, Darnell R, McPoil T. Foot orthoses and physiotherapy in the treatment of patellofemoral pain syndrome: a randomised clinical trial. BMC musculoskeletal disorders. 2008;9:27. 16. Whittaker GA, Munteanu SE, Menz HB, Tan JM, Rabusin CL, Landorf KB. Foot orthoses for plantar heel pain: a systematic review and meta-analysis. Br J Sports Med. 2017; 17. Willson JD, Bjorhus JS, Williams DS, 3rd, Butler RJ, Porcari JP, Kernozek TW. Short-term changes in running mechanics and foot strike pattern after introduction to minimalistic footwear. PM R. 2014;6:34-43; quiz 43. Movement Science Laboratory

Acknowledgements OSET Organizing Committee Collaborators: John Willson, PT, PHD; Stacey Meardon, PT, PhD; Paul DeVita, PhD, Ryan Mizner, PT, PhD, Christian Barton, PT, PhD Rich.willy@umontana.edu @rwilly2003 Movement Science Laboratory

Focus on the individual: Shoe prescription 24 year-old female marathoner Left repeat proximal 5 th metatarsal stress fracture Movement Science Laboratory

Rocker bottom sole Sobhani 2013 Reduced Achilles tendon loads Sobhani 2013, 2015 Reduced forefoot pressures Sobhani 2014 Movement Science Laboratory

Effect of training in minimalist shoes Willson 2014 Vibram.com 6 x 20 min training in minimalist shoes “Some runners shift off their heels with these shoes” Training phase Rearfoot strikers Non-rearfoot strikers At enrollment (Standard shoes) 19 0 Baseline (Vibrams) 12 5 Post-training (Vibrams) 9 8 10/19 runners demonstrated bone marrow edema Ridge 2013 Movement Science Laboratory

Movement Science Laboratory

Foot orthoses: Injury prevention Absolute Risk Reduction: 0.49 (p<0.001): Favoring orthoses Foot orthoses: Effective at reducing primarily bone stress injuries Median PEDro: 5/10, range: 3-8 Movement Science Laboratory