Category: Sports Medicine

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Biomechanics: Wearing footwear with toe springs requires less muscle work

Press Release:

Wearing footwear with an upward curvature at the front of the shoe – known as the toe spring – requires less work from the muscles of the feet to walk than shoes with a flatter sole, according to an experimental study published in Scientific Reports.

Toe springs keep the toes continually elevated above the ground in a flexed upwards position to help the front part of the foot roll forward when walking or running and are present in most modern athletic shoes, but their effect on natural foot function and vulnerability of the feet to injury has not been widely studied.

Freddy Sichting and colleagues from Harvard University, the Chemnitz University of Technology and Buffalo University investigated the effects of toe springs on foot biomechanics using a controlled experiment in which 13 participants walked barefoot on a treadmill at a comfortable walking pace. The participants were then asked to repeat the process wearing four different pairs of specially designed sandals with varying upward curvature of the toe region in order to simulate the curvature of modern athletic footwear. 3D motion data were captured using markers placed on each subject’s knee, ankle and foot.

The authors found that toe springs decrease the work of the muscles around the joints that connect the toes to the foot bones. The higher the upwards curve of the toes in respect to the rest of the foot, the less work the foot muscles had to perform to support the joints when walking.

The findings explain why toe springs are so comfortable and popular but suggest that shoes with toe springs may contribute to weakening of the foot muscles with long-term use. This may increase susceptibility to common pathological conditions such as plantar fasciitis, inflammation of the foot that connects the heel bone to the toes, according to the authors.

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Causes of Higher Risk of Stress Fractures in Female Runners

Press Release:

PHILADELPHIA – Running is one of the most popular forms of exercise, enjoyed by a broad range of age groups and skill levels.  More women are running recreationally compared to men; specifically 54% of runners are female as indicated by a 2018 National Runner Survey. Women, however, are at least twice as likely as men to develop stress fractures, an injury that impacts around 20% of runners. However, information is still lacking on how to best prevent and treat stress fractures in women. New pilot research from Jefferson suggests physiological factors that could be included in routine screening for stress fracture risk, as well as changes in training approach to aid in prevention.

The researchers examined physiological differences that might contribute to increased risk of stress fractures in a study published in Sports Healthand also surveyed women’s perception of risk and behaviors that contribute to stress fractures in a separate study published in Physical Therapy in Sport. 

“Most of the literature focuses on elite runners or athletes,” says Therese Johnston, PT, PhD, MBA, Professor in the Department of Physical Therapy and first author of both studies. “It was important for us to capture the regular or average female runner in these studies, and the main goal was to see how we can prevent a first or subsequent fracture.”

Both studies surveyed the same group of 40 female recreational runners, age 18-65 years. 20 women had a history of running-related stress fractures, and they were matched according to age and running abilities with 20 women with no history of stress fractures. The two studies aimed to assess what contributed to risk of stress fractures, from the physiological, such as – bone structure and density, muscle mass, hormonal status, to ones influenced by training routine, such as training intensity, nutrition, insufficient strengthening, and ignoring pain.

“This mixed methods approach provides a richer context and a more detailed picture of the practices and risks that contribute to stress fractures in every-day women runners,” says Jeremy Close, MD, associate professor in family and sports medicine and one of the lead authors on the research. “It also tells us how perceived risk informs physiological risk.”

For the study focused on physiological factors, the subjects underwent a comprehensive blood panel that examined levels of hormones like estradiol and testosterone, vitamins and minerals important for bone health such as vitamin D and calcium, and bone markers. They also underwent dual energy x-ray absorptiometry (DXA) to test for bone mineral density. The researchers found that while there was no difference in estradiol hormone levels between the two groups, women who had a stress fracture history reported menstrual changes or irregular periods as a result of their training, or during peak training times. The blood panel also examined markers for bone formation and resorption, and pointed to increased bone turnover in the group of women with stress fractures. They also found through the DXA testing that women with a history of stress fractures had lower hip bone mineral density compared to women with no history of stress fractures, indicating decreased bone strength that could increase risk of injury.

“DXA for bone density and blood testing for bone markers are not routinely performed in this population – they are usually reserved for post-menopausal women – so we may be missing important clinical indicators for stress fractures in these women,” says Dr. Johnston. “While the link between menstrual changes and bone strength is unclear, our findings also indicate that asking female runners about any menstrual irregularities during heavier training times is important during routine screening.”

For the study investigating women’s self-perception of risk, interviews were conducted with the goals of finding out which factors women thought were associated with stress fractures or maintaining bone health while running. Several themes emerged from these interviews. Specifically, compared to women without stress fractures, women with histories of stress fractures had increased their training load more quickly. Also, while they knew of the importance of nutrition and strengthening exercises, women with a history of stress fracture more often reported not having or making the time for a balanced diet and proper cross-training to complement their running regimen.

Finally, women in this group reported pushing through the pain and running despite an injury more often than those without stress fracture. “In the interviews, it sounded like these women had trouble knowing which pain was normal, and which pain was abnormal. They also reported not always receiving appropriate guidance from healthcare providers on how to progress running safely,” says Dr. Johnston.

“It is clear that there needs to be more guidance from healthcare providers for woman runners on how to prevent stress fractures” says Dr. Close. “It can be very frustrating for these women who are on a path to wellness, but are impeded by an injury that can take several months to heal. If they don’t have the proper guidance on how to return to running safely, they risk a second injury.”

“We hope that our findings will encourage more thorough and routine screening in women runners for bone density and strength,” says Dr. Johnston, “as well as a comprehensive education plan on how to balance running with cross-training, and how to interpret pain cues from the body, to help women differentiate between normal aches and pains and indicators of a serious injury.”

Dr. Johnston plans to continue this research by studying women with acute stress fractures as they start running again, in order to identify factors related to successful or unsuccessful return to running following a stress fracture. The study will include Dr. Close as well as Marc Harwood, MD, service chief in the department of non-operative sports medicine at Rothman Orthopaedic Institute.

The work was funded by the Thomas Jefferson University Office of the Provost. The authors report no conflict of interest

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Running research: Heel-toe or toe-heel?

Press Release:

New research from La Trobe University suggests there is no evidence that changing a runner’s strike pattern will help prevent injuries or give them a speed boost.

In a bid to avoid shin splints, sore knees and other injuries, many runners have adopted a toe-to-heel trend, running on the balls of their feet. This is often encouraged by coaches and health professionals.

However, in research out this week in Sports Medicine, La Trobe injury researcher and physiotherapist Dr Christian Barton found there is no evidence to suggest running on the front of your feet reduces injury risk or improves performance.

“We analysed 53 studies which looked at the impact of forefoot, rearfoot and flatfoot running patterns on injury, running economy and running biomechanics,” senior author of the study, Dr Barton said

“Our comprehensive review suggests that telling someone to run on the ball of their foot instead of their heel may make them less efficient, at least in the short term. Additionally, there is no evidence either way on whether running on the balls of your feet reduces injury.”

Dr Barton said switching your running style shifts the body’s loads but doesn’t make them disappear.

“Running toe-heel might help injuries at the knee, where loads are reduced. However, it may cause injuries to the feet and ankle, where loads are increased,” Dr Barton said.

“Put simply, when it comes to running style: If it ain’t broke, don’t fix it.”

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New Balance Golf Shoes

Press release:

Boston, Mass., March 6, 2020 – New Balance Golf has added two new styles to its Fresh Foam LinksSL collection for spring.

New Balance’s Fresh Foam technology was first introduced in the company’s performance running shoes and is now used across almost all categories of New Balance footwear.

Fresh Foam Technology

CUSH+ – A molded insole for superior comfort and lateral stability.

FRESH FOAM – An innovative midsole with a data-driven design that identified zones in the midsole where altering levels of compression and resistance are aligned to provide ultra-soft cushioning and lateral stability.

SMART RUBBER OUTSOLE – The spikeless outsole on the Fresh Foam LinksSL has omni-directional traction lugs with pressure mapping colors to highlight key performance zones.

Fresh Foam LinksSL

The Fresh Foam LinksSL features a waterproof performance mesh upper and a spikeless smart rubber outsole. The smart rubber outsole has pressure mapping colors to highlight key performance zones during the swing. The suggested retail is $99.95. The green and white colorway is available March 15th and the red, white and blue colorway will be available May 1st.

About New Balance

New Balance, headquartered in Boston, MA has the following mission: Demonstrating responsible leadership, we build global brands that athletes are proud to wear, associates are proud to create and communities are proud to host. Manufactured in the U.S. for over 75 years and representing a limited portion of our U.S. sales, New Balance Made U.S. is a premium collection that contains a domestic value of 70% or greater. New Balance owns five factories in New England and one in Flimby, U.K. New Balance employs more than 6,000 associates around the globe, and in 2018 reported worldwide sales of $4.1 billion. To learn more about New Balance, please visit www.newbalance.com.

More on injuries in golf.

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Concussions Increase Risk Of Lower Extremity Injuries

Press Release:

A new study shows that college athletes who sustain concussions are more likely to have a lower extremity injury in the same season after they return from the concussion.

Dr. Daniel Herman, a fellow in primary care sports medicine at the University of Florida, presented this research at the American Medical Society for Sports Medicine conference in San Diego, California. Athletes with concussions were 3.79 times more likely to get a muscle or ligament injury than their non-concussed teammates. The severity of the injuries was not statistically different between the two groups. This research takes the popular topic of concussions in a direction that many people have not thought about.

“These results may have clinical implications ranging from pre-season injury risk stratification to post-concussion rehabilitation practices to return to play considerations, said Dr. Herman. My colleagues and I are working to develop additional studies investigating the impact of neurocognitive performance on musculoskeletal injuries.”

Dr. Daniel Herman, a fellow in primary care sports medicine at the University of Florida, received his MD and PhD (Biomedical Engineering) at the University of North Carolina, and completed his residency in Physical Medicine and Rehabilitation at the University of Virginia. His research focuses on neuromuscular and neurocognitive risk factors for musculoskeletal injury, and he is a prior recipient of the American Orthopedic Society for Sports Medicine’s O’Donoghue Award for Sports Injury Research. He will be starting at an Assistant Professor in the Department of Orthopedics and Rehabilitation at the University of Florida in July 2013.

A new study shows that college athletes who sustain concussions are more likely to have a lower extremity injury in the same season after they return from the concussion.

Dr. Daniel Herman, a fellow in primary care sports medicine at the University of Florida, presented this research at the American Medical Society for Sports Medicine conference in San Diego, California. Athletes with concussions were 3.79 times more likely to get a muscle or ligament injury than their non-concussed teammates. The severity of the injuries was not statistically different between the two groups. This research takes the popular topic of concussions in a direction that many people have not thought about.

“These results may have clinical implications ranging from pre-season injury risk stratification to post-concussion rehabilitation practices to return to play considerations following concussion, said Dr. Herman. My colleagues and I are working to develop additional studies investigating the impact of neurocognitive performance on musculoskeletal injuries.”

Dr. Daniel Herman, a fellow in primary care sports medicine at the University of Florida, received his MD and PhD (Biomedical Engineering) at the University of North Carolina, and completed his residency in Physical Medicine and Rehabilitation at the University of Virginia. His research focuses on neuromuscular and neurocognitive risk factors for musculoskeletal injury, and he is a prior recipient of the American Orthopedic Society for Sports Medicine’s O’Donoghue Award for Sports Injury Research. He will be starting at an Assistant Professor in the Department of Orthopedics and Rehabilitation at the University of Florida in July 2013.

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Would changing gait pattern decrease your likelihood of running injuries?

ROSEMONT, Ill. (April 6, 2016)–Are runners less injury-prone trekking barefoot than in pricey running shoes? Maybe, according to a new literature review in the March issue of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS). Advances in running shoe technology in the last 40 years have not reduced injuries, but racing “barefoot” in shoes with minimal cushioning could help runners change their strides and landing patterns to prevent repetitive heel pain and stress fractures.

Three of four active runners sustain injuries, mostly in the knee and lower leg. Most distance runners who use cushioned running shoes run heel-to-toe, or in a rearfoot strike (RFS) pattern. This action is associated with longer strides and excessive load force–up three times the runner’s body weight–on the lower leg, knee, and hip. This leads to bone and soft-tissue injuries, tibial stress fractures, and severe heel pain, such as plantar fasciitis.

Minimalist, including barefoot running has become popular in recent years. Minimalist running shoes have thinner soles and less cushioning and are more flexible than conventional runners’ footwear. Advocates believe these shoe changes alter running so the front or middle of the foot strikes the ground first–a forefoot or midfoot strike (FFS and MFS)–which reduces load stress on the knee, lower leg, and heel. Flatter foot placement dissipates load impact on the heel.

“Injury patterns among long-distance runners are unacceptably high, and while some research in minimalist running seems promising regarding injury prevention, there still are a lot of unknowns, and the debate continues,” says lead author and orthopaedic surgeon Jonathan Roth, MD, with Fort Belvoir Community Hospital in Virginia. “Evidence to date shows that changing gait patterns, not shoe selection, is the best intervention to lower the injury prevalence in runners. Minimalist shoes may give better feedback to runners and allow them to focus on changing their gait, but not everyone does, and this could lead to more injury.”

Dr. Roth added that increasing acceptance of minimalist running has outpaced medical evidence of its benefits. Orthopaedic literature, however, has demonstrated that with less-cushioned footwear, runners spontaneously transition from the RFS to the FFS gait pattern. Whether FFS running truly can reduce injuries is unknown, but the most compelling data were published in a 2012 study involving a Division I collegiate cross-country team. The results showed:

  • The athletes had a 75 percent injury rate per year, categorized as either traumatic or repetitive;
  • Strike type was characterized for each athlete and showed that 31 percent ran in the FFS pattern and 69 percent demonstrated RFS; and,
  • There was no difference in the traumatic injury rate between FFS and RFS runners; and,
  • FFS runners were 1.7 times less likely to sustain repetitive injuries than RFS runners.

Other findings in the JAAOS literature review include:

  • Barefoot and minimalist running is not injury-proof and poses risk for metatarsal (toe) stress fractures, plantar fasciitis, and puncture wounds;
  • Runners can transition to the FFS pattern in any shoe with appropriate training; and,
  • Barefoot and minimalist running is an emerging phenomenon that requires further exploration of its orthopaedic implications to identify true long-term benefits and risks.

Runners interested in exploring minimalist running shoes to provide more feel and less of a heel-to-toe offset, and to allow easier landing midfoot to forefoot, “should consider themselves as non-runners and start over by walking and gradually adding running distance week to week,” advises Dr. Roth. “This will help assure proper transitioning to build strength, flexibility, stability, and endurance around the foot and ankle.” Transition from a RFS to FFS gait pattern should be a gradual process–over many months. Runners should expect to run minimal mileage when transitioning and always remember the 10 percent rule when increasing in distance. An abrupt switching of gait patterns can lead to an increase in other repetitive stress injuries if not done correctly.