Foot kinematics in runners with plantar heel pain during running gait

Abstract

Background: Plantar heel pain associated with plantar fascia pathology (PHP) is one of the most common running overuse injuries. Degeneration and changes in the mechanical properties of the plantar fascia associated with PHP can result in changes in foot kinematics during gait.

Research question: How do running gait foot kinematics differ between female and male runners with and without PHP?

Methods: Retrospective study of 13 runners with PHP (7 female, 6 male) and a matched group of 13 uninjured runners (6 female, 7 male). A seven-segment foot model was used to quantify six functional articulations (rearfoot complex, lateral and medial midfoot, lateral and medial forefoot, and first metatarsophalangeal). Functional articulation ROM during early, mid, and propulsion running stance subphases was assessed. Two-way ANOVAs and Friedman's two-way ANOVA for ranks tests were conducted for normally distributed variables and non-normally distributed variables, respectively.

Results: During early stance, PHP runners demonstrated significantly increased lateral midfoot eversion ROM compared to uninjured runners. During the propulsion phase, male runners with PHP demonstrated increased medial midfoot eversion and dorsiflexion ROM and increased medial forefoot plantar flexion compared to uninjured male runners. Also during propulsion, females with PHP went through significantly less medial forefoot plantar flexion ROM compared to uninjured female runners.

Significance: Given the function of the plantar fascia to assist foot supination, the differences in runners with PHP, which were consistent with increased pronation or inadequate supination, may be the result of insufficient tension during the stance phase of running gait caused by degeneration of the plantar fascia. Further, the significant medial midfoot and medial forefoot group by sex interactions during propulsion suggest that PHP may affect male and female runners differently. Understanding the effect of PHP on foot function during running may aid in the development of future rehabilitation programs and/or treatment outcome assessments.

Keywords: Multi-segment foot model; Plantar fasciitis; Stance phase; Ultrasound.