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The Role of Athletic Shoe Gear in Your Biomechanical Practice

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The Role of Athletic Shoe Gear in Your Biomechanical Practice The Role of Athletic Shoe Gear in Your Biomechanical Practice Derek Anselmo, DPM Case Study The minimalist runner Female mid-20’s with elevated BMI begins a workout routine of explosive plyometric exercises and distance running and develops pain in the lateral midfoot that is debilitating. She has had to scale back work activities. • XR shows stress reaction metatarsal 3 • US confirms 2nd plantar plate tear Derek Anselmo, DPM Agenda 1 Evolution of Athletic Shoes 2 Motion Control Paradigm 3 Minimalist vs. Maximalist 4 Performance Enhancement 8000 B.C. Derek Anselmo, DPM 1830 - 1916 Derek Anselmo, DPM 1917 Derek Anselmo, DPM 1936 Derek Anselmo, DPM 1960 $ 15.65 Derek Anselmo, DPM 1963 Derek Anselmo, DPM 1966 1972 Derek Anselmo, DPM 1974 Villanova Vantage Derek Anselmo, DPM 1978 Derek Anselmo, DPM 1979 Derek Anselmo, DPM 1982 $ 265.69 Derek Anselmo, DPM Derek Anselmo, DPM 1986 Derek Anselmo, DPM Derek Anselmo, DPM 2005 Derek Anselmo, DPM 2011 Derek Anselmo, DPM 2017 Derek Anselmo, DPM World Record 2:01:39 2019 Derek Anselmo, DPM The Motion Control Paradigm Derek Anselmo, DPM Assumptions 1.Too much frontal plane pronation will lead to injury and reduce performance 2.Keeping the lower extremity rectus during motion reduces the incidence and severity of injury Derek Anselmo, DPM Why Is Pronation Control Important ? Excessive STJ Pronation Has Been Linked to the Development of: • Plantar Fasciitis, • Hallux Limitus/Rigidus • Hallux Abducto Valgus, • Neuroma • Sesamoiditis • Patello-femoral pain • Illio-Tibial Band Syndrome • Overuse Injury • Knee Pain • Hip dysfunciton • Lumbar spine Pain Derek Anselmo, DPM Why Should I Care About This ? • Runners sustain injuries at a rate of 37-56% • Pronation control through high end motion control footwear is a very common conservative clinical treatment approach to LE biomechanical pathology Heel Cup Heel Flare Dual Density Midsole Derek Anselmo, DPM Kirby KA. Biomechanics of the normal and abnormal foot. J Am Podiatr Med Assoc. 2000;90(1):30-34 Are Motion Control Shoes Effective? “Biomechanical and epidemiological studies have raised significant questions about the capacity of running shoes incorporating either cushioning, heel elevation or subtalar control systems to prevent injury and have identified their potential to cause harm.” Richards et al, Br J Sports Med 2009 Derek Anselmo, DPM Some Problems = = Stability Support Overpronation = = Motion Control Max Support Stability Derek Anselmo, DPM American Podiatric Medical Students’ Association (APMSA) Research Grant Program Generously sponsored in part by the APMSA Corporate Advisory Board (CAB) ANNOUNCEMENT FOR 2014- 2015 The APMSA CAB, established in 1985, provides corporations a means to demonstrate commitment and support to podiatric medical student endeavors. The APMSA is appreciative to the following Publicationcompanies who generously support the APMSA: Bias The 2014 - 2015 APMSA Corporate Advisory Board (CAB) Aerolase 877-379-2435 Aetrex Worldwide, Inc. 800-526-2739 ASICS America Corporation 800-333-8404 Bako Integrated Physician Solutions 855-4Bako-CTS ComfortFit Labs, Inc. 888-523-1600 CrocsRx 801-455-8558 Darco International, Inc. 800-999-8866 Gill Podiatry Supply and Equipment Company 800-321-1348 Gordon Laboratories 800-356-7870 Langer Biomechanics 800-645-5520 Merz North America 888-296-1852 Moore Medical Corporation 800-234-1464 New Balance Athletic Shoes, Inc. 800-343-4648 Organogenesis 888-432-5232 Performance Health/Hygienic Corporation 800-246-3733 PICA Group 800-251-5727 Present e-Learning Systems 888-802-6888 ProLab Orthotics 800-477-6522 SAS Shoemakers 877-782-7463 Shire Regenerative Medicine 800-828-2088 Straight Arrow Products, Inc. 610-882-9606 Upsher-Smith Laboratories, Inc. 1-800-654-2299 Valeant Pharmaceuticals 866-246-8245 Applications for grants are reviewed by the APMSA Research Grant Review Panel and awarded on a competitive basis with the maximum amount of funding of 3, $1,000 grants. Grants are Derek Anselmo, DPM paid in two equal installments; one in advance, the other upon completion of the research program requirements. Unutilized funds are to be returned to APMSA by July 1, 2016. A completed application including all supporting materials must be electronically received no later than May 1, 2015. Applications may be obtained through the APMSA website www.apma.org or by contacting Kim Vouzikas [email protected]. Conflicts of Interest from Funding Acknowledgements: “This study was funded in part by a research grant from Nike. The study sponsors were involved Minimalist shoes perform as in the study design, if the person were barefoot interpretation of data, writing of and the motion control the manuscript, and in the shoes control motion decision to submit the manuscript for publication.” Competing Interests: “Primary “We identified no clinical trials author is a partner in the that assessed the effect of the footwear design company Pronation Control Elevated Barefoot on Grass” Cushion Heel design” Derek Anselmo, DPM Peltz et all, J Biomechanics, 2014. Ryan et al, Br J Sports Med 2011. Hoffman S et. al, Gait & Posture, 2015 Anselmo et al. 2018 Methods • 25 Female subjects recruited • Subjects screened on the basis of AHI, MVI and BMI • DP and Lat radiographs in barefoot, “neutral shoe”, and “Motion Control” shoe conditions • Osseous relationships evaluated Anselmo et al. Comparative evaluation of radiographic parameters of foot pronation in two different conditions versus barefoot. J Am Podiatr Med Assoc. Derek Anselmo, DPM Talus-second metatarsal angle Calcaneal-first metatarsal angle Talonavicular coverage angle Calcaneal inclination Murley et al, J. A protocol for classifying normal- and flat-arched foot posture for research studies using clinical and radiographic measurements Foot and Ankle Research 2009 Derek Anselmo, DPM Clarke et al. 1983 Findings: • Maximum pronation was greater in the soft EVA midsole than the medium/hard • A >15o heel flare produced a significant decrease in pronation Limitations: • The study acknowledges that they are essentially measuring the shank angle to the back of the sneaker assuming that the sneaker and the calcaneus move together and have constant, parallel axes CLARKE et al. The effects of shoe design parameters on rearfoot control in running. Medicine & Science in Sports & Exercise. 1983 Derek Anselmo, DPM Derek Anselmo, DPM Cheung et al. 2011 Findings: The overall weighted mean change in foot pronation was significantly decreased in motion control footwear (P=0.0002) and the mean reduction in foot pronation was 2.05º (95% CI) Limitations: Most studies have mixed gender populations, publication bias, very small population sizes, no foot type screening or control Cheung et al. Efficacies of different external controls for excessive foot pronation: a meta-analysis. British Journal of Sports Medicine. 2011 Derek Anselmo, DPM Fuller et al. 2015 Fuller JT, Bellenger CR, Thewlis D, Tsiros MD, Buckley JD. The Effect of Footwear on Running Performance and Running Economy in Distance Runners. Sports Medicine. 2014 Derek Anselmo, DPM Malisoux et al. 2016 Findings: The overall injury risk was lower among the participants who had pronated foot types and received motion- control shoes • Not all shoes in each category are the same Limitations: Criteria for injury: “any physical pain located at the lower limbs or lower back region, sustained during or as a result of running practice, and impeding planned running activity for at least 1 day” Malisoux et al. Injury risk in runners using standard or motion control shoes: a randomised controlled trial with participant and assessor blinding. British Journal of Derek Anselmo, DPM Sports Medicine. 2016 The Minimalist Shoe Dogma 2009 “Cushioned, engineered, structured running shoes are the worst thing that has ever made contact with a human foot.” “There are no evidence-based studies – not one – that demonstrate that running shoes make you less prone to injury.” “The only controversy comes from podiatrists.” Derek Anselmo, DPM Lafortune et al. 1994 Findings: The results of this study showed that the shoe sole modifications did not produce the expected systematic effects on the test variables • No significant differences in internal tibiofemoral rotation between normal and varus wedged shoes Limitations: A lot of inter-subject variation suggests a larger sample size must be used (N=5) Lafortune et al. Foot inversion-eversion and knee kinematics during walking. Journal of Orthopaedic Research. 1994 Derek Anselmo, DPM Stacoff et al. 2001 Findings: •No significant change in touchdown inversion related to shoe sole modifications • Large lateral heel flares were found neither to increase foot eversion velocity nor internal tibial rotation velocity compared with reduced heel flares. Limitations: • (N=5) + Considerable inter-subject variability • Measured relation of marker to shoe STACOFF et al. Effects of shoe sole construction on skeletal motion during running. Medicine and Science in Sports and Exercise. 2001 Derek Anselmo, DPM Richards et al. 2009 Findings: “The clinical efficacy of pronation control systems remains untested, with no longitudinal trials having been reported that compare injury rates in runners wearing shoes with and without pronation control systems. We have identified several studies suggesting that these features either fail to achieve their desired purpose, or worse still, have the potential to cause harm.” Limitations: Disclosed conflict of interest Derek Anselmo, DPM Richards et al. Is your prescription of distance
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