How to help runners steer clear of injury
Assess risk factors, then work to address modifiable ones, such as wearing the right running shoes and building up slowly. Don’t let overweight or OA dampen enthusiasm.
PRACTICE RECOMMENDATIONS
› Counsel runners to cross-train, replace shoes regularly, and use shoes with moderate-to-high (8-12 mm) heel-to-toe drop. C
› Don’t discourage running for exercise, as long as it is tolerated, in patients who have osteoarthritis. C
› Encourage moderation in running distance and intensity, especially in novice runners. C
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series
Gait analysis is not feasible in most primary care clinics. Instead, patients who run and (1) in whom pain persists despite more traditional treatments and (2) who have had recurring injury should be referred to a gait lab for analysis, usually by a physical therapist.
Nonmodifiable risk factors
Arch height. A high arch (pes cavus) is associated with increased risk of running-related injury, including bone stress injury, Achilles tendinopathy, plantar fasciitis, and patellofemoral pain syndrome.5 The mechanism of injury is thought to be increased forefoot loading forces.1
A review article showed that patients with pes cavus have reduced pain when using an orthosis, although there is no associated decrease in the risk of injury.5 To the contrary, a prospective study concluded that arch height was unrelated to increased risk of running-related injury.7
Evidence regarding flat feet (pes planus) and risk of injury is also mixed. Some studies show that pes planus is not associated with increased risk of injury in athletes.12 A cross-sectional study in older patients showed those with pes planus morphology had a higher rate of knee pain and wearing away of medial compartment cartilage.13 Because this study comprised only older adults, it is not generalizable to runners—nor can conclusions be drawn about causation, given the cross-sectional nature of the study.
Although a foot orthosis can correct mechanical differences caused by pes planus morphology, there is not enough evidence to conclude that correction results in a lower rate of injury. In sum, data are mixed with regard to arch height as a risk factor for running-related injury.
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