Musculosketal Studies Lower Extremity Overuse Thesis

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Running on pavement that is cantilevered, such as on a road that is designed to 'run off' rainwater, is more apt to be a culprit in developing patellofemoral pain, regardless of the individual's foot type, while running downhill may exacerbate the tendency of an individual to develop IB syndrome. Improper running shoes for the individual's foot type can also exacerbate both conditions -- inflexible new running shoes again heightening the chance of developing IB syndrome (Hunter, Dolan & Davis, 1995, p.31).

Stress fractures are another common orthopedic plague. They are small fractures of the bone that develop over time, again often from overuse activities like running. Medical literature suggests that certain foot types are more apt to develop stress fractures in certain places than other areas of the body. For example, some believe that flat-footedness may actually guard against overuse injuries in certain places. One clinical study of fifty healthy subjects -- 34 with normal feet, 16 with flat feet -- walked and ran five trials each at standard speeds. An "assessment of impact found that biomechanically, individuals with a flat foot could be at a lower risk for lateral column metatarsal stress fractures, indicating that foot type should be assessed when determining an individual's risk for metatarsal stress fractures" (Chuckpaiwong, Nunley, Mall, Queen 2008, p.403). Outside of the 'laboratory,' individuals with cavus or high-arched feet seem more apt to contract 'Jones' fractures of the proximal fifth metatarsal, which do not heal well, as well as femoral and tibial stress fractures (Hunter, Dolan & Davis, 1995, p.30-31).

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However, a 1989 study of military recruits suggested that flat-footed individuals are more prone to metatarsal stress fractures, while high-arched individuals are more prone to tibial and femoral fractures Hunter, Dolan & Davis, 1995, p.30).

This contradictory literature about metatarsal stress fractures and the more 'injury prone' flat footed athlete is partially the product of different types of studies -- some of populations studied were engaged in activities in the field, others in the lab, and the studies had wide discrepancies in the numbers of participants. All of which may (or may not) explain the divergent results. Also, other causative factors may come into play -- individuals who are heavier or run more mileage may be more apt to be flat-footed, while high-arched individuals may prefer sports other than running that have less impact on the joints in question. Further study is needed to determine if flat-footedness is truly a detriment to full enjoyment of physical activities involving repetitive stress, and the idea that the shock-absorbing potential of pronation may even be helpful in some limited instances should also be entertained.

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