The Role of Shoe Design in Ankle Sprain Rates Among Collegiate Basketball Players

Orthopaedic Associates of Wisconsin, Waukesha, WI 53188, USA.
Journal of athletic training (Impact Factor: 2.02). 05/2008; 43(3):230-3. DOI: 10.4085/1062-6050-43.3.230
Source: PubMed


Much of the recent focus in shoe design and engineering has been on improving athletic performance. Currently, this improvement has been in the form of "cushioned column systems," which are spring-like in design and located under the heel of the shoe in place of a conventional heel counter. Concerns have been raised about whether this design alteration has increased the incidence of ankle sprains.
To examine the incidence of lateral ankle sprains in collegiate basketball players with regard to shoe design.
Prospective cohort study.
Certified athletic trainers at 1014 National Collegiate Athletic Association (NCAA)-affiliated schools sponsoring basketball during the 2005-2006 regular season were notified of an online questionnaire. Athletic trainers at 22 of the 1014 schools participated.
A total of 230 basketball players (141 males, 89 females; age = 20.2 +/- 1.5 years) from NCAA Division I-III basketball programs sustained lateral ankle sprains.
Ankle sprain information and type of shoe worn (cushioned column or noncushioned column) were collected via online survey. The incidence of lateral ankle sprains and type of shoes worn were compared using a chi-square analysis.
No difference was noted in ankle sprain incidence between groups (chi(2) = 2.44, P = .20, relative risk = 1.47, 95% confidence interval [CI] = 0.32, 6.86). The incidence of ankle sprains was 1.33 per 1000 exposures in the cushioned column group (95% CI = 0.62, 3.51) and 1.96 per 1000 exposures in the noncushioned column group (95% CI = 0.51, 4.22).
No increased incidence of ankle sprains was associated with shoe design.

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    • "Prevention of recurrences depends on the type of activity performed by patients. Sports such as football, volleyball or basketball increase the risk for relapse (Fong et al., 2007; Curtis et al., 2008; Fong et al., 2008; Ivins, 2006). Some studies show that asymmetry in muscle testing of ankle flexors associated with overweight and a high body mass index increases the risk of sprains in football players (Fousekis et al., 2012). "
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    ABSTRACT: Background. Anatomically, the ankle and the foot form an anatomical and functional structure with the role of supporting body weight, maintaining orthostatism and performing walking. Aims. The aim of this study was to highlight the importance of rehabilitation treatment in athletes diagnosed with trauma to the ankle. Monitoring of these patients was performed using pain assessment scores, assessing the quality of life, and perfor-ming functional clinical assessments. Methods. The study was conducted on 60 athletes with mild and moderate ankle sprains. Patient selection was done in the Department of Rheumatology and Rehabilitation and in the Department of Orthopaedics, Mureş County Emergency Hospital from January 2013 -December 2013. Two groups of 30 patients each were studied. Patients in group C were only recom-mended rest, compression bandages, pain relievers and anti-inflammatory treatment, while patients in group E were recom-mended complex rehabilitation treatment procedures over a period of 14 sessions. Patients were evaluated initially, at the end of the treatment, two weeks after, and at an interval of 3 months using the visual analogue scale (VAS), clinical assessment, and joint testing. Results. No statistically significant improvement was found in group C patients in terms of pain and joint mobility, while in group E a statistically significant improvement was found regarding the patients' pain assessed by VAS and mobility of the joint assessed by joint testing. Joint swelling was encountered in 70% of patients in group C 2 weeks after the traumatic event and in 40% of patients 3 months after. Only 25% of the patients in group E showed joint swelling 2 weeks after the injury, and only 10% after 3 months. Conclusions. Our study shows that recovery treatment significantly alleviates pain and improves mobility in athletes with ankle traumas, maintaining positive effects in the long run. Keywords: rehabilitation treatment, trauma to the ankle, athletes. Rezumat Premize. Glezna, ca structură anatomică, formează un tot unitar împreună cu piciorul, alcătuind o structură anatomofuncţio-nală cu rol de susţinere a greutăţii corpului, de menţinere a ortostatismului şi de efectuare a mersului. Obiective. Scopul acestui studiu a fost evidenţierea importanţei tratamentului de recuperare la pacienţii cu activitate sportivă diagnosticaţi cu traumatisme la nivelul gleznei, la care monitorizarea evoluţiei în timp s-a făcut utilizând scoruri de evaluare a durerii, a calităţii vieţii şi evaluări clinico-funcţionale. Metode. Studiul a fost realizat pe pe un număr de 60 de sportivi cu entorse uşoare şi medii. Selecţia pacienţilor s-a făcut din Secţia de Reumatologie şi Recuperare şi Secţia de Ortopedie a Spitalului Clinic Judeţean de Urgenţă Mureş pe perioada ianu-arie 2013-decembrie 2013. S-au luat în studiu două loturi de câte 30 de pacienţi. Pacienţilor din lotul C li s-a recomandat doar repaus, compresie cu bandaj elastic, tratament antiinflamator şi antialgic, în timp ce pacienţilor din lotul E li s-a recomandat un tratament complex de recuperare, pe o durată de 14 şedinţe. Evaluarea pacienţilor s-a făcut iniţial, la sfârşitul tratamentului, după două săptămâni şi la un interval de 3 luni, utilizând scala VAS (visual analog scale), evaluarea clinică a pacienţilor şi testingul articular. Rezultate. În lotul C de pacienţi nu s-a constat o ameliorare statistic semnificativă în ceea ce priveşte durerea şi mobilitatea articulară, în timp ce în lotul E, s-a constat o amelioarare statistic semnificativă a durerii apreciată prin scala VAS (visual analog scale) şi a mobilităţii articulare evaluată prin testingul articular. Tumefierea articulară s-a menţinut în lotul C la 70% dintre pacienţi după evenimentul traumatic la 2 săptămâni şi la 40% dintre pacienţi la 3 luni. La pacienţii din lotul E, doar 25% mai prezentau tumefiere articulară la 2 săptămâni după traumatismul sportiv, în timp ce la 3 luni doar 10%. Concluzii. Studiul nostru dovedeşte că prin tratamentul de recuperare se ameliorează semnificativ atât durerea, cât şi mo-bilitatea la sportivii cu patologie traumatică la nivelul gleznei, cu menţinerea acestor efecte pe termen lung. Cuvinte cheie: tratament de recuperare, traumatisme gleznă, sportivi.
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    ABSTRACT: xix, 191 leaves : ill. (some col.) ; 30 cm. PolyU Library Call No.: [THS] LG51 .H577P RS 2010 Cheung Motion control footwear is a common technology in running shoe designs. The function of motion control footwear is mainly to reduce excessive rearfoot pronation in runners for injury prevention. Because erratic rearfoot kinematics may affect proximal joints by the linkage of human kinetic chain, the functions of motion control footwear may not only be confined to kinematic control. The functions of motion control footwear are not well explored and understood. Thus, the overall purpose of this thesis is to explore functions of motion control footwear in runners with excessive rearfoot pronation. Experiments were conducted to test the efficacy of motion control footwear in terms of 1) rearfoot kinematics control; 2) plantar loading control; and 3) lower extremity muscle activity control. These parameters were also tested after muscle fatigue because runners are more prone to injury in such status. A total of forty eight female runners were recruited. Three of them were rejected due to their normal rearfoot pronation. All the subjects were provided standard motion control footwear and neutral footwear for treadmill running sessions with 1-week apart. Motion capture analysis suggested that the maximum rearfoot pronation of runners was reduced in motion control footwear condition, compared with neutral footwear condition (p <0.001; 10.58° with motion control footwear, 13.94° with neutral footwear). After 1500m run, while the rearfoot supinators were fatigued (p <0.01), the maximum rearfoot pronation further increased when runners put on neutral footwear (p <0.01; 6.5° 95% C.I. 4.7-8.2°) but not in motion control footwear condition (p =0.06; 0.7° 95% C.I. -0.3-1.4°). Subjectively, runners were not able to differentiate the kinematics control function between two test footwear model, indicated by feedback score (p =0.711) in a validated questionnaire. These results highlighted the importance of rearfoot posture assessment by medical professionals, rather than self adjustment by runners. Plantar loading sensors revealed that the medial foot structures sustained higher loading (p =0.001; 364 to 418 N; 15% increase at medial midfoot) with neutral footwear condition after muscle fatigue caused by running 1500m. This increased loading pattern is highly associated with various running injuries. On the other hand, the plantar loading was similar in motion control footwear condition (p =0.572). Electromyography indicated that the muscle activity of tibialis anterior (TA) and peroneus longus (PL) increased with mileage during 10km run. The activation of both TA (p <0.001; normalized RMS 10.5% higher) and PL (p <0.001; normalized RMS 9.6% higher) was higher in neutral footwear condition than motion control footwear condition. Also, significantly higher amount of muscle fatigue was noted in PL during the neutral footwear testing condition (p <0.001; median frequency drop in motion control footwear = 2.10 Hz; median frequency drop in neutral footwear = 11.60 Hz). In quadriceps muscles, the experiments showed that the amplitude of median frequency (MF) drop in vastus medialis oblique (VMO) was higher in the neutral footwear condition (p=0.008; median frequency drop in motion control footwear = 1.23 Hz; median frequency drop in neutral footwear = 9.51 Hz) while the vastus lateralis (VL) had a more significant drop in MF when running with motion control footwear (p=0.001; median frequency drop in motion control footwear = 3.80 Hz; median frequency drop in neutral footwear = 1.78 Hz). Early fatigue of the major patella stabilizing muscle VMO, which occurred in neutral footwear condition, may lead to patellofemoral pain syndrome in runners. The onset timing of VMO and VL was significant different with footwear condition change and mileage (p=0.001). Numerically, the VMO of the subjects activated at around 5.3% of a duty cycle earlier than VL when running with motion control footwear; whereas for the neutral footwear running condition, there was a delay in VMO activation by about 4.6% of a duty cycle compared to VL. The onset delay time of VMO was strongly correlated (r = 0.948; p < 0.001) with the running mileage in neutral footwear condition only. In the motion control footwear condition, this correlation was very weak (r = 0.258; p =0.472). The results of electromyography experiments suggested motion control footwear provided favorable running conditions in terms of higher resistance towards muscle fatigue, more stable activation of shank stabilizing muscles, as well as enhanced temporal activation of patella stabilizers. These footwear functions may be able to reinforce injury prevention in running population. The findings of this thesis form a basis for the establishment of a running injury prevention program or adjunct therapy intervention by appropriate footwear prescription in runners with excessive rearfoot pronation problem. Ph.D., Dept. of Rehabilitation Sciences, The Hong Kong Polytechnic University, 2010
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