Gait-related risk factors for exercise-related lower-leg pain during shod running

Purpose : Exercise-related lower-leg pain (ERLLP) is a common chronic sports injury. In clinical practice, deviant gait biomechanics are frequently considered to play a role in the development of ERLLP, although there is scarce scientific evidence that gait-related variables predispose athletes to this injury. The purpose of this study was to examine prospectively the gait-related risk factors for ERLLP during shod running in a young, physically active population. Methods: The gait pattern during shod running of 400 physical education students was evaluated at the beginning of their academic study. This was accomplished by means of plantar pressure measurements and 3D gait kinematics. After this evaluation, the same sports physician registered all sports injuries during this study. Results: During the follow-up period, 46 subjects developed ERLLP, of whom 29 subjects had bilateral complaints. Thus, 75 symptomatic lower legs (35 left and 40 right) were classified into the ERLLP group. Bilateral feet of 167 subjects who sustained no injuries at the lower extremities served as the referent group. Cox regression analysis revealed that subjects who will develop ERLLP have an altered running pattern compared with the referent subjects. More specifically, these subjects showed a significantly increased pronation excursion, accompanied by more pressure underneath the medial side of the foot, a delayed maximal eversion, and an accelerated reinversion. Conclusion: The findings of this study suggest that altered gait biomechanics during shod running play a role in the genesis of ERLLP and, thus, should be considered in prevention and rehabilitation of this pathology.