SLR - April 2011 - Michael Brondon
Reference: Franklyn-Miller, A, et al. American Journal of Sports Medicine. 39,1: 2011 Doi: 10.1100/0363546510382852
Reviewed by: Michael Brondon, DPM/PGY1
Residencey Program: Central Alabama Veterans Health Care System
Sceintific Literature Review
Podiatric Relevance:
Over use injuries are common in initial military training, in particular medial tibial stress syndrome, stress fx, anterior knee and patellofemoral pain, Achilles tendinopathy and plantar fasciitis. Some significant factors of these injuries can be attributed to abnormal gait biomechanics and rapid onset of training volume and load. Foot orthoses have been commonly used to combat these types of injuries. Through this study, the authors hypothesize that there would be a reduction in injury rates with those who are fitted with the D3D orthotic than those who do not.
Methods:
Randomized controlled trial of 400 soldiers. Distribution of the orthotics were given at random, and participants were blind to the study. Using plantar pressure software, 8 anatomical areas were identified and if abnormal, used in notifying the researchers that a correction was needed in the orthotic device. The participants were grouped into low risk (0 corrections), medium risk (1 correction) and high risk (2 corrections). Training regiment consisted of 2-3 periods of physical training, with daily load and mileage gradually increasing to 27 miles in 48 hours, carrying a personal load of 30kg at the end of a 7 week period. The researchers measured the number of overuse lower limb injury that required removal from physical training for 2 or more days.
Results:
82 total injuries were sustained by the participants in this study, most common was medial tibial stress syndrome, followed by IT band syndrome and Achilles tendinopathy. Men were calculated to have a higher absolute risk reduction (0.44 vs. 0.04 for women) Orthotic group participants sustained 21 injuries, as compared to 61 in the control group. Side effects of the orthoses were limited to blisters.
Conclusions:
There was a reduced rate of exercise-related injury for those at risk who were prescribed D3D orthoses. The rate of injury was lower than expected (20% as compared to 30%). Despite the discrepancy of injuries in men vs. women, their injury profiles differed. Also, literature shows those with an increased BMI (heavier, shorter, and have larger feet) are more prone to injury.