SLR - September 2013 - Elizabeth Wakefield
Reference: Owens BD, Moriatis Wolf J, Seelig AD, Jacobson IG, Boyko EJ, Smith B, Ryan AK, Gackstetter GD, Smith T. C. (2013). Risk Factors for Lower Extremity Tendinopathies in Military Personnel. The Orthopaedic Journal of Sports Medicine, 1(1), 2325967113492707.
Scientific Literature Review
Reviewed by: Elizabeth Wakefield, DPM
Residency Program: Grant Medical Center
Podiatric Relevance: Lower extremity tendinopathies including Achilles, patellar tears and plantar fasciitis can influence the activity level of occupational groups as well as the general public. Preventing the tendinopathy through identifying modifiable factors and individuals who are at risk for tendon injury via behavioral risks may have an impact on those who are active.
Methods: Data was collected via the Millennium Cohort Study, a 21-year prospective study of deployed military to identify long-term outcomes of military service. Three panels were formed based on the year of enrollment in the military. Panel one included 77,047 participants enrolling between 2001-2003, panel two included 31,110 participants enrolled from 2004-2006, and panel three included 43,440 participants enrolled from 2007-2008. The total number of participants for this analysis was 80,106. The questionnaire included demographics, service branch, health, lifestyle, body mass index (BMI), and tobacco and alcohol use. Achilles and patellar tendonopathies and plantar fasciitis were identified through electronic medical records and associated ICD-9 codes. Descriptive and univariate analyses were used to analyze population characteristics.
Results: Within the first year of baseline enrollment, there were 450 Achilles tendinopathy diagnoses, 584 patellar tendinopathy diagnoses, and 1,228 plantar fasciitis diagnoses. Achilles tendinopathy was associated with overweight or obese individuals and moderate weekly alcohol drinkers, as well as those enrolled in the Army. A linear near-inverse relationship between age and incidence of patellar tendinopathy was noted, as well as increased incidence noted in the Army or other technical and allied specialties. Recent deployment did not affect incidence of patellar tendinopathy. Plantar fasciitis was significantly increased in recent deployments, and increased in those who were overweight/obese. Reduced odds were noted in current smokers. Women had higher odds of developing plantar fasciitis and younger military members were less likely. A history of tendinopathy or fracture was four times more likely to develop plantar fasciitis than those with no history.
Conclusions: Behavioral risks and past history of injury significantly impact certain lower extremity tendinopathies. Alcohol use, smoking history, and BMI were influential in Achilles tendinopathy and plantar fasciitis. Race and sex were not clearly identified as risk factors in any lower extremity tendinopathy. Positive history of prior fracture or tendinopathy, and certain jobs increased risk for future tendinopathy.