The influence of midsole horizontal and vertical deformation on soft tissue vibrations and bone acceleration during running.

Increased midsole deformation can limit exposure to high impact and vibration magnitudes while running. The aim of this study was to evaluate the effect of shoes eliciting different midsole deformation on ground reaction forces, heel impact, soft tissue vibrations and bone vibrations. Forty-eight runners performed a 5-min running task on an instrumented treadmill at a self-selected pace with four different shoes. Midsole horizontal and vertical deformations were quantified with relative displacement of seven reflective markers placed on the midsole of the shoe and tracked by eight optoelectronic cameras. Heel impacts, soft tissue and bone vibrations of lower leg muscle groups, sacrum and head were quantified with tri-axial accelerometers. Continuous wavelet transform was used to assess magnitude and frequency of the acceleration data. Linear mixed models and non-parametric one-dimensional regressions between the accelerometer data and shoe deformation were performed. Greater horizontal and vertical deformations decreased the magnitude (up to 4.6% per mm) and frequency (up to 0.6 Hz per mm) of soft tissue vibrations and bone accelerations. Accelerations of the heel, tibia, gastrocnemius medialis and vastus lateralis were more influenced than the sacrum and head. Increasing midsole deformation could therefore mitigate the risk of injury, while increasing running comfort and smoothness.

The influence of midsole shear on running economy and smoothness with a 3D-printed midsole.

The objectives of this study were to first determine whether a newly designed 3D-printed midsole, configured with a mechanism to increase anterior-posterior deformation, could increase anterior midsole shear during the stance phase of running. We then wanted to determine whether these shoes could affect running economy and smoothness. Two footwear conditions, differing in midsole technology, were used in this study. The control condition consisted of a thermoplastic polyurethane midsole (TPU-Control), whereas the prototype shoes (3D-Shear) were constructed with a 3D-printed lattice midsole designed for greater anterior foot displacement during early to mid-stance. Twenty male participants ran on a treadmill for 6 min in each condition, and data were collected during the final 2 min. Midsole shear was measured using 3D kinematic data; running smoothness was quantified with peak acceleration and jerk magnitudes from the foot, sacrum, and head; and running economy was determined with oxygen consumption data. As hypothesised, the anterior midsole shear was greater in the 3D-Shear condition compared to the TPU-Control. The 3D-Shear did not improve running economy. Runners exhibited significantly lower peak accelerations at the sacrum, along with lower magnitudes of jerk at the foot, sacrum, and head in the 3D-Shear condition, indicating smoother running patterns.

Effects of midsole cushioning stiffness on Achilles tendon stretch during running.

Footwear midsole material can have a direct influence on running performance. However, the exact mechanism of improved performance remains unknown. The purpose of this study was to determine if Achilles tendon energetics could potentially play a role in the performance improvements, by testing if changes in footwear midsole stiffness elicit changes in Achilles tendon stretch. Fourteen runners ran in two footwear conditions while kinematic, kinetic, metabolic and ultrasound data were recorded. There was a moderate positive correlation between the difference in stretch and the difference in performance, which was statistically significant (r(12) = 0.563, p = 0.036). Twelve participants had greater stretch and better performance in the same footwear condition. Based on stretch estimates, the difference between conditions in energy returned from the Achilles tendon was 3.9% of the mechanical energy required per step. Energy return of this magnitude would be relevant and could cause the improved performance observed. These results suggest that increasing energy returned from the Achilles could be a valid mechanism for improving running performance due to changes in footwear. These findings lead the way for future research to further understand internal mechanisms behind improved running performance.

Are subject-specific models necessary to predict patellar tendon fatigue life? A finite element modelling study.

Patellar tendinopathy is an overuse injury that occurs from repetitive loading of the patellar tendon in a scenario resembling that of mechanical fatigue. As such, fatigue-life estimates provide a quantifiable approach to assess tendinopathy risk and may be tabulated using nominal strain (NS) or finite element (FE) models with varied subject-specificity. We compared patellar tendon fatigue-life estimates from NS and FE models of twenty-nine athletes performing countermovement jumps with subject-specific versus generic geometry and material properties. Subject-specific patellar tendon material properties and geometry were obtained using a data collection protocol of dynamometry, ultrasound, and magnetic resonance imaging. Three FE models were created for each subject, with: subject-specific (hyperelastic) material properties and geometry, subject-specific material properties and generic geometry, and generic material properties and subject-specific geometry. Four NS models were created for each subject, with: subject-specific (linear elastic) material properties and moment arm, generic material properties and subject-specific moment arm, subject-specific material properties and generic moment arm, and generic material properties and moment arm. NS- and FE-modelled fatigue-life estimates with generic material properties were poorly correlated with their subject-specific counterparts (r2≤0.073), while all NS models overestimated fatigue life compared to the subject-specific FE model (r2≤0.223). Furthermore, FE models with generic tendon geometry were unable to accurately represent the heterogeneous strain distributions found in the subject-specific FE models or those with generic material properties. These findings illustrate the importance of incorporating subject-specific material properties and FE-modelled strain distributions into fatigue-life estimations.

Effect of Shoe and Surface Stiffness on Lower Limb Tendon Strain in Jumping.

BACKGROUND: Tendinopathies are painful overuse injuries observed in athletes participating in jumping sports. These injuries are heavily dependent on the resulting strain from the applied mechanical load. Therefore, mechanisms to reduce tendon strain may represent a primary prevention strategy to reduce the incidence of tendinopathy. PURPOSE: The purpose of this study was to examine the effect of shoe and surface stiffness on Achilles and patellar tendon strains during jumping. We hypothesized that less stiff shoes and surfaces would reduce Achilles and patellar tendon strains during jumping. METHODS: Thirty healthy male basketball players performed countermovement jumps in three shoes and on three surfaces with different stiffness properties while motion capture, force platform, and jump height data were collected. Magnetic resonance imaging was used to obtain participant-specific tendon morphology, and a combined dynamometry/ultrasound/electromyography session was used to obtain tendon material properties. Finally, a musculoskeletal model was used to estimate tendon strains in each surface and shoe combination. RESULTS: Achilles tendon strains during landing were reduced by 5.3% in the least stiff shoe compared with the stiffest shoe (P = 0.021) likely due to in bending stiffness altering the center of pressure location. Furthermore, Achilles tendon strains during landing were 5.7% and 8.1% lower on the stiffest surface compared with the least stiff and middle stiffness surfaces, respectively (P ≤ 0.047), because of changes in ground reaction force magnitude and center of pressure location. No effects of shoe stiffness or surface construction were observed for jump height (P > 0.243) or peak patellar tendon strains (P > 0.259). CONCLUSIONS: Changes to shoe stiffness and surface construction can alter Achilles tendon strains without affecting jump performance in athletes.

Development of a Footwear Sizing System in the National Football League.

CONTEXT:: Footwear performance and injury mitigation may be compromised if the footwear is not properly sized for an athlete. Additionally, poor fit may result in discomfort and foot injury such as fifth metatarsal stress fracture, foot deformities, turf toe, and blisters. Current footwear fitting methods consist of foot length and width measurements, which may not properly describe the shape of the individual foot, correlated with shoe size descriptors that are not standardized. Footwear manufacturers employ a range of sizing rubrics, which introduces shoe size and shape variability between and even within footwear companies. This article describes the synthesis of literature to inform the development and deployment of an objective footwear fitting system in the National Football League (NFL). The process may inform athletic footwear fitting at other levels of play and in other sports. EVIDENCE ACQUISITION:: Literature related to footwear fitting, sizing, and foot scanning from 1980 through 2017 was compiled using electronic databases. Reference lists of articles were examined for additional relevant studies. Sixty-five sources are included in this descriptive review. STUDY TYPE:: Descriptive review. LEVEL OF EVIDENCE:: Level 5. RESULTS:: Current methods of footwear fitting and variability in the size and shape of athletic footwear complicate proper fitting of footwear to athletes. An objective measurement and recommendation system that can match the 3-dimensional shape of an athlete's foot to the internal shape of available shoe models can provide important guidance for footwear selection. One such system has been deployed in the NFL. CONCLUSION:: An objective footwear fitting system based on 3-dimensional shape matching of feet and shoes can facilitate the selection of footwear that properly fits an athlete's foot.

Foot structure and knee joint kinetics during walking with and without wedged footwear insoles.

The relationship between static foot structure characteristics and knee joint biomechanics during walking, or the biomechanical response to wedged insoles are currently unknown. In this study, 3D foot scanning, dual X-ray absorptiometry and gait analysis methods were used to determine structural parameters of the foot and assess their relation to knee joint loading and biomechanical response to wedged insoles in 30 patients with knee osteoarthritis. In multiple linear regression models, foot fat content, height of the medial longitudinal arch and static hind foot angle were not associated with the magnitude of the knee adduction moment (R2 = 0.24, p = 0.060), knee adduction angular impulse (R2 = 0.21, p = 0.099) or 3D resultant knee moment (R2 = 0.23, p = 0.073) during gait. Furthermore, these foot structure parameters were not associated with the patients' biomechanical response to medial or lateral wedge footwear insoles (all p < 0.01). These findings suggest that static foot structure is not associated with gait mechanics at the knee, and that static foot structure alone cannot be utilized to predict an individual's biomechanical response to wedged footwear insoles in patients with knee osteoarthritis.

Influence of Compression and Stiffness Apparel on Vertical Jump Performance.

Compression apparel alters both compression of the soft tissues and the hip joint stiffness of athletes. It is not known whether it is the compression elements, the stiffness elements, or some combination that increases performance. Therefore, the purpose of this study was to determine how systematically increasing upper leg compression and hip joint stiffness independently from one another affects vertical jumping performance. Ten male athletes performed countermovement vertical jumps in 8 concept apparel conditions and 1 control condition (loose fitting shorts). The 8 apparel conditions, 4 that specifically altered the amount of compression exerted on the thigh and 4 that altered the hip joint stiffness by means of elastic thermoplastic polyurethane bands, were tested on 2 separate testing sessions (one testing the compression apparel and the other testing the stiffness apparel). Maximum jump height was measured, while kinematic data of the hip, knee, and ankle joint were recorded with a high-speed camera (480 Hz). Both compression and stiffness apparel can have a positive influence on vertical jumping performance. The increase in jump height for the optimal compression was due to increased hip joint range of motion and a trend of increasing the jump time. Optimal stiffness also increased jump height and had the trend of decreasing the hip joint range of motion and hip joint angular velocity. The exact mechanisms by which apparel interventions alter performance is not clear, but it may be due to alterations to the force-length and force-velocity relationships of muscle.

The effect of translational and rotational traction on lower extremity joint loading.

Previous studies have linked footwear traction to lower extremity non-contact injury; however, these studies mainly focussed on rotational traction exclusively. While studies have shown that increases in traction lead to increases in joint loading, represented by joint moments, these studies failed to determine how the individual components of rotational and translational traction affect joint loading. Therefore, this study investigated how each component of traction independently affects lower extremity joint loading. Traction testing was performed using a robotic testing machine on three shoes that had independent alterations of translational and rotational traction. All testing was conducted on a sample piece of artificial turf. Kinematic and kinetic data were then collected on 10 athletes performing two cutting movements in each shoe condition. As rotational and translational traction were independently altered, decreased rotational traction led to significant decreases in transverse and frontal plane joint loading at the ankle and knee joints, while increases in translational traction led to increases in frontal plane joint loading at the ankle and knee joints. Increases in joint loading in the transverse and frontal planes are one of the possible mechanisms of lower extremity non-contact injury. Both translational and rotational traction can independently alter the joint loading.

Footwear traction and three-dimensional kinematics of level, downhill, uphill and cross-slope walking.

Outdoor activities are a popular form of recreation, with hiking being the most popular outdoor activity as well as being the most prevalent in terms of injury. Over the duration of a hike, trekkers will encounter many different sloped terrains. Not much is known about the required traction or foot-floor kinematics during locomotion on these sloped surfaces, therefore, the purpose was to determine the three-dimensional foot-floor kinematics and required traction during level, downhill, uphill and cross-slope walking. Ten participants performed level, uphill, downhill and cross-slope walking along a 19° inclined walkway. Ground reaction force data as well as 3D positions of retro reflective markers attached to the shoe were recorded using a Motion Analysis System. Peak traction coefficients and foot-floor kinematics during sloped walking were compared to level walking. When walking along different sloped surfaces, the required traction coefficients at touchdown were not different from level walking, therefore, the increased likelihood of heel slipping during hiking is potentially due to the presence of loose material (rocks, dirt) on hiking slopes, rather than the overall lack of traction. Differences in required traction were seen at takeoff, with uphill and cross-sloped walking requiring a greater amount of traction compared to level walking. Changes in sagittal plane, frontal plane and transverse plane foot-floor angles were seen while walking on the sloped surfaces. Rapid foot-floor eversion was observed during cross-slope walking which could place the hiker at risk of injury with a misstep or if there was a slight slip.

The effect of lateral banking on the kinematics and kinetics of the lower extremity during lateral cutting movements.

There are many aspects of cutting movements that can limit performance, however, the implementation of lateral banking may reduce some of these limitations. Banking could provide a protective mechanism, placing the foot and ankle in orientations that keep them out of dangerous positions. This study sought to determine the effect of two banking angles on the kinematics and kinetics of the lower extremity during two athletic maneuvers. Kinematic and kinetic data were collected on 10 recreational athletes performing v-cuts and side shuffle movements on different banked surfaces (0°, 10°, 20°). Each sample surface was rigidly attached to the force platform. Joint moments were calculated and compared between conditions using a repeated measures ANOVA. Banking had a pronounced effect on the ankle joint. As banking increased, the amount of joint loading in the transverse and frontal planes decreased likely leading to a reduction in injury risk. Also an increase in knee joint loading in the frontal plane was seen during the 20° bank during the v-cut. Conversely loading in the sagittal plane at the ankle joint increased with banking and coupled with a reorientation of the ground reaction vector may facilitate a performance increase. The current study indicates that the 10° bank may be the optimal bank, in that it decreases ankle joint loading, as well as increases specific performance variables while not increasing frontal plane knee joint loading. If banking could be incorporated in footwear it may be able to provide a protective mechanism for athletes.

Footwear traction and lower extremity noncontact injury.

PURPOSE: Football is the most popular high school sport; however, it has the highest rate of injury. Speculation has been prevalent that foot fixation due to high footwear traction contributes to injury risk. Therefore, the purpose of the study was to determine whether a relationship exists between the athlete's specific footwear traction (measured with their own shoes on the field of play) and lower extremity noncontact injury in high school football. METHODS: For 3 yr, 555 high school football athletes had their footwear traction measured on the actual field of play at the start of the season, and any injury the athletes suffered during a game was recorded. Lower extremity noncontact injury rates, grouped based on the athlete's specific footwear traction (both translational and rotational), were compared. RESULTS: For translational traction, injury rate reached a peak of 23.3 injuries/1000 game exposures within the midrange of translational traction, before decreasing to 5.0 injuries/1000 game exposures in the high range of traction. For rotational traction, there was a steady increase in injury rate as footwear traction increased, starting at 4.2 injuries/1000 game exposures at low traction and reaching 19.2 injuries/1000 game exposures at high traction. CONCLUSIONS: A relationship exists between footwear traction and noncontact lower extremity injury, with increases in rotational traction leading to a greater injury rate and increases in translational traction leading to a decrease in injury. It is recommended that athletes consider selecting footwear with the lowest rotational traction values for which no detriment in performance results.

Normalization of ground reaction forces, joint moments, and free moments in human locomotion.

Authors who report ground reaction force (GRF), free moment (FM), and resultant joint moments usually normalize these variables by division normalization. Normalization parameters include body weight (BW), body weight x height (BWH), and body weight x leg length (BWL). The purpose of this study was to explore the appropriateness of division normalization, power curve normalization, and offset normalization on peak GRF, FM, and resultant joint moments. Kinematic and kinetic data were collected on 98 subjects who walked at 1.2 and 1.8 m/s and ran at 3.4 and 4.0 m/s. Linear curves were best fit to the data, and regression analyses performed to test the significance of the correlations. It was found that the relationship between peak force and BW, as well as joint moments and BW, BWH, and BWL, were not always linear. After division normalization, significant correlations were still found. Power curve and offset normalization, however, were effective at normalizing all variables; therefore, when attempting to normalize GRF and joint moments, perhaps nonlinear or offset methods should be implemented.

Footwear traction and lower extremity joint loading.

BACKGROUND: Traction is influenced by the sole architecture and playing surface, with increases in traction potentially leading to injury. The mechanism as to how or why increased traction could lead to injury remains unknown. PURPOSE: This study was undertaken to determine how shoes of different sole designs and traction influence knee and ankle joint moments. STUDY DESIGN: Controlled laboratory study. METHODS: Traction testing was performed on 2 shoes of varying sole designs (tread vs smooth) using a robotic testing machine. All testing was conducted on a 60-cm x 90-cm piece of sample track surface. Kinematic and kinetic data were then collected on 13 recreational athletes performing running V-cuts in the 2 different shoe conditions. Five trials per condition were collected with reflective markers placed on the right shank and shoe of each participant. Kinematic and kinetic data were collected using an 8-high-speed camera system and force plate. RESULTS: The coefficient of translational traction and the peak moment of rotation were both significantly higher in the tread shoe compared with the smooth shoe (1.00 vs 0.87 and 23.87 N.m vs 16.12 N.m, respectively). The high-traction shoe had significantly higher peak ankle external rotation moments (89.58 N.m vs 80.17 N.m), peak knee external rotation moments (36.23 N.m vs 32.02 N.m), peak knee adduction moments (224.0 N.m vs 186.8 N.m), and knee adduction angular impulse (2.10 Nms vs 1.83 Nms) compared with the low-traction shoe. CONCLUSION: Increased shoe traction significantly increased ankle and knee joint moments during a V-cut. Despite the significant difference in traction, no difference in performance was observed. These changes could have an effect on ankle and knee joint injury. CLINICAL RELEVANCE: Shoes with decreased traction could be used in sports to reduce the joint moments in the knee and ankle and potentially reduce injury without a loss in performance.