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Comparing Risk Factors for the Development of Medial Tibial Stress Syndrome (Shin Splints) on Habitual Barefoot vs Conventional Running Shoe Runners

Are you interested in participating in a research study comparing if the risk factors associated with medial tibial stress syndrome differ between runners who habitually run in minimal footwear and those who wear conventional running shoes? 

Dublin City University are looking for participants for a study investigating whether runners who habitually uses minimalist footwear differ from those using conventional running shoes with regards to:

  1. The amount of pressure under the medial (inside) of the foot when running
  2. The amount of hip internal and external range of motion
  3. The amount of navicular drop (fall in foot arch height)

 

To participate contact Kirsty McIlwaine via This email address is being protected from spambots. You need JavaScript enabled to view it. or call 086 057 5432

 

These measures were chosen because they are recognized risk factors for a number of injuries, including medial tibial stress syndrome (MTSS), also known as shin splints. If you are interested in participating or reading more about this area of research, we provide background into the topic and study below.

We are seeking barefoot runners as study participants. Your involvement will include tasks such as running on a treadmill at your own pace, allowing us to measure the range of movement available at ankle and hip joints and completing dynamic movements such as a squat. The emphasis will be on your personal adaptation to barefoot running and not fitness levels.

 dcu

Motivation for the study

Running can expose the body to a relatively high risk of injury with the incidence varying between 19-79% (van Gent et al 2007). Medial tibial stress syndrome (MTSS) also known as shin splints, is a complex and multifactorial overuse injury with an incidence of 13-20% in runners. MTSS causes exercise-induced pain over the anterior tibia which can lead to further tibial stress if not addressed (Yates and White, 2004). Key biomechanical risk factors associated with this injury include, high medial plantar pressure at initial foot contact, increased navicular drop and greater range of hip external ROM (Becker et al., 2018; Winkelmann et al., 2016; Hamstra-Wright et al 2015).Running can expose the body to a relatively high risk of injury with the incidence varying between 19-79% (van Gent et al 2007). Medial tibial stress syndrome (MTSS) also known as shin splints, is a complex and multifactorial overuse injury with an incidence of 13-20% in runners. MTSS causes exercise-induced pain over the anterior tibia which can lead to further tibial stress if not addressed (Yates and White, 2004). Key biomechanical risk factors associated with this injury include, high medial plantar pressure at initial foot contact, increased navicular drop and greater range of hip external ROM (Becker et al., 2018; Winkelmann et al., 2016; Hamstra-Wright et al 2015).

The type of footwear that is habitually worn may have an influence on the development of MTSS. Given that shoes are an interface between the foot and the ground it has been suggested that different footwear can alter running biomechanics (Salzler et al., 2012). Furthermore, different footwear may have different effects on the biomechanical risk factors associated with MTSS. A popular topic within recent literature are the biomechanical differences between minimal footwear (MFW) and conventional running shoes (CRS). There is an ongoing debate over whether the use of MFW or CRS facilitate more appropriate running biomechanics associated with injury risk and prevention.

Many studies have compared CRS and MFW analysing biomechanical differences such as plantar pressures, foot strike and foot posture (Larson, 2014; Hall et al., 2013; Shu et al 2015). The differences found in these studies have not been compared to risks associated with MTSS. There are no studies that directly examine the risk factors of MTSS between the MFW and CRS. The primary aim of this study is to compare and contrast the risk factors for the development of medial tibial stress syndrome which include higher medial plantar pressures, increased navicular drop and increased hip external ROM, between runners who habitually run in minimal footwear and those who wear conventional running shoes. Testing participants who have adapted to the shoe condition is key for observing a pattern in foot function.

The inclusion criteria for all participants includes; no pain or injury in the lower extremities in the past 6 months and aged between 18-40yrs. MFW group will have to be running in minimal footwear more than 6 months prior to the entry of study and running 10km a week. MFW shoes worn by the participants must have minimalist properties including level to minimal heel-to-toe drop, light weight, flexible and a wide toe box with no cushioning (e.g. Figure 1). Vibram five-finger shoes or any shoe that replicates that design can not be used during testing because our measurement pressure insoles do not fit this design fo shoe. However, if you normally wear these shoes alternative minimal footwear will be provided for test purposes. CRS will act as the control in this study. CRS include the common running shoe with added cushioning, high heel-to-toe drop and a high level of support (e.g Figure 2).

 

To participate contact Kirsty McIlwaine via This email address is being protected from spambots. You need JavaScript enabled to view it. or call 086 057 5432

Figure 1. MFW     Figure 2. CRS

Figure 1. MFW     Figure 2. CRS

How does it work?

  • The study consists of single-session testing on all participants in DCU biomechanics laboratory, lasting 45 minutes. All sections of the study are provided on the flow chart below (Figure 4). Time and date can be arranged to suit (including weekends).
  • Section one is designed to provide each participant with an overview of the study.
  • Anthropometric measurements will be taken which include measuring height and weight. The warm up includes walking for 1 minute followed by jogging at a self-selected speed for 6 minutes on a treadmill wearing pressure plate insoles in shoes (Figure 5). Each participant will be given 5 minutes to do their usual stretches completed before a run.
  • Plantar pressure will be measured at a set speed of 3.3m/s on the treadmill. The testing trial will last 2 minutes. Data will be collected in the last 30 seconds analysing 10 foot strikes. Static hip external ROM will be measured in a seated position (Figure 6).
  • The navicular drop will then be measured which involves the participants navicular bone being marked and measured both seated with the foot in neutral and standing in a relaxed foot posture (Figure 7).

 Figure 4. Flow Chart of the Layout of the Study.

Figure 4. Flow Chart of the Layout of the Study.

 Figure 5. In-shoe plantar pressure sensor by Pedar Novel (Novel Quality in Measurement. Available online: http://www.novel.de/).

Figure 5. In-shoe plantar pressure sensor by Pedar Novel (Novel Quality in Measurement. Available online: http://www.novel.de/

 Figure 6. Hip external ROM assessment (Cheatham et al., 2017).

Figure 6. Hip external ROM assessment (Cheatham et al., 2017).

 Measurement of navicular drop test (McPoil et al., 2013).

Figure 7: Measurement of navicular drop test (McPoil et al., 2013).

Who is running the study?

This study is being run by Kirsty McIwaine, final year student of Athletic Therapy and Training in Dublin City University.

 

How do I sign up?

To participate, get in touch with Kirsty at: This email address is being protected from spambots. You need JavaScript enabled to view it. and please feel free to share with interested parties. Your support is greatly appreciated.

 

To participate contact Kirsty McIlwaine via This email address is being protected from spambots. You need JavaScript enabled to view it. or call 086 057 5432

 

References

  • Becker, J., Nakajima, M., Wu, W.F.W., 2018. Factors Contributing to Medial Tibial Stress Syndrome in Runners: A Prospective Study. Med. Sci. Sports Exerc. 50, 2092–2100. https://doi.org/10.1249/MSS.0000000000001674
  • Becker, J., Nakajima, M., Wu, W.F.W., 2018. Factors Contributing to Medial Tibial Stress Syndrome in Runners: A Prospective Study. Med. Sci. Sports Exerc. 50, 2092–2100. https://doi.org/10.1249/MSS.0000000000001674
  • Cheatham, S., Hanney, W.J., Kolber, M.J., 2017. HIP RANGE OF MOTION IN RECREATIONAL WEIGHT TRAINING PARTICIPANTS: A DESCRIPTIVE REPORT. Int. J. Sports Phys. Ther. 12, 764–773.
  • Hall, J.P.L., Barton, C., Jones, P.R., Morrissey, D., 2013. The biomechanical differences betweenbarefoot and shod distance running: a systematic review and preliminary meta-analysis. Sports Med. Auckl. NZ 43, 1335–1353.
  • Hamstra-Wright, K.L., Bliven, K.C.H., Bay, C., 2015. Risk factors for medial tibial stress syndrome in physically active individuals such as runners and military personnel: a systematic review and meta-analysis. Br. J. Sports Med. 49, 362–369. https://doi.org/10.1136/bjsports-2014-093462
  • Larson P. 2014. Comparison of foot strike patterns of barefoot and minimally shod runners in a recreational road race. Journal of Sport and Health Science 3(2).
  • McPoil T.G., Cornwall M.W. Abeler M.M., Devereaux K.J., Flood L.J., Merriman S.E., Sullivan S., van Der Laan M.J., Villadiego T.A and Wilson K. The Optimal Method to Assess the Vertical Mobility of the Midfoot: Navicular Drop versus Dorsal Arch Height Difference? Clinical Research on Foot & Ankle. 1:1.
  • Salzler MJ, Bluman EM, Noonan S, Chiodo CP, de Asla RJ. 2012. Injuries observed in minimalist runners. Foot Ankle Int. 262-266
  • Shu Y, Mei Q, Fernandez J, Li Z, Feng N, Gu Y. 2015. Foot morphological differences between habitually shod and unshod runners. PLoS ONE 10(7): e0131385.
  • van Gent, R.N., Siem, D., van Middelkoop, M., van Os, A.G., Bierma-Zeinstra, S.M.A.,
  • Koes, B.W., 2007. Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review. Br. J. Sports Med. 41, 469–480; discussion 480 https://doi.org/10.1136/bjsm.2006.033548
  • Winkelmann, Z.K., Anderson, D., Games, K.E., Eberman, L.E., 2016. Risk Factors for Medial Tibial Stress Syndrome in Active Individuals: An Evidence-Based Review. J. Athl. Train. 51, 1049–1052. https://doi.org/10.4085/1062-6050-51.12.13
  • Yates, B., White, S., 2004. The incidence and risk factors in the development of medial tibial stress syndrome among naval recruits. Am. J. Sports Med. 32, 772–780. https://doi.org/10.1177/0095399703258776

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