Foot posture and Q-angle and running-related injuries

Here is another one on foot posture and running injury. I previously looked at the nonsense surrounding “overpronation”; how the media and the running blogs and forums fell for a hyped press release on how “overpronation” was not a risk factor (when in reality they removed all the high risk “overpronators” from the study); and then ignored another study that came out about the same time reporting the opposite results; so we now have to rely on the pooling of data in the meta-analysis’s of all the studies that concluded that ‘overpronation’ is a small, but still statistically significant risk factor for injury in runners. Now we have this study from August (I missed it at the time) that adds to that mix:

No association between q-angle and foot posture with running-related injuries: a 10 week prospective follow-up study.
Ramskov D, Jensen ML, Obling K, Nielsen RO, Parner ET, Rasmussen S.
Int J Sports Phys Ther. 2013 Aug;8(4):407-15.
There is a paucity of knowledge on the association between different foot posture quantified by Foot Posture Index (FPI) and Quadriceps angle (Q-angle) with development of running-related injuries. Earlier studies investigating these associations did not include an objective measure of the amount of running performed. Therefore, the purpose of this study was to investigate if kilometers to running-related injury (RRI) differ among novice runners with different foot postures and Q-angles when running in a neutral running shoe.
A 10 week study was conducted including healthy, novice runners. At baseline foot posture was evaluated using the foot posture index (FPI) and the Q-angle was measured. Based on the FPI and Q-angle, right and left feet / knees of the runners were categorized into exposure groups. All participants received a Global Positioning System watch to allow them to quantify running volume and were instructed to run a minimum of two times per week in a conventional, neutral running shoe. The outcome was RRI.
Fifty nine novice runners of mixed gender were included. Of these, 13 sustained a running-related injury. No significant difference in cumulative relative risk between persons with pronated feet and neutral feet was found after 125 km of running (Cumulative relative risk = 1.65 [0.65; 4.17], p = 0.29). Similarly, no difference was found between low and neutral Q-angle (Cumulative relative risk = 1.25 [0.49; 3.23], p = 0.63).
Static foot posture as quantified by FPI and knee alignment as quantified by Q-angle do not seem to affect the risk of injury among novice runners taking up a running regimen wearing a conventional neutral running shoe. These results should be interpreted with caution due to a small sample size.

This prospective study (good) showed that foot posture, as measured by the Foot Posture Index (good) and the Q-angle did not predict the 13 injuries in the 59 runners in the 10 weeks of the study. How much weight should be given to the 13/59? If it was sufficient, it would tilt the results of a subsequent meta-analysis back towards “overpronation” not being a risk factor, but how far? Far enough to conclude it is not a risk factor? I probably don’t think so, as 13/59 is right down the bottom end of being acceptable.

As always, I go where the evidence takes me until convinced otherwise, and this study does show that foot “overpronation” was not a risk factor in a small sample size. It needs to be interpreted in the context of what the meta-analyses and systematic reviews are showing. The study is not enough to reverse those conclusions.

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2 Responses to Foot posture and Q-angle and running-related injuries

  1. Rodger Kram November 6, 2013 at 1:36 am #

    title has a typo Q-angle, not Q-ankle

    • Craig Payne November 6, 2013 at 2:10 am #

      Fixed it! i often make that mistake!

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