Effects of new military footwear on knee loading during running

Do biomechanical foot-based interventions reduce patellofemoral joint loads in adults with and without patellofemoral pain or osteoarthritis? A systematic review and meta-analysis

OBJECTIVE

To evaluate the effects of biomechanical foot-based interventions (eg, footwear, insoles, taping and bracing on the foot) on patellofemoral loads during walking, running or walking and running combined in adults with and without patellofemoral pain or osteoarthritis.

DESIGN

Systematic review with meta-analysis.

DATA SOURCES

MEDLINE, CINAHL, SPORTdiscus, Embase and CENTRAL.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

English-language studies that assessed effects of biomechanical foot-based interventions on peak patellofemoral joint loads, quantified by patellofemoral joint pressure, reaction force or knee flexion moment during gait, in people with or without patellofemoral pain or osteoarthritis.

RESULTS

We identified 22 footwear and 11 insole studies (participant n=578). Pooled analyses indicated low-certainty evidence that minimalist footwear leads to a small reduction in peak patellofemoral joint loads compared with conventional footwear during running only (standardised mean difference (SMD) (95% CI) = -0.40 (-0.68 to -0.11)). Low-certainty evidence indicated that medial support insoles do not alter patellofemoral joint loads during walking (SMD (95% CI) = -0.08 (-0.42 to 0.27)) or running (SMD (95% CI) = 0.11 (-0.17 to 0.39)). Very low-certainty evidence indicated rocker-soled shoes have no effect on patellofemoral joint loads during walking and running combined (SMD (95% CI) = 0.37) (-0.06 to 0.79)).

CONCLUSION

Minimalist footwear may reduce peak patellofemoral joint loads slightly compared with conventional footwear during running only. Medial support insoles may not alter patellofemoral joint loads during walking or running and the evidence is very uncertain about the effect of rocker-soled shoes during walking and running combined. Clinicians aiming to reduce patellofemoral joint loads during running in people with patellofemoral pain or osteoarthritis may consider minimalist footwear.

Biomechanics of running: A special reference to the comparisons of wearing boots and running shoes

Boots are often used in sports, occupations, and rehabilitation. However, there are few studies on the biomechanical alterations after wearing boots. The current study aimed to compare the effects of running shoes and boots on running biomechanics. Kinematics and ground reaction forces were recorded from 17 healthy males during running at 3.3 m/s with shoe and boot conditions. Temporal distance gait variables, ground reaction force components as well as lower limb joints angle, moment, and power were compared using Paired t-test and Statistical Parametric Mapping package for time-series analysis. Running with boots was associated with greater stride, step, flight, and swing times, greater flight length, and smaller cadence (p<0.05). The only effect of boots on lower limb joints kinematics during running was a reduction in ankle range of motion (p<0.05). Significantly greater hip flexor, abductor, and internal rotator moments, greater knee extensor and abductor moments, and ankle plantar flexor moments were observed at push-off phase of running as well as greater ankle dorsiflexor moment at early-stance in boot condition (p<0.05). Also, knee joint positive power was greater with a significant temporal shift in boot condition, suggesting a compensatory mechanism in response to limited ankle range of motion and the inability of the ankle joint to generate the required power. Our findings showed that running with boots is physically more demanding and is associated with a greater net contribution of muscles spanning hip and knee joints in order to generate more power and compensate for the ankle joint limitations, consequently, may increase the risk of both musculoskeletal injuries and degenerative joint diseases.

Methods to assess patellofemoral joint stress: A systematic review

Changes in patellofemoral joint (PFJ) stress are related to the development and course of PFJ dysfunctions. Different methods for PFJ stress calculation have been used, making the comparison of PFJ stress values across different studies difficult. The purpose of this study was to systematically review the methods for PFJ stress calculation and highlight the differences among the methods. A systematic literature search was conducted in Medline, Embase, CINAHL, SPORTDiscus and Web of Science databases. Included studies examined PFJ stress in subjects with or without musculoskeletal conditions. Of 12,670 identified studies, 53 were included, with a total of 1134 subjects evaluated. The main differences among the methods to calculate PFJ stress were: i) method to calculate PFJ contact area; ii) method to calculate a constant (coefficient k) that defines the relation between quadriceps force and PFJ reaction force; iii) the inclusion of adjustments for sagittal plane forces. Considerable variability in PFJ stress results was observed. The greatest PFJ stress value was 55.03 MPa during a dance jump and the lowest value was 1.9 MPa during walking at the speed of 1.4 m/s. Most studies applied methods which use data from previous studies. However, methods which use data from their own participants for most parts of the calculation might be preferred to minimize potential errors. When direct measures are not possible, a standard method could be applied to facilitate comparisons among studies.

Shock attenuation characteristics of three different military boots during gait

Musculoskeletal injuries are related to the cushioning properties of boots in military populations. This study aimed to compare ground reaction force (GRF) and subjective perceived comfort from two different military boots supplied by the Brazilian Army with a commercial boot. Twenty army recruits volunteered for a GRF assessment during walking on a 10-m walkway and a perceived comfort test after 20min walking on a treadmill. Both experiments were conducted with three different military boots: CC10 (styrene-butadiene rubber - SBR - midsole 30mm thickness, 65 Shore A; 631.8g weight; supplied by the Brazilian Army); CC13 (SBR midsole 20.6mm thickness, 66 Shore A; 530.3g weight; supplied by the Brazilian Army) and CAT (polyurethane - PU - midsole 31.7mm thickness, 55 Shore A; 423g weight; commercially available). GRF was analyzed in the time (principal component analysis - PCA) and frequency (Blackman-Tukey) domains. No difference was found for the first and second peak forces or loading rate; however, significant influence from the military boots' design on GRF was found by PCA and frequency analysis. Loading factor presented higher values at early stance with lower force for CC10 compared to CC13 at these epochs. CC13 also presented higher power spectral density compared to CC10 at higher frequency bands. However, CAT was significantly more comfortable than CC10. These results suggest that the thicker SBR midsole boot was more effective in reducing impact, while the lightest boot with softer midsole hardness made with PU was the most comfortable.

Work boot design affects the way workers walk: A systematic review of the literature

Safety boots are compulsory in many occupations to protect the feet of workers from undesirable external stimuli, particularly in harsh work environments. The unique environmental conditions and varying tasks performed in different occupations necessitate a variety of boot designs to match each worker's occupational safety and functional requirements. Unfortunately, safety boots are often designed more for occupational safety at the expense of functionality and comfort. In fact, there is a paucity of published research investigating the influence that specific variations in work boot design have on fundamental tasks common to many occupations, such as walking. This literature review aimed to collate and examine what is currently known about the influence of boot design on walking in order to identify gaps in the literature and develop evidence-based recommendations upon which to design future research studies investigating work boot design.