Is There Any Association Between Foot Posture and Lower Limb-Related Injuries in Professional Male Basketball Players? A Cross-Sectional Study

Risk Factors Influencing the Incidence of Ankle Sprain Among Elite Football and Basketball Players: A Prospective Study

Introduction. The objective of the present study was to investigate whether certain intrinsic factors (foot hyperpronation, generalized joint laxity) and clinical tests (anterior drawer and talar tilt tests, single-leg balance test and star excursion balance test, ankle and first metatarsophalangeal range of motion) could predict the incidence of lateral ankle sprains among elite football and basketball players during a full year. Method. In a prospective cohort study, 106 elite basketball and football players were recruited. During the preseason period, players underwent baseline measurements. Team physicians in following year reported occurrence of new ankle sprains. Results. Ankle sprain was more frequent among basketball players (P = .01). The history of recurrent (P = .001) and acute ankle sprain (P = .01) and each 5-year increase in age (P = .039) were predictive factors for ankle sprain. No evidence for relationship between other risk factors and occurrence of ankle sprain were achieved. Conclusion. In our study, the history of recurrent and acute ankle sprain was the strongest predictor for ankle injuries. Considering the limitations of this study, it seems mandatory to conduct more prospective studies with a larger sample size and longer follow-up period.Levels of Evidence: Level II: Prognostic.

Abnormalities of foot and ankle alignment in individuals with chronic ankle instability: a systematic review

Background

To prevent recurrent ankle sprain, it is important to clarify the pathology of chronic ankle instability (CAI). An association has been reported between CAI and abnormalities of foot posture and ankle alignment. There is no consensus on the types of these abnormalities that occur in individuals with CAI. The objective of this systematic review is to clarify the relevance of abnormality of foot posture and ankle alignment for CAI.

Methods

A systematic computerized literature search was performed of the PubMed, CINAHL, SPORTDiscus, Web of Science, and the Cochrane Register of Clinical Trials databases. The selected studies either compared CAI patients with a control group or CAI ankles with contralateral healthy ankles and specifically reported foot posture and alignment of the ankle in the outcomes. They were written in English and published prior to June 2021. The methodological quality of the included studies was evaluated using a 16-question index. Data were extracted independently by two reviewers, and the certainty of evidence was assessed using GRADE approach.

Results

Sixteen studies including 872 patients of high to low methodological quality were included. These showed there was significant anterior displacement and internal rotation of the talus in CAI ankles (low evidence), but there was no consensus on fibular alignment or foot posture.

Conclusions

This review showed there was significant anterior displacement and internal rotation of the talus in CAI ankles but found no consensus on the characteristics of fibular and foot alignment. Further investigations are required to clarify the characteristic foot and ankle malalignment in CAI to facilitate the development of efficient interventions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-021-04537-6.

FOOT ALIGNMENT IN SYMPTOMATIC NATIONAL FOOTBALL LEAGUE (NFL) ATHLETES: A WEIGHTBEARING CT ANALYSIS

Objective:

Our aim was to describe the foot alignment in National Football League (NFL) players with different symptomatic foot and ankle pathologies using weightbearing cone-beam computed tomography (WBCBCT), comparing them to normally aligned feet as control group.

Methods:

41 feet (36 active NFL players) were assessed using WBCBCT and compared to 20 normally aligned controls from a normal population. Measurements included: Foot and Ankle Offset (FAO); Calcaneal Offset (CO); Hindfoot Alignment Angle (HAA); angle between inferior and superior facets of the talus (Inftal-Suptal); angle between inferior facet of the talus and the horizontal/floor (Inftal-Hor); Forefoot Arch Angle (FAA); navicular- and medial cuneiform-to-floor distance.

Results:

NFL athletes showed a neutrally aligned hindfoot when compared to controls (FAO: 1% vs 0.5%; CO: 2.3 mm vs 0.8 mm; HAA: 2.9° vs 0.8° in two groups, with all p > 0.05) and a normal morphology of the subtalar joint (no difference in Inftal-Suptal and Inftal-Hor angles). Conversely, in athletes we found a decreased medial longitudinal arch (FAA: 15° vs 18.3°, p = 0.03) with smaller navicular (38.2 mm vs 42.2 mm, p = 0.03) and medial cuneiform (27 mm vs 31.3 mm, p = 0.01) mean distances to the floor when compared to controls.

Conclusion:

In our series, NFL players presented a lower medial longitudinal arch than controls but a neutrally aligned hindfoot. WBCBCT may help shed light on anatomical risk factors for injuries in professional players. Level of Evidence III, Retrospective comparative study.

Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains Revision 2021

This revised clinical practice guideline (CPG) addresses the distinct but related lower extremity impairments of those with a first-time lateral ankle sprain (LAS) and those with chronic ankle instability (CAI). Depending on many factors, impairments may continue following injury. While most individuals experience resolution of symptoms, complaints of instability may continue and are defined as CAI. The aims of the revision were to provide a concise summary of the contemporary evidence since publication of the original guideline and to develop new recommendations or revise previously published recommendations to support evidence-based practice. J Orthop Sports Phys Ther 2021;51(4):CPG1-CPG80. doi:10.2519/jospt.2021.0302.

Relationship between foot posture index and weight bearing computed tomography 3D biometrics to define foot alignment

BACKGROUND

The Foot Posture Index (FPI) was originally validated only against two dimensional radiographic imaging at the time of its inception since weight bearing three dimensional (3D) imaging did not exist. This technology is now widely available but it is not known if the FPI will continue to correlate well against it.

RESEARCH QUESTION

How does the clinical assessment tool of FPI correlate against 3D biometrics of foot alignment assessed on weight bearing computerised tomography (WBCT)?

METHODS

The FPI and 3D biometrics of 66 feet in 33 patients presenting to a single foot and ankle unit were assessed by two observers independently. All measurements were assessed for intra-rater and inter-rater reliability, and the association between the clinically assessed FPI and radiologically assessed 3D biometrics was identified.

RESULTS

The FPI demonstrated excellent intra-rater and good inter-rater reliability. All 3D biometric measures demonstrated excellent intra-rater and inter-rater reliability. A strong and significant correlation was identified between the FPI and 3D biometrics overall although subgroup analysis revealed the strength of association dropped when the hindfoot had a valgus alignment.

SIGNIFICANCE

This study confirmed that the FPI is a valid tool for assessing foot position. However, correlation between the FPI and 3D biometrics fell in the valgus aligned hindfoot so caution must be used when the FPI is used for assessment in this population.

Effects of foot orthoses on dynamic balance and basketball free-throw accuracy before and after physical fatigue

While it is not uncommon for athletes to use foot orthoses to relieve pain and improve sports performance, little has been known about their effects on basketball performance. Free-throw basketball shooting is very important. However, fatigue deteriorates postural balance which might decrease free-throw shooting performance. This study investigated the effects of foot orthoses on dynamic balance and accuracy performance during free-throw shooting before and after physical fatigue was induced. Thirteen male recreational basketball players were tested with two foot orthoses (medial-arch support versus flat control) and fatigue conditions (before and after fatigue), when they performed standard free-throw shooting on a force platform. Results revealed that fatigue significantly increased coefficient of variance of medial-lateral center of pressure (CoP) excursion when participants worn flat control orthoses (p < 0.05). Meanwhile, foot orthoses improved dynamic balance during shooting as they significantly reduced total resultant and anterior-posterior sway excursions as well as resultant and anterior-posterior CoP velocities, and base of support area. Although this study found that fatigue and orthoses did not significantly affect the scores gained by free-throw shooting, the significant improvements in dynamic balance during shooting with the use of foot orthoses could have considerable impact on motor control during basketball shooting.

Foot Alignment in Symptomatic National Basketball Association Players Using Weightbearing Cone Beam Computed Tomography

Background:

Weightbearing cone beam computed tomography (WB CBCT) allows detailed 3-dimensional imaging of the foot and ankle in a weightbearing state and provides improved accuracy and reliability of foot alignment measures, especially when compared with conventional radiographic views.

Purpose:

To describe the foot alignment in National Basketball Association (NBA) players with different symptomatic foot and ankle injuries using WB CBCT and to determine if any predominant morphotype would be identified.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

A total of 45 active NBA players (mean age, 24.4 years [range, 20-34 years]; N = 54 feet [29 right, 25 left]) were assessed using WB CBCT. Measurements included the following: (1) foot and ankle offset (FAO), (2) calcaneal offset (CO), (3) hindfoot alignment angle (HAA), (4) angle between the inferior and superior facets of the talus (Inftal-Suptal), (5) angle between the inferior facet of the talus and the horizontal floor line (Inftal-Hor), (6) forefoot arch angle (FAA), (7) navicular-to-floor distance, and (8) medial cuneiform–to-floor distance. Measurements were then compared with values available in the literature for a “normal” foot morphotype.

Results:

Among the 54 feet, the mean FAO was 0.48% (95% CI, –0.25% to 1.21%), the mean CO was 1.18 mm (95% CI, –0.50 to 2.87 mm), and the mean HAA was 1.42° (95% CI, –0.80° to 3.65°). The mean Inftal-Suptal angle was 5.31° (95% CI, 3.50°-7.12°), while the mean Inftal-Hor angle was 4.04° (95% CI, 2.56°-5.51°). The mean FAA was 15.84° (95% CI, 14.73°-16.92°), the mean navicular-to-floor distance was 38.30 mm (95% CI, 36.19-40.42 mm), and the mean medial cuneiform–to-floor distance was 26.79 mm (95% CI, 25.30-28.28 mm). None of these values were found to be significantly different when comparing forwards, guards, and centers.

Conclusion:

NBA players presenting with symptomatic foot and ankle injuries had a fairly “normal” foot morphology, with a tendency toward a varus hindfoot and a high-arched morphotype. No significant differences were found between players based on their position on the court. WB CBCT may help to shed light on anatomic risk factors for common injuries in professional players and may aid in the planning of specific prevention programs.