Assessing footwear in the presence of running-related injuries
Despite the general acceptance that running-related injuries (RRI) are multifactorial, identifying specific risk-factors has been a prominent epidemiological research objective. For more than five decades, footwear has been a common variable among studies investigating the causal nature of running-related injuries. Several footwear characteristics (i.e. type, midsole properties, and comfort) have been implicated as beneficial or detrimental in the aetiology of such injuries. Reasons for these conflicting results could be attributed to the complexities of footwear design and use. Furthermore, the need for and utility of footwear measurements in research and clinical settings is unclear. A recently developed systems-based theoretical model, the running-injury system, has suggested a paradigm shift to consider that injury is an emergent property of multiple factors (i.e. personal, social and environmental). Reducing the risk of injury requires understanding the structure and relationships between these factors and improving the functionality of the system’s components. The footwear micro-system is a component of the running-injury system that has not previously been explored in the academic literature. Doing so involves addressing three main objectives: (1) identify areas in need of strengthening, (2) examine indirect effects of the footwear micro-system on running-related injuries, and (3) present novel interventions to prevent injury. Given these criteria, the current thesis aimed to adopt a systems-based perspective while answering five specific research questions: 1. What are the methods and tools currently used for assessing footwear on running-related injuries? 2. What factors influence runners’ footwear choices? 3. How do clinicians perceive footwear when assessing and treating patients with running-related injuries? 4. Is the footwear total asymmetry score tool (TAS) a reliable assessment of mediolateral asymmetry? 5. Is it feasible to conduct an observational study for determining the association between footwear asymmetry and running-related injuries (RRI) among runners? Multiple study designs were used to answer these questions. A systematic review of the literature highlighted that current research procedures do not use consistent methods of assessing footwear characteristics (Chapter 3), ultimately limiting the evidence of the effects of footwear on RRI (Chapter 4). Qualitative research revealed runners behaviours towards their footwear selections are influenced by economics, other people and their own needs (Chapter 5). Chapter 6 determined that most clinicians have a person-centred approach when assessing and prescribing footwear among patients with RRI. However, one outlier clinician presented an objective footwear assessment tool which was carried forward in the subsequent Chapters. Chapter 7 determined that the total asymmetry score tool is a reliable footwear assessment tool for determining the mediolateral asymmetry at the rearfoot and forefoot of running shoes. The results of the feasibility study in Chapter 8, indicated conducting a full-sized prospective trial assessing the association of footwear Total Asymmetry Score tool (TAS) to RRI is not feasible in Dunedin, New Zealand. While the results of Chapter 8 are not ideal, this thesis contributes to an emerging body of knowledge utilising complex systems theory to complement traditional epidemiological approaches to better understand the influence of footwear on RRI.
Advisor: Ribeiro, Daniel; Lamb, Peter
Degree Name: Doctor of Philosophy
Degree Discipline: Physiotherapy
Publisher: University of Otago
Keywords: footwear; Running; physiotherapy; injury; shoes
Research Type: Thesis