Marco Hagen

Effects of different shoe-lacing patterns on the biomechanics of running shoes

Abstract In the present study, we examined the influence of shoe lacing on foot biomechanics in running. Twenty experienced rearfoot runners ran in six different lacing conditions across a force platform at a speed of 3.3 m · s−1. Foot pronation during contact, tibial acceleration, and plantar pressure distribution of the right leg were recorded. The test conditions differed in the number of laced eyelets (1, 2, 3, 6 or 7) and in lacing tightness (weak, regular or strong). The results show reduced loading rates (P < 0.05) and pronation velocities (P < 0.01) in the tightest and highest lacing conditions. The lowest peak pressures under the heel and lateral midfoot (P < 0.01) were observed in the high (seven-eyelet) lacing pattern. Regular six-eyelet cross-lacing resulted in higher loading rates (P < 0.05) and higher peak heel pressures (P < 0.01) than seven-eyelet lacing, without any significant differences in perceived comfort. The low lace shoe conditions resulted in lower impacts (P < 0.01) and lower peak pressures under metatarsal heads III and V (P < 0.01), which is probably induced by the foot sliding within the shoe. A firm foot-to-shoe coupling with higher lacing leads to a more effective use of running shoe features and is likely to reduce the risk of lower limb injury.

Effects of Different Shoe-Lacing Patterns on Dorsal Pressure Distribution During Running and Perceived Comfort

The purpose of this study was to investigate the effects of four lacing patterns (one regular, one tight, and two seven-eyelet lacings) on dorsal foot pressures during running and the perception of comfort and stability with 14 male rearfoot runners. By using a pressure insole, peak dorsal pressures were measured under the shoes tongue. Highest peak pressures were found above the talus, the navicular bone, and the first ray. Seven-eyelet lacings showed a significant enhancement of perceived stability without differences in perceived comfort compared with a regular six-eyelet technique. Reduction of pressure on the talus, the navicular bone, and the extensor tendons is related to better comfort. With individually chosen special seven-eyelet lacings runners can improve foot-shoe coupling without increasing peak dorsal pressures on the tarsus. Knowledge of the location of the dorsal pressure distribution is useful for new tongue and lacing constructions to improve comfort in running shoes while maintaining stability.

Prevalence of femoro-acetabular impingement in international competitive track and field athletes

PurposeThe aim of our study was to analyse the prevalence of femoro-acetabular impingement (FAI) in national elite track and field athletes compared to peers using magnetic resonance imaging (MRI) and clinical examination including impingement tests.MethodsA total of 44 participants (22 national elite track and field athletes and 22 non-athletes) underwent an MRI for radiological findings associated with FAI, including alpha angle, lateral centre edge angle (CEA), findings of labral and cartilage lesions. The study group was furthermore investigated by the hip outcome score (HOS) and a clinical hip examination including range of motion (ROM) and impingement tests.ResultsConcerning the cam impingement, there was a significant difference measured by mean alpha angle between the athlete group (52.2 ± 7.29°) and the control group (48.1 ± 5.45°, P = 0.004). Eleven athletes showed a cam impingement, while two probands of the control group had a pincer impingement and one a mixed form (P = 0.0217). There was no statistically significant difference concerning the CEA upon evaluating pincer impingement. Seven track and field athletes had a positive impingement test, whereof three had an increased alpha angle >55°. No participant of the control group showed pathological results in the impingement test (P = 0.0121).ConclusionsMRI evidence and clinical examination suggest that cam impingement is more common in elite athletes in comparison to non-athletes. At a professional level, the intense practice of track and field athletics is susceptible for FAI.

The role of arthroscopy in patients with persistent hip pain after total hip arthroplasty

BACKGROUND Total hip arthroplasty (THA) is a safe and successful procedure for the treatment of osteoarthritis. One of the most common postoperative problems remains persistent hip pain. The arthroscopic evaluation of persistent hip pain following THA can be a valuable diagnostic tool in a select number of patients when carried out by experts in this technique. OBJECTIVE Indication for arthroscopy was persistent pain after THA. Inclusion criteria were an absence of radiological loosening and a sterile aspiration 6 weeks before arthroscopy. Hip joint function and pain were evaluated pre- and postoperatively using the visual analogue scale (VAS) and the Hip Outcome Score (HOS), which scored the activities of daily living (ADL), and a sports subscale. METHODS 5 patients (3 female, 2 male) with an average age of 60.2 ± 4.27 years (range 51-72 years) were included in the study. Arthroscopy with biopsy, adhesiolysis and psoas tendon release was performed 21.0 ± 21.97 months (range 6-57 months) after primary hip replacement. RESULTS Pathological findings were prosthetic joint infection (two cases), impingement between acetabular component and psoas tendon (two cases), adhesions of the periprosthetic tissue (one case). The patients achieved a significant improvement of the Hip Outcome Score (HOS), from an average of 45.6 ± 22.5 (range 14.0-63.1) to 76.5 ± 3.8 (range 41.0-89.4, P=0.016). Evaluation of the VAS showed a significant improvement from a preoperative value of 8.8 ± 0.5 to a postoperative value of 3.4 ± 1.0 (P=0.001). CONCLUSION Hip arthroscopy provides a minimal-invasive tool for diagnosis and therapy. In cases of persistent pain after THA, standard diagnostic procedures should be utilised. Arthroscopy of a hip post-THA would be highly specialised. As a next step, arthroscopy helps the diagnosis and therapy of persistent pain after THA.

Biomechanical and functional indicators in male semiprofessional soccer players with increased hip alpha angles vs. amateur soccer players

BackgroundFemoroacetabular impingement (FAI) is predominant in young male athletes, but not much is known about gait differences in cases of increased hip alpha angles. In our study, the hip alpha angle of Nötzli of soccer players was quantified on the basis of magnetic resonance imaging (MRI) with axial oblique sequences. The aim of the current study was to compare the rearfoot motion and plantar pressure in male semiprofessional soccer players with increased alpha angles to age-matched amateur soccer players.MethodsIn a prospective analysis, male semiprofessional and amateur soccer players had an MRI of the right hip to measure the alpha angle of Nötzli. In a biomechanical laboratory setting, 14 of these participants in each group ran in two shoe conditions. Simultaneously in-shoe pressure distribution, tibial acceleration, and rearfoot motion measurements of the right foot were performed.ResultsIn the semiprofessional soccer group, the mean value of the alpha angle of group was 55.1 ± 6.58° (range 43.2-76.6°) and 51.6 ± 4.43° (range 41.9-58.8°) in the amateur group. In both shoe conditions, we found a significant difference between the two groups concerning the ground reaction forces, tibial acceleration, rearfoot motion and plantar pressure parameters (P < 0.01, P < 0.05, P = 0.04). Maximum rearfoot motion is about 22% lower in the semiprofessional group compared to the amateur group in both shoe conditions.ConclusionsThis study confirmed that semiprofessional soccer players with increased alpha angles showed differences in gait kinematics compared to the amateur group. These findings support the need for a screening program for competitive soccer players. In cases of a conspicuous gait analysis and symptomatic hip pain, FAI must be ruled out by further diagnostic tests.

Reliability of two goniometric methods for measuring active subtalar range of motion

BACKGROUND Measuring subtalar joint (STJ) motion is accompanied by complications due to the oblique STJ axis which results in triplanar pronation and supination. OBJECTIVE We developed a pronator and supinator testing apparatus whose axis was aligned with Inmans STJ axis. The purpose of this study was to assess day-to-day reliability of active STJ range of motion (ROM) measurements and to compare the results with those of a rearfoot goniometer. METHODS Active pronation, supination and total STJ ROM measurements were administered to 12 men (mean age: 23.8 years) and 12 women (mean age: 22.3 years) at two separate test sessions. Intraclass correlations (ICC), limits of agreement (LoA) and minimum detectable change (MDC) were calculated. RESULTS Except for pronation ROM in men, the STJ goniometer revealed substantial (ICC > 0.8) reliability in all conditions. Relative MDCs and LoAs were below 15% and 10%, respectively. Significantly higher total ROM (P< 0.05) was found for women compared to men when using the STJ goniometer. The rearfoot goniometer showed high reliability (ICCs > 0.7) but underestimated STJ ROM in average of 37%. CONCLUSIONS Both goniometric methods showed high day-to-day reliability. However, when using the rearfoot goniometer, researchers have to consider whether the level of underestimation of STJ motion is acceptable in the context of the planned investigation.

Is the Kinect system suitable for evaluation of the hip joint range of motion and as a screening tool for femoroacetabular impingement (FAI)

BACKGROUND In the clinical evaluation of femoroacetabular impingement (FAI), there is a lack of quantitative, reliable and informative assessment methods for the overall functional capability of an individual. OBJECTIVE We compared clinical and radiological measurements of the hip joint with a new methodology based on the concept of 3-dimensional reachable workspace using Microsoft Kinect. METHODS We assessed the correlation between the alpha angle of Nötzli on full-length radiographs and the clinical internal rotation. We evaluated the accuracy of joint positions and angles of the hip between the Kinect system and clinical examination including range of motion (ROM). RESULTS The results of our clinical trial with 24 study participants showed a significant difference between normal internal rotation (> 21°) and reduced internal rotation (⩽ 21°) in comparison to the radiological alpha angle of Nötzli (P=0.026). The acquired reachable Kinect data demonstrated a moderate agreement between the Kinect and clinical examination (correlation coefficients between 0.230 and 0.375). CONCLUSIONS The findings suggest that a higher grade alpha angle of Nötzli accompanies reduced clinical internal rotation. The Kinect system provides reliable results of hip ROM. However, further test series must be performed for the application of Kinect in the clinical evaluation of FAI.

Development of a functional anatomical subtalar pronator and supinator strength training machine.

BACKGROUND The strength training industry has failed in designing a machine for exercising the pronators and supinators, despite their substantial medio-lateral bracing function. OBJECTIVE The present study documents the muscle strength generation capabilities of the pronators and supinators within their functional anatomic movement plane, using an innovative strength training machine with an oblique axis. METHODS By using two force transducers, the angle-torque relationship of the pronators and supinators of 18 healthy male subjects was identified during maximum voluntary isometric contractions at five anatomical joint angles. Surface EMG was recorded from anterior tibial (TA), peroneus longus (PL) and soleus (SOL) muscles. RESULTS The pronator strength curve showed an inverted U-shaped characteristic, whereas the supinator curve descends from pronated to supinated position. Compared to the muscle activities for one-leg heel raise and toe raise, PL (108-131%) and TA (59-83%), respectively, showed highest activity during pronations. The most activated supinator is SOL (67% of a one-leg heel raise). CONCLUSIONS Differences in the shape of the pronator and supinator strength curves revealed that two different variable cams have to be implemented for matching the human torque capability. We anticipate our study to be a starting point for preventive machine-based training interventions.

Comfort and stability ratings of different shoe lacing patterns depend on the runners’ level of performance

INTRODUCTION Recent studies have shown the influence of shoe lacing on the biomechanics of walking (Fiedler et al., 2011) and running (Hagen and Hennig 2009; Hong et al., 2011). With his choice of lacing tightness, number of laced eyelets, and special lacing techniques a runner is able to adjust the shoe’s upper to his individual foot morphology and, therefore, to optimize shoe fit (Hagen et al., 2010). It is also well known that most competitive runners choose very tight lacing to avoid movement of the foot within the shoe. The most common running shoes are provided with six straight eyelets in line. Many running shoes are also featured with a higher seventh eyelet that is slightly shifted to the lateral side. Most runners, however, do not use this additional seventh eyelet. Although the above mentioned laboratory studies revealed the positive effects of higher lacings, it is questionable whether the use of seven-eyelet techniques is practicable.

Shank Muscle Strength Training Changes Foot Behaviour during a Sudden Ankle Supination

Background The peroneal muscles are the most effective lateral stabilisers whose tension braces the ankle joint complex against excessive supination. The purpose of this study was to identify the morphological and biomechanical effects of two machine-based shank muscle training methods. Methods Twenty-two healthy male recreationally active sports students performed ten weeks of single-set high resistance strength training with 3 training sessions per week. The subjects conducted subtalar pronator/supinator muscle training (ST) with the right leg by using a custom-made apparatus; the left foot muscles were exercised with machine-based talocrural plantar and dorsiflexor training (TT). Muscle strength (MVIC), muscle volume and foot biomechanics (rearfoot motion, ground reaction forces, muscle reaction times) during a sudden ankle supination were recorded before and after the intervention. Results Compared to TT, ST resulted in significantly higher pronator (14% vs. 8%, P<0.01) and supinator MVIC (25% vs. 12%, P<0.01). During sudden foot inversions, both ST and TT resulted in reduced supination velocity (-12%; P<0.01). The muscle reaction onset time was faster after the training in peroneus longus (PL) (P<0.01). Muscle volume of PL (P<0.01) and TA (P<0.01) increased significantly after both ST and TT. Conclusion After both ST and TT, the ankle joint complex is mechanically more stabilised against sudden supinations due to the muscle volume increase of PL and TA. As the reduced supination velocities indicate, the strength training effects are already present during free-fall. According to a sudden ankle supination in standing position, both machine-based dorsiflexor and pronator strength training is recommended for enhancing the mechanical stability of the ankle.