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A prospective study on gait-related intrinsic risk factors for lower leg overuse injuries
  1. N Ghani Zadeh Hesar1,2,
  2. A Van Ginckel1,
  3. A Cools1,
  4. W Peersman3,
  5. P Roosen1,
  6. D De Clercq4,
  7. E Witvrouw1
  1. 1
    Faculty of medicine, Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
  2. 2
    Faculty of Literature and Human Science, Department of Physical Education and Sport Science, Urmia University, Iran
  3. 3
    Rehabilitation Sciences and Physiotherapy Ghent, Ghent University, University Artevelde College, Ghent, Belgium
  4. 4
    Faculty of Medicine and Health Sciences, Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
  1. Correspondence to Dr N Ghani Zadeh Hesar, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Science, Ghent University, De Pintelaan 185, 3B3 9000 Ghent, Belgium; Narmin.Ghanizadehhesar{at}


Objective: To determine prospectively gait-related risk factors for lower leg overuse injury (LLOI).

Design: A prospective cohort study.

Setting: Male and female recruits from a start-to-run (STR) programme during a 10-week training period.

Participants: 131 healthy subjects (20 men and 111 women), without a history of any lower leg complaint, participated in the study.

Interventions: Before the start of the 10-week STR programme, plantar force measurements during running were performed. During STR, lower leg injuries were diagnosed and registered by a sports physician.

Main Outcome Measures: Plantar force measurements during running were performed using a footscan pressure plate.

Results: During the STR, 27 subjects (five men and 22 women) developed a LLOI. Logistic regression analysis revealed that subjects who developed a LLOI had a significantly more laterally directed force distribution at first metatarsal contact and forefoot flat, a more laterally directed force displacement in the forefoot contact phase, foot flat phase and at heel-off. These subjects also had a delayed change of the centre of force (COF) at forefoot flat, a higher force and loading underneath the lateral border of the foot, and a significantly higher directed force displacement of the COF at forefoot flat.

Conclusions: These findings suggest that a less pronated heel strike and a more laterally directed roll-off can be considered as risk factors for LLOI. Clinically, the results of this study can be considered important in identifying individuals at risk of LLOI.

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  • Competing interests None.

  • Ethics approval The study was approved by the ethical committee of the Ghent university hospital.

  • Patient consent Obtained.

  • Provenance and Peer review Not commissioned; externally peer reviewed.