Foot Pronation and Lower Extremity Injury in Baseball
Foot Pronation and Lower Extremity Injury in Baseball
Abstract & Commentary
Synopsis: Measures of static forefoot position correlated with dynamic rear foot position inversely; however, there was no association between excessive pronation and lower extremity injuries.
Source: Donatelli R, et al. Relationship between static and dynamic foot postures in professional baseball players. J Orthop Sports Phys Ther 1999;29:316-330.
Anecdotal evidence has for years linked severe pronation at the subtalar joint with a variety of lower extremity and low back pathologies. Degree of pronation is often measured relative to the subtalar joint neutral position (STJN), a position at which the foot resides during the midstance phase of gait when the maximal amount of pronation and supination is available to the subtalar joint. Theoretically, this position is the best position for the rear foot and the one used to fabricate orthotics. Similar positions are measured at the forefoot. This study used the STJN and other measures to determine if these static measures are related to abnormal foot position during gait, and if a relationship exists between an abnormal foot position (in this case, pronation) and the incidence of lower extremity overuse injuries.
Seventy-four professional baseball players (51 pitchers, 22 position players, and 1 unspecified) were randomly selected. Players were questioned and a history obtained regarding the incidence of lower extremity injuries. Five measurements were taken: 1) STJN; 2) forefoot position; 3) passive ankle dorsiflexion; 4) standing tibia-to-floor angle; and 5) standing rear foot angle. The standing STJN was measured by palpation of the navicular and talus. When the talus appeared even, the angle of the lower leg relative to the calcaneous from a posterior approach was measured. The static measures were all performed with a goniometer by one individual with 15 years of experience. In order to determine reliability, every fifth measurement was repeated. In addition, dynamic foot measures were performed with a motion analysis system, also from a posterior angle. These included such variables as pronation at heel strike, maximum pronation during the stance phase, and pronation at toe-off. Data analysis included t-tests and a chi-square statistic to determine associations between forefoot position and rear foot angle at maximum pronation dynamically.
Results indicated that a statistically significant relationship exists between static forefoot position and dynamic rear foot position. Subjects with forefoot varus had greater standing valgus rear foot angles than those with forefoot valgus. In addition, more subjects had rear foot valgus than expected. While there were some differences between pitchers and positional players relative to forefoot and rear foot positions, these conditions were not considered statistically significant. Interestingly, only 43% of the subjects who demonstrated excessive pronation reported a history of lower extremity injury. Thus, no correlation between pronation and lower extremity complaints was found.
Comment by Clayton F. Holmes, EdD, PT, ATC
Static measures such as STJN have long been in question with regard to their clinical usefulness. Even though we commonly use this particular measure when fabricating orthotics for correction of forefoot or rear foot abnormalities (such as pronation), many have questioned whether this is appropriate and functional. This study is important in that it begins to shed some light on this topic. It is a critical finding of this study to relate static forefoot measures to dynamic rear foot position.
Those of us who care for baseball players frequently use orthotics to address foot position, perhaps because of poor footwear available in this sport. This is certainly a population worth studying since they are susceptible to overuse lower extremity injuries. One should not read too much into the finding that only 43% of the individuals with excessive pronation had a history of lower extremity overuse pathology. This portion of the study was retrospective, with obvious limitations regarding sampling. Perhaps a longitudinal, prospective study may find a relationship with predictive validity. In summary, while there were limitations in design, this study provides evidence to continue this line of research and indicates that perhaps static measures such as STJN may be more clinically relevant than popular opinion suggests.
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