Running is one of the most popular sports activities and is the basis of most aerobic fitness programs. Running is also the basis of most sports as well as a sport on its own – any biomechanical abnormality of the lower limb (combined with other risk factors)  the effect will be magnified to due higher loads (magnitude and quantity).

Differences between running and walking:
• narrower base of gait  a ‘functional’ varus develops (one foot is placed directly in front of other rather than the more normal base of gait of 10-20cm) – the so-called ‘runners varus’ – may not occur at lower running speeds
• float phase in which neither foot is in contact with the ground
• angle of gait tends to decrease with increased speed
• as running speed increases, the percent of the gait cycle spent in stance phase decreases
• normal heel contact of walking may be lost – tendency to move from rearfoot strike to midfoot strike to forefoot strike with greater speed of running  implications for use of foot orthoses
• centre of gravity of body is held more anteriorly when running compared to walking
• heel impact is greater during running than walking

Common injuries:
Numerous epidemiological studies have reported on the incidence and prevalence of running injuries, but different methodological issues, such as source of subjects and definitions of particular injuries  reported injury rates vary from 24% to 77%. Generally two out of three runners will have an injury in any one year.
Patellofemoral pain syndrome is the most common problem (~30%), followed by medial tibial stress syndrome (~20%), achilles tendonitis (~5-10%), plantar fasciitis (~5-10%), stress fractures (~5-10%) and iliotibial band syndrome (~5-8%).
Most of the injuries are assumed to be due to combination of faulty training methods, training surface, muscle dysfunction and inflexibility, footwear design and lower limb biomechanics.
Runners have been shown not to be at any greater risk of developing degenerative joint disease .

If have heel strike  better chance of controlling foot.
Softer orthoses are often preferred by runners due to comfort, but more rigid devices may be needed to control excessive motion (depends on the amount of force causing the excessive motion). Pre-fabricated devices may be indicated if force needed to control foot is relatively low or if indication for orthoses is not clear.
If runners dynamically have a very narrow base of gait or a slight cross over when running, consider inverting orthoses 2 – 4 degrees more to compensate for this ‘runners’ or ‘functional’ varus.
Sprinting (no heel strike)  limited ability to control foot function – can only use strapping or padding in forefoot (limited ability to control rearfoot). Can use more rigid devices in shoes other than racing ‘spikes’.

Running footwear:
Components of running shoes:
• Upper – wraps around foot to provide support, protection and ventilation – made of leather, nylon, nylon mesh/weave or synthetic. Nylon mesh and leather provide ventilation.
• Heel counter – reinforcement in upper at rear of shoe – a sturdy heel counter is assumed important to provide rearfoot support and stability, but this is not supported by evidence – usually made of plastic. Heel tab above counter is to help with putting shoe on or taking off – if too high  can irritate achilles tendon during foot plantarflexion.
• Innersole – generally for comfort – also give options for use of orthoses if more depth is needed in shoe. Moulded supports are found in a number of shoes, but are very compressible  not really capable of providing support
• Lining – usually made of nylon (may be backed with foam) – aim is for strength and comfort
• Midsole – between upper and sole – aim is to provide sock absorption and stability. Mostly made of ethylene vinyl acetate (EVA) or polyurethane (PU). Firmer midsoles are suggested by manufacturers as being able to control excessive pronation and softer midsoles as being more able to absorb shock  compromise has to be reached depending on the needs of individual runners. Midsoles are sometimes flared on the lateral and/or medial sides  lateral flare can increase lever arm resulting in greater heel strike pronation. The medial arch area of midsole may be ‘cut out’ to decrease weight of shoe  may compromise stability. Many have different densities under different parts of the foot to enhance motion control and shock absorption.
• Outersole – designed to provide traction, durability, abrasion resistance and flexibility. Usually made of a rubber compound – sometimes with carbon. May have different densities under areas of high wear. Sometimes have transverse groves in them in metatarsophalangeal region to facilitate flexibility, during propulsion.

the foot shaped form that the shoe is made on
3 types of construction used in sports shoes:
1. Board lasted – upper is pulled over last and cemented to flexile innersole board, then sole unit is attached. Shoes made this way are more rigid and stable. Have less flexibility around metatarsophalangeal joints
2. Slip lasted – upper is pulled over last and stitched on underside (no innersole board is used) and then glued to sole unit. Shoes made this way are more flexible and are lighter
3. Combination lasting – uses innersole board in rearfoot for stability and slip lasted in forefoot for flexibility
• last may have different shapes – they may be straight, semi-curved or curved  these may be often important factors in individual comfort and fit. The straight last places more of the sole material in the arch area and is claimed to give more medial support to the foot. Curve last indicated for running at higher speeds.

Running shoe technology:
All manufacturers have different technologies for increasing motion control, anti-pronation and sock absorption – different claims are made by each manufacturer for their products.
many different opinions and claims made for each of the different technologies
Nike ‘Free’ Running shoe (‘minimal footwear’) – designed to mimic barefoot running; difficult to fit foot orthoses into if needed; have been shown to increase strength of some lower limb muscles ;

Prescribing running shoes:
• proper fit is key feature and is no different to the selection of any footwear
• difficult for health professionals to keep a database of available running shoes  need to find a good local retailer and get to know them. The market is always rapidly changing in an unpredictable fashion.
• trade off/compromise between cushioning/shock absorption and stability/motion control
• decision regarding which shoe is based on the activity (eg running mileage, cross training, aerobics); structure and function of foot (eg high arch/low arch; pronated/supinated foot type); running style (eg heel, midfoot or forefoot striker)
• consensus is that:
• Pronator foot type  high density midsole with higher density under medial heel area; firmer heel counter (maybe extended along medial arch area); combination lasted; straight last; no lateral heel flare; medial heel flare; wider toe box
• Supinator or rigid foot type  more cushioning in rearfoot and forefoot; soft midsole; slip lasted; deeper toe box
• feet tend to increase in size during day  shop for shoes at end of day
• most running shoes should last up to 800km, but will vary with material, density and runners body weight

Softer footwear are believed to inhibit sensory perception of hard surfaces and therefore moderates the lower limbs normal impact moderating behaviour  assumed to alter the natural body shock absorbing functions  may lead to long term structural and functional changes in the lower limb.

Lacing techniques:
Lacing techniques can be used to refine fit and many manufacturers incorporate changeable lacing patterns.
Variations in the lacing technique can be used to help manage some pathologies (eg if dorsal exostosis is painful, the eyelets for the laces in that area can not be used, so laces do not apply pressure to the painful area)

Barefoot Running:

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