Concordância entre métodos de avaliação da postura do pé.

Abstract

Introduction: The understanding of injury mechanisms related to running has been the subject of numerous studies. Intrinsic factors, such as muscle imbalances in the lower limbs, foot posture morphology and inappropriate movement patterns, and extrinsic factors, such as volume, frequency and footwear, have been reported as elements that contribute to the onset of injuries in runners. Variations of the neutral foot posture classified as pronated and supinated alter the mechanics of the lower limbs, which may facilitate the onset of injuries in runners. Taking this into account, it is essential that the clinical examiner is aware of the various methods of assessing foot posture so that, in light of the evidence and experience, he can choose the method that he will use in his clinical practice. At the other end, is the influence of running shoe paradigms. The practice of prescribing sneakers in order to prevent injuries is controversial, whether in the paradigm of controlling or not pronation movements or in the paradigm of minimalist sneakers that, because they are lighter and more flexible than traditional ones, would allow a more natural and less harmful run. However, few studies pay attention to the demonstration of foot posture evaluative instruments that support clinical decision-making, whether for adjusting the biomechanical model or for orienting shoes for running. Objective: To analyze the degree of agreement between different foot posture assessment methods, as well as conducting a systematic review of the literature on the relationship between minimalist sneakers and the occurrence of injuries in runners. Methods: To analyze the agreement between the methods for defining foot posture, a cross-section was carried out in a sample of 26 participants of both sexes. To this end, a test-by-test correlation analysis was conducted between the 6-item Foot Posture Index (PPI-6), Baropodometry and 2D videogrammetry, in addition to the intra-examiner reliability analysis (test-retest) of the 2D videogrammetry instrument for both walking and running. Regarding the systematic review, two independent reviewers looked for studies involving the influence of the heel of running shoes on the occurrence of injury in different electronic databases (Embase, Pubmed and Cochrane), and for the included studies, the risks of bias were analyzed through the PEDro scale. For homogeneous results, a meta-analysis was conducted. The results were analyzed in groups by the weighted mean difference, and the 95% confidence interval was calculated. Results: The neutral foot posture was the most frequent in all methods. The mean maximum angular deviation of rearfoot eversion was 9.06±4.12 degrees in walking and 10.29±4.10 degrees in running. The average variation or range of movement of the hindfoot between the maximum and minimum value in walking was 6.24±2.53 degrees and in running, 7.70±2.62 degrees. The IPP-6 was the method that showed the lowest agreement with the other methods. Baropodometry and 2D videogrammetry showed moderate agreement. There was no agreement between the IPP-6 and the baropodometry with the 2D videogrammetry to define the posture of the foot running at 10Km/h. 2D videogrammetry walking at 4km/h showed high reliability for the variable "variation between maximum and minimum" and moderate reliability for the variable "maximum eversion" [30 (-0.10-0.61), p<0.05] and moderate reliability in the variable "variation between maximum and minimum” [ICC = 0.51 (0.15-0.75), p<0 .05]. Regarding the systematic review with meta-analysis, the global effect test (Z= 6.89, p<0.0001) revealed that minimalist running shoes significantly increased the occurrence of injury (RR 2.59, 95% CI 1.93 – 3.27) when compared to traditional running shoes. The subanalysis of the partially and fully minimalist groups indicates that the injury was more frequent in the partially minimalist group. Conclusion: The most frequent foot posture among the studied methods was neutral. In general, the tests showed poor reliability, with the IPP-6 showing the lowest reliability. Baropodometry and 2D videogrammetry were more reliable. 2D videogrammetry proved to be reliable in defining foot posture while walking, but not reliable in running at 10 km/h, and the outcome "variation between maximum and minimum” seems to be the option of choice to assess foot posture during walking. The systematic review pointed out that minimalist shoes tend to increase the occurrence of injuries in runners and that, for this reason, it might be prudent to carry out an adaptation stage to the characteristics of minimalist shoes. Keywords: Running shoes. Minimalist. Shoe drop. Running related injuries. Foot posture. Foot arc.