INTRODUCTION: Plantar fasciitis (PF) is one of the most common running-related injuries. PURPOSE: The aim of this prospective study was to determine the incidence of PF and identify potential risk or protective factors for PF in runners and non-runners. METHODS: Data from 1206 participants from the 4HAIE cohort study (563 females/643 males; 715 runners/491 non-runners; 18-65 yr of age) were included in the analysis. We collected biomechanical data during overground running using a three-dimensional motion capture system at the baseline and running distance data via retrospective questionnaires and followed the participants for 12 months following the baseline data collection. Participants were asked weekly about any sports-related injury (including PF). A binary logistic regression was performed to reveal potential associations between running distance and biomechanical risk factors and PF while controlling for running distance, sex, and age. RESULTS: The total incidence of PF was 2.3% (28 PF from 1206 participants), 2.5% in runners and 2.0% in non-runners ( P = 0.248). Runners who ran more than 40 km·wk -1 had six times higher odds of suffering PF than individuals who ran 6-20 km·wk -1 ( P = 0.009). There was a significant association between maximal ankle adduction and PF; that is, runners with a lower abduction angle during the stance period had higher risk of PF ( P = 0.024). No other biomechanical variables indicated significant associations with PF. CONCLUSIONS: Regular running with a moderate weekly volume and more toeing out of the foot relative to the shank may reduce the risk against PF in runners, which may be useful for researchers, runners, coaches, and health professionals to minimize PF injury risk.

Department of Human Movement Studies University of Ostrava Ostrava CZECH REPUBLIC

Institute for Research and Applications of Fuzzy Modeling University of Ostrava CE IT4Inonovation Ostrava CZECH REPUBLIC

Zobrazit více v PubMed

Kakouris N, Yener N, Fong DTP. A systematic review of running-related musculoskeletal injuries in runners. J Sport Heal Sci. 2021;10(5):513–22. PubMed PMC

Van Leeuwen KDB, Rogers J, Winzenberg T, Van Middelkoop M. Higher body mass index is associated with plantar fasciopathy/‘plantar fasciitis’: systematic review and meta-analysis of various clinical and imaging risk factors. Br J Sports Med. 2016;50(16):972–81. PubMed

Wiegand K, Mercer JA, Navalta JW, Pharr J, Tandy R, Freedman Silvernail J. Running status and history: a self-report study. Phys Ther Sport. 2019;39:8–15. PubMed

Beeson P. Plantar fasciopathy: revisiting the risk factors. Foot Ankle Surg. 2014;20(3):160–5. PubMed

Wearing SC, Smeathers JE, Urry SR, Hennig EM, Hills AP. The pathomechanics of plantar fasciitis. Sport Med. 2006;36(7):585–611. PubMed

Di Caprio F, Buda R, Mosca M, Calabrò A, Giannini S. Foot and lower limb diseases in runners: assessment of risk factors. J Sport Sci Med. 2010;9(4):587–96. PubMed PMC

Pohl M, Hamill J, Davis IS. Biomechanical and anatomic factors associated with a history of plantar fasciitis in female runners. Clin J Sport Med. 2009;19(5):372–6. PubMed

Ribeiro AP, Trombini-Souza F, Tessutti VD, Lima FR, João SMA, Sacco ICN. The effects of plantar fasciitis and pain on plantar pressure distribution of recreational runners. Clin Biomech (Bristol). 2011;26(2):194–9. PubMed

Ribeiro AP, João SMA, Dinato RC, Tessutti VD, Sacco ICN. Dynamic patterns of forces and loading rate in runners with unilateral plantar fasciitis: a cross-sectional study. PLoS One. 2015;10(9):e0136971. PubMed PMC

Wiegand K, Tandy R, Freedman Silvernail J. Plantar fasciitis injury status influences foot mechanics during running. Clin Biomech (Bristol). 2022;97:105712. PubMed

Chen TLW, Wong DWC, Wang Y, Lin J, Zhang M. Foot arch deformation and plantar fascia loading during running with rearfoot strike and forefoot strike: a dynamic finite element analysis. J Biomech. 2019;83:260–72. PubMed

Johnson CD, Tenforde AS, Outerleys J, Reilly J, Davis IS. Impact-related ground reaction forces are more strongly associated with some running injuries than others. Am J Sports Med. 2020;40(28):3072–80. PubMed

Willwacher S Kurz M Robbin J, et al. . Running-related biomechanical risk factors for overuse injuries in distance runners: a systematic review considering injury specificity and the potentials for future research. Sport Med. 2022;52(8):1863–77. PubMed PMC

Chang R, Rodrigues PA, Van Emmerik REA, Hamill J. Multi-segment foot kinematics and ground reaction forces during gait of individuals with plantar fasciitis. J Biomech. 2014;47(11):2571–7. PubMed

Plesek J Skypala J Hamill J, et al. . Ankle kinematics and plantar fasciitis in runners: a one-year prospective 4HAIE study. In: ISBS Proceedings Archive. Salzburg: NMU Commons; 2024. pp. 764–7 Available from: https://commons.nmu.edu/isbs/vol42/iss1/215.

Jandacka D Uchytil J Zahradnik D, et al. . Running and physical activity in an air-polluted environment: the biomechanical and musculoskeletal protocol for a prospective cohort study 4HAIE (Healthy Aging in Industrial Environment—Program 4). Int J Environ Res Public Health. 2020;17(9142):9142. PubMed PMC

Elavsky S Jandačková V Knapová L, et al. . Physical activity in an air-polluted environment: behavioral, psychological and neuroimaging protocol for a prospective cohort study (Healthy Aging in Industrial Environment Study—Program 4). BMC Public Health. 2021;21(1):126. PubMed PMC

Cipryan L Kutac P Dostal T, et al. . Regular running in an air-polluted environment: physiological and anthropometric protocol for a prospective cohort study (Healthy Aging in Industrial Environment Study—Program 4). BMJ Open. 2020;10(12):e040529. PubMed PMC

VanGent RN, Siem D, Van Middeloop M, Van Os AG, Bierma-Zeinstra SMA, Koes BW. Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review. Br J Sports Med. 2007;41:469–80. PubMed PMC

VanMiddelkoop M, Kolkman J, VanOchten J, Bierma-Zeinstra SMA, Koes BW. Risk factors for lower extremity injuries among male marathon runners. Scand J Med Sci Sports. 2008;18(6):691–7. PubMed

Kluitenberg B, Van Middelkoop M, Diercks R, Van der Worp H. What are the differences in injury proportions between different populations of runners? A systematic review and meta-analysis. Sport Med. 2015;45(8):1143–61. PubMed PMC

Peduzzi P, Concato J, Kemper E, Holford TR, Feinstem AR. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol. 1996;49(12):1373–9. PubMed

WHO . Global Recommendations on Physical Activity for Health. Geneva (Switzerland): World Health Organization. 2010. PubMed

Kohl HW, Blair SN, Paffenbarger RS, Macera CA, Kronenfeld JJ. A mail survey of physical activity habits as related to measured physical fitness. Am J Epidemiol. 1988;127(6):1228–39. PubMed

Leardini A, Benedetti MG, Berti L, Bettinelli D, Nativo R, Giannini S. Rear-foot, mid-foot and fore-foot motion during the stance phase of gait. Gait Posture. 2007;25(3):453–62. PubMed

Malus J Skypala J Silvernail JF, et al. . Marker placement reliability and objectivity for biomechanical cohort study: Healthy Aging in Industrial Environment (HAIE—Program 4). Sensors (Basel). 2021;21(5):1830. PubMed PMC

Robertson E, Gordon D, Caldwell GE, Hamill J, Kamen G, Whittlesey SN. Research Methods in Biomechanics. 2nd ed. Champaign: Human Kinetics; 2014. p. 428.

Boyer ER, Rooney BD, Derrick TR. Rearfoot and midfoot or forefoot impacts in habitually shod runners. Med Sci Sports Exerc. 2014;46(7):1384–91. PubMed

Samaan CD, Rainbow MJ, Davis IS. Reduction in ground reaction force variables with instructed barefoot running. J Sport Heal Sci. 2014;3(2):143–51.

Peterson RA. Finding optimal normalizing transformations via bestNormalize. R J. 2021;13(1):310–29.

Agyekum EK, Ma K. Heel pain: a systematic review. Chin J Traumatol. 2015;18(3):164–9. PubMed

Rhim HC, Kwon J, Park J, Borg-Stein J, Tenforde AS. A systematic review of systematic reviews on the epidemiology, evaluation, and treatment of plantar fasciitis. Life (Basel). 2021;11(12):1287. PubMed PMC

Hamill J, Bates BT, Knutzen KM. Ground reaction force symmetry during walking and running. Res Q Exerc Sport. 1984;55(3):289–93.

Brown AM, Zifchock RA, Hillstrom HJ. The effects of limb dominance and fatigue on running biomechanics. Gait Posture. 2014;39(3):915–9. PubMed

Knurr KA, Kliethermes SA, Stiffler-Joachim MR, Cobian DG, Baer GS, Heiderscheit BC. Running biomechanics before injury and 1 year after anterior cruciate ligament reconstruction in division I collegiate athletes. Am J Sports Med. 2021;49(10):2607–14. PubMed PMC

Silbernagel KG, Willy R, Davis I. Preinjury and postinjury running analysis along with measurements of strength and tendon length in a patient with a surgically repaired Achilles tendon rupture. J Orthop Sports Phys Ther. 2012;42(6):521–9. PubMed

Blyton SJ, Snodgrass SJ, Pizzari T, Birse SM, Likens AD, Edwards S. The impact of previous musculoskeletal injury on running gait variability: a systematic review. Gait Posture. 2023;101:124–33. PubMed

Hespanhol Junior LC, Pena Costa LO, Lopes AD. Previous injuries and some training characteristics predict running-related injuries in recreational runners: a prospective cohort study. J Physiother. 2013;59(4):263–9. PubMed

Stone AA, Shiffman S, Atienza AA, Nebeling L. The Science of Real-Time Data Capture: Self-Reports in Health Research. New York: Oxford University Press; 2007. p. 416.

Bittel KM O’Briant KY Ragaglia RM, et al. . Associations between social cognitive determinants and movement-related behaviors in studies using ecological momentary assessment methods: systematic review. JMIR Mhealth Uhealth. 2023;11:e44104. PubMed PMC

Saragiotto BT, Yamato TP, Hespanhol Junior LC, Rainbow MJ, Davis IS, Lopes AD. What are the main risk factors for running-related injuries? Sport Med. 2014;44(8):1153–63. PubMed

Jandacka D Jandackova VK Juras V, et al. . Achilles tendon structure is associated with regular running volume and biomechanics. J Sports Sci. 2023;41(4):381–90. PubMed

Orner S, Kratzer W, Schmidberger J, Grüner B. Quantitative tissue parameters of Achilles tendon and plantar fascia in healthy subjects using a handheld myotonometer. J Bodyw Mov Ther. 2018;22(1):105–11. PubMed

Stecco C Corradin M Macchi V, et al. . Plantar fascia anatomy and its relationship with Achilles tendon and paratenon. J Anat. 2013;223(6):665–76. PubMed PMC

Shiotani H Takahashi K Honma Y, et al. . Mechanical linkage between Achilles tendon and plantar fascia accounts for range of motion of human ankle-foot complex. Med Sci Sports Exerc. 2023;55(1):66–73. PubMed PMC

Lee D, Brellenthin AG, Thompson PD, Sui X, Lee IM, Lavie CJ. Running as a key lifestyle medicine for longevity. Prog Cardiovasc Dis. 2017;60(1):45–55. PubMed

McClay I, Manal K. A comparison of three-dimensional lower extremity kinematics during running between excessive pronators and normals. Clin Biomech (Bristol). 1998;13(3):195–203. PubMed

Warren BL. Plantar fasciitis in runners treatment and prevention. Sport Med. 1990;10(5):338–45. PubMed

Nigg BM, Baltich J, Hoerzer S, Enders H. Running shoes and running injuries: mythbusting and a proposal for two new paradigms: ‘preferred movement path’ and ‘comfort filter.’. Br J Sports Med. 2015;49(20):1290–4. PubMed

Nigg BM. The role of impact forces and foot pronation: a new paradigm. Clin J Sport Med. 2001;12(1):57–9. PubMed

Ribeiro AP. Biomechanical aspects of the static and dynamic patterns of the feet of runners with plantar fasciitis and their relationship with sports shoes. In: Taiar R, editor. Contemporary Advances in Sports Science. London: IntechOpen; 2021. p. 336.

Kjaer M Langberg H Miller BF, et al. . Metabolic activity and collagen turnover in human tendon in response to physical activity. J Musculoskelet Neuronal Interact. 2005;5(1):41–52. PubMed

Magnusson SP, Langberg H, Kjaer M. The pathogenesis of tendinopathy: balancing the response to loading. Nat Rev Rheumatol. 2010;6(5):262–8. PubMed

Breda SJ Oei EHG Zwerver J, et al. . Effectiveness of progressive tendon-loading exercise therapy in patients with patellar tendinopathy: a randomised clinical trial. Br J Sports Med. 2021;55(9):501–9. PubMed PMC

Rabusin CL Menz HB Mcclelland JA, et al. . Efficacy of heel lifts versus calf muscle eccentric exercise for mid-portion Achilles tendinopathy (HEALTHY): a randomised trial. Br J Sports Med. 2021;55(9):486–92. PubMed

Boonchum H, Bovonsunthonchai S, Sinsurin K, Kunanusornchai W. Effect of a home-based stretching exercise on multisegmental foot motion and clinical outcomes in patients with plantar fasciitis. J Musculoskelet Neuronal Interact. 2020;20(3):411–20. PubMed PMC

Huffer D, Hing W, Newton R, Clair M. Strength training for plantar fasciitis and the intrinsic foot musculature: a systematic review. Phys Ther Sport. 2017;24:44–52. PubMed

Siriphorn A, Eksakulkla S. Calf stretching and plantar fascia-specific stretching for plantar fasciitis: a systematic review and meta-analysis. J Bodyw Mov Ther. 2020;24(4):222–32. PubMed