Page 2716
Asian Journal of Engineering, Social and Health
Volume 3, No. 12 December 2024
Volume 3, No. 12 December 2024 - (2716-2728)
p-ISSN 2980-4868 | e-ISSN 2980-4841
https://ajesh.ph/index.php/gp
The Relationship of Dynamic Foot Posture with Injuries and Other
Related Factors in Recreational Long Distance Runners
Elina Widiastuti1*, Nani Cahyani Sudarsono2, Tirza Z Tamin3
Universitas Indonesia, Indonesia
Emails: elina.widiastuti@gmail.com
ABSTRACT
Foot posture is one of the risk factors that is thought to play a role in the occurrence of running-related injuries.
This research aims to see if there is an association between foot posture and running-related injuries in long-
distance recreational runners. Methods A cross-sectional research was conducted on 131 recreational long-
distance runners (94 men and 42 women). Foot posture was determined by Arch Index values calculated from
static and dynamic footprints, then tested whether it was associated with running-related injuries. The results
showed that dynamic and static foot posture were not associated with running-related injuries in recreational
long-distance runners (OR=0.67(0.21-2.20), 95% CI, p=0.516), (OR=0.87(0.29-2.61), 95% CI, p=0.806). On
dynamic examination, low arch and high arch foot postures were not associated with running-related injuries
in recreational long distance runners (OR=0.67(0.21-2.19), 95% CI, p=0.508), (OR=0.86(0.07-10.67), 95% CI,
p=1.00). Most subjects had low arch foot posture on dynamic (83.8%) and static (82.4%) examination. Running-
related injuries were found to be 28.7%, with most injuries in the knee (19.5%), calf (17.9%), and sole (15.6%)
areas. The conclusions and suggestions in this research are that dynamic and static foot posture are not
associated with running-related injuries in long-distance recreational runners, so further prospective research
needs to be done to get a clearer picture of other risk factors that cause running-related injuries.
Keywords: Dynamic Foot Posture, Static Foot Posture, Running-Related Injuries, Recreational Long Distance
Runners.
INTRODUCTION
Running is a cardiopulmonary endurance sport that is increasingly popular and easy to do. The
increasing popularity of running in the last decade is also accompanied by an increase in the number
of running competitions held from year to year, which will be followed by an increase in the incidence
of running-related injuries, especially overuse injuries. Previous research states that the incidence of
running-related injuries to the lower extremities is 37% with the highest incidence of injury in women
(Dempster et al., 2021).
One intrinsic risk factor that is gaining attention as a cause of running-related injuries is foot
posture. Several studies have suggested that high-arch and low-arch/flat feet are associated with
lower extremity injuries (Tong & Kong, 2013). Data on the prevalence of foot posture and running-
The Relationship of Dynamic Foot Posture with Injuries and Other Related Factors in Recreational Long
Distance Runners
Page 2717
Asian Journal of Engineering, Social and Health
Volume 3, No. 12 December 2024
related injuries in recreational long-distance runners is still very limited. This has piqued the interest
of researchers to examine dynamic foot posture in relation to running-related injuries in recreational
long-distance runners.
Running is a high-intensity physical activity, which is equivalent to >6.0 METs, and is performed
in high frequency and distance in long-distance and marathon runners (Riebe et al., 2018). This will
be accompanied by increased injury rates, especially due to overuse injuries.
Based on consensus with a modified Delphi approach in recreational runners, running-related
injuries should have 3 (three) domains, namely: physical complaints, interruption of training or
competition, and the need for medical assistance (Yamato et al., 2015). The body system involved is
the musculoskeletal system of the lower extremity, hip, pelvis, and lower back area resulting from
running-related activities, during training or during competition, which results in training being
interrupted, having to be reduced or stopped (Benca et al., 2020); (Dempster et al., 2021).
Etiology and Risk Factors
Running-related injuries can result from a variety of risk factors. The mechanism of injury is a
simple conceptual model, which is divided into 4 parts, namely: (A) Loading capacity of specific
structures when entering the running session; (B) Cumulation of specific structural loads per running
session; (C) Reduction in specific structural capacity during the training session; and (D) exceeding
specific structural capacity (Malisoux et al., 2015).
Figure 1. Conceptual framework of causal mechanisms underlying the occurrence of running-
related injuries in a single running session (Malisoux et al., 2015)
Meeuwisse, describes injuries in terms of dynamic and repetitive/recursive sports injuries,
where exposure can alter risk factors and allow athletes to return to the cycle model repeatedly. Each
athlete, has a set of intrinsic risk factors (e.g. bone strength, neuromuscular control, age, previous
injuries, etc). Coupled with repeated exposure to extrinsic risk factors (equipment, environment, etc)
and the same mechanism or event can result in the athlete becoming injured. Once an injury occurs,
there is a retreat from further exposure, and recovery facilitates the athlete's return to sport, with
Elina Widiastuti, Nani Cahyani Sudarsono, Tirza Z Tamin
Page 2718
Asian Journal of Engineering, Social and Health
Volume 3, No. 12 December 2024
the potential for a new set of risk factors. Unfortunately, not all athletes are able to return to sport
after injury. Athletes with severe injuries, or with inadequate recovery, may be excluded from
potential further exposure or injury. Another possibility is that the athlete was exposed to a potential
injury, but did not sustain an injury. Adaptation or maladaptation of tissues, equipment, etc. occurs
that alters intrinsic and/or extrinsic risk factors. Based on the cycle model above, athletes can enter
the injury chain at any point.
One of the intrinsic risk factors that may play a role in the occurrence of injuries in runners is
foot posture. Foot posture is characterized by the contour of the medial longitudinal arch of the foot
in the weight-bearing position, which is then divided into categories: normal (rectus), low-arch
(planus), and high-arch (cavus). Foot posture examination can be performed in both static and
dynamic conditions (Menz et al., 2013).
Examination of foot posture can be done through various means, including: visual estimation,
anthropometric values, footprint parameters, and radiographic evaluation (Neal et al., 2014). One of
the many examinations performed is using the footprint index, including: Arch Index (AI) which was
first described by Cavanagh and Rogers in 1987. AI is calculated as the ratio of the area of the middle
third of the sole to the area of the entire sole (excluding the toes) with higher values representing
flatter feet (Neal et al., 2014) (Figure 3) Once the AI value is calculated, the footprint can be classified
into: high-arch/cavus (AI ≤ 0.21); normal arch/rectus (AI 0.21-0.26); and low-arch/planus (AI ≥ 0.26).
Figure 2. Footprint with reference line for calculating AI
Foot Posture and Running Biomechanics
Running, like walking, is a series of pronation and supination movements of the foot. Running
is distinguished from walking by the increase in speed, or distance traveled per unit of time, and the
presence of a float phase. During the running cycle, there are two float periods when neither foot
touches the ground. This results in reduced time in the stance phase and increased time in the swing
phase. As speed increases, a further reduction of the stance phase occurs, with the duration of the
hovering phase increasing. Unlike walking, the forward momentum required for running is gained
through the swinging of the legs and arms, rather than the treadling of the feet. The walking and
running cycles also differ in that the vertical ground reaction force per one step is greater in running
than in walking and fast walking.
The Relationship of Dynamic Foot Posture with Injuries and Other Related Factors in Recreational Long
Distance Runners
Page 2719
Asian Journal of Engineering, Social and Health
Volume 3, No. 12 December 2024
Foot posture is often associated with the risk of injury or pain in the feet (Tong & Kong, 2013).
This can be explained because mechanically foot posture is considered to contribute to the
occurrence of malalignment and pathology in the proximal foot through rotation of the tibia (internal
rotation in pronated feet), as well as due to stiffness in the leg and increased vertical force loading
(supinated feet). (WHO Guidelines on Physical Activity and Sedentary Behaviour at A Glance, 2020)
Long-distance running activities are thought to also change foot posture and potentially lead to
changes in running biomechanics. In a research conducted by Mei et al, an increase in static foot
pronation was found after running 5 km on a treadmill (examination was carried out with the Foot
Posture Index) (Mei et al., 2019).
In relation to foot posture, in the last 50-100 years, running shoes have also undergone many
dramatic changes (Nigg et al., 2015); (Sun et al., 2020). This development is inseparable from efforts
to reduce the incidence of injury and improve runner performance with the support of the sports
industry and academics. (Nigg et al., 2015); (Sun et al., 2020). Individuals with a plantar shape with a
low-arch are thought to have greater rear foot and mid-foot mobility which allows the foot to pronate
more during the stance phase of running. Motion control shoes are recommended for individuals
with low-arch/pronation, as they are thought to control excessive pronation of the foot. Individuals
with a plantar shape with a high arch are expected to have rigid and inflexible feet, resulting in greater
ground impact force and less pronation during running. Cushioned shoes are recommended for
individuals with high arch/supination, as they are thought to improve shock absorption by allowing
more pronation and better cushioning to reduce ground impact.
Individuals with normal foot arches are expected to impact the ground with less force and have
appropriate pronation during running. Neutral/stability shoes are thought to have moderate
cushioning and motion-control characteristics, making them recommended for individuals with
normo-arch foot posture types. There are many things that influence a runner's preference in
choosing a running shoe, a factor cited by shoe reviewers, runners, and experts in the shoe industry
as important is the feeling of running, i.e. the feeling of comfort when using the shoe (Agresta et al.,
2020) (Walton & French, 2016). Other influential factors include: personal preferences, the influence
of others, and the economy (Ramsey et al., 2022).
Based on the above background, the aim of this research was to analyze the relationship
between dynamic foot posture and the risk of running-related injuries in recreational long-distance
runners. The research also aimed to identify intrinsic risk factors related to foot posture, as well as
their influence on running biomechanics and running shoe selection. In addition, this research seeks
to provide an overview of the biomechanical adaptations of the foot due to distance running activities
and how the use of appropriate running shoes can influence injury risk. The benefit of this research
is that it contributes to understanding the biomechanical factors that influence injuries in runners,
particularly in relation to foot posture. The results of this research are expected to serve as a basis
for runners, coaches, and the sports shoe industry in choosing shoes that are suitable for foot posture
to reduce the risk of injury. In addition, this research can also support the development of injury
prevention interventions and improve running performance through a better understanding of the
relationship between foot posture, running biomechanics and shoe design.
Elina Widiastuti, Nani Cahyani Sudarsono, Tirza Z Tamin
Page 2720
Asian Journal of Engineering, Social and Health
Volume 3, No. 12 December 2024
RESEARCH METHOD
The research was conducted with a cross-sectional design and data collection was carried out
at the Center for Sports and Exercise Studies (CSES) IMERI FK UI, April-May 2024. The research was
conducted on a population of long-distance runners, with the target population being adult long-
distance recreational runners, and the reach population being adult long-distance recreational
runners in the city of Jakarta in 2024.
The inclusion criteria in this research were: (1) Male and female recreational runners, aged 18-
65 years with a training history of at least 1-3 times/week within 6 consecutive months, with a
minimum cumulated distance per week of 10 km (kilometers); (2) Subjects have participated in
running competitions of at least 10 km and a maximum of 21 km (half marathon) within the last 6
months; (3) Willing to become a research subject, undergo a foot posture examination, and fill out
the questionnaire provided; (4) Subjects are in a condition that can be examined for foot posture (no
injuries, deformities, and can stand or walk without pain and limping that can affect the results of the
examination (footprint); (5) Signed the research consent form.
The exclusion criteria in this research were: (1) Subjects with foot or leg pain, resulting in
inability to stand or walk with normal stride (e.g. limping) (2) Subjects with a history of significant leg
injury, or a history of surgery affecting leg posture prior to the examination; (3) Subjects with leg
length discrepancy (LLD) of more than 2 cm; (4) Subjects who performed trail running (on mountains
or on uneven surfaces) more than 2 times in 1 month; (5) Performed exercise of more than 5 km, 24
hours prior to the examination.
The minimum sample size required was 113 runners and sampling was done consecutively
within a 6-week period. The instruments used were measuring tape, Omron HBF-375 Karada Scan
Body Composition Scale, Harris mat foot imprinter measuring 36 cm x 15 cm manufactured by
Diabetic Foot Care India Pvt Limited, paid computer application SketchAndCalcTM area calculator to
calculate the footprint area which will be used to calculate the Arch Index (AI) value, A3 paper cut to
36 cm x 15 cm, scanner machine and questionnaire.
The types of data used in this research are primary data and quantitative data used in this
research are data from age, gender, body mass index, understanding of foot posture, accuracy of
running shoe selection, results of the calculation of static and dynamic footprint Arch Index (AI)
values, and running-related injuries. Data collection was carried out according to the protocol that
had been made and tested first, and had passed the ethical review with number: KET-
264/UN2.F1/ETIK/PPM.00.02/2024 on February 16, 2024.
At the time of recruitment, data was collected through an online questionnaire in the form of
a google form, data collection of body weight and height measured directly using a weight scale and
stadiometer to calculate body mass index (BMI), and direct collection of static and dynamic footprint
data using a Harris mat. The static and dynamic footprints obtained were analyzed using the
SketchAndCalc computer application to calculate the Arch Index (AI) value to further determine the
type of foot posture of the research subject. Data analysis was carried out with SPSS software licensed
by the Faculty of Medicine, University of Indonesia.
The Relationship of Dynamic Foot Posture with Injuries and Other Related Factors in Recreational Long
Distance Runners
Page 2721
Asian Journal of Engineering, Social and Health
Volume 3, No. 12 December 2024
RESULT AND DISCUSSION
Data collection was conducted offline at CSES, with 131 subjects who filled out the recruitment
form in advance online via google form, and 8 who came directly to CSES without filling out the
recruitment form online. Three subjects who did not meet the inclusion criteria were excluded. The
total data analyzed further was 136 subjects.
Based on the results, the mean age of the research subjects was 35.11 ± 8.81 years. The mean
body mass index (BMI) of the research subjects was 24.43 ± 3.67 kg/m2. There were more runners
with male gender (69.1%) than female (30.9%).
Based on the dynamic foot posture examination using a footprint calculated by the Arch Index
value, it was found that the number of subjects categorized as low arch was more (83.8%) than in the
static foot posture examination (82.4%). Subjects categorized as high arch were equally numerous in
both dynamic and static examinations (2.9%). Based on the category of problematic foot posture (low
arch and high arch) or not (normal arch), it was found that most subjects had dynamic foot posture
in the problematic category, (86.8%) slightly more than in the static foot posture examination (86%).
Subjects who understood their respective foot posture before the footprint examination was
carried out were only 19.1%. Based on the accuracy of choosing running shoes with foot posture,
subjects who chose the right shoes with their foot posture were only 2.2%. Subjects who experienced
running-related injuries, no one chose the right shoes according to their foot posture (0%), and
subjects who did not experience running-related injuries only 3 people (3.1%) chose the right shoes,
the remaining 94 people (96.9%) chose the wrong shoes.
Based on injury history, those with a history of injury more than 6 months ago were 27.9%, and
those without a history of injury more than 6 months ago were 72.1%. Of the subjects who were
injured in the past 6 months, 38.5% had a history of injury more than 6 months ago, more than the
subjects who were not injured.
Table 1. Basic characteristics of the research subjects
Characteristics
With Running-Related
Injuries
N = 39 (28,7 %)
No Running-Related
Injuries
N = 97 (71,3 %)
Total N = 136
Age (years)
32,82 ± 8,54
36,03 ± 8,79
35,11 ± 8,81
IMT
25,18 ± 3,27
24,12 ± 3,79
24,43 ± 3,67
Gender
Male
Female
31 (79,5%)
8 (20,5%)
63 (64,9 %)
34 (35,1 %)
94 (69,1%)
42 (30,9%)
Dynamic foot posture
Low arch
Normo arch High arch
34 (87,2%)
4 (10,3%)
1 (2,6%)
80 (82,5 %)
14 (14,4 %)
3 (3,1 %)
114 (83,8%)
18 (13,2%)
4 (2,9%)
Static foot posture
Low arch Normo arch
High arch
34 (87,2%)
5 (12,8%)
0 (0%)
78 (80,4 %)
15 (15,5 %)
4 (4,1 %)
112 (82,4%)
20 (14,7%)
4 (2,9%)
Foot posture (dynamic)
No problem
Trouble
4 (10,3%)
35 (89,7%)
14 (14,4 %)
83 (85,6 %)
18 (13,3%)
118 (86,8%)
Elina Widiastuti, Nani Cahyani Sudarsono, Tirza Z Tamin
Page 2722
Asian Journal of Engineering, Social and Health
Volume 3, No. 12 December 2024
Characteristics
With Running-Related
Injuries
N = 39 (28,7 %)
No Running-Related
Injuries
N = 97 (71,3 %)
Total N = 136
Foot posture (static)
No problem
Trouble
5 (12,8%)
34 (87,2%)
10 (10,3%)
87 (89,7%)
19 (14%)
117 (86%)
Injury history
Yes
No
15 (38,5%)
24 (61,5%)
23 (23,7%)
74 (76,3%)
38 (27,9%)
98 (72,1%)
Understanding of foot
posture
Understand
Don't understand
6 (15,4%)
33 (84,6%)
20 (20,6%)
77 (79,4%)
26 (19,1%)
110 (80,9%)
Appropriateness of Shoe
selection
Exactly
Inappropriate
0 (0%)
39 (100%)
3 (3,1%)
94 (96,9%)
3 (2,2%)
133 (97,8%)
Running-related injuries were found in 28.7% of all subjects. The three most common areas of
injury/complaints encountered in this research were the knee area at 19.5%, the calf area at 17.9%,
and the sole of the foot at 15.6%.
Table 2. Most common injury/complaint areas
Total (n=128)
25 (19,5%)
23 (17,9%)
20 (15,6%)
15 (11,7%)
13 (10,2%)
10 (7,8%)
8 (6,3%)
7 (5,5%)
4 (3,1%)
3 (2,3%)
Bivariate tests conducted in an effort to prove the hypothesis found that dynamic and static
foot postures were not associated with running-related injuries in recreational long-distance runners
(OR=0.67(0.21-2.20), 95% CI, p=0.516), (OR=0.87(0.29-2.61), 95% CI, p=0.806).
In the dynamic examination, low arch and high arch foot postures were not significantly
associated with running-related injuries in recreational long distance runners (OR=0.67(0.21-2.19),
95% CI, p=0.508), (OR=0.86(0.07-10.67), 95% CI, p=1.00). On static examination, it was also found
that low arch and high arch foot postures were not significantly associated with running-related
injuries in long distance recreational runners (OR=0.76(0.26-2.27), 95% CI, p=0.629), (OR=0.75(0.58-
0.97), 95% CI, p=0.544).
The Relationship of Dynamic Foot Posture with Injuries and Other Related Factors in Recreational Long
Distance Runners
Page 2723
Asian Journal of Engineering, Social and Health
Volume 3, No. 12 December 2024
Table 3. Relationship between Foot Posture and Running-Related Injuries
Running-Related Injuries
Total
P-value
OR (95% CI)
Injury n (%)
No Injury n (%)
Dynamic Foot Posture
Trouble
35 (29,7%)
83 (70,3%)
118
0,516cs
0,67 (0,21-2,20)
No problem
4 (22,2%)
14 (77,8%)
18
Static Foot Posture
Trouble
34 (29,1%)
83 (70,9%)
117
0.806cs
0,87 (0,29-2,61)
No
problematic
5 (26,3%)
14 (73,7%)
19
Dynamic Foot Posture
Low arch
34 (29,8%)
80 (70,2%)
114
0,508cs
0,67 (0,21-2,19)
High arch
1 (25%)
3 (75%)
4
1,00fs
0,86 (0,07-
Normal arch
4 (22,2%)
14 (77,8%)
18
10,67)
Static Foot Posture
Low arch
34 (30,4%)
78 (69,6%)
112
0,629cs
0,76 (0,26-2,27)
High arch
0 (0,0%)
4 (100%)
4
0,544fs
0,75 (0,58-0,97)
Normal arch
5 (25%)
15 (75%)
20
cs) Chi square test
fs) Fisher's exact test
Discussion
In this research, 136 subjects were analyzed, with a mean age of 35.11 ± 8.81 years. This finding
is in line with research conducted in New York, which found that the mean age of recreational long-
distance runners was 37.4 years, higher than the mean age of elite long-distance runners, which was
23 years (Chowdhary et al., 2024).
The mean Body Mass Index (BMI) in the subjects of this research, namely: 24.43 ± 3.67 kg/m2
and mostly male, namely: 69,1%. This finding is almost similar to the findings in a research conducted
on long-distance runners participating in the Inijubliana marathon, Slovenia, which obtained a mean
BMI of 23 kg/m2. When compared to sprinters, generally the BMI of long-distance runners is smaller
than that of sprinters, this is because muscle mass plays an important role in the performance of
sprinters, while for long-distance runners, endurance is more dominant (Stachoń et al., 2023).
The dynamic and static foot postures obtained based on the Arch Index (AI) values are mostly
low arch (83.8%, 82.4%), followed by normal arch (13.2%, 14.7%) and high arch (2.9%, 2.9%). Based
on the Arch Index value, dynamic and static foot postures were further divided into problematic foot
postures (low arch and high arch) and non-problematic foot postures (normal arch). Dynamic and
static problematic foot postures were found to be 86.8% and 86%. This finding is in line with research
conducted in India which examines the difference between static and dynamic footprints, where in
the research they found that the AI value was significantly greater in dynamic footprints (0.23 ± 0.04)
compared to static footprints (0.22 ± 0.05) with a p value of 0.011 (Mukhra et al., 2020). This is
because in the stance phase when walking there is a phase of resting on one foot so that the force
imposed on the foot is greater than when standing with both feet.
Running-related injuries were found to be 28.7% with the most common injury/complaint areas
found were complaints in the knee area (19.5%), followed by complaints in the calf area (17.9%), and
Elina Widiastuti, Nani Cahyani Sudarsono, Tirza Z Tamin
Page 2724
Asian Journal of Engineering, Social and Health
Volume 3, No. 12 December 2024
the soles of the feet (15.6%), supported by the findings of Van Poppel et al., in his research which
found the most injured areas were in the knees, thighs and calves (van Poppel et al., 2014). Kakouris
et al., in their systematic review, found the highest prevalence of injuries in the knee, lower leg and
foot / toe areas (Kakouris et al., 2021).
In a research conducted at Ningbo University, China, found that foot pronation after running a
medium distance (5 km) is an early indicator of increased load on the lower extremity joints (Mei et
al., 2019). This is in line with other research which states that, runners with high arch feet have a
higher incidence of ankle, bone, and lateral side injuries. Runners with low arch feet have a higher
incidence of knee, soft tissue, and medial side injuries. This is related to the change in the inclination
angle at the subtalar joint in low arch feet which results in eversion of the subtalar joint and the distal
component of the tibia undergoing internal rotation, and further increases valgus of the knee and
internal rotation of the femur, resulting in a greater load on the medial side of the knee.
In the population, generally the most common foot posture is a foot posture with a normal
arch or normal arch such as research findings in a population of medical students at the University of
Indonesia aged 17-21 years (normal arch 89%, low arch 4%, and high arch 7%) (Wicaksono et al.,
2021). Another research on flat feet in a random population in Spain, also found that flat feet were
found in 26.62%, assessed using footprints using Clarke's angle, Chippaux-Smirak Index and Stahell
arch Index (Pita-Fernandez et al., 2017).
In contrast to the findings in the general population, in this research the foot posture of long-
distance recreational runners in both static and dynamic examinations was mostly low arch foot
posture. This may be influenced by the different ways of analyzing foot posture used in both studies
conducted by previous studies even though they both use footprints.
Another thing that may be related to the finding of many low arch foot postures in long-
distance recreational runners in this research is that: long-distance running or prolonged fingering
may affect foot posture, although these studies assessed the condition of foot posture immediately
after a long-distance run was performed (Cowley & Marsden, 2013); (Fukano & Iso, 2015); (Jastifer,
2022); (Mei et al., 2019). In a research conducted on subjects who participated in the Plymouth Half
Marathon, a navicular drop of 5 mm was obtained in both feet and in the Foot Posture Index-6 (FPI-
6) examination the foot posture changed towards a pronated position after the subject ran a half
marathon which was thought to be fatigue in the muscles and soft tissues that support the medial
longitudinal arch of the foot (Cowley & Marsden, 2013). Another research found that after running
35 km on the road, there was a significant decrease in dorsal height, navicular height, and arch height
ratio in the research subjects (Fukano & Iso, 2015).
Existing studies have shown changes immediately after long-distance running, but no
prospective studies have been conducted on long-distance runners to assess whether these
immediate changes can permanently change the foot posture of runners after years of long-distance
running. From the results of this research, it was found that most of the research subjects were
recreational long-distance runners with low arch foot posture, 83.8% (dynamic) and 82.4% (static).
Aside from the direct impact of long-distance running on foot posture changes, there are several
The Relationship of Dynamic Foot Posture with Injuries and Other Related Factors in Recreational Long
Distance Runners
Page 2725
Asian Journal of Engineering, Social and Health
Volume 3, No. 12 December 2024
other possibilities that also influence the findings of the research, such as: the length of running
experience and training volume of the runners that we did not assess in this research.
Based on the results of bivariate data analysis, it was found that neither dynamic nor static foot
posture was significantly associated with running-related injuries in long-distance recreational
runners. This may be because there are other risk factors that may contribute to the occurrence of
running-related injuries in recreational long-distance runners other than foot posture.
Malisoux in his conceptual model of the determinants of running-related injuries divides them
into 4 parts, namely: the loading capacity of specific structures when entering a running session, the
cumulation of specific structural loads per running session, the reduction in specific structural
capacity during training sessions, and the presence of training loads that exceed specific structural
capacity (Malisoux et al., 2015). In this research, the foot posture itself was included in the cumulation
of specific structural loads per running session, including body mass index (BMI) and running shoes.
The amount of load on each stride and the distribution of the load over the tissue structure of each
stride, along with the increasing number of strides, will contribute to the increasing cumulative
structure-specific load per running session. If this is coupled with poor recovery and a history of
previous injury, it can result in a reduction of specific structural capacity during training sessions,
which then results in an overload of running specific structural capacity leading to running-related
injuries.
Based on the concept initiated by Meeuwisse, injury is a combination of various risk factor
exposures, including intrinsic, extrinsic, and inciting events that occur recursively and dynamically.
Foot posture itself is part of the intrinsic risk factors. Beyond the cumulation of specific structural
loads per running session and the intrinsic risk factor of foot posture, there are other factors that also
influence the occurrence of running-related injuries, which were not assessed in this research, such
as extrinsic risk factors, training history (training volume), recovery (diet, sleep, time between running
sessions), running experience and inciting events.
Good recovery time between workouts, diet, sleep, and previous running experience are other
factors related to the prevention of running-related injuries. In the process of loading exerted during
training, musculoskeletal structures undergo adaptations that are influenced by various factors such
as time between training or competitions, running experience, previous injuries, menstrual patterns,
diet, sleep, oral contraceptive use, participation in other sports activities, gender and age (Malisoux
et al., 2015).
Based on the results of the research, it was found that most (80.9%) long-distance recreational
runners did not understand their foot posture, which would certainly affect runners' preferences in
choosing running shoes used daily. The selection of running shoes based on foot posture has not been
a consideration for runners in choosing running shoes, although the use of proper running shoes in
accordance with foot posture in reducing the risk of running-related injuries has been supported by
several written studies. Research found that the risk of injury was generally lower in participants with
pronated feet who used motion control shoes (HR=0.34; 95% CI 0.13-0.84), and runners with
pronated feet who used standard shoes had a higher risk of injury compared to runners with neutral
feet (HR=1.80; 95% CI 1.01-3.33) (Malisoux et al., 2016).
Elina Widiastuti, Nani Cahyani Sudarsono, Tirza Z Tamin
Page 2726
Asian Journal of Engineering, Social and Health
Volume 3, No. 12 December 2024
Of the total 136 runners who became research subjects, only 2.2% chose the right type of shoe
according to their foot posture. This is thought to be influenced by several factors, such as: the
availability of motion control shoes which are difficult to find in the running shoe market in Indonesia,
most types of shoes sold on the market are stability and cushioned shoes, and runners have other
reasons/preferences in choosing shoes such as comfort, recommendations, or economic factors as
mentioned by Ramsey in his research on the reasons runners choose shoes (Ramsey et al., 2022). The
list of running shoe types based on foot posture (motion control shoes, stability, and cushioned
shoes) that researchers use is only available on big brand running shoes, while in this research not a
few runners use domestically made running shoes for which there is no reference type classification.
For these reasons, no further analysis was conducted on the relationship between the variables of
understanding foot posture and the accuracy of running shoe selection on running-related injuries.
CONCLUSION
In conclusion, this research found that the majority of recreational long-distance runners
exhibited foot posture with low arches in both static (82.4%) and dynamic (83.8%) examinations.
Despite this, most runners (80.9%) were unaware of their foot posture, and only a small proportion
(2.2%) selected shoes that were appropriate for their foot posture. Running-related injuries were
reported by 28.7% of runners, with the most common complaints occurring in the knee (19.5%), calf
(17.9%) and sole (15.6%).
Analysis showed no significant association between foot posture - either static or dynamic -
and the occurrence of running injuries. Similarly, certain types of foot posture such as low arch and
high arch showed no significant correlation with injury risk. These findings suggest that factors
beyond foot posture may have a greater impact on injury risk among recreational runners. Future
research should explore the interaction between foot posture, shoe selection, biomechanics, and
other intrinsic and extrinsic risk factors. In addition, this research contributes to the development of
customized injury prevention strategies and highlights the importance of educating runners on
proper shoe selection and injury prevention measures to improve their performance and safety.
REFERENCES
Agresta, C., Peacock, J., Carmichael, A., Nielsen, K. E., Zendler, J., & Gonzalez, R. (2020). The
perception of ride is multidimensional for running footwear. Footwear Science, 12(1), 15–
24.
Benca, E., Listabarth, S., Flock, F. K. J., Pablik, E., Fischer, C., Walzer, S. M., Dorotka, R., Windhager,
R., & Ziai, P. (2020). Analysis of running-related injuries: The Vienna Research. Journal of
Clinical Medicine, 9(2), 438.
Chowdhary, K., Crockett, Z., Chua, J., & Soo Hoo, J. (2024). Exploring the Relationship between
Running-Related Technology Use and Running-Related Injuries: A Cross-Sectional Research
of Recreational and Elite Long-Distance Runners. Healthcare, 12(6), 642.
Cowley, E., & Marsden, J. (2013). The effects of prolonged running on foot posture: a repeated
measures research of half marathon runners using the foot posture index and navicular
The Relationship of Dynamic Foot Posture with Injuries and Other Related Factors in Recreational Long
Distance Runners
Page 2727
Asian Journal of Engineering, Social and Health
Volume 3, No. 12 December 2024
height. Journal of Foot and Ankle Research, 6, 1–7.
Dempster, J., Dutheil, F., & Ugbolue, U. C. (2021). The Prevalence of Lower Extremity Injuries in
Running and Associated Risk Factors: A Systematic Review. Physical Activity & Health (2515-
2270), 5(1).
Fukano, M., & Iso, S. (2015). Changes in foot shape after long-distance running. Journal of
Functional Morphology and Kinesiology, 1(1), 30–38.
Jastifer, J. R. (2022). Contemporary review: The foot and ankle in long-distance running. Foot &
Ankle Orthopaedics, 7(3), 24730114221125456.
Kakouris, N., Yener, N., & Fong, D. T. P. (2021). A systematic review of running-related
musculoskeletal injuries in runners. Journal of Sport and Health Science, 10(5), 513–522.
Malisoux, L., Chambon, N., Delattre, N., Gueguen, N., Urhausen, A., & Theisen, D. (2016). Injury
risk in runners using standard or motion control shoes: a randomised controlled trial with
participant and assessor blinding. British Journal of Sports Medicine, 50(8), 481–487.
Malisoux, L., Nielsen, R. O., Urhausen, A., & Theisen, D. (2015). A step towards understanding the
mechanisms of running-related injuries. Journal of Science and Medicine in Sport, 18(5),
523–528.
Mei, Q., Gu, Y., Xiang, L., Baker, J. S., & Fernandez, J. (2019). Foot pronation contributes to altered
lower extremity loading after long distance running. Frontiers in Physiology, 10, 573.
Menz, H. B., Dufour, A. B., Riskowski, J. L., Hillstrom, H. J., & Hannan, M. T. (2013). Association of
planus foot posture and pronated foot function with foot pain: the Framingham foot
research. Arthritis Care & Research, 65(12), 1991–1999.
Mukhra, R., Krishan, K., Nirenberg, M. S., Ansert, E., & Kanchan, T. (2020). Comparative analysis
of static and dynamic bare footprint dimensions in a north Indian population. Forensic
Science International, 308, 110169.
Neal, B. S., Griffiths, I. B., Dowling, G. J., Murley, G. S., Munteanu, S. E., Franettovich Smith, M.
M., Collins, N. J., & Barton, C. J. (2014). Foot posture as a risk factor for lower limb overuse
injury: a systematic review and meta-analysis. Journal of Foot and Ankle Research, 7, 1–13.
Nigg, B. M., Baltich, J., Hoerzer, S., & Enders, H. (2015). Running shoes and running injuries:
mythbusting and a proposal for two new paradigms:‘preferred movement path’and
‘comfort filter.’ British Journal of Sports Medicine, 49(20), 1290–1294.
Pita-Fernandez, S., Gonzalez-Martin, C., Alonso-Tajes, F., Seoane-Pillado, T., Pertega-Diaz, S.,
Perez-Garcia, S., Seijo-Bestilleiro, R., & Balboa-Barreiro, V. (2017). Flat foot in a random
population and its impact on quality of life and functionality. Journal of Clinical and
Diagnostic Research: JCDR, 11(4), LC22.
Ramsey, C. A., Lamb, P., & Ribeiro, D. C. (2022). Factors influencing runner’s choices of footwear.
Frontiers in Sports and Active Living, 4, 829514.
Riebe, D., Ehrman, J. K., Liguori, G., Magal, M., & Medicine, A. C. of S. (2018). ACSM’s guidelines
for exercise testing and prescription. (No Title).
Stachoń, A., Pietraszewska, J., & Burdukiewicz, A. (2023). Anthropometric profiles and body
composition of male runners at different distances. Scientific Reports, 13(1), 18222.
Sun, X., Lam, W.-K., Zhang, X., Wang, J., & Fu, W. (2020). Systematic review of the role of footwear
constructions in running biomechanics: Implications for running-related injury and
performance. Journal of Sports Science & Medicine, 19(1), 20.
Elina Widiastuti, Nani Cahyani Sudarsono, Tirza Z Tamin
Page 2728
Asian Journal of Engineering, Social and Health
Volume 3, No. 12 December 2024
Tong, J. W. K., & Kong, P. W. (2013). Association between foot type and lower extremity injuries:
systematic literature review with meta-analysis. Journal of Orthopaedic & Sports Physical
Therapy, 43(10), 700–714.
van Poppel, D., Scholten‐Peeters, G. G. M., van Middelkoop, M., & Verhagen, A. P. (2014).
Prevalence, incidence and course of lower extremity injuries in runners during a 12‐month
follow‐up period. Scandinavian Journal of Medicine & Science in Sports, 24(6), 943–949.
Walton, P. D., & French, D. P. (2016). What do people think about running barefoot/with
minimalist footwear? A thematic analysis. British Journal of Health Psychology, 21(2), 451–
468.
Wicaksono, A., Kusumaningtyas, S., & Tulaar, A. B. M. (2021). Foot Arch and Plantar Pressure in
the Age of 17-21 Years. Foot, 21(2), 124–129.
Yamato, T. P., Saragiotto, B. T., & Lopes, A. D. (2015). A consensus definition of running-related
injury in recreational runners: a modified Delphi approach. Journal of Orthopaedic & Sports
Physical Therapy, 45(5), 375–380.
Copyright holder:
Elina Widiastuti, Nani Cahyani Sudarsono, Tirza Z Tami (2024)
First publication right:
Asian Journal of Engineering, Social and Health (AJESH)
This article is licensed under: