Assessment of Foot Pronation and Lower Limb Injuries Among Recreational Runners: A Cross-Sectional Study
Foot Pronation and Injuries
DOI:
https://doi.org/10.54393/tt.v5i03.260Keywords:
Foot Pronation, Lower Limb Injuries, Recreational Runners, Foot Posture IndexAbstract
Recreational runners may be at risk for lower limb injuries due to foot pronation. Objective: To assess the association between foot pronation and lower limb injuries in recreational runners. Methods: A cross-sectional analytical study was conducted on 142 recreational runners (both sexes, aged >18) who ran at least three times weekly. Individuals with walking impairments or undergoing rehabilitation were excluded. Ethical approval was obtained, and informed consent was collected. Post-hoc power analysis confirmed 82% power (α = 0.05, Cohen’s h = 0.3) for chi-square testing. Foot posture was assessed using the Foot Posture Index (FPI), and foot mobility via the Sit-to-Stand Navicular Drop Test (SSNDT). Lower limb function was evaluated using the Lower Extremity Functional Scale (LEFS). Statistical analysis was performed using SPSS version 28.0. Descriptive statistics summarized participant data. Chi-square and Fisher’s exact tests assessed injury prevalence across foot posture categories. T-tests or Mann-Whitney U tests compared navicular drop and LEFS scores between injured and non-injured groups. Logistic regression analyzed associations between FPI scores and injury risk, adjusting for BMI and age. Results: Most participants were young adults, with more females. Common injuries involved the groin (52.8%), knee (54.9%), and ankle (ligamentous: 56.3%; non-ligamentous: 49.3%). Pronated feet were found in 38.7% of runners. Mean FPI score was 5.04 ± 3.67; navicular drop was 11.31 ± 3.66 mm. Mean LEFS score was 42.61 ± 20.39. Conclusion: Foot pronation is significantly associated with lower limb injuries. Clinical tools like FPI and SSNDT are effective for identifying at-risk individuals.
References
Galloso-Lagos MJ, González-Elena ML, Pérez-Belloso AJ, Coheña-Jiménez M, Elena-Pérez M, Muriel-Sánchez JM et al. A short-term evaluation of foot pronation tendency in healthy recreational runners. Life. 2023 Nov; 13(11): 2202. doi: 10.3390/life13112202.
Andrade AC, Catelli DS, Bedo BL, Cesar GM, Santos TF, Junqueira EB et al. Association between the strength of flexor hallucis brevis and abductor hallucis and foot mobility in recreational runners. Biomechanics. 2022 Dec; 2(4): 613-22. doi: 10.3390/biomechanics2040048.
Dempster J, Dutheil F, Ugbolue UC. The prevalence of lower extremity injuries in running and associated risk factors: a systematic review. Physical Activity and Health. 2021 Jul; 5(1). doi: 10.5334/paah.109.
Sanfilippo D, Beaudart C, Gaillard A, Bornheim S, Bruyere O, Kaux JF. What are the main risk factors for lower extremity running-related injuries? A retrospective survey based on 3669 respondents. Orthopaedic Journal of Sports Medicine. 2021 Nov; 9(11): 23259671211043444. doi: 10.1177/23259671211043444.
Mason J, Kniewasser C, Hollander K, Zech A. Intrinsic risk factors for ankle sprain differ between male and female athletes: a systematic review and meta-analysis. Sports Medicine-Open. 2022 Dec; 8(1): 139. doi: 10.1186/s40798-022-00530-y.
Stennett R, Scheer V, Kaulback K. Bone Stress Injury Epidemiology and Risk Factors in Female Off-Road Runners: A Systematic Review. Journal of Sport Rehabilitation. 2025 Jan; 34(5): 470-83. doi: 10.1123/jsr.2024-0288.
Lopezosa-Reca E, Gijon-Nogueron G, Morales-Asencio JM, Cervera-Marin JA, Luque-Suarez A. Is there any association between foot posture and lower limb-related injuries in professional male basketball players? A cross-sectional study. Clinical Journal of Sport Medicine. 2020 Jan; 30(1): 46-51. doi: 10.1097/JSM.0000000000000563.
Kliethermes SA, Stiffler-Joachim MR, Wille CM, Sanfilippo JL, Zavala P, Heiderscheit BC. Lower step rate is associated with a higher risk of bone stress injury: a prospective study of collegiate cross country runners. British Journal of Sports Medicine. 2021 Aug; 55(15): 851-6. doi: 10.1136/bjsports-2020-103833.
Chemperek E, Zawadka M, Fábrega-Cuadros R, Aibar-Almazán A, Hita-Contreras F, Gawda P. Static and dynamic balance in physically active females with pronated feet. Physiotherapy Theory and Practice. 2025 Jan: 1-0. doi: 10.1080/09593985.2024.2447473.
Jafarnezhadgero AA, Jahangirpour A, Parsa H, Sajedi H, Granacher U, Souza Oliveira A. The impact of excessive body weight and foot pronation on running kinetics: a cross-sectional study. Sports Medicine-Open. 2023 Dec; 9(1): 116. doi: 10.1186/s40798-023-00663-8.
Raghav¹ U, Mahajan R, Khan FA. Correlation of over-pronated feet with static and dynamic balance among runners. Yugato. 2024 Jul; 76(1).
Ratter J, Pellekooren S, Wiertsema S, van Dongen JM, Geleijn E, de Groot V et al. Content validity and measurement properties of the Lower Extremity Functional Scale in patients with fractures of the lower extremities: a systematic review. Journal of Patient-Reported Outcomes. 2022 Jan; 6(1): 11. doi: 10.1186/s41687-022-00417-2.
Otani R, Nishikawa H, Saeki J, Nakamura M. Relationship Between the Flexion Torque of the First Metatarsophalangeal Joint and Intrinsic Foot Muscles Depends on the Ankle Joint Position. Foot & Ankle Orthopaedics. 2024 Aug; 9(3): 24730114241266847. doi: 10.1177/24730114241266847.
Willwacher S, Kurz M, Robbin J, Thelen M, Hamill J, Kelly L 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. Sports Medicine. 2022 Aug; 52(8): 1863-77. doi: 10.1007/s40279-022-01666-3.
Chen J, Tang L, Yang X, Tang J, Cheng Q, Zhao C et al. A cross-sectional study of medial longitudinal arch development in children with different BMI. Frontiers in Pediatrics. 2024 Jul; 12: 1343162. doi: 10.3389/fped.2024.1343162.
Domaradzki J, Koźlenia D, Popowczak M, Šimonek J, Paška Ľ, Horička P. Prognostic power of foot mobility in identifying the risk of musculoskeletal injuries: A cross-sectional study of male volleyball players at different competitive levels. Journal of Clinical Medicine. 2024 Feb; 13(5): 1189. doi: 10.3390/jcm13051189.
Okamura K, Hasegawa M, Ikeda T, Fukuda K, Egawa K, Kanai S. Classification of medial longitudinal arch kinematics during running and characteristics of foot muscle morphology in novice runners with pronated foot. Gait & Posture. 2022 Mar; 93: 20-5. doi: 10.1016/j.gaitpost.2022.01.006.
Safar Cherati A, Khalifeh Soltani S, Moghadam N, Hassanmirzaei B, Haratian Z, Khalifeh Soltani S et al. Is there a relationship between lower-extremity injuries and foot postures in professional football players? A prospective cohort study. Science and Medicine in Football. 2022 Jan; 6(1): 49-59. doi: 10.1080/24733938.2020.1870711.
Keivanfar N, Shadmehr A, Otadi K, Mir SM, Salehi S. Comparison of the Plantar Pressure and Foot Function and Range of Motion in Distance Runners With the Normal, Pronated, and Supinated Feet During Static Standing. Journal of Modern Rehabilitation. 2021 Dec; 15(1): 15-24. doi: 10.32598/JMR.15.1.3.
Kraus E, Tenforde AS, Nattiv A, Sainani KL, Kussman A, Deakins-Roche M et al. Bone stress injuries in male distance runners: higher modified Female Athlete Triad Cumulative Risk Assessment scores predict increased rates of injury. British Journal of Sports Medicine. 2019 Feb; 53(4): 237-42. doi: 10.1136/bjsports-2018-099861.
Goodrum M, Viljoen C, Kaulback K. Incidence, severity, and risk factors for injuries in female trail runners-A retrospective cross-sectional study. Physical Therapy in Sport. 2025 Jan; 71: 1-7. doi: 10.1016/j.ptsp.2024.11.004.
Werner T, Michel-Kröhler A, Berti S, Wessa M. Not all injuries are the same: Different patterns in sports injuries and their psychosocial correlates. Sports. 2023 Dec; 11(12): 237. doi: 10.3390/sports11120237.
Collings TJ, Bourne MN, Barrett RS, du Moulin W, Hickey JT, Diamond LE. Risk factors for lower limb injury in female team field and court sports: a systematic review, meta-analysis, and best evidence synthesis. Sports Medicine. 2021 Apr; 51(4): 759-76. doi: 10.1007/s40279-020-01410-9.
Thuany M, Gomes TN, Almeida MB. Is there any difference between "amateur" and "recreational" runners? A latent class analysis. Motriz: Revista de Educação Física. 2020 Nov; 26(4): e10200140. doi: 10.1590/s1980-65742020000400140.
Fredette A, Roy JS, Perreault K, Dupuis F, Napier C, Esculier JF. The Association between Running Injuries and Training Parameters: A Systematic Review. Journal of Athletic Training. 2022 Jul 1;57(7):650-671. doi: 10.4085/1062-6050-0195.21.
Agresta C, Giacomazzi C, Harrast M, Zendler J. Running injury paradigms and their influence on footwear design features and runner assessment methods: A focused review to advance evidence-based practice for running medicine clinicians. Frontiers in Sports and Active Living. 2022 Mar; 4: 815675. doi: 10.3389/fspor.2022.815675.
Moreno-Barriga OS, Romero-Morales C, Becerro-de-Bengoa-Vallejo R, Losa-Iglesias ME, Gómez-Salgado J, Caballero-López J et al. Effects of foot structure type on core stability in university athletes. Life. 2023 Jun; 13(7): 1487. doi: 10.3390/life13071487.
Ekanem AU, Edem GD, Okon KA, Victor EQ. Assessment of Plantar Arch Index and the prevalence of foot deformity among athletes and non-athletes students at the University of Uyo, Nigeria. African Anthropologist. 2024 Jul; 22(2). doi: 10.4314/aa.v22i2.5.
Domaradzki J. Navicular drop height asymmetry as an intrinsic risk factor for lower limb injury in male recreational athletes. Symmetry. 2024 Oct; 16(10): 1390. doi: 10.3390/sym16101390.
Tenriwulan AF. Correlation of Navicular Drop Height and Force Foot Distribution Characteristic and Pelvic Drop in Asymptomatic Runners. ACTIVE: Journal of Physical Education, Sport, Health and Recreation. 2022 Dec; 11(3): 186-92.
Ho MT and Tan JC. The association between foot posture, single leg balance and running biomechanics of the foot. The Foot. 2022 Dec; 53: 101946. doi: 10.1016/j.foot.2022.101946.
Burke A, Dillon S, O'Connor S, Whyte EF, Gore S, Moran KA. Risk factors for injuries in runners: a systematic review of foot strike technique and its classification at impact. Orthopaedic Journal of Sports Medicine. 2021 Sep; 9(9): 23259671211020283. doi: 10.1177/23259671211020283.
Liao C, Liu J, Hou S, Zhang W, Zhao X, Hou Z et al. Relationship between bilateral symmetry of foot posture and lower limb musculoskeletal injuries among workers engaged in physically demanding occupations: A cross-sectional investigation. Mechanobiology in Medicine. 2025 Mar; 3(1): 100098. doi: 10.1016/j.mbm.2024.100098.
Stenerson LR, Melton BF, Bland HW, Ryan GA. Running-Related Overuse Injuries and Their Relationship with Run and Resistance Training Characteristics in Adult Recreational Runners: A Cross-Sectional Study. Journal of Functional Morphology and Kinesiology. 2023 Sep; 8(3): 128. doi: 10.3390/jfmk8030128.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 THE THERAPIST (Journal of Therapies & Rehabilitation Sciences)

This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open-access journal and all the published articles / items are distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. For comments editor@thetherapist.com.pk