Injuries in runners: A prospective study of alignment

Objective: To determine if measurable lower extremity alignment is a risk f actor for overuse running injuries. Design: Prospective cohort study. Setting: Thirty-two week marathon training program. Patients or Participants: Three hundred fifty-five volunteers from the mara thon training program began the study; 255 finished the study. Interventions: None. Main Outcome Measures: Past training and injury history was determined by q uestionnaire, and five lower extremity alignment measures were performed at the beginning of the training program: arch index (AI), heel valgus (HV), knee tubercle-sulcus angle (TSA), knee varus (KV), and leg-length differenc e (LLD). Overuse injuries, incurred by the runners and categorized by anato mic parts, were recorded during the training period. Results: Ninety subjects experienced overuse injuries. Multivariate analyse s with stepwise Poisson regression showed few consistent relationships betw een alignment and overuse injury rates. Higher AT was protective against ov erall injuries and knee injuries; higher HV was protective against knee and foot injuries; higher TSA was associated with shin injuries; higher KV was associated with shin injuries; and low LLD was associated with more overal l injuries. Conclusions: Minor variations in lower extremity alignment do not appear co nclusively to be major risk factors for overuse injuries in runners. Becaus e of the study limitations and the likely multifactorial nature of running injuries, further study is suggested, perhaps in more novice runners.