Department of Family Medicine and Community Health (Drs. Sidhar and Hammer) and Department of Orthopedics and Rehabilitation (Dr. Hammer), University of Wisconsin School of Medicine and Public Health, Madison kartiksidhar@gmail.com
The authors reported no potential conflict of interest relevant to this article.
Patients with pes planus or pes cavus should not be discouraged from running, however. If they experience pain with running, they might benefit from a trial of arch support inserts; or consider referral to an orthotist for evaluation for a custom orthosis.
Sex. Based on a prospective cohort study, female runners have a slightly higher rate of running injury than male counterparts.4 Similarly, a study showed that female military members generally had a higher incidence of stress fractures than male military members—specifically, femoral shaft and neck stress fractures.14 Runners who fall in the spectrum of the female athlete triad, as described earlier, are particularly vulnerable to bone stress injury. It is reasonable, therefore, to review risk factors for injury with female runners (as it is with all runners), especially those who have sustained a prior running-related injury.
Increased Q-angle (an obsolete risk factor).The Q-angle is approximated by drawing a line from the anterior superior iliac spine to the patella and a second line from the patella to the tibial tubercle. In males, a normal Q-angle is 14°; in females, 17° (SD = 4.5°). The Q-angle can be obtained by goniometric or radiographic measurement.
An increased Q-angle had been considered an intrinsic risk factor for running injury but has not been shown to be associated with increased risk of running-related injury or patellofemoral pain syndrome.27,28 Because the Q-angle is not a clinically relevant tool in assessing risk of injury, do not routinely measure it or include it in risk-factor counseling.
OA. Based on a systematic review of observational studies, data are inconclusive with regard to whether running contributes to, or is protective against, knee OA.15 In a large cohort study, running (1) was protective against development of hip OA and (2) decreased the risk of requiring hip replacement.29 This finding was supported by animal-model research that concluded that it is inactivity that results in thinning of articular cartilage.29 In addition, a systematic review of randomized controlled trials concluded that knee joint-loading exercises are not harmful to articular cartilage (this is low-quality evidence, however).16
