Foot Structure Problems May Lead to Injury in Athletes

From the WebMD Archives

Nov. 22, 1999 (Baltimore) -- A study of more than 400 Navy SEAL trainees shows that the structure of the foot is related to injuries suffered from intensive training. For civilians with high arches or flat feet who engage in strenuous activities, such as running, the study may offer helpful advice for preventing injuries to the leg and foot.

The study researchers stress in an article in American Journal of Sports Medicine that the injury risk factors -- flat feet, high arches, and restricted movement of the ankle -- can all be corrected. They point out that appropriate footwear can compensate for these structural conditions and, therefore, be effective in reducing the risk of injury.

"There were really three significant findings to come out of this study," the study's lead author, Kenton R. Kaufman, PhD, tells WebMD. "We found that those people who had low arches in this study were at increased risk of injury. Most of the literature supports the view that those with high arches experience more injuries, but in this study we found that low arches could also cause problems."

"Another significant finding is that we did not see a relationship between knee problems and pronation of the feet, which many have thought are associated," he says. People who pronate walk on the inner side of their feet. "Finally, we found that people with tight heel cords were more likely to develop Achilles tendonitis." Achilles tendonitis is one of the most common injuries to the leg in athletes and is characterized by a sore Achilles tendon. Kaufman is an associate professor at the Mayo Clinic in Rochester, Minn.

Using several methods, the researchers evaluated the structure of the feet in male SEAL trainees before they began intensive training. The trainees were followed throughout training to see who developed leg and foot injuries.

One-third of the SEAL trainees had injuries to their lower legs caused by the training. Out of 449 SEALs studied, 149 suffered 348 such injuries, most of them within the first 9 weeks of training. The most common injuries were stress fractures, inflammation, and pain in the different structures of the lower leg. Stress fractures typically occurred in the lower leg, the foot, and the thigh.


According to Bruce Jones, MD, MPH, the association of high and low arches with injury is important. "In the past, we've looked at flat feet as the most significant risk factor for injury, but the association between high and low arches and their relationship to injury needs to be explored further," he tells WebMD. Jones is a retired Army colonel with more than 20 years of experience researching foot injuries in military personnel and is now with the CDC injury prevention division.

While this study did not look at any specific ways to prevent injury, Kaufman says that some interventions might be tried. "People should be aware of potential relationships between their foot structure and the types of injuries they might sustain. Those with tight heel cords should stretch before exercising, while those with low arches might consider some type of footwear modification."

Jones agrees. "It's important to establish guidelines for screening for arch problems very carefully. You don't want to discourage people from exercising because it's so important for so many aspects of health. I think it's not necessary for people to have an analysis of their foot structure unless they are experiencing a problem or have a history of injury. Then an evaluation is appropriate."

Vital Information:

  • A new study shows that foot structure is related to injuries in athletes who train intensively.
  • People with low arches, high arches, and tight heel cords are more likely to experience injuries.
  • Researchers suggest that preventive measures could be taken to avoid injuries, such as wearing a type of foot modification for low arches, or stretching for tight heel cords.
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