Shank and rearfoot coordination and its variability during running in flatfoot

Flatfoot is a risk factor for patellofemoral pain syndrome (PFPS), and excessive rearfoot eversion occurring in flatfoot has been associated with the development and progression of PFPS; however, the mechanism remains unclear. This study aimed to investigate transverse shank and frontal rearfoot coordination patterns and variability when running with normal foot and flatfoot. Participants with normal foot (n = 13) and flatfoot (n = 13) were asked to run at their preferred speed. The coupling angle between the shank and rearfoot, representing intersegmental coordination, was calculated using the modified vector coding technique and categorized into four coordination patterns. Standard deviation of the coupling angle was computed as a measure of coordination variability during the stance phase. No differences in the characteristics and spatiotemporal parameters between groups were found, and all participants had rearfoot strike pattern. During midstance, the flatfoot group showed a significantly greater proportion of anti-phase with proximal (shank) dominancy than the normal foot group (p = 0.04, effect size = 0.88 [large]). Furthermore, flatfoot group showed a significantly greater in variability than the normal foot group (p = 0.03, effect size = 0.91 [large]). This study's results may help explain why flatfoot is likely to result in PFPS. However, the occurrence mechanism of running injuries like PFPS is multi- factorial. Since these results alone are not sufficient to explain the cause-effect relationship between flatfoot and injuries like PFPS, a prospective study including other factors such as patellofemoral joint stress would also be needed.