Master of Osteopathy

RESEARCH PROPOSAL SUBMISSION FORM

TITLE:

Defining types and causes of injuries of the foot and lower leg in runners: A scoping review

Conducted at: Unitec Institute of Technology

Programme: Master of Osteopathy

Credit Value: 90

Course number / name: HEAL9312

Proposed submission date of completed thesis:

26 October 2019

2.   POSTGRADUATE STUDENT

Name: Morgan Hancock

Current Address:      79B Dormer Rd, RD2, Helensville, Auckland

Phone No. 021407572

Email: morgan@elitehealth.co.nz

Student ID No. 1032631

Date: 15/10/2018

Full-time / Part-time:   Full-time

3.  PRINCIPAL AND ASSOCIATE SUPERVISOR

Principal supervisor

Name: Alexandra Hart

Network:

Postgraduate – Health care specialisation leader

Associate supervisor

Name: Andre Kleinbaum

Network:

Postgraduate – Community Development

Table of ContentsTable of Contents..................................................................................................................................3

1 Working title..................................................................................................................................3

2 Outline of the project.....................................................................................................................4

3 Research questions, aim and objectives.........................................................................................4

3.1 Research question..................................................................................................................4

3.2 Aim........................................................................................................................................4

3.3 Objectives..............................................................................................................................4

4 Background Literature...................................................................................................................5

4.1 Disorders of the foot..............................................................................................................5

4.2 Elements of the Foot..............................................................................................................6

4.2.1 The plantar fascia...........................................................................................................6

4.2.2 Plantar Fasciosis............................................................................................................6

4.3 Types of runner......................................................................................................................7

4.3.1 Sprinters and middle-distance runners...........................................................................8

4.3.2 Long distance running....................................................................................................8

4.4 Conclusion and statement of research aim.............................................................................9

5 Research Method...........................................................................................................................9

5.1 Design..................................................................................................................................10

5.1.1 Framework Stage 1: Identification of the research question.........................................10

5.1.2 Framework stage 2: Identification of relevant studies..................................................10

5.1.3 Framework stage 3: Study selection.............................................................................11

5.1.4 Framework stage 4: Charting the data..........................................................................12

5.1.5 Framework stage 5: Collating, summarizing and reporting results..............................12

6 Ethical considerations..................................................................................................................13

7 Māori consultation.......................................................................................................................13

8 Timeline......................................................................................................................................13

9 Resource requirements.................................................................................................................14

10 Expected outcomes and outputs...............................................................................................14

11 References...............................................................................................................................14

12 Schedule One (40)....................................................................................................................18

1 Working titleDefining types and causes of injuries of the foot and lower leg in runners: A scoping review

2 Outline of the projectRunning is one of the most popular physical activities worldwide (1) and has become increasingly

popular over the last four decades (2). In that time there have been a range of developments in training

methods, types of footwear and the design of running shoes (3,4). However, there is no conclusive

clinical or epidemiological evidence to suggest that running related injuries (RRI) are decreasing due

to these developments(2,4).

Distance running introduces constant pressure on the heel, muscles, and ligaments of the foot, muscles

of the feet, lower limb, and hip joints. This strain can lead to significant tissue damage, increase

pronation of the foot and leg length discrepancies or muscle imbalances(5). Up to 50% of regular

runners report more than one injury per year(6) while studies reporting on the incidence rates of lower

leg injuries in runners range from between 19% and 92% depending on the definitions used to

determine a running injury and the population studied(1,7,8).

A large literature base regarding incidence rates, risk factors and research on individual running

injuries currently exist. However, due to the multifactorial nature of running injuries, the studies cover

diverse methodologies, definitions, epidemiologies, anatomical, biomechanical and training risk

factors (9–15). Furthermore, this array of factors and studies make the development of treatment plans

difficult when utilising a best-evidence based methodology for patients.

The purpose of this project is to appraise, characterise and summarise the current evidence and

definitions on the types of gradual onset injuries sustained to the foot and lower leg by runners,

through a scoping review. This review has been selected to systematically map the current research in

this area and provide a base for the future development of a treatment framework for runner’s injuries.

3 Research questions, aim, and objectives

3.1 Research questionWhat are the types and causes, both intrinsic and extrinsic, of injuries of the foot and lower leg in

runners?

3.2 AimTo explore and map the current published peer-reviewed literature involving foot and lower leg

injuries to runners, to identify and categorise the types and causes of those injuries.

3.3 Objectives1. To execute a scoping review of published peer-reviewed studies relating to the definitions,

incidence rates, causes and types of injuries of the foot and lower leg, sustained by runners.

2. To critically review the range, themes and extent of current research investigating foot and

lower leg injuries in runners.

3. To establish patterns within the current research investigating foot and lower leg injuries in

runners.

4. To identify and define key themes or categories of foot and lower leg injuries for use in future

research.

4 Background LiteratureThis literature review will discuss the incident rates of running injuries and provide a brief overview

of the anatomy of the human foot as an example of a more complete anatomical overview in the full

study. In addition, it will provide an example of the current literature around a single site of running

injury; the plantar fascia, and the wide range of categorisation applied to its potential causes of injury.

Finally, it will discuss the terms of classification that can be applied to runners and why this proposal

is excluding a particular class of runner.

4.1 Disorders of the footFoot disorders are commonly experienced following long-term musculoskeletal disorders or systemic

diseases and can involve any tissues of the foot including; joints, ligaments, muscles, tendons, bones,

skin, or nerves (16).

In 2007 a study compared the health of the modern humans metatarsal bones with those of pre-

pastoral human skeletons dated between 9720 - 2000 years B.P and concluded that pathological

lesions in the modern human feet were more severe in nature than the pre-pastoral ancestors(17). This

study generated a hypothesis that habitual footwear and exposure to modern substrates may be linked

to common pathological changes in the modern foot(17).

While there have been many developments in footwear over the last forty years there seems to be no

correlating reduction in the RRI and runners continue to experience high rates of injury despite these

advances(2,4). The high incidence of runner injuries is unsurprising when considering that during

running the vertical ground reaction forces acting on the lower limbs effectively double or triple the

body weight of a runner (12). Due to running’s cyclic motion, impact absorption at the heel, plantar

ligaments and fascia are of even greater magnitude, reaching up to five times the body weight of the

runner(13).

Injury prevention and reduction are important goals for clinicians, trainers, and individuals involved

in regular physical activity. Historical and current research on sports injuries is primarily prevention

based and describes models or frameworks that aid in the design of prevention strategies(9,10,18).

Current research specific to running leans heavily towards incidence rates, risk factors or

investigations on the epidemiological and aetiological factors of gradual onset running injuries

(7,10,11,19). This specificity of the research has created a wide span of information, spread among an

equally wide span of publications.

4.2 Elements of the FootConsisting of 26 bones, 33 joints, 112 ligaments and controlled by 21 intrinsic and 13 extrinsic

muscles, the human foot is both a fixed and flexible structure(20). Made up of three distinct sections;

forefoot, midfoot and hind foot, it provides an anatomical system that allows for the complex

kinematics required for both weight bearing support, flexibility over uneven surfaces, and as a rigid

lever for propulsion(21).

4.2.1 The plantar fascia

Also known as the plantar aponeurosis, the plantar fascia is a thickened layer of white longitudinal

fibrous connective tissue originating from an insertion point at the medial calcaneal tubercle(22). The

central bundle of the tissue thickens as it extends distally and is bounded by a thinner lateral and

medial portion of tissue. As the central bundle progresses it divides into 5 separate bands surrounding

the deep fascia and transverse ligaments. These radiate towards and attach to, all five metatarsal

heads(23). The plantar fascia also blends with the paratenon of the achilles tendon and intrinsic foot

muscles.

Originally described by Hicks(24) the plantar fascia provides the hypotenuse in a triangle truss that is

formed by the metatarsals, midtarsal joint and calcaneus (Figure 1). Vertical forces traveling down the

tibia flatten the medial longitudinal arch of the foot while ground reaction forces travel up from the

calcaneus and metatarsal heads(25). The presence of the plantar fascia provides an anatomical tie-rod

that prevents the collapse of the arch from these forces and due to its tensile strength, simulates a

flexible cable enabling activation of the “windless mechanism” during a person’s gait cycle(25).

Figure 1(26)

4.2.2 Plantar Fasciosis

Plantar fasciosis (PF) is one of most common foot pain conditions treated, accounting for

approximately 11% to 15% of all foot problems(27). With a prevalence rate as high as 17.5% among

runners, it is also one of the most common running-related musculoskeletal injuries(28). A study by

Taunton et al found that 60% of runners with lower extremity injuries had PF(8).

While the term fasciitis indicates an inflammatory process the condition has been more accurately

reclassified as a fasciosis; a chronic dysfunction or disease of the foot similar to a tendinopathy(29–

31). This is due to ongoing degenerative changes in the fascia characterized by micro tears, collagen

cell death, vascular hyperplasia, and plantar fascia fibrosis.

There are both intrinsic and extrinsic risk factors in the development of PF (Table 1). Extrinsic risk

factors relate to physical activities including incorrect training techniques, overuse, and inadequate

footwear. Intrinsic risk factors relate to anatomical, degenerative and functional body attributes.

Principal Risk Factors Causes

INTRINSIC

Anatomic Risk

Pes planus

Pes cavus

Overpronation

Leg-Length discrepancy

Excessive lateral tibial torsion

Excessive femoral anteversion

Overweight

Functional Risk

Gastrocnemius and soleus muscles tightness

Achilles tendon tightness

Gastrocnemius, soleus and intrinsic foot muscles weakness

Degenerative Risk

Aging of the heel fat pad

Atrophy of the heel fat pad

Plantar fascia stiffness

EXTRINSIC

Overuse Mechanical stresses and micro-tearing

Poor training

A too-fast increase in the distance, intensity, duration or

frequency of activities that involve repetitive impact loading

of the feet

Inadequate FootwearPoorly cushioned surface

Lack of arch supportTable 1 (32)

4.3 Categories of runnerRunners fall into one of three broad categories, based primarily on distances the individual regularly

trains for; sprinters, middle distance or long-distance runners(33). These three basic subsets are based

on the separate physical and mental requirements of the running styles. They are important to clarify

in this review due to the different intrinsic and extrinsic forces involved in a runner’s injuries based on

these running styles.

4.3.1 Sprinters and middle-distance runners

Sprinters require a powerful take-off and fast acceleration over short distances of up to and including

400 meters, making it a highly anaerobic activity (Table 2). This maximum distance is based on

human physiology being unable to provide a top-speed for more than 30-35 seconds due to depletion

of phosphocreatine stores within the muscles. As a basic subdivision, a large percentage of a sprinters

musculature will consist of fast-twitch, type II muscle fibre; a muscle fibre providing high anaerobic

capacity and contraction speed(34).

Table 2 (33)

Middle distance running includes distances involving 800mtrs to 5000mtrs(33). This running style is

considered an extremely tactical style of running, requiring the athlete to extend their anaerobic

capacity for final sprints to the finish while ensuring a high enough aerobic capacity for the distances

involved(33).

4.3.1.1 Exclusion of sprintersDue to the difference of running style, sprinters will be excluded from the review process. Many

injuries experience by sprinters are of a traumatic nature and tend to favour hamstring damage(35–

37). This review seeks to consider gradual onset causes of injuries to runners. Such injuries are of a

broader scope and have a higher potential for intervention and prevention-based approaches to

treatment.

4.3.2 Long distance running

Physiologically long-distance running is aerobic in nature (Table 2). A human’s aerobic capacity is

dependent on the efficiency by which the body transports blood to or from the lungs to reach muscle

tissue which is further dependant on a high cardiac output, high levels of haemoglobin and an efficient

vascular system(38). To this end, a regular long-distance runner will develop slow-twitch, type I

muscle fibres that are resistance to fatigue and aerobically efficient(34).

Long distance runners can be divided into two subsets, based on distances covered. A runner that

trains for distances of 5-21km can be classified as an endurance runner. Those that train for distances

greater than 21km fall into the marathon runner classification(33). This distinction is due to distinct

differences in physiological and psychological demands between a half and full marathon distance.

The accessibility and range of distances of the endurance runner has made this area of running the

most popular in recent times. A 2017 United States national runners survey identified the most

favoured event distance for regular runners to train for was the half marathon, followed by the 10km

and 5km events(39).

4.4 Conclusion and statement of research aimDue to the multifactorial nature of running injuries, the literature reviewed covers diverse

methodologies, definitions, epidemiologies, anatomical, biomechanical and training risk factors. It is a

broad and extensive field of information crossing multiple modalities providing little amalgamation of

its knowledge for clinical practitioners.

The initial review on the aspects of the plantar fascia, a single anatomical structure involved in

running injuries, required consolidation of a range of source materials. Petraglia et al’s table (32)

summarises tightness of the achilles tendon as an intrinsic anatomical risk factor in developing PF.

Biomechanically this is due to its impact in limiting the ankle's ability to achieve normal dorsiflexion;

as the range of ankle dorsiflexion decreases, the risk of PF increases (40). This poses the question of

what the preceding factors of the achilles tightness are and, based on those factors, whether the

classification of an intrinsic anatomical risk is the correct thematic category. Understanding the

aetiology of injuries is a key step in the treatment and future prevention of them, from both the

clinician and patient’s standpoint.

It is an analysis, consolidation, and categorisation of the information regarding foot and lower leg

gradual onset injuries in runners, which is lacking in the literature and is, therefore, the aim of the

proposed review to provide.

5 Research MethodThis study will conduct a scoping review which is a relatively new methodology useful for

synthesizing and collating the literature on a broad topic(41). Unlike a systematic review, where

studies chosen are used to summarise the highest quality of evidence around a single question, a

scoping review seeks to present an overview of the research material and collate that material in order

to summarise and disseminate its findings(42). A scoping review is particularly relevant in this study,

due to the need to answer a broad question beyond those related to the effectiveness of a specific

treatment or intervention.

While not part of the original design paradigm of scoping reviews, critical appraisals of a subset of the

studies used in such a review is now recommended to ensure methodological reliability(41).

Currently, the recommended reporting guidelines for use within scoping reviews are provided by the

PRISMA-ScR extension (Preferred reporting items for systematic reviews and meta-analysis

extension for scoping reviews) as attached in schedule 1(43). This guideline allows for a formalised

system of quality assessment and critical appraisal of the stages of a review and will be used to guide

the development of this review. One section of this guideline includes a critical appraisal stage of

selected studies being used.

5.1 Critical reviewThe subset of studies used for this appraisal will be selected once initial themes begin to emerge,

which will allow for the subset to fall within a specific category of papers. These papers will be

appraised using the AMSTAR-2 measurement tool (44), a tool specifically for the appraisal of

healthcare interventions.

5.2 DesignThe study is a scoping review utilising the framework outlined by Arksey & O’Malley in 2005 which

is underpinned by the methods of systematic reviews, in that each stage of the framework is to be

conducted in a rigorous and transparent way(42) This framework methodology has been reviewed and

appraised in 2014 by Pham et al.(45) and 2015 by Peters et al.(41).

The data will be reviewed using a blend of inductive content analysis; a method involving the

establishment of patterns within the data, through examination of that data, without any priori

framework(46), and thematic analysis; emphasizing the identification, organization, and recording of

themes within the data(47).

5.2.1 Framework stage 1: Identification of the research question

Stage 1 allows for the development of the initial research question and directs search parameters for

stage 2. A scoping review, by its design, allows this question to remain broad. This projects current

question is “What are the types and causes, both intrinsic and extrinsic, of injuries of the foot and

lower leg in runners”. This is a relatively open question even with the limitations of the anatomical

lower leg and specificity to a subset of runners. The open nature allows search parameters to generate

a wide coverage of results, thus appropriate decisions can be made in stage 3 on study selection, once

a sense of the volume of the literature in the field has been gained.

5.2.2 Framework stage 2: Identification of relevant studies

The second stage allows for a comprehensive search identifying key studies and reviews that will be

suitable to begin to address the main research question and provide direction for further searches.

These searches will be conducted using: ScienceDirect (Elsevier), Ebsco health databases,

SPORTDiscus, PubMed, Google Scholar, and the Cochrane Library; specifically, the database of

systematic reviews. In addition, the reference lists of studies selected for inclusion will also be

disseminated for additional studies to include in order to reach saturation.

5.2.2.1 Search criteria

Searches will include a timeframe from 1950 through to the date of the search. This is due to many

older papers providing a broader discussion on running injuries. More modern work now favors

details on individual risk factors that lead to specific injury types. Both periods of work are relevant in

this search.

The search will be restricted to studies published in English, although the original text may be of

foreign origin. Studies must be published and peer-reviewed.

5.2.2.2 Exclusion criteria

Due to the array of differences previously discussed between sprinters and distance runners this

review will exclude studies specific to sprinters. It is the intension of this review to focus on distance

runners.

In addition, this review seeks to examine overuse injuries, thus studies that focus on traumatic injuries

will also be excluded.

5.2.2.3 Initial search terms and keywords

An initial array of search terms has been used to provide an indication of the current literatures scope.

These terms were taken from keywords of journal articles used in this proposal. The title or abstract of

an article had to include a combination of the following as shown in Table 3:

Date of

retrieval

Databas

e

Syntax Numbe

r of hits

26/10/201

8

PubMed Running AND injury 2584

26/10/201

8

PubMed Long distance run* AND injury 105

06/10/201

8

PubMed Run* AND causation 76

06/10/201 PubMed Incidence AND determinants AND run* 27

8

06/10/201

8

PubMed Musculoskeletal AND injury AND run* 227

06/10/201

8

PubMed Run* AND risk factors 2302

06/10/201

8

PubMed Run* AND risk factors AND biomechanical 46

06/10/201

8

PubMed Run* AND leg injur* 15

06/10/201

8

PubMed Run* AND overuse injur* 344

06/10/201

8

PubMed Long distance run* AND injur* AND ankle 16

06/10/201

8

PubMed Long distance run* AND injur* AND knee 31

06/10/201

8

PubMed Long distance run* AND injur* AND foot 24

06/10/201

8

PubMed Run* AND overuse injur*AND

musculoskeletal

32

Table 3 – Initial electronic search on PubMed

As shown in the first search the term “Running AND Injury” provided over 2500 results and is of no

use for the purposes of a literature search.

Changing the search parameters to be more precise about the specific nature of injuries greatly

reduced the results to more manageable levels. While the use of the specific Long distance runn*

further reduced the results, this may not be used in the final search syntax due to its reductionist

impact on the results and the tendency of many studies to not expressly note the use of “long

distance” in their titles or abstracts when referring to runners.

5.2.3 Framework stage 3: Study selection

The third stage of the process is based on the selection of content appropriate studies as per figure 3.

A scoping study provides for some development of the search parameters post hoc, based on

increasing familiarity of the literature throughout the search process. This process also provides for

the identification of further relevant articles through manual searches of reference lists.

The title/abstract search terms will be developed based on the search structures discussed in stage 2,

and further appraised by the thesis supervisors and in consultation with the Unitec libraries knowledge

specialist.

Figure 3 PRISMA-SCR flow diagram for scoping review (43)

5.2.4 Framework stage 4: Charting the data

Stage four consists of interpretation and synthesis by sorting data according to key terms and

developing themes. A mixture of inductive content analysis and thematic analysis will be used in

order to identify implicit and explicit concepts within the data.

Given that the nature of a scoping review is inherently interpretive the risk of bias, values and

judgment of the thesis author will need to be acknowledged and taken into account during data

presentation. This will be offset, in part, by the thesis supervisor’s review and input on subsets of the

data being collected and collated.

Reference management will be via the Mendeley online reference system(48). Data will be managed

through Office 365 programs, Word and Excel, and physical filing of the various studies.

A critical review of a subset of the studies will also be completed in this stage of development. The

subset will be selected during stage 3 once initial themes are being developed and can indicate a

potentially associated subset of papers.

5.2.5 Framework stage 5: Collating, summarizing and reporting results

Unlike a systematic review, a scoping review does not seek to synthesis its data into weighted

evidence-based arguments. Instead, the final stage of a scoping review seeks to collate and summarize

the literature and by doing so prioritize certain aspects of that literature. Due to the nature of the

discovery of the data and thematic/conductive analysis, it is not possible to predetermine the form this

stage will take. By ensuring a consistent approach is used to report the findings the author should be

able to draw comparisons of the information across a range of research and identify contradictory

evidence(42).

6 Ethical considerationsThis scoping review will not involve any human or animal participants. In addition, the research will

only involve existing publicly available documents or data. To that end as per the Unitec policy and

procedure document “Research Ethics”(49) this study does not require specific approval from the

Unitec Research Ethics Committee (UREC). An email will be sent to the UREC by the thesis author

detailing this study to confirm this.

6.1 Māori consultationThis scoping review will utilise publicly available research and publications. The review itself is

specific to running injuries and therefore unlikely to find themes or gaps in the literature that is of

particular significance to Māori.

7 TimelineOctober 2018 Submit proposal to the committee

Make changes as required

UREC email to confirm non-requirement of ethics approval

November - January

2018

Begin initial literature search; Framework Stage 2 –

identification of relevant studies

Feb - March 2019 Framework stage 3 – Study selection.

Literature review – thesis adaption

April - May 2019 Framework stage 4 - Charting results

Framework stage 5 – Summarising and reporting results

June 2019 Formal write up of thesis draft and update of lit review

July 2019 Thesis draft to supervisors and revisions

August-September 2019 Thesis draft 2 to supervisors and revisions

Present at forum

October 2019 Submit final thesis

8 Resource requirementsItem Availability Resolution

Journal article access Unitec library systems n/a

Independent assessment of

search terms

Unitec library knowledge specialists n/a

Independent assessment of

articles for inclusion in the

study

Thesis supervisors n/a

Printing of specific studies up

to $100

Unitec thesis grant or credit with Unitec printing

facilities.

TBC

9 Expected outcomes and outputs1. Produce and publish the thesis.

2. Provide a framework for future research regarding injuries of the foot and lower leg in

runners.

3. Publish in the Australian, American, British or New Zealand Journal of Sports Medicine.

10 References

1. Saragiotto BT, Yamato TP, Lopes AD. What do recreational runners think about risk factors for running injuries? A descriptive study of their beliefs and opinions. J Orthop Sport Phys Ther. 2014 Oct;44(10):733–8.

2. Mann R, Malisoux L, Urhausen A, Meijer K, Theisen D. Plantar pressure measurements and running-related injury: A systematic review of methods and possible associations. Gait Posture. 2016 Jun;47:1–9.

3. Nigg B, Baltich J, Hoerzer S, Enders H. Running shoes and running injuries: mythbusting and a proposal for two new paradigms: ‘preferred movement path’ and ‘comfort filter.’ Br J Sports Med. 2015 Oct;49(20):1290–4.

4. Reinschmidt C, Nigg BM. Current issues in the design of running and court shoes. Sport · Sport. 2000 Sep;14(3):72–81.

5. Agyekum EK, Ma K. Heel pain: A systematic review. Chinese J Traumatol. 2015;18(3):164–9.

6. Tschopp M, Brunner F. Diseases and overuse injuries of the lower extremities in long distance runners. Z Rheumatol. 2017 Jun 24;76(5):443–50.

7. van Gent RN, Siem D, van Middelkoop M, van Os AG, Bierma-Zeinstra SMA, Koes BW.

Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review. Br J Sports Med. 2007 Aug 1;41(8):469 LP-480.

8. Taunton JE, Ryan MB, Clement DB, McKenzie DC, Lloyd-Smith DR, Zumbo BD. A retrospective case control analysis of 2002 running injuries. Br J Sports Med. 2002;36:95–102.

9. Meeuwisse WH. Assessing causation in sport injury: A multifactorial model. Clin J Sport Med. 1994;4(3).

10. Meeuwisse WH, Tyreman H, Hagel B, Emery C. A dynamic model of etiology in sport injury: the recursive nature of risk and causation. Clin J Sport Med. 2007 May;17(3):215–9.

11. Powell K, Kohl H, Casperson C, Blair S. An epidemiological perspective on the causes of running injuries. Phys Sportsmed. 1986;14(6).

12. Murphy K, Curry EJ, Matzkin EG. Barefoot running: Does it prevent injuries? Sport Med. 2013 Nov 30;43(11):1131–8.

13. Giddings VL, Beaupré GS, Whalen RT, Carter DR. Calcaneal loading during walking and running. Med Sci Sports Exerc. 2000 Mar;32(3):627–34.

14. Ribeiro AP, João SMA, Dinato RC, Tessutti VD, Sacco ICN. Dynamic patterns of forces and loading rate in runners with unilateral plantar fasciitis: A cross-sectional study. Stokes K, editor. PLoS One. 2015 Sep 16;10(9):e0136971.

15. Sobhani S, Dekker R, Postema K, Dijkstra PU. Epidemiology of ankle and foot overuse injuries in sports: A systematic review. Scand J Med Sci Sports. 2013 Dec;23(6):669–86.

16. Malkin K, Dawson J, Harris R, Parfett G, Horwood P, Morris C, et al. A year of foot and ankle orthotic provision for adults: Prospective consultations data, with patient satisfaction survey. Foot. 2008 Jun;18(2):75–83.

17. Zipfel B, Berger L. Shod versus unshod: The emergence of forefoot pathology in modern humans. Foot. Churchill Livingstone; 2007 Dec 1;17(4):205–13.

18. Wilkerson GB, Colston MA, Baker CS. A sport fitness index for assessment of sport-related injury risk. Clin J Sport Med. 2016 Sep;26(5):423–8.

19. von Rosen P, Floström F, Frohm A, Heijne A. Injury patterns in adolescent elite endurance athletes participating in running, orienteering, and cross-country skiing. Int J Sports Phys Ther. 2017 Oct;12(5):822–32.

20. D’Antoni A. Pelvic girdle and lower limb. In: Standring S, editor. Grays Anatomy. 41st ed. Elsevier; 2015. p. 1584.

21. Tan BHM, Nather A, David V. Biomechanics of the foot. Diabetic Foot Problems. WORLD SCIENTIFIC; 2008. p. 67–75.

22. Chen D, Li B, Aubeeluck A, Yang Y, Huang Y, Zhou J, et al. Anatomy and biomechanical properties of the plantar aponeurosis: a cadaveric study. PLoS One. 2014;9(1):e84347.

23. McNally E, Shetty S. Plantar Fascia: Imaging diagnosis and guided treatment. Semin Musculoskelet Radiol. 2010 Sep 10;14(03):334–43.

24. HICKS JH. The mechanics of the foot. II. The plantar aponeurosis and the arch. J Anat. 1954 Jan;88(1):25–30.

25. Bolgla LA, Malone TR. Plantar fasciitis and the windlass mechanism: a biomechanical link to clinical practice. J Athl Train. 2004 Jan;39(1):77–82.

26. DiGiovanni C, Greisberg J. Core knowledge in Orthopaedics: Foot and ankle. Foot Ankle Spec. 2008 Oct;1(5):312–312.

27. Kage V, Bindra R. Effect of active release technique v/s myofascial release on subjects with plantar fasciitis: a randomized clinical trial. Physiotherapy. 2015 May;101:e702.

28. Lopes AD, Hespanhol LC, Yeung SS, Costa LOP. What are the main running-related musculoskeletal injuries? Sport Med. 2012 Oct;42(10):891–905.

29. Lemont H, Ammirati KM, Usen N. Plantar fasciitis: A degenerative process (Fasciosis) without inflammation. J Am Podiatr Med Assoc. 2003 May;93(3):234–7.

30. League AC. Current concepts review: Plantar Fasciitis. Foot Ankle Int. 2008 Mar;29(3):358–66.

31. Owens JM. Diagnosis and management of Plantar Fasciitis in primary care. J Nurse Pract. 2017 May;13(5):354–9.

32. Petraglia F, Ramazzina I, Costantino C. Plantar fasciitis in athletes: diagnostic and treatment strategies. A systematic review. Muscle, Ligaments Tendons J. 2017;7(1):107.

33. Hawley J. Physiology and biochemistry of sprinting, middle distance and long distance running. Running:Olympic handbook fo sports medicine. John WIley & Sons; 2008.

34. Canepari M, Pellegrino MA, D’Antona G, Bottinelli R. Skeletal muscle fibre diversity and the underlying mechanisms. Acta Physiol. 2010 Aug;199(4):465–76.

35. Jonhagen S, Nemeth G, Eriksson E. Hamstring Injuries in Sprinters. Am J Sports Med. 1994 Mar 23;22(2):262–6.

36. Orchard JW. Hamstrings are most susceptible to injury during the early stance phase of sprinting: Table 1. Br J Sports Med. 2012 Feb;46(2):88–9.

37. Chumanov ES, Schache AG, Heiderscheit BC, Thelen DG. Hamstrings are most susceptible to injury during the late swing phase of sprinting. Br J Sports Med. 2012 Feb;46(2):90–90.

38. Sarelius I, Pohl U. Control of muscle blood flow during exercise: local factors and integrative mechanisms. Acta Physiol. 2010 Aug;199(4):349–65.

39. Running USA. 2017 National Runner Survey. 2017.

40. Riddle DL, Pulisic M, Pidcoe P, Johnson RE. Risk factors for Plantar fasciitis: a matched case-control study. J Bone Joint Surg Am. 2003 May;85–A(5):872–7.

41. Peters MDJ, Godfrey CM, Khalil H, McInerney P, Parker D, Soares CB. Guidance for conducting systematic scoping reviews. Int J Evid Based Healthc. 2015;13(3):141–6.

42. Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005 Feb;8(1):19–32.

43. Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;

44. BJ, Shea, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, Moher D TP, Welch V, Kristjansson E H DA. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017;21(358).

45. Pham MT, Rajić A, Greig JD, Sargeant JM, Papadopoulos A, Mcewen SA. A scoping review of scoping reviews: Advancing the approach and enhancing the consistency. Res Synth Methods. 2014;5(4):371–85.

46. Thorpe R, Holt R. Inductive analysis. The SAGE Dictionary of Qualitative Management Research. 1 Oliver’s Yard, 55 City Road, London EC1Y 1SP United Kingdom: SAGE Publications Ltd; 2008.

47. Maguire M, Delahunt B. Doing a thematic analysis: A practical, step-by-step guide for learning and teaching scholars. Irel J Teach Learn High Educ. 2017;3.

48. Mendeley reference management [Internet]. Available from: https://www.mendeley.com/

49. Unitec New Zealand. Unitec research ethics policy and procedure. 2010.

11 Schedule One (43)