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Sensorimotor deficits in distance runners with medial plantar pain

Context: Medial plantar pain is a complex and multifactorial condition experienced by some distance runners, which makes etiological differentiation and diagnosis challenging. Objective: To assess plantar sensation, pain perception and sensitivity, intrinsic foot strength, and foot morphology before and after a 9.7 km run in long-distance runners with and without medial plantar pain. Design: Descriptive laboratory study Setting: Laboratory. Patients: Seven distance runners with medial plantar pain (four males, three females; aged 22.3 {+/-} 3.7 years; BMI 22.3 {+/-} 3.5 kg/m2) and seven matched healthy controls (four males, three females; aged 20.3 {+/-} 1.0 years; BMI 22.0 {+/-} 1.7 kg/m2) were recruited from a public university. Intervention(s): Participants ran a six-mile course in their own footwear at a self-selected pace. Main Outcome Measures: Pain visual analogue scale (VAS), pressure pain thresholds (PPT), plantar sensation, foot morphology, weight-bearing dorsiflexion (WBDF), forefoot joint mobility, toe flexion, intrinsic foot muscle strength, and a seated neural provocation test were analyzed pre-and post-run utilizing mixed model group by time ANOVAs, post hoc effect size point estimates, and 95% confidence intervals. Results: A significant group by time interaction was observed for PPT at the mid-arch (Control: pre: 83.0 {+/-} 27.4N, post: 79.5 {+/-} 22.6N; Symptomatic: pre: 90.5 {+/-} 31.9N, post: 70.1 {+/-} 32.7 N; p=.03) and posterior tibialis (PT) (Control: pre: 75.7 {+/-} 19.5 N, post: 65.7 {+/-} 14.2N; Symptomatic: pre: 75.8{+/-}20.4 N, post: 51.1 {+/-} 11.9 N; p=.05) sites. PPT in the posterior tibialis significantly decreased in the symptomatic group following the run (ES=1.5, 95% CI: 0.3, 2.7). Both groups demonstrated significantly decreased plantar sensation thresholds at the base of the 5th metatarsal (p=.04), PPT at the calcaneal tuberosity (p=.001), and increased TMT extension (p=.01) and WBDF (p=.01) following the run. Conclusions: The etiology of medial plantar pain observed in our sample was likely attributed to central sensitization and running-induced sensory changes. Clinicians should include sensorimotor testing when managing patients with medial plantar pain. Disclosures: The views expressed in this manuscript reflect the results of research conducted by the author(s) and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the U.S. Government. Commander John J. Fraser is a military service member and this work was prepared as part of his official duties. Title 17, USC, subsec. 105 provides that 'Copyright protection under this title is not available for any work of the U.S. Government.' Title 17, USC, subsec. 101 defines a U.S. Government work as a work prepared by a military service member or employee of the U.S. Government as part of that person's official duties. All participants provided informed consent and this study was approved by the Institutional Review Board for Health Sciences Research at the University of Virginia in compliance with all applicable Federal regulations governing the protection of human subjects.