Long distance running increases plantar pressures beneath the metatarsal heads: A barefoot walking investigation of 200 marathon runners

Background The growing popularity of endurance sports activities is associated with a growing number of metatarsal stress fractures in recreational runners. Excessive foot loading has been suggested as a potential cause for these problems [Bennell, K, Matheson G, Meeuwisse W, Brukner P. Risk factors for stress fractures. Sports Med 1999;28(2):91–122]. Therefore, the question arises whether long distance running affects foot loading characteristics like ground reaction forces and peak pressure in specific areas of the foot. Purpose To investigate the effects of long distance running on plantar pressure patterns before and after a marathon race. Study design Repeated measurements of recreational runners before and after a marathon race. Methods Two hundred participants of the third Muenster marathon, 2004, were measured before and after the race with plantar pressure measurements during barefoot walking on a capacitive platform. The ratio between forefoot and toe loading was calculated to assess a suggested loading shift between these areas. Results The results of the whole group of participants revealed a significant difference in foot loading characteristics before and after the race. Post-race peak pressure and impulse values were higher in the forefoot regions and reduced under the toes. Conclusions The increased peak pressure under the metatarsal heads after the race indicates a load shift from the toes to the metatarsal heads. This suggests an increased loading of the metatarsal bones and could explain the increased incidence of metatarsal stress fractures in long distance runners.