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Journal of Foot and Ankle Research

Open Access

Rear-foot kinematics in runners with PFPS during walking, squatting and uphill running

  • Jessica Leitch1Email author,
  • Kathleen Reilly2,
  • Julie Stebbins3 and
  • Amy B Zavatsky1
Journal of Foot and Ankle Research20125(Suppl 1):P26

Published: 10 April 2012


Overuse InjuryJoint KinematicPatellofemoral PainFemale RunnerLevel Running


Patellofemoral pain syndrome (PFPS) is the most common overuse injury in distance runners. A pilot investigation found that runners with a history of PFPS exhibited increased rear-foot eversion and reduced rear-foot dorsiflexion compared to uninjured controls during level treadmill running [1]. The aim of the present study was to investigate whether these kinematic alterations were also demonstrated during activities that demanded more dorsiflexion (uphill running and squatting) and less dorsiflexion (walking) compared to level running.

Materials and methods

Nine female runners with a previous history of PFPS and ten female controls participated in the study. Spherical reflective markers (9-mm) were attached to anatomical landmarks of both lower limbs [2]. A 12-camera Vicon MX System (Vicon Motion Systems, Oxford, UK) was used to collect 3-D spatial data at 200 Hz as the subject performed (i) five over-ground walking strides (self-selected speed), (ii) five squats and (iii) five uphill running strides on a treadmill (speed = 2.96 ms-1, incline = 10o). Rear-foot joint angles were calculated using the Oxford Foot Model [2]. The five trials for each activity and each subject were normalised to the stance (squat) period using cubic spline interpolation. Discrete kinematic parameters (peak rear-foot dorsiflexion, dorsiflexion excursion, peak rear-foot eversion) were identified for each of the five trials of each subject. The variables were compared between groups using one-tailed t-tests with an alpha level set at 0.05.


Subjects with a history of PFPS demonstrated significantly less dorsiflexion (peak) during walking and squatting compared to uninjured controls (Table 1). Dorsiflexion excursion was significantly lower and rear-foot eversion significantly higher in subjects with a history of PFPS compared to uninjured controls during uphill running.
Table 1

Kinematic parameters during walking, running and squatting for subjects with a history of PFPS (P) and uninjured controls (N). * Indicates a statistically significant difference (p < 0.05).



Uphill Run


Angle (o)










Peak dorsiflexion

11.2 (3.2)

7.9 (2.8)


18.9 (7.2)

15.9 (2.5)


25.0 (8.2)

19.0 (3.3)


Dorsiflexion excursion

17.0 (2.5)

15.1 (2.8)


17.5 (3.8)

14.0 (2.3)


19.5 (8.8)

17.0 (2.5)


Peak eversion

5.8 (6.2)

9.5 (3.3)


7.1 (7.5)

12.8 (3.1)


6.5 (10.8)

10.1 (3.2)



The kinematic alterations that had been observed in subjects with a history of PFPS during level running [1] were also apparent during walking, uphill running and squatting. Further investigations to understand the relationship between rear-foot joint motion and patellofemoral joint kinematics are required.

Authors’ Affiliations

Department of Engineering Science, University of Oxford, Oxford, UK
Department of Physiotherapy, Nuffield Orthopaedic Centre, Oxford, UK
Oxford Gait Laboratory, Nuffield Orthopaedic Centre, Oxford, UK


  1. Leitch J, Reilly K, Stebbins J, Zavatsky AB: Lower-limb and foot kinematics in distance runners with patellofemoral pain syndrome. Proceedings of the 2nd Patellofemoral Pain Syndrome International Research Retreat:. 2011, August ; Ghent,BelgiumGoogle Scholar
  2. Stebbins J, Harrington M, Thompson N, Zavatsky AB, Theologis T: Repeatability of a model for measuring multi-segment foot kinematics in children. Gait Posture. 2006, 23: 401-410. 10.1016/j.gaitpost.2005.03.002.View ArticlePubMedGoogle Scholar


© Leitch et al; licensee BioMed Central Ltd. 2012

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.