Orthotic Implications in the Military

The physiological demands of military training entail performing repetitive high-risk movement patterns and intensive routines involving running, jumping and marching while carrying weights on different types of terrain and in various conditions.

With occurrences of overuse injuries common in the military population, individual biomechanical assessments can serve to protect recruits by early identification and subsequent treatment of lower limb abnormalities.

If left untreated for an extended period of time, these discrepancies could eventually become precursors to lower limb conditions such as iliotibial band syndrome, plantar fasciitis and patellar tendinopathy that can result in significant loss of training time.

Alterations in gait of Indian Infantry soldiers who carry loads of differing intensities for marching orders were outlined by Majumdar et al. in their study on how military load carriage affects kinematic responses in this population.

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The authors observed increases in step length, stride length, cadence and midstance with the addition of load; the ankle was more dorsiflexed while the knee and hip were more flexed during foot strike to help in the absorption of load. 

The trunk was also established to be more forward leaning with the addition of load to counterbalance the hip moments and to stabilise the body’s centre of mass. This helped minimise energy expenditure of load carriage and increase the efficiency of the walking process.

Based on these results, the authors suggested redesigning of load carriage ensembles and equipment for optimising soldiers’ performance and to reduce the probability of joint injuries whilst carrying out military operations.

The Dynamic Integrated Movement Enhancement (DIME) warm-up was designed as a way to train athletes to avoid high-risk movement patterns such as medial knee displacement and limited sagittal-plane motion that may contribute to an increased risk of lower extremity injury.

Carow et al. sought to determine if the implementation of such a programme in a military training environment could help in lowering the risk of lower extremity injury in military academy cadets.

Participants were divided into one of two warm-up groups – active warm-up and DIME warm-up  – the latter was further sub-divided into a cadre-supervised group and expert-supervised group.

The significant systematic differences observed in the incidence of injury in the cadre-supervised and expert-supervised group suggest that for successful implementation of lower extremity injury-prevention programme, a high level of supervision is necessary so as to avoid inadequate training that could have detrimental effects on the lower limbs.

Hesarikia et al. evaluated the effect of foot orthoses on ankle and foot injuries in 300 military service recruits who were given semi-rigid orthotics to wear in their boots while training.

Orthotics were found to significantly reduce pain and tenderness in heels, foot arch and metatarsals, playing an important role in reducing injury intensity and preventing training loss.

The benefit of an orthotic intervention in the form of highly customised orthotics such as MASS4D® in training programmes is the inclusion of an individual’s predisposition to lower limb injury in the manufacture of the product; this will help in not only the treatment of specific conditions but also in targeting specific biomechanical discrepancies to prevent injury or recurrence.

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Related Links
Do Flat Feet Affect the IT Band?
Assessing The Cause of Plantar Fasciitis
The Various Aetiologies of Heel Pain

References:

1. Carow, S. D., Haniuk, E. M., Cameron, K. L., Padua, D. A., Marshall, S. W., DiStefano, L. J., de la Motte, S. J., Beutler, A. I., Gerber, J. P. (2016) Risk of Lower Extremity Injury in a Military Cadet Population After a Supervised Injury-Prevention Program. Journal of Athletic Training: November 2016, Vol. 51, No. 11, pp. 905-918. doi: 10.4085/1062-6050-49.5.22
2. Hesarikia, H., Nazemian, S. S., Rasouli, H. R., Kazemi, H. M. (2014) Effect of Foot Orthoses on Ankle and Foot Injuries in Military Service Recruits: A Randomized Controlled Trial. Biosciences Biotechnology Research Asia: December 2014, Vol. 11, No. 3, pp. 1141-1148. doi: http://dx.doi.org/10.13005/bbra/1499
3. Majumdar, D., Pal, M. S., Majumdar, D. (2010) Effects of military load carriage on kinematics of gait. Ergonomics: June 2010, Vol. 53, No. 6, pp. 782-791. DOI: 10.1080/00140131003672015

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