Torsional deformities and overuse injuries: what does the literature tell us

Abstract

Overuse injuries imply the occurrence of a repetitive or an increased load on a specific anatomical segment which is unable to recover from this redundant microtrauma, thus leading to an inflammatory process of tendons, physis, bursa, or bone. Even if the aetiology is controversial, the most accepted is the traumatic one. Limb malalignment has been cited as one of the major risk factors implicated in the development of overuse injuries. Many authors investigated correlations between anatomical deviations and overuse injuries, but results appear mainly inconclusive. Establishing a causal relationship between mechanical stimuli and symptoms will remain a challenge, but 3D motion analysis, musculoskeletal, and finite element modelling may help in clarifying which are the major risk factors for overuse injuries.

Keywords: gait analysis; malalignment; overuse injuries.

Figure 1

Proposed pathogenetic path involved in the development of overuse injuries; the interplay between anatomic deviations and increased physical activity leading top altered musculoskeletal loads, which can determine the onset of overuse pathologies.

Figure 2

Medial and lateral condyle knee compressive forces during gait computed by means of musculoskeletal modelling (AnyBody Technology A/S, Aalborg, Denmark). Knee compressive forces are normalized by body weight (BW) and reported over the gait cycle for left (red solid line) and right (blue dashed line) leg. The example refers to the clinical gait analysis of one adolescent patient with knee pain. The patient presented CT-confirmed femoral retroversion on both sides, as well as dynamic genu valgum and foot external rotation during gait. The analysis of joint loads indicates an altered load distribution, with an overload of the lateral compartment during gait, more pronounced on the left knee.

Figure 3

Forces transmitted from the quadriceps to the patella during gait, computed by means of musculoskeletal modelling (AnyBody Technology A/S, Aalborg, Denmark). Muscle forces are normalized by body weight (BW) and reported over the gait cycle for left (red solid line) and right (blue dashed line) leg. The example refers to the clinical gait analysis of one adolescent patient with bilateral Osgood–Schlatter disease. The patient is habitual toe-walker, and his gait pattern is associated with larger forces produced by the knee extensors. Repetitive high loads on the patella might lead to an overload of the patellar ligament and the onset of Osgood–Schlatter disease.