Gait retraining targeting foot pronation: A systematic review and meta-analysis

Abstract

Foot pronation is a prevalent condition known to contribute to a range of lower extremity injuries. Numerous interventions have been employed to address this issue, many of which are expensive and necessitate specific facilities. Gait retraining has been suggested as a promising intervention for modifying foot pronation, offering the advantage of being accessible and independent of additional materials or specific time. We aimed to systematically review the literature on the effect of gait retraining on foot pronation. We searched four databases including PubMed, Web of Science, Scopus and Embase from their inception through 20 June 2023. The Downs and Black appraisal scale was applied to assess quality of included studies. Two reviewers screened studies to identify studies reporting the effect of different methods of gait-retraining on foot pronation. Outcomes of interest were rearfoot eversion, foot pronation, and foot arch. Two authors separately extracted data from included studies. Data of interest were study design, intervention, variable, sample size and sex, tools, age, height, weight, body mass index, running experience, and weekly distance of running. Mean differences and 95% confidence intervals (CI) were calculated with random effects model in RevMan version 5.4. Fifteen studies with a total of 295 participants were included. The results of the meta-analysis showed that changing step width does not have a significant effect on peak rearfoot eversion. The results of the meta-analysis showed that changing step width does not have a significant effect on peak rearfoot eversion. Results of single studies indicated that reducing foot progression angle (MD 2.1, 95% CI 0.62, 3.58), lateralizing COP (MD -3.3, 95% CI -4.88, -1.72) can effectively reduce foot pronation. Overall, this study suggests that gait retraining may be a promising intervention for reducing foot pronation; Most of the included studies demonstrated significant improvements in foot pronation following gait retraining. Changing center of pressure, foot progression angle and forefoot strike training appeared to yield more favorable outcomes. However, further research is needed to fully understand its effectiveness and long-term benefits.

Fig 1. Flow chart of study selection process.

Fig 2. Results of meta-analysis for changing step width on peak rearfoot eversion.

Fig 3. Results of changing step width on rearfoot pronation/eversion.

Fig 4. Results of Changing foot progression angle on rearfoot eversion and MLAA.

Fig 5. Results of changing foot progression angle by 10 degrees on rearfoot eversion.

Fig 6. Results of changing step rate on rearfoot eversion.

Fig 7. Results of pose training (changing speed) on rearfoot eversion.

Fig 8. Results of running softer on MLAA.

Fig 9. Results of changing COP on rearfoot eversion and MLAA.

Fig 10. Results of changing foot strike on rearfoot eversion and MLAA.

Fig 11. Results of backward walking on foot posture.

Fig 12. Graphical abstract of the effects of gait retraining on dynamic peak pronation and static foot arch.