James et al. systematically evaluated 180 runners with 232 conditions to characterize injury patterns, biomechanical causes, and treatment outcomes. The paper asks: what causes running injuries, how should the lower extremity be examined, and which non-operative interventions actually work? It introduced a structured protocol for measuring subtalar neutral position and leg-heel-forefoot alignment that became standard in biomechanical assessment.
When a runner comes in with knee pain, the instinct to diagnose chondromalacia is almost always wrong — James et al. Showed that peripatellar pain in runners stems from abnormal transverse rotation driven by compensatory pronation, not articular surface wear.
This paper is why we examine the entire lower extremity from hip to foot in every running injury: no single anatomic variant correlates with any specific diagnosis, so a limited exam will miss the cause.
When you see excessive pronation, look proximally for the driver. Tibial varum, functional equinus, subtalar varus, or forefoot supination. And address it with a subtalar-neutral orthotic rather than treating the foot in isolation.
The subtalar neutral assessment technique described here (palpating the talar head until it no longer bulges medially or laterally) is still the standard method used in biomechanics labs and podiatric clinics worldwide. For the board exam: training errors cause 60% of running injuries, orthotics resolve 78% of cases, and surgery is almost never the answer.
James et al. systematically evaluated 180 runners with 232 conditions to characterize injury patterns, biomechanical causes, and treatment outcomes. The paper asks: what causes running injuries, how should the lower extremity be examined, and which non-operative interventions actually work? It introduced a structured protocol for measuring subtalar neutral position and leg-heel-forefoot alignment that became standard in biomechanical assessment.
When a runner comes in with knee pain, the instinct to diagnose chondromalacia is almost always wrong — James et al. Showed that peripatellar pain in runners stems from abnormal transverse rotation driven by compensatory pronation, not articular surface wear.
This paper is why we examine the entire lower extremity from hip to foot in every running injury: no single anatomic variant correlates with any specific diagnosis, so a limited exam will miss the cause.
When you see excessive pronation, look proximally for the driver. Tibial varum, functional equinus, subtalar varus, or forefoot supination. And address it with a subtalar-neutral orthotic rather than treating the foot in isolation.
The subtalar neutral assessment technique described here (palpating the talar head until it no longer bulges medially or laterally) is still the standard method used in biomechanics labs and podiatric clinics worldwide. For the board exam: training errors cause 60% of running injuries, orthotics resolve 78% of cases, and surgery is almost never the answer.