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J Orthop Res. 2009 Mar;27(3):318-24. doi: 10.1002/jor.20744.

Shoes influence lower limb muscle activity and may predispose the wearer to lateral ankle ligament injury.

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Institution of Motion Analysis & Research, Orthopaedic & Trauma Surgery, TORT Centre, Ninewells Hospital & Medical School, University of Dundee, Dundee DD1 9SY, Scotland, United Kingdom.


Lateral ankle ligaments are injured by hyperinversion of the foot. Foot position is controlled by the lower limb muscles. Awareness of foot position is impaired by wearing shoes. We aimed to determine the influence of wearing shoes upon muscle activity. Sixty-two healthy subjects underwent the same measurements, barefoot and with standardized shoes in a random order. Electromyography (EMG) was recorded from the peroneus longus muscle in response to sudden and unanticipated inversion of the ipsilateral foot. Following foot inversion, the EMG signal showed an initial peak muscle contraction followed by a sustained smaller contraction. Both changes were significantly greater in shoes compared to the barefoot condition for all tested degrees of inversion. Muscle contraction following sudden inversion of the foot was significantly greater when wearing shoes. This greater muscular contraction may be an intrinsic mechanism to oppose the increased moment created by the inverted foot/shoe condition, and hence, may counter balance the increased tendency to injure the lateral ankle ligaments created by wearing shoes.

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