{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T18:30:24Z","timestamp":1783535424909,"version":"3.55.0"},"reference-count":23,"publisher":"Oxford University Press (OUP)","issue":"5-6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,5,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>The six-item Foot Posture Index (FPI-6) was previously developed as an assessment tool to measure the posture of the foot across multiple segments and planes. It was derived from a criterion-based observational assessment of six components of each foot during static standing. The association between abnormal foot posture and musculoskeletal injuries remains unclear and is in of need further exploration.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Hypothesis\/Purpose<\/jats:title>\n                  <jats:p>The purpose of this study was to assess the association between foot biomechanics and self-reported history of musculoskeletal pain or injury.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Study Design<\/jats:title>\n                  <jats:p>Retrospective, cross-sectional study of collegiate football players at the U.S. Naval Academy.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>For each athlete, data were recorded on height, weight, self-reported history of pain or injury, and foot posture, which was measured using a FPI-6 with each item measuring the degree of pronation\/supination. The primary outcome was each athlete\u2019s maximum deviation from neutral posture across the six-item index (FPImax). The prespecified primary analysis used generalized linear models to measure the association between FPImax and self-report history of pain or injury. Exploratory analyses measured the association using penalized regression (L1-norm) and a type of tree-based ensemble known as extreme gradient boosting (XGBoost).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Data were collected on 101 athletes, 99 of whom had sufficient body mass index (BMI) data to be included for analysis. Among the 99 athletes, higher FPImax was associated with a prior history of musculoskeletal pain (odds ratio [OR] 1.15, 95% confidence interval [CI] 0.97 to 1.35), although the sample size was too small for the association to be significant with 95% CI (P\u2009=\u2009.107). FPImax was not associated with a history of knee injury\/pain (OR 0.98, 95% CI 0.83 to 1.15, P\u2009=\u2009.792), nor with a history of ankle\/foot injury or pain (OR 1.04, 95% CI 0.90 to 1.21, P\u2009=\u2009.599). From the L1-penalized model, the FPI components with the strongest linear associations were the L6, R2, R1-squared, and FPImax. From the XGBoost model, the most important variables were FPItotal, BMI, R1, and R2.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The U.S. Naval Academy football players whose foot postures deviated from neutral were more likely to have reported a previous history of musculoskeletal pain. However, this deviation from normal was not strongly associated with a specific history of pain or injury to the knee, ankle, or foot.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Clinical Relevance<\/jats:title>\n                  <jats:p>The information ascertained from this study could be used to better inform clinicians about the value of the FPI in predicting or mitigating injuries for varsity football athletes.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usab370","type":"journal-article","created":{"date-parts":[[2021,9,24]],"date-time":"2021-09-24T18:29:56Z","timestamp":1632508196000},"page":"684-689","source":"Crossref","is-referenced-by-count":7,"title":["A Retrospective Study of Foot Biomechanics and Injury History in Varsity Football Athletes at the U.S. Naval Academy"],"prefix":"10.1093","volume":"187","author":[{"given":"Jennifer","family":"Windsor","sequence":"first","affiliation":[{"name":"The Center for Rehabilitation Sciences Research, Uniformed Services University of the Health Sciences, Bethesda, MD 20814 , USA"},{"name":"Department of Physical Medicine and Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA"},{"name":"Department of Surgery, Evans Army Community Hospital, Fort Carson, CO 80925, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Jeffries","sequence":"additional","affiliation":[{"name":"The Center for Rehabilitation Sciences Research, Uniformed Services University of the Health Sciences, Bethesda, MD 20814 , USA"},{"name":"Department of Physical Medicine and Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA"},{"name":"The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeff","family":"Sorensen","sequence":"additional","affiliation":[{"name":"The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly","family":"Bach","sequence":"additional","affiliation":[{"name":"The Center for Rehabilitation Sciences Research, Uniformed Services University of the Health Sciences, Bethesda, MD 20814 , USA"},{"name":"Department of Physical Medicine and Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA"},{"name":"The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evan","family":"Benedek","sequence":"additional","affiliation":[{"name":"The Center for Rehabilitation Sciences Research, Uniformed Services University of the Health Sciences, Bethesda, MD 20814 , USA"},{"name":"The Henry M. 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