{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:11:53Z","timestamp":1760058713787,"version":"build-2065373602"},"reference-count":35,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,4,23]],"date-time":"2025-04-23T00:00:00Z","timestamp":1745366400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"United States Army Medical Research and Development Command, Military Operational Medical Research Program","award":["MO240034"],"award-info":[{"award-number":["MO240034"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>Shock attenuation may be a clinically feasible method to assess changes in lower extremity joint loading induced by gait modifications, such as decreasing foot strike angle (forefoot striking). The purpose of this study was to identify changes in lower extremity shock attenuation between habitual and forefoot strike gait conditions. Eighteen participants ran on a treadmill with their habitual gait and an instructed forefoot strike gait. Shock attenuation was measured with inertial measurement units as the ratio of proximal to distal peak resultant\/vertical accelerations, with three sensor combinations: ankle to below\/above knee (BK\/A; AK\/A) and AK\/BK. Three participants were excluded who were habitual forefoot strikers or failed to decrease their foot strike angle by at least 5\u00b0 in the forefoot strike condition. The results showed significantly greater resultant shock attenuation in the forefoot strike compared to the habitual condition for BK\/A (mean \u0394 = 0.13, p = 0.004) and AK\/A (mean \u0394 = 0.23, p = 0.007). No significant differences were found for AK\/BK or vertical shock attenuation. These results suggest that shock attenuation may not reflect joint-specific loading changes that have been shown for forefoot striking (i.e., increased ankle\/shank and decreased knee moments). However, it may capture changes in overall lower extremity loading (i.e., decreased vertical ground reaction forces).<\/jats:p>","DOI":"10.3390\/s25092656","type":"journal-article","created":{"date-parts":[[2025,4,23]],"date-time":"2025-04-23T03:43:37Z","timestamp":1745379817000},"page":"2656","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Effects of Decreasing Foot Strike Angle on Lower Extremity Shock Attenuation Measured with Wearable Sensors"],"prefix":"10.3390","volume":"25","author":[{"given":"Lucas","family":"Sarantos","sequence":"first","affiliation":[{"name":"Military Performance Division, U.S. Army Research Institute of Environmental Medicine, 10 General Greene Ave., Natick, MA 01760, USA"},{"name":"Oak Ridge Institute for Science and Education, 100 Orau Way, Oak Ridge, TN 37830, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David J.","family":"Zeppetelli","sequence":"additional","affiliation":[{"name":"Military Performance Division, U.S. Army Research Institute of Environmental Medicine, 10 General Greene Ave., Natick, MA 01760, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7649-8824","authenticated-orcid":false,"given":"Cole A.","family":"Dempsey","sequence":"additional","affiliation":[{"name":"Military Performance Division, U.S. Army Research Institute of Environmental Medicine, 10 General Greene Ave., Natick, MA 01760, USA"},{"name":"Oak Ridge Institute for Science and Education, 100 Orau Way, Oak Ridge, TN 37830, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takashi","family":"Nagai","sequence":"additional","affiliation":[{"name":"Military Performance Division, U.S. Army Research Institute of Environmental Medicine, 10 General Greene Ave., Natick, MA 01760, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4945-7813","authenticated-orcid":false,"given":"Caleb D.","family":"Johnson","sequence":"additional","affiliation":[{"name":"Military Performance Division, U.S. Army Research Institute of Environmental Medicine, 10 General Greene Ave., Natick, MA 01760, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1249\/JSR.0b013e31822d403f","article-title":"Running Injuries-Changing Trends and Demographics","volume":"10","author":"Fields","year":"2011","journal-title":"Curr. Sports Med. Rep."},{"key":"ref_2","first-page":"21","article-title":"The proportion of lower limb running injuries by gender, anatomical location and specific pathology: A systematic review","volume":"18","author":"Francis","year":"2019","journal-title":"J. Sports Sci. Med."},{"key":"ref_3","unstructured":"Cowan, D.N., Jones, B.H., and Shaffer, R.A. (2003). Musculoskeletal injuries in the military training environment, Military Preventative Medicine: Mobilization and Deployment."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1249\/00005768-199302000-00006","article-title":"Epidemiology of injuries associated with physical training among young men in the army","volume":"25","author":"Jones","year":"1993","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_5","first-page":"22","article-title":"The Etiology of Injuries in US Army Initial Entry Training","volume":"2-18","author":"Hauschild","year":"2018","journal-title":"US Army Med. Dep. J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/S0749-3797(00)00114-8","article-title":"Military training-related injuries: Surveillance, research, and prevention","volume":"18","author":"Kaufman","year":"2000","journal-title":"Am. J. Prev. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"S57","DOI":"10.1519\/JSC.0000000000001115","article-title":"Physical training, fitness, and injuries: Lessons learned from military studies","volume":"29","author":"Jones","year":"2015","journal-title":"J. Strength Cond. Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"3072","DOI":"10.1177\/0363546520950731","article-title":"Impact-related ground reaction forces are more strongly associated with some running injuries than others","volume":"48","author":"Johnson","year":"2020","journal-title":"Am. J. Sports Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1136\/bjsports-2015-094579","article-title":"Greater vertical impact loading in female runners with medically diagnosed injuries: A prospective investigation","volume":"50","author":"Davis","year":"2016","journal-title":"Br. J. Sports Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2211","DOI":"10.1177\/0363546518773755","article-title":"A 2-year prospective cohort study of overuse running injuries: The runners and injury longitudinal study (TRAILS)","volume":"46","author":"Messier","year":"2018","journal-title":"Am. J. Sports Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/j.humov.2017.02.007","article-title":"A prospective comparison of lower extremity kinematics and kinetics between injured and non-injured collegiate cross country runners","volume":"52","author":"Dudley","year":"2017","journal-title":"Hum. Mov. Sci."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1016\/j.jshs.2019.07.006","article-title":"Transition to forefoot strike reduces load rates more effectively than altered cadence","volume":"9","author":"Futrell","year":"2020","journal-title":"J. Sport. Health Sci."},{"key":"ref_13","unstructured":"Kleindienst, F., Campe, S., Graf, E., Michel, K., and Witte, K. (2007, January 23\u201327). Differences between fore-and rearfoot strike running patterns based on kinetics and kinematics. Proceedings of the International Society of Biomechanics in Sport, Ouro Preto, Brazil."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1578","DOI":"10.1249\/MSS.0000000000000254","article-title":"Joint kinetics in rearfoot versus forefoot running: Implications of switching technique","volume":"46","author":"Stearne","year":"2014","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2306","DOI":"10.1249\/MSS.0b013e31829efcf7","article-title":"Forefoot strikers exhibit lower running-induced knee loading than rearfoot strikers","volume":"45","author":"Kulmala","year":"2013","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.gaitpost.2018.11.002","article-title":"Patellofemoral joint stress measured across three different running techniques","volume":"68","author":"Nakagawa","year":"2019","journal-title":"Gait Posture"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.ptsp.2014.02.005","article-title":"Is the rearfoot pattern the most frequently foot strike pattern among recreational shod distance runners?","volume":"16","author":"Saragiotto","year":"2015","journal-title":"Phys. Ther. Sport."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"830","DOI":"10.7205\/MILMED-D-14-00220","article-title":"Characterization of foot-strike patterns: Lack of an association with injuries or performance in soldiers","volume":"180","author":"Warr","year":"2015","journal-title":"Mil. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/0167-9457(95)00004-C","article-title":"Shock attenuation and stride frequency during running","volume":"14","author":"Hamill","year":"1995","journal-title":"Hum. Mov. Sci."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Xiang, L., Gu, Y., Rong, M., Gao, Z., Yang, T., Wang, A., Shim, V., and Fernandez, J. (2022). Shock acceleration and attenuation during running with minimalist and maximalist shoes: A time-and frequency-domain analysis of tibial acceleration. Bioengineering, 9.","DOI":"10.3390\/bioengineering9070322"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1249\/01.MSS.0000048837.81430.E7","article-title":"Individual Effects of Stride Length and Frequency on Shock Attenuation during Running","volume":"35","author":"Mercer","year":"2003","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1016\/j.jshs.2014.03.004","article-title":"Impact shock frequency components and attenuation in rearfoot and forefoot running","volume":"3","author":"Gruber","year":"2014","journal-title":"J. Sport. Health Sci."},{"key":"ref_23","unstructured":"(2018). ACSM\u2019s Guidelines for Exercise Testing and Prescription, Wolters Kluwer. [10th ed.]."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/j.gaitpost.2022.05.019","article-title":"What differentiates rearfoot strike runners with low and high vertical load rates?","volume":"96","author":"Johnson","year":"2022","journal-title":"Gait Posture"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.gaitpost.2015.10.022","article-title":"Quantifying performance and effects of load carriage during a challenging balancing task using an array of wireless inertial sensors","volume":"43","author":"Cain","year":"2016","journal-title":"Gait Posture"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Bradach, M.M., Gaudette, L.W., Tenforde, A.S., Outerleys, J., de Souza J\u00fanior, J.R., and Johnson, C.D. (2023). The effects of a simple sensor reorientation procedure on peak tibial accelerations during running and correlations with ground reaction forces. Sensors, 23.","DOI":"10.3390\/s23136048"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2164","DOI":"10.1111\/sms.13228","article-title":"Kinetic Risk Factors of Running-Related Injuries in Female Recreational Runners","volume":"28","author":"Napier","year":"2018","journal-title":"Scand. J. Med. Sci. Sports"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1016\/j.jsams.2012.08.002","article-title":"Differences in kinetic variables between injured and noninjured novice runners: A prospective cohort study","volume":"16","author":"Bredeweg","year":"2013","journal-title":"J. Sci. Med. Sports"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1016\/j.jbiomech.2019.01.039","article-title":"Validity and reliability of peak tibial accelerations as real-time measure of impact loading during over-ground rearfoot running at different speeds","volume":"86","author":"Six","year":"2019","journal-title":"J. Biomech."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1016\/S0966-6362(01)00125-4","article-title":"The reliability of kinetic and kinematic variables used to analyse normal running gait","volume":"14","author":"Diss","year":"2001","journal-title":"Gait Posture"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1016\/j.gaitpost.2011.09.104","article-title":"A kinematic method for footstrike pattern detection in barefoot and shod runners","volume":"35","author":"Altman","year":"2012","journal-title":"Gait Posture"},{"key":"ref_32","unstructured":"Cohen, J. (1988). Statistical Power Analysis for the Behavior Science, Lawrence Erlbaum Associates. [2nd ed.]."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Napier, C., Fridman, L., Blazey, P., Tran, N., Michie, T.V., and Schneeberg, A. (2022). Differences in peak impact accelerations among foot strike patterns in recreational runners. Front. Sports Act. Living, 4.","DOI":"10.3389\/fspor.2022.802019"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Johnson, C.D., Outerleys, J., Tenforde, A.S., and Davis, I.S. (2020). A comparison of attachment methods of skin mounted inertial measurement units on tibial accelerations. J. Biomech., 113.","DOI":"10.1016\/j.jbiomech.2020.110118"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1007\/s00421-002-0646-9","article-title":"Relationship between shock attenuation and stride length during running at different velocities","volume":"87","author":"Mercer","year":"2002","journal-title":"Eur. J. Appl. Physiol."}],"container-title":["Sensors"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8220\/25\/9\/2656\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:19:41Z","timestamp":1760030381000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8220\/25\/9\/2656"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,23]]},"references-count":35,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,5]]}},"alternative-id":["s25092656"],"URL":"https:\/\/doi.org\/10.3390\/s25092656","relation":{},"ISSN":["1424-8220"],"issn-type":[{"type":"electronic","value":"1424-8220"}],"subject":[],"published":{"date-parts":[[2025,4,23]]}}}