Foot loading characteristics during three fencing specific movements

Journal of Sports Sciences, December 2011; 29(15): 1585–1592

Foot loading characteristics during three fencing-specific movements

CAROLINE TRAUTMANN1, NICOLO MARTINELLI2, & DIETER ROSENBAUM1 1

Motion Analysis Laboratory, Institute of Experimental Musculoskeletal Medicine, University Hospital Muenster, Muenster, Germany and 2Department of Foot and Ankle Surgery, Galeazzi Hospital, Milan, Italy

(Accepted 12 July 2011)

Abstract Plantar pressure characteristics during fencing movements may provide more specific information about the influence of foot loading on overload injury patterns. Twenty-nine experienced fencers participated in the study. Three fencing-specific movements (lunge, advance, retreat) and normal running were performed with three different shoe models: Ballestra (Nike, USA), Adistar Fencing Lo (Adidas, Germany), and the fencers’ own shoes. The Pedar system (Novel, Munich, Germany) was used to collect plantar pressures at 50 Hz. Peak pressures, force–time integrals and contact times for five foot regions were compared between four athletic tasks in the lunge leg and supporting leg. Plantar pressure analysis revealed characteristic pressure distribution patterns for the fencing movements. For the lunge leg, during the lunge and advance movements the heel is predominantly loaded; during retreat, it is the hallux. For the supporting leg, during the lunge and advance movements the forefoot is predominantly loaded; during retreat, it is the hallux. Fencing-specific movements load the plantar surface in a distinct way compared with running. An effective cushioning in the heel and hallux region would help to minimize foot loading during fencing-specific movements.

Keywords: Plantar pressure distribution, pedobarography, foot injuries, fencing shoes, fencing movements

Introduction Fencing is one of the oldest sports and was admitted to the first Olympic Games in Athens in 1896. The Fe´de´ration Internationale d’Escrime (FIE) represents 129 member federations, with more than a million licensed participants. The German Fencing Association listed 25,000 participants in 2008 (http:// www.fechten.org). The sport involves three skills: blade work, footwork, and tactics. Asymmetric motions and rapid change in momentum are essential components in this discipline. The sport of fencing requires athletes to perform a constant series of advance, retreat, and lunging moves during the course of a competitive match.

Previous research has revealed that the lower extremity is the most frequent location for fencing injuries (Carter, Heil, & Zemper, 1993; Roi & Bianchedi, 2008; Zemper & Harmer, 1996). Acute and overload injuries are a problem for elite and nonelite fencers and higher injury rates were reported for national and international competitions (Zemper & Harmer, 1996). In a 5-year prospective study, over 184 time-loss injuries were recorded for 610 athletes,

with an overall rate of 0.3 per 1000 athletic exposure (Harmer, 2008a). The knee was the most frequently injured region (19.6%), followed by the thigh (15.2%) and the ankle (13%). Half of all reported injuries are first- or second-degree strains (26.1%) and sprains (25.5%) (Harmer, 2008b; Ja¨ger, 2003; Trautmann & Rosenbaum, 2008; Whitside, Fleagle, & Kalenak, 1981; Wild et al., 2001). Ja¨ger (2003) and Trautmann and Rosenbaum (2008) reported that the most frequently injured regions were the foot and ankle: 29% and 35.6% respectively. In addition, Wild et al. (2001) found that most lower limb injuries showed a high chronic morbidity rate. Due to the uniqueness and asymmetric nature of fencing movements, examination of the plantar pressure distribution during typical fencing manoeuvres appears warranted. Knowledge about the high pressures during explosive and dynamic fencing movements could assist shoe designers to focus more appropriately on the regions that require better cushioning and help to prevent acute and overuse injuries.

To our knowledge, only one previous study of the plantar pressure distribution of fencing shoes has

Correspondence: D. Rosenbaum, Motion Analysis Laboratory, Institute of Experimental Musculoskeletal Medicine, University Hospital Muenster, Domagkstr. 3, D-48149 Muenster, Germany. E-mail: diro@uni-muenster.de ISSN 0264-0414 print/ISSN 1466-447X online Ó 2011 Taylor & Francis http://dx.doi.org/10.1080/02640414.2011.605458

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been published, in which one pair of fencing shoes was used (Geil, 2002). Geil reported high peak pressures in the lunge foot under the heel region and in the supporting foot under the medial forefoot, during three fencing-related movements.

Unfortunately, Geil’s study was limited by the reporting of just one plantar pressure parameter (peak pressure). To provide a better understanding of foot-loading characteristics, the force–time integral should be used to describe the overall loading effect under specific foot areas. The purpose of the present study was to characterize the plantar pressure distribution patterns during three fencingrelated movements with three different fencing shoe models. Two hypotheses were tested: (1) different fencing-specific movements show specific plantar pressure patterns, with highly loaded regions of the foot for different athletic tasks; and (2) shoe models have a significant influence on pressure distribution patterns.

Methods Twenty-nine experienced fencers (20 males, 9 females) were recruited for this study: 18 elite fencers (national team members) with fencing experience of 14.4 + 3.3 years and 11 non-elite athletes with fencing experience of 11.2 + 2.5 years.

Their mean age, mass, and height were 19.3 + 4.3 years, 70.8 + 11.2 kg, and 176.3 + 8.0 cm, respectively. Each fencer was a specialist in one weapon.

The participants were free of lower extremity injuries and had no history of surgery in the lower extremities within the previous 6 months. Before testing, the fencers provided informed consent to participate in the study. Testing was conducted at the Olympic Fencing Center of Bonn, Germany (Olympischer Fechtclub Bonn). The study was conducted according to the Declaration of Helsinki.

The Pedar-Mobile-System (Novel, Munich, Germany) was used to measure plantar pressure distribution. The system uses two flexible insoles with 99 sensors in a matrix design, covering the whole plantar aspect. The plantar pressure data were sampled at 50 Hz via Bluetooth technology. All insoles were calibrated up to 1000 kPa prior to data

collection according to the manufacturer’s guidelines. Excellent reproducibility was reported for the Pedar system during walking and running (Kernozek & Zimmer, 2000).

The fencers completed a warm-up before data collection. Testing was conducted on a 14 6 2 m FIE-approved aluminium fencing piste.

The insoles were manually positioned into the fencing shoes using the correct size for each participant. Furthermore, each fencer provided feedback about the correct positioning of the insoles inside the shoe. A pre-test was conducted to check the sensor’s function. The shoe conditions were not randomized. The fencing-specific movements of lunge, advance, and retreat together with running were performed with three different shoe models: the athletes’ own fencing shoes (used for training and competition), Ballestra (Nike, Beaverton, OR, USA), and Adistar Fencing Lo (Adidas, Herzogenaurach, Germany). The Adidas and Nike shoes were new, with the correct size for each volunteer. The athlete began all movements from the En Garde position: front hip flexed and externally rotated, both knees flexed, back hip flexed (Figure 1). The front foot (lunge leg) was kept parallel to the fencing piste while the supporting leg was positioned perpendicular to the front foot. .

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The advance is a step forward. The fencer, pushing off the supporting leg, lifts the lunge leg forward and lands with the heel first. When the heel contacts the ground, the fencer moves the supporting leg forward.

The retreat is a step backward. The movement starts by pushing backwards from the lunge leg and simultaneously retreating the supporting leg. As the supporting leg touches the ground, the fencer moves the front foot backward.

The lunge is a method of quickly attacking an opponent while maintaining balance for a rapid recovery to the En Garde position. The fencer kicks the front foot forward by extending the front leg from the knee. As the front leg extends, the fencer moves the body forward by pushing off from the rear leg. The lunge leg lands on the heel followed by knee flexion to approximately

Figure 1. Sequence of fencing movement during the lunge (e´pe´e fencer). (a) En Garde position. (b) Lifting of the lunge leg. (c) Forward movement of the lunge leg (leading leg), simultaneous push off of the supporting leg. (d) Landing in the lunge, extension of the rear arm. (e) Final lunge position, lunge leg flexed at 908, supporting leg fully extended.

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model. Statistical significance was set at P 5 0.05.

When significant interactions among movement and shoe were identified, simple main effects were evaluated. To detect between-movement differences, Tukey’s test was employed for post-hoc analyses. A Bonferroni correction was applied for paired comparisons between the four movement patterns to keep the experiment-wise error rate at 0.05 (see Bland & Altman, 1995). The lunge leg and the supporting leg were not compared statistically because of the asymmetric nature of fencing-specific movements.

908. During this action, the supporting leg is fully extended.

For the running movement, athletes ran a distance of about 17 m at approximately 70% of maximum speed. A flying start was used to begin the trial.

Fencers were required to finish the four movements using one shoe model before changing into the next shoe. The participants were asked to perform fencing movements at maximum speed to simulate a powerful attack as in competition. They were asked to complete five trials in each of the three different shoe types for a total of 15 trials per movement.

Participants were also allowed approximately 1 min of rest between trials and 5 min of rest between shoe conditions to prevent the effects of fatigue. Five trials for each movement and each type of shoe were averaged and used for statistical analysis.

To analyse the in-shoe pressure data, the foot was divided into five anatomical regions using the Novel Multiproject software (Novel): heel, midfoot, forefoot, hallux, and lesser toes. The following parameters were determined for the whole foot and the selected regions: contact time, force–time integral, and peak pressure.

A two-way repeated-measures analysis of variance (ANOVA) was conducted with the factors movement (running, advance, retreat, and lunge) and shoe

Results Plantar pressure parameters for each foot region during the advance, lunge, retreat, and running are presented for the lunge leg and supporting leg in Table I and Table II, respectively.

Lunge leg Significant interactions between movement and shoe model were found in the heel and midfoot for peak pressure, and in the midfoot, forefoot, and hallux for force–time integral (P 5 0.05). Simple main effect indicated that peak pressure in the heel, for each shoe model, was significantly higher for the lunge compared with the other movements (P 5 0.01). In the

Table I. Means and standard deviations of pressure parameters for the lunge leg#.

Movement

Lunge leg

Run

Peak pressure (kPa) Heel 216.4 (63.5) Midfoot 150.7 (28.6) Forefoot 280.0 (79.5) Hallux 277.5 (86.9) Toes 154.8 (36.0)

Lunge

551.8a 156.3 205.4a 255.6 170.4

(113.9) (30.2) (51.9) (68.9) (40.2)

Force–time integral (N s) Heel 38.9 (16.4) 179.2a (76.3) Midfoot 35.6 (11.3) 76.0a (31.2) Forefoot 113.7 (34.4) 175.6a (60.3.2) Hallux 21.4 (6.8) 47.9a (22.3) Toes 20.9 (5.8) 55.1a (21.7) Contact time (ms) Heel 187.9 (48.7) Midfoot 227.4 (39.7) Forefoota 265.3 (34.9) Hallux 232.9 (38.1) Toes 234.2 (35.5)

705.4a 690.9a 674.3a 627.6a 634.4a

(166.9) (163.7) (173.9) (177.1) (176.6)

Shoe

Advance

Retreat

Nike Ballestra

Adidas FL

Athletes’ own shoes

Main effects and/or interaction

314.5a 108.4a 219.6a 229.1 130.3

(67.3) (28.0) (71.0) (76.3) (35.5)

186.3 106.0a 285.7 341.0 158.3

(41.3) (27.0) (88.5) (122.4) (37.6)

287b 119.2b 235.0b 256.0 160.6

(60.8) (21.2) (59.8) (60.9) (35.5)

302.9b 128.0b 245.8 287.7 147.1

(63.6) (24.9) (70.4) (73.1) (32.8)

361.9 143.9 262.8 283.6 152.7

(49.2) (27.5) (68.9) (85.8) (29.6)

M, M, M, M, M

59.6a 16.9a 40.0a 9.7a 8.1a

(16.4) (6.3) (9.0) (2.1) (3.1)

31.7 17.4a 68.9a 18.7 16.6a

(15.3) (9.5) (19.6) (6.8) (7.4)

77.1 31.6b 102.7b 24.7b 26.6

(24.3) (9.6) (24.9) (8.4) (9.0)

78.2 37.1 105.7 27.4 24.8

(30.2) (16.9) (30.6) (9.5) (11.1)

76.8 41.1 90.0 21.1 24.1

(30.7) (16.6) (28.5) (8.6) (7.9)

M M, S, I M, S, I M, S, I M

216.4a 179.4a 207.2a 165.7a 146.8a

(46.1) (43.4) (47.7) (41.4) (33.9)

188.2 188.0a 219.3a 205.0a 192.2a

(51.9) (46.1) (64.6) (43.0) (45.0)

314.2 313.2 340.4 304.2 301.1

(69.4) (12.2) (70.5) (76.8) (71.5)

328.7 324.4 354.4 325.2b 312.8

(65.1) (64.6) (63.0) (63.3) (70.0)

330.5 326.7 329.9 293.9 291.8

(62.5) (61.4) (69.5) (67.3) (60.3)

M M M M, S M

Note: M ¼ main effect of movement; S ¼ main effect of shoes; I ¼ interaction between movement and shoes. a Significant differences in movement. Only differences compared with running are presented. b Significant differences in shoes. Only differences compared with the athletes’ own shoes are presented. # Highest values for each region are shown in bold type face.

S, I S, I S S

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Table II. Means and standard deviations of pressure parameters for the supporting leg#.

Movement

Supporting leg

Run

Lunge

Shoe

Advance

Retreat

Nike Ballestra

Peak pressure (kPa) Heel 216.4 (63.5) 84.6a (29.0) Midfoot 150.7 (29.0) 71.2a (21.5) Forefoot 280.0 (80.7) 207.8a (86.7) Hallux 277.5 (88.3) 170.2a (52.2) Toes 154.8 (36.6) 87.7a (35.0)

47.2a 61.0a 362.5a 343.5a 159.5

(26.3) (18.8) (27.5) (148.1) (38.2)

39.1a 55.7a 289.3 352.7a 180.7

integral (N s) 38.9 (16.7) 82.3a (39.3) 35.6 (11.3) 51.2a (25.8) 113.7 (30.0) 128.3a (46.3) 21.4 (7.0) 39.9a (21.5) 20.9 (6.0) 25.3 (16.9)

6.0a 8.7a 89.5 26.5a 16.8a

(5.3) (8.0) (31.7) (12.7) (5.9)

4.2a 5.2a 53.5a 20.3 15.2a

(2.1) (4.3) (18.3) (6.4) (5.9)

29.2b 20.4 105.2b 25.8 20.0

171.4 197.4 249.6 233.8 230.0

(129.6) (61.3) (45.2) (43.6) (40.9)

115.7a 136.4a 197.2a 191.8a 177.0a

(54.9) (63.5) (46.8) (36.6) (35.0)

269.1 298.3 363.0 332.3 318.0

Force–time Heel Midfoot Forefoot Hallux Toes

Contact time (ms) Heel 187.9 (9.2) Midfoot 227.4 (7.5) Forefoota 265.3 (49.5) Hallux 232.9 (38.7) Toes 234.2 (35.5)

622.6a 635.7a 717.8a 682.2a 604.6a

(161.5) (178.7) (127.6) (124.9) (147.5)

(23.1) 85.9b (24.7) (23.6) 78.8 (20.4) (113.0) 254.5b (82.3) (88.3) 272.8 (66.7) (52.7) 152.2 (31.7)

Adidas FL

Athletes’ own shoes

Main effects and/or interaction

99.7 93.9 293.3 292.0 137.5

(34.4) (24.2) (106.0) (72.6) (39.3)

104.9 81.3 306.9 293.0 147.4

(29.0) (17.7) (108.7) (65.1) (39.3)

M, S, I M, S, I M, S, I M M

(15.0) (9.6) (39.3) (9.1) (8.0)

26.1b 26.7 99.5b 28.8b 19.3

(11.8) (13.4) (30.6) (11.3) (8.0)

42.4 28.4 83.9 26.4 19.3

(16.1) (2.6) (14.0) (9.6) (7.0)

M, M, M, M, M

(86.1) (84.5) (62.4) (59.2) (14.0)

281.7 316.5 369.0 350.1 320.3

(77.0) (80.2) (54.3) (54.3) (75.9)

272.4 282.8 340.3 323.2 296.1

(87.2) (72.6) (66.7) (55.4) (78.0)

M M M M M

S, S, S, S,

I I I I

Note: M ¼ main effect of movement; S ¼ main effect of shoes; I ¼ interaction between movement and shoes. a Significant differences in movement. Only differences compared with running are presented. b Significant differences in shoes. Only differences compared with the athletes’ own shoes are presented. # Highest values for each region are shown in bold type face.

midfoot, for each shoe model, higher peak pressures were detected for the lunge and running compared with the advance and retreat (P 5 0.01). For each shoe model, a significantly higher force–time integral were found for the lunge in the midfoot, forefoot, and hallux compared with the advance, retreat, and running (P 5 0.01). Significant main effects for movement type were detected for residual parameters (P 5 0.01) (Table I).

Peak pressure analysis revealed characteristic patterns for the three fencing-specific movements (Figure 2). The lunge resulted predominantly in loading of the heel and hallux, with average peak pressures of 551 kPa and 255 kPa, respectively.

Furthermore, the heel and midfoot showed higher peak pressures during the lunge compared with the advance, retreat, and running. During the lunge, similar peak pressures were recorded for the Nike and Adidas shoes in the heel (average peak pressure of 486 kPa and 499 kPa, respectively) and in the midfoot (average peak pressure of 144 kPa and 143 kPa, respectively). In addition, the force–time integral and contact time were significantly greater during the lunge compared with the other athletic tasks.

The advance resulted in loading mainly on the heel and hallux, with average peak pressures of 314 kPa and 229 kPa, respectively. In addition, the lesser toes had lower peak pressure compared with the lunge,

retreat, and running. The force–time integral and contact time beneath the heel were greater during the advance compared with running.

For the retreat, the highest peak pressures were found in the hallux and forefoot, with average figures of 341 kPa and 285 kPa, respectively. The hallux and forefoot had higher peak pressures during the retreat than during the lunge, advance, and running.

In addition, the midfoot had lower peak pressure than the advance, lunge, and running. The force– time integral and contact time were lower compared with running, except for the force–time integral under the heel and hallux, and contact time under the heel.

During running, high peak pressures were recorded under the forefoot and hallux, with averages of 280 kPa and 277 kPa, respectively. Compared with running, peak pressures were higher for some foot regions during the three fencing-specific tasks.

Increases of 255% and 145% were observed for the heel in the lunge and advance, respectively. In the retreat, an increase of 123% was found for the hallux.

Significant main effects for shoe model were observed in the forefoot and hallux for peak pressure, and in the hallux for contact time (P 5 0.01). For peak pressure, a significant decrease was observed in the forefoot for the Nike shoe compared with the athletes’ own shoes, and in the hallux for the Nike shoe compared with the athletes’ own shoes and the

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Figure 2. Plantar pressure measurement during the advance, retreat, lunge, and running, in a right-handed fencer.

Adidas shoe. Furthermore, the Adidas shoe recorded a significantly higher contact time in the hallux than the athletes’ own shoes and the Nike shoe (Table I).

Supporting leg Significant interactions between movement and shoe model were found in the heel, midfoot, and forefoot for peak pressure, and in the heel, midfoot, forefoot, and hallux for force–time integral (P 5 0.05). Simple main effects analyses of the interactions indicated that peak pressure in the heel, for each shoe model, was significantly lower for the fencing-specific movements compared with running (P 5 0.01); the lunge resulted in higher peak pressures than the advance and retreat (P 5 0.01). In the midfoot, for each shoe model, lower peak pressures were detected for the fencing movements than for running (P 5 0.01).

With the athletes’ own shoes, the midfoot recorded lower peak pressure in the retreat compasred with the advance and lunge (P 5 0.01).

For each shoe model, significantly higher peak pressures were recorded in the forefoot for the lunge compared with the advance, retreat, and running (P 5 0.01); lower peak pressures were observed for the forefoot when performing the lunge compared with the other athletic tasks (P 5 0.01).

Significant main effects for movement type were detected for the hallux and toes (P 5 0.01) (Table

II). During the advance and retreat, peak pressure was higher compared with the lunge and running.

Compared with running, peak pressures were higher for some areas during the fencing tasks. An increase of 129% for the forefoot was found in the advance.

During retreat, an increase of 129% was observed for the hallux.

Simple main effects analyses of the interactions indicated that the force–time integral, for each shoe model, in the heel, midfoot, forefoot, and hallux was higher during the lunge compared with the advance and retreat (P 5 0.01). Significant main effects for movement type were detected in the toes: the force–time integral was higher when performing the lunge than when performing the advance and retreat.

Significant main effects for movement type were found in all regions for contact time (P 5 0.01). A significantly higher contact time was found, in all regions, when performing the lunge compared with the advance, retreat, and running.

Peak pressure analysis revealed similar loading patterns for the three fencing-specific tasks. The lunge, advance, and retreat resulted in loading mainly on the forefoot and hallux. In addition, the heel and midfoot had lower peak pressures for all fencing tasks compared with running. The force– time integral and contact time, for forefoot and hallux, showed similar loading characteristics.

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Discussion In this study, in-shoe plantar pressure analysis was used to determine foot loading characteristics during three different fencing-specific movements. The lunge, retreat, and advance showed characteristic loading patterns of the foot. During the lunge and advance, participants recorded the highest peak pressures in the lunge leg under the heel and hallux, and the highest force–time integral beneath the heel and forefoot. The retreat showed high peak pressures in the forefoot and hallux. This result is consistent with the findings of Geil (2002), who found high peak pressures in the heel region of the lunge leg and in the forefoot region of the supporting leg when performing three fencing-related movements. This could be explained by the specific technique of the lunge: the foot loading starts with a dynamic landing on the heel and with a rapid transfer of the centre of pressure to the hallux. The fencer remains for a short time in the lunge position, pushing on the rear foot, before recovering to the En Garde position.

In the supporting leg during the advance movement, plantar pressure was higher in the forefoot and hallux regions compared with the more explosive lunge movement. When fencers launch a lunge, their body weight is transferred to the supporting leg.

Fencers move the body forward by pushing off from the trailing foot. The heel of the front foot touches the ground first. Although plantar pressure is higher in the forefoot and hallux, more load is shifted to the heel and midfoot compared with the advance and retreat, because fencers require good balance for a fast recovery into the En Garde position.

Although comparisons with other studies are not possible due to differences in sport-specific shoe models, areas of interest, and specific movements, the results of the present study are in general agreement with those for soccer players when comparing peak pressures during running (Eils et al., 2004; Orendurff et al., 2008; Whong et al., 2007).

Compared with running, the lunge showed higher peak pressures in the heel, midfoot, and toes region in the lunge leg. Compared with running, both the advance and lunge recorded significantly lower peak pressures beneath the forefoot. Beneath the hallux and forefoot, the retreat produced higher peak pressures than running. The supporting leg showed lower peak pressures and force–time integrals in the heel and midfoot in running versus the advance and in running versus the retreat. However, both the advance and retreat showed higher peak pressures beneath the forefoot and hallux than running.

High impact forces have been suggested to increase the risk of overuse running injury, due to the intensity of shock waves damaging the musculoskeletal structures surrounding the foot and ankle

(Clinghan, Arnold, Drew, Cochrane, & Abboud, 2007; Herelija, 2004; Scotto & Gaudebert, 1981). In fencing, peak pressure under the heel of the lunge leg is much higher than during running. These findings could help shoe designers to introduce elements for reducing impact forces experienced by the lower limb in order to prevent chronic overuse injuries.

Direct comparisons between the lunge leg and the supporting leg are not useful due to the uniqueness of fencing-specific movements and the asymmetric positioning of the athletes. However, a clear difference between the lunge leg and supporting leg was observed in the advance and retreat for the pressure under the heel and midfoot.

The results of this study indicate high peak pressures in the heel, forefoot, and hallux region during fencing movements. The comparison of shoe types revealed that the new shoe models have a significant influence on peak pressure, the force–time integral, and contact time in specific foot regions. In general, the two new shoe models (Nike Ballestra and Adidas Adistar Fencing Lo) showed similar cushioning characteristics when compared with the fencers’ own shoes (Figure 3). In the lunge leg, the Nike shoe showed significantly lower force–time integrals compared with the athletes’ own shoes during lunge for midfoot. Furthermore, in the supporting leg, the Nike shoe showed significantly lower peak pressures compared with the athletes’ own shoes for advance and retreat in forefoot.

However, it should be acknowledged that this study focused only on foot loading and cushioning. Before drawing any definitive conclusions concerning the relationship between cushioning and risk of injury, the durability of insoles and midsoles should be investigated. Furthermore, shear stress at the sole of the foot may play an additional role in the development of overuse injuries and should be considered when interpreting the results. Friction blisters in the lower extremity, as an expression of high shear forces between the shoe and the ground, are common in fencers. The inability of the in-shoe pressure measurement system to investigate shear forces could lead to underestimation of the shoe’s ability to attenuate plantar pressures during fencing movements.

The foot of the lunge leg in particular is exposed to an increased load compared with running, irrespective of the shoe worn. The heel, for example, experienced a doubling in peak pressure, force–time integral, and contact time during the lunge compared with running. Shoe cushioning characteristics should be considered as an extrinsic risk factor for overloading of the lower limbs (Kelm et al., 2003).

Meniscal and chondral lesions of the knee should be considered as an expression of such repetitive tasks in which high-load demands are placed on the foot

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Figure 3. Peak pressure by foot region (heel, midfoot, forefoot, hallux, and toes) for the three fencing-specific movements (lunge, advance, and retreat) and running. White bars: Own fencing shoe; grey bars: Adistar Fencing Lo shoe; black bars: Nike Ballestra shoe.

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(Kelm, Anagnostakos, Deubel, Schließing, & Schmitt, 2004).

Harmer (2008b) suggested teaching athletes to check insole wear and to maintain good quality insoles, so as to reduce the incidence of shear stress injuries, such as friction blisters at the first metatarsal head and at the Achilles tendon of the supporting leg.

The results of this study indicate that improved cushioning beneath the heel and metatarsal heads could be advantageous after an injury or in preventing an injury during competition or training. In addition, fencers should be limited in performing high-demand tasks, especially the lunge, early during recovery from an injury.

Previous literature has indicated that the speed of movements can influence plantar pressure distribution (Hennig & Milani, 2000; Rosenbaum, Hautmann, Gold, & Claes, 1994). One potential limitation of the study is that the athletes’ own shoes had an average wear-time of 5 months, and we did not record the exposure time of training and competition of the athletes. However, differences between used and new shoes are a clear indication of the fast wear in this short period.

In conclusion, the present results indicate that plantar pressure during fencing shows characteristic loading patterns in the lunge leg and in the supporting leg. During the lunge and advance, the load is mainly located in the posterior to middle portion of the plantar surface for the lunge leg and in the anterior portion for the supporting leg. The retreat resulted in loading mainly of the anterior portion of the plantar surface in both feet. As a consequence, shoe designs could gain from modifications aimed at reducing the loads in these regions.

Acknowledgements The authors thank Nike, Inc. (Oregon, USA) for financial support as well as all participating athletes and coaches. We would also like to thank the anonymous reviewers for their very helpful comments.

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