title: The influence of muscle fatigue on electromyogram and plantar pressure patterns as an explanation for the incidence of metatarsal stress fractures.
abstract: BACKGROUND
  Stress fractures are common overuse injuries in runners and appear most frequently in the metatarsals.
  
  
  OBJECTIVE
  To investigate fatigue-related changes in surface electromyographic activity patterns and plantar pressure patterns during treadmill running as potential causative factors for metatarsal stress fractures.
  
  
  METHODS
  Prospective cohort study with repeated measurements.
  
  
  METHODS
  Thirty experienced runners volunteered to participate in a maximally exhaustive run above the anaerobic threshold. Surface electromyographic activity was monitored for 14 muscles, and plantar pressures were measured using an in-shoe monitoring system. Fatigue was documented with blood lactate measurements.
  
  
  RESULTS
  The results demonstrated an increased maximal force (5%, P < .01), peak pressure (12%, P < .001), and impulse (9%, P < .01) under the second and third metatarsal head and under the medial midfoot (force = 7%, P < .05; pressure = 6%, P < .05; impulse = 17%, P < .01) toward the end of the fatiguing run. Contact area and contact time were only slightly affected. The mean electromyographic activity was significantly reduced in the medial gastrocnemius (-9%, P < .01), lateral gastrocnemius (-12%, P < .01), and soleus (-9%, P < .001) muscles.
  
  
  CONCLUSIONS
  The demonstrated alteration of the rollover process with an increased forefoot loading may help to explain the incidence of stress fractures of the metatarsals under fatiguing loading conditions.
authors.affiliation: Funktionsbereich Bewegungsanalytik (Movement Analysis Lab), Klinik und Poliklinik für Allgemeine Orthopädie (Orthopaedic Department), University Hospital Münster, Germany.
authors.forename: Roger
authors.initials: R
authors.lastname: Weist
authors.forename: Eric
authors.initials: E
authors.lastname: Eils
authors.forename: Dieter
authors.initials: D
authors.lastname: Rosenbaum
mesh_terms: D000328:Adult; D004576:Electromyography; D005080:Exercise Test; D005260:Female; D005528:Foot / Q000503:physiopathology; D015775:Fractures, Stress / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008328:Man-Machine Systems; D008682:Metatarsal Bones / Q000293:injuries / Q000503:physiopathology*; D018763:Muscle Fatigue / Q000502:physiology*; D018482:Muscle, Skeletal / Q000503:physiopathology; D011312:Pressure; D011446:Prospective Studies; D012420:Running / Q000502:physiology*; D016474:Weight-Bearing / Q000502:physiology*