title: The association of foot arch posture and prior history of shoulder or elbow surgery in elite-level baseball pitchers.
abstract: METHODS
  Case-control.
  
  
  OBJECTIVE
  The specific aim of this study was to examine the association between abnormal foot arch postures and a history of shoulder or elbow surgery in baseball pitchers.
  
  
  BACKGROUND
  Pitching a baseball generates forces throughout the musculoskeletal structures of the upper and lower limbs. Structures such as the longitudinal arch of the foot are adaptable to stresses over time. Repeated pitching-related stresses may contribute to acquiring abnormal foot arch postures. Inversely, congenitally abnormal foot arch posture may lead to altered stresses of the upper limb during pitching.
  
  
  METHODS
  A convenience sample of 77 pitchers was recruited from a Division I university team and a professional baseball franchise. Subjects who had a history of shoulder or elbow surgery to the pitching arm were classified as cases. Subjects who met the criteria for classification of pes planus or pes cavus based on longitudinal arch angle were classified as having abnormal foot arch posture. Odds ratios were calculated to examine the association between abnormal foot arch posture and pitching-arm injury requiring surgery.
  
  
  RESULTS
  Twenty-three subjects were classified as cases. The odds of being a case were 3.4 (95% confidence interval: 1.2, 9.6; P = .02) times greater for subjects with abnormal foot arch posture and 2.9 (95% confidence interval: 1.0, 8.1; P = .04) times greater for subjects with abnormal foot posture on the lunge leg.
  
  
  CONCLUSIONS
  Abnormal foot arch posture and a surgical history in the pitching shoulder or elbow may be associated. Because the foot and its arches are adaptable and change over time, the pathomechanics of this association should be further explored.
authors.affiliation: UHealth Sports Performance and Wellness Institute, Department of Physical Therapy, University of Miami Miller School of Medicine, Miami, FL.
authors.forename: Luis A
authors.initials: LA
authors.lastname: Feigenbaum
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Roach
authors.forename: Lee D
authors.initials: LD
authors.lastname: Kaplan
authors.forename: Bryson
authors.initials: B
authors.lastname: Lesniak
authors.forename: Sean
authors.initials: S
authors.lastname: Cunningham
mesh_terms: D000328:Adult; D001134:Arm Injuries / Q000503:physiopathology* / Q000601:surgery; D001484:Baseball / Q000502:physiology*; D016022:Case-Control Studies; D005528:Foot / Q000503:physiopathology*; D006801:Humans; D008297:Male; D055815:Young Adult