Relação entre alterações na cinemática da articulação subtalar e lesões na cadeia cinética proximal: uma revisão da literatura

Abstract

The movements of pronation and supination of the subtalar joint during gait are crucial for absorbing shocks and leverage, respectively, and should occur at the appropriate times and with appropriate magnitude. The relation between pronation and supination of the foot and lower limb rotation in both static posture and gait has been proposed and supported by biomechanical arguments. Due to these inter-relations between the kinematics of the subtalar joint and leg, the occurrence of foot hiperpronation or hipopronation can promote the development of lesions in the tibia, knee, sacroiliac joints pubis, and generate excessive loading in the spine. However, this argument requires support from studies that directly show the relations. Therefore, the objective of this study was to conduct a literature review to investigate the correlation between changes in kinematics and subtalar joints lesions in the proximal kinetic chain (lumbar spine, sacroiliac, hip, knee and stress fracture of tibia). We performed a search of electronic databases (PubMed, ScienceDirect, Google Scholar and SciELO), including articles published up to 2010, crossing the pronation, foot pronation and subtalar pronation descriptors, separately from low back pain, pain lumbopelvic, spinal pain, hip pain, anterior knee pain, patellofemoral pain syndrome, shin splints and stress fracture descriptors. From the analysis of abstracts and full reading of the articles pre-selected, it was included ten exploratory observational articles (cross-sectional, case-control and cohort), six items related to changes in the subtalar joint and lesions in the knee joint, three containing injured leg and one with chronic back pain. The results suggest that kinematic changes of the subtalar joint in static posture in functional activities (walking and down stairs) and during sports activities (running and landing from jumps), may be related to lesions in the proximal kinetic chain. Despite the small number of studies found, it was observed that lesions in the tibia, femur, knee and lumbar spine were correlated with the presence of hyperpronation or hypopronation or foot, which highlights the necessity of evaluating the kinematics of the foot and the subsequent intervention when these dysfunctions are related to lesions in the proximal kinetic chain.