![]() ![]() The plantar flexion of the metatarsal heads results in a tightening of the plantar fascia. The foot is front pointing onto the distal toe phalanges. Lateral X rays within the climbing shoe show that the normal foot weight distribution onto the first and fifths metatarsal head and the heal is not given any more. In front pointing the proximal and mostly also the distal interphalangeal joints are flexed and the metatarsophalangeal joints are over extended (crimping toes). The foot shortens through supination and contraction of the digits. The shoe seize reduction forces the foot to conform the shoe and changes the biomechanical position of the foot within the shoe. The majority of climbing foot injuries result from wearing climbing shoes unnaturally shaped or too small in size. These special climbing shoes should facilitate the ability to stand on friction with straight toes and on edges with bent toes with precision and proper contact. Attributes like downturn, the concave shape that places pressure on the toes, and asymmetry, concentrating the pressure on the big toe, are basic elements of modern climbing shoes (Figure (Figure2). Shoes today have become specialized into the type of rock climbing one wants to do. in the 1970 s, and a new generation of rock shoes with sticky rubber was just around the corner. Leather boots were replaced by the legendary E.B. An extra pair of socks was often worn, and the foot was held in a leather cast that protected it but also took away any sensitivity and the need for strength in the toes. Up until about 40 years ago, most alpine climbing and rock climbing was done in heavy mountain boots. Nevertheless as e.g., the study by Neuhof et al showed, that the mostly injured region were the feet (19.2%), these injuries are of a high importance and need to be examined further (Table (Table1 1). Studies and reports on lower limb injuries and overuse syndromes are rare. This may be based on the fact that various upper limb injuries as e.g., pulley injuries, lumbrical shift syndrome, extensor hood syndrome or epiphyseal fatigue fractures in young climbers are new pathologies and rather specific for the sport. Scientific research in rock climbing up to date focused extensively on upper limb injuries. ![]() Also, besides the acute lower limb injuries the incidence of chronic feet problems increases in the higher levels of sport climbing. In summary, most of the studies found that overuse injuries are mainly affecting the upper extremity, while acute traumatic injuries are more frequently located on the lower extremity. Neuhof et al in contrast found a even injury distribution between the upper (42.6%) and lower extremities (41.3%) (Figure (Figure1). Killian et al found a significant correlation between the incidence of ankle sprains and bouldering as well as in between ankle sprains and sport climbing. In another recent study on rock climbing injuries, traumatic injuries involved the lower extremities (foot, toe and ankle) in 50% while upper extremities accounted for 36% of the injuries. Largiadèr et al found in an inquiry among 332 climbers, that 34.4% suffered from injuries and that 34.6% of these were feet injuries. Backe et al reported that out of all acute climbing injuries 50% involved the foot, toe and ankle. The authors suggest that these findings may be partially explained by the minor nature of many rock climbing related injuries recalled by participants in the other surveys. Bowie et al found most fractures (63%) in rock climbers on the lower extremity, primarily the ankle, tibia or fibula. In contradiction two studies that analysed climbing injuries treated in American hospitals or emergency rooms reported that most climbing injuries involved the lower extremities and resulted from big swings into the wall or big falls. Schöffl et al analysed 604 injured climbers (sport climbing, indoor climbing) and reported 247 of 604 (40.9%) injuries involved the hand, 9.1% the foot. So far, most research indicates that the upper extremity to be the most injured body region in non-alpine rock-climbing. Many scientific climbing papers only present case studies or common hand injuries and are therefore not suitable for injury distribution analysis. ![]() The literature data on injury distribution between the upper and lower extremity is inconsistent. ![]()
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