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Footscan in the British Armed Forces

Having access to the right tools; both software and hardware, is an essential part of the job for any researcher. When Dr. Sharon Dixon of the University of Exeter first discovered Footscan at a footwear biomechanics conference in 1996, she knew she'd found them; and has used a combination of the analysis software and pressure plates ever since.

Fast forward to today, and Dr. Dixon has become well acquainted with the latest version of the software, Footscan 9. It has become a key part of her research, with the speed of data collection being the major advantage over previous versions. There are a number of reasons for this improved speed, namely in the way researchers can use the system. Instead of having to click ‘save’ every time a participant runs over the plate, Dr. Dixon can watch the steps on the screen and instruct each person to continue until sufficient data is collected, then store it all in one go. When working with large groups, such as the Royal Marines, every minute saved is invaluable.

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“One of the reasons I was not able to collect pressure data for the full cohort of military recruits in previous projects is because it would have taken too long. With Footscan 9, I can collect the information of one person in less than three minutes. Now, we can collect data from up to 60 recruits in two-and-a-half to three hours on a regular basis. I wouldn't have managed a fraction of that with the old system."

 

Naturally, being user-friendly is just one requirement for software like this. It also needs to provide results that can be acted upon and corroborated. For Dr. Dixon, Footscan has proven to be as effective in the field as it is in the classroom, particularly in the case of her research with the Royal Marines. In 2011, she began to use Footscan in research projects demonstrating aspects of barefoot pressure data that were predictive of lower limb stress fracture risk. These results have helped to support changes in footwear and have provided evidence to support later research.

“Between 2010 and 2012, metatarsal stress fractures were the main problem, and we found that high forefoot pressure increased risk of this injury. But since then, the footwear has changed, and the new boot seems to protect against this injury by lowering the localised load on the forefoot. So we can say, look, we’ve demonstrated this, and so we can provide an explanation for the reduction in this injury.” Those findings laid the groundwork for the project she began in 2018, collecting data from the roughly 800 soldiers who begin training each year. “The medical team is very much on board with trying to utilise this information,” she tells us. “This is only possible with the evidence base we have developed over many years. “They say, OK, you’ve provided us with evidence that these measures have been linked with increased risk, so let’s collect data for everyone that starts the program. Now we routinely collect barefoot walking and running pressure data at the start of Royal Marine training.”

 

With a sizeable evidence base taken from a conveniently homogenous group — a researcher’s dream from a scientific point of view — Dr. Dixon began to identify patterns, particularly with the number of tibial stress fractures or other overuse injuries and the potential relationship with pressure patterns. And while she says that much more data is required to confidently act in a preventative manner, previous studies have shown that the potential to do so is there.

 

While it may be some time before this latest round of data can inspire preventative change, the Royal Marines are already benefitting when it comes to recovering from injury. “What's really been nice is by doing this collection and working with the clinical team, we've found that this information can support treatment and rehabilitation. So, in addition to using research evidence, we've found that having baseline measurements when they start training has been really useful from a rehabilitation perspective. “So knowing what this person's foot strike and pressure pattern looked like before they were injured can be used to know what we're trying to get back to, or to identify possible factors influencing the injury occurrence. It's there straight away, as long as you've created that baseline data.”

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In March 2024, Forces News provided a behind the scenes look into how Footscan is being used in the latest research amongst the Royal Navy to minimise the risk of musculoskeletal injuries...

"At any one time around 10% of the total Royal Navy and Royal Marines population are medically downgraded – which means they are largely undeployable. Around half of these are musculoskeletal injuries. Armed forces around the world are having the same problem, so scientists are working together to try to solve it, with the Navy starting at the place where so many new sailors begin their careers – HMS Raleigh. This latest research is a collaboration between the Institute of Naval Medicine and the universities of Exeter, Bath and Southampton."

Dr. Joanne Fallowfield, from the Institute of Naval Medicine, told Forces News: "Historically we haven't focused on this bit of kit – we haven't focused on the person. There's kind of an implicit understanding that they will pick up the knowledge and what they should be eating, how they should be training as they go through training. But actually we haven't made it explicit that this bit of kit is as important as all the other pieces of kit, this makes everything else function. This is a huge project. The aim is to collect a large amount of data and then follow this cohort through, tracking their injuries. Hopefully, patterns will emerge that allow injuries in future recruits to be predicted, and then they can tailor training around each individual so they do not get hurt."

Lieutenant Colonel Erik Nielsen, a project lead at the Institute of Naval Medicine, said: "We don't know what we don't know at the moment. The nirvana is, as an individual joins we screen them either bio-mechanically or plantar pressure and we see red flags; ie we've seen that kind of pressure before, and we know there's a percentage chance that leads to a lower limb injury of some description. Might be something as easy as orthotics or just a little bit of extra strength training around a particular area for that individual. The start point is lower, potentially than what it was 10-15 years ago, so we need to ensure we understand that in the way we put our training programmes together and how we train the individuals and we need to understand that from prevention of injury. Collectively, all those assets put together, we'll be able to deliver something for this generation of recruits going forward."

Thank you to Dr. Sharon Dixon, Dr. Joanne Fallowfield and Lieutenant Colonel Erik Nielsen for sharing their thoughts and reasoning behind this fascinating research utilising Footscan.

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