Risk Factors for Lower Extremity Tendinopathies in Military Personnel

Brett D Owens, Jennifer Moriatis Wolf, Amber D Seelig, Isabel G Jacobson, Edward J Boyko, Besa Smith, Margaret A K Ryan, Gary D Gackstetter, Tyler C Smith, Millennium Cohort Study Team, Melissa Bagnell, Gina Creaven, Nancy Crum-Cianflone, James Davies, Nisara Granado, Dennis Hernando, Jaime Horton, Kelly Jones, Cynthia LeardMann, William Lee, Michelle Linfesty, Gordon Lynch, Hope McMaster, Sheila Medina-Torne, Amanda Pietrucha, Teresa Powell, Kari Sausedo, Beverly Sheppard, Katherine Snell, Steven Speigle, Martin White, James Whitmer, Charlene Wong, Brett D Owens, Jennifer Moriatis Wolf, Amber D Seelig, Isabel G Jacobson, Edward J Boyko, Besa Smith, Margaret A K Ryan, Gary D Gackstetter, Tyler C Smith, Millennium Cohort Study Team, Melissa Bagnell, Gina Creaven, Nancy Crum-Cianflone, James Davies, Nisara Granado, Dennis Hernando, Jaime Horton, Kelly Jones, Cynthia LeardMann, William Lee, Michelle Linfesty, Gordon Lynch, Hope McMaster, Sheila Medina-Torne, Amanda Pietrucha, Teresa Powell, Kari Sausedo, Beverly Sheppard, Katherine Snell, Steven Speigle, Martin White, James Whitmer, Charlene Wong

Abstract

Background: Overuse injuries have a significant impact on United States military service members, but research to date has been limited in its ability to assess occupational and behavioral risk factors.

Hypothesis/purpose: To prospectively identify risk factors for the development of lower extremity tendinopathy and plantar fasciitis in United States military personnel.

Study design: Descriptive epidemiology study.

Methods: Baseline data from the Millennium Cohort Study, a long-term observational cohort of military personnel, were utilized. Service members were enrolled in the cohort in 2001, 2004, and 2007. A total of 80,106 active-duty personnel were followed over 1 year for the development of patellar tendinopathy, Achilles tendinopathy, and plantar fasciitis. Regression analyses were used to estimate significant associations between each tendinopathy, plantar fasciitis, and demographic, behavioral, and occupational characteristics.

Results: Using medical records, 450 cases of Achilles tendinitis, 584 cases of patellar tendinopathy, and 1228 cases of plantar fasciitis were identified. Recent deployment was associated with an increased risk for developing plantar fasciitis (adjusted odds ratio [AOR], 1.27; 95% confidence interval [CI], 1.04-1.56). Moderate weekly alcohol consumption was marginally associated with an increased risk for Achilles tendinopathy (AOR, 1.33; 95% CI, 1.00-1.76). Overweight or obese individuals were more likely to develop Achilles tendinopathy and plantar fasciitis.

Conclusion: Lower extremity tendinopathies and plantar fasciitis are common among military service members, and this study identified several modifiable risk factors for their occurrence. These potential risk factors could serve as the focus for future preventive and intervention studies.

Keywords: Achilles tendinopathy; military deployment; patellar tendinopathy; plantar fasciitis.

Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: Dr Owens is a paid consultant for the Musculoskeletal Transplant Foundation and Mitek (Johnson & Johnson); he also receives a salary from the American Journal of Sports Medicine. The Millennium Cohort Study is funded through the Military Operational Medicine Research Program of the US Army Medical Research and Materiel Command, Fort Detrick, Maryland. The funding organization had no role in the design and conduct of the study; collection, analysis, or presentation of data; or preparation, review, or approval of the manuscript. Dr Boyko’s participation in this research was supported by VA Puget Sound, Washington.

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