Gesellschaft für Orthopädisch-Traumatologische Sportmedizin

Vorfußlauf

Privatdozent Dr. Markus Walther entkräftet ein Vorurteil

Nach einer Studie mit 2000 Läufern: Der Vorfußlauf schützt nicht vor Überlastungsproblemen

Seit einigen Jahren wird das Laufen auf dem Vorfuß von einigen “Experten” als das Allheilmittel gegen laufassoziierte Verletzungen propagiert. Die Auswertung der Daten von über 2000 Läufern im Rahmen einer epidemiologischen Untersuchung von Privatdozent Dr. Markus Walther, Oberarzt am Lehrstuhl für Orthopädie der Universität Würzburg, stellt diesen Zusammenhang jedoch in Frage. Vorfuß- und Rückfußlauf beinhalten durch die grundsätzlich andere Art, sich zu bewegen, das Risiko für unterschiedliche Überlastungsprobleme. Eine Überlegenheit des Vorfußlaufes gegenüber dem Rückfußlauf bezüglich der Verletzungshäufigkeit besteht jedoch nicht.

In verschiedenen Szenebüchern wird von einigen Experten der Vorfußlauf als die Möglichkeit dargestellt, durch das Laufen hervorgerufene Verletzungen vorzubeugen oder diese ganz zu vermeiden. Es wird dabei auf die vermeintlich natürlichere Art der Fortbewegung hingewiesen, die man bei Läufern vom afrikanischen Kontinent immer wieder beobachten kann. Im gleichen Atemzug wird dann auf die hohe Rate der laufassoziierten Verletzungen verwiesen. Immerhin kommt es bei 30 bis 50 Prozent der Läufer einmal pro Jahr zu Beschwerden, die in Zusammenhang mit dem Laufsport stehen.

Wird der Vorfuß- mit dem Rückfußlauf verglichen, so handelt es sich um grundsätzlich andere Bewegungsabläufe. Beim Rückfußlauf setzt der Sportler zuerst mit der Ferse auf, gefolgt von einer Kippbewegung im unteren Sprunggelenk (Pronation), um sich dann über den Vorfuß abzudrücken. Beim Vorfußlauf wird der Boden ausschließlich mit dem Vorfuß berührt. Nach einer kurzen Phase des Bodenkontaktes drückt sich der Läufer wieder nach vorne ab. Daher wird der Vorfußlauf bevorzugt bei kurzen und schnellen Distanzen eingesetzt, von Leistungssportlern jedoch auch bei langen Strecken bis hin zum Marathon.

Unabhängig vom Laufstil ist der Läufer gezwungen, beim Bodenkontakt sein Körpergewicht abzufangen und dabei seine natürlichen Dämpfsysteme einzusetzen. Beim Rückfußlauf ist dies die Pronationsbewegung im Rückfuß, die zu einer entsprechend hohen Belastung der am Innenknöchel liegenden Tibialis-posterior-Sehne führt, verbunden mit einer Beugung in Sprunggelenk, Knie und Hüfte. Überlastungsreaktionen beim Rückfußläufer betreffen daher bevorzugt die Sehnenregion am Innenknöchel.

Der Vorfußläufer fängt sein Körpergewicht über die Wadenmuskulatur und die Achillessehne ab. Entsprechend häufiger finden sich beim Vorfußläufer Überlastungsreaktionen an diesen Strukturen.

Die statistische Auswertung epidemiologischer Daten zeigt klar, dass das Risiko, eine laufassoziierte Verletzung zu erleiden, für Vorfuß- und Rückfußläufer ähnlich hoch ist. Wenn es zu Problemen kommt, sind jedoch unterschiedliche Regionen am Fuß betroffen.

Tipp:

Wenn Sie über viele Jahre beschwerdefrei Laufsport ausüben, gibt es zumindest aus sportorthopädischer Sicht keinen Grund, den Laufstil zu ändern. Gerade im fortgeschrittenen Alter ist das Risiko groß, dass es durch eine Umstellung des Laufstils vom Rückfußlauf auf den Vorfußlauf zu Überlastungsreaktionen im Bereich der Achillessehne kommt, die häufig nur sehr schwer behandelbar sind. Das Risiko mit laufassoziierten Verletzungen konfrontiert zu werden, ist statistisch für Vorfußläufer genauso hoch wie für Rückfußläufer, auch wenn in beiden Gruppen unterschiedliche Verletzungsmuster dominieren.

PD Dr. Markus Walther, 7. April 2005

Privatdozent Dr. Markus Walther ist Oberarzt am Lehrstuhl für Orthopädie der Universität Würzburg und betreut den Schwerpunkt Fußorthopädie. Er ist Verfasser von zahlreichen Publikationen aus dem Bereich Sportmedizin, Fußorthopädie und Biomechanik sowie Träger mehrer wissenschaftlicher Auszeichnungen, darunter der Arthur-Vick-Preis, der DEGUM-Preis und der Michael-Jäger-Preis der GOTS 2003. Er ist Mitglied des GOTS-Vorstandes und des DAF-Fellow-Kreises. Seine aktuellen wissenschaftlichen Schwerpunkte sind die Sporttraumatologie des Fußes, präventive Biomechanik in der Sportmedizin sowie die Epidemiologie von laufassoziierten Verletzungen. Dr.M.Walther@t-online.de

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