Association Between Running Shoe Characteristics and Lower Extremity Injuries

NewsBot · Sep 15, 2019

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Association Between Running Shoe Characteristics and Lower Extremity Injuries in United States Military Academy Cadets
Gary L. Helton, PT, DSc, SCS, OCS, Kenneth L. Cameron, PhD, MPH, ATC, CSCS, FNATA, Rebecca A. Zifchock, PhD, ...
The American Journal of Sports Medicine September 9, 2019

Background:
Running-related overuse injuries are very common among recreational runners, with the reported annual injury rates ranging from 39% to 85%. Relatively few large prospective cohort studies have been conducted to investigate injury risk associated with different running shoe characteristics, and the results of the existing studies are often contradictory.

Purpose/Hypothesis:
The purpose was to investigate the relationship between running shoe characteristics and lower extremity musculoskeletal injury. It was hypothesized that the risk of injury would be increased in individuals wearing shoes with minimal torsional stiffness and heel height compared with those wearing shoes with greater levels of torsional stiffness and heel height.

Study Design:
Cohort study; Level of evidence, 2.

Methods:
The study included 1025 incoming cadets. Shoe torsional stiffness and heel height were calculated and recorded. Demographic data were recorded and analyzed as potential covariates. Lower extremity injuries sustained over 9 weeks during cadet basic training were documented by use of the Armed Forces Health Longitudinal Technology Application and the Cadet Illness and Injury Tracking System. Kaplan-Meier survival curves were estimated, with time to incident lower extremity injury as the primary outcome by level of the independent predictor variables. Risk factors or potential covariates were carried forward into multivariable Cox proportional hazards regression models. Absolute and relative risk reduction and numbers needed to treat were calculated.

Results:
Approximately 18.1% of participants incurred a lower extremity injury. Cadets wearing shoes with moderate lateral torsional stiffness were 49% less likely to incur any type of lower extremity injury and 52% less likely to incur an overuse lower extremity injury than cadets wearing shoes with minimal lateral torsional stiffness, both of which were statistically significant observations. Injury risk was similar among cadets wearing shoes with minimal and extreme lateral torsional stiffness.

Conclusion:
Shoes with mild to moderate lateral torsional stiffness may be appropriate in reducing risk of lower extremity injury in cadets. Shoes with minimal lateral torsional stiffness should be discouraged in this population.
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NewsBot · Oct 6, 2019

Asymmetric footwear among running-related injuries
C. Ramsey et al
October 2019Volume 22, Supplement 2, Pages S18–S19

Introduction: Running-related injuries (RRI) are well documented and highly prevalent among runners. Indeed, RRI are emergent properties of a complex system and cannot be deduced to a single risk factor. Nonetheless, effectively monitoring risk factors can improve the control and feedback mechanisms within the RRI system, and can help researchers and clinicians understand the interactions between risks and injury outcomes. Asymmetric footwear is one such risk factor that when evaluated in a field-based setting can provide objective data regarding the influence of specific footwear characteristics on RRI.

Purpose: To investigate the feasibility of conducting a prospective cohort study, for assessing the association between footwear asymmetry and RRI.

Methods: We conducted a prospective, repeated measures study (baseline, week 3, week 6, week 9 and week 12) designed to explore the feasibility of assessing the association between footwear asymmetry and RRI. Footwear measurements were taken at each time point using a reliable method of assessing footwear asymmetry (Ramsey, 2018). Preliminary statistics and feasibility data was extracted and analysed.

Results: A total of 27 participants were included in the study. Despite non-gender specific recruitment methods, all participants were female. Participant retention was low with 15/27 (56%) participants finishing the study. However, among the finishers, there was 99% adherence to the standardised training program and footwear assessment sessions and high satisfaction (80-92%) of study procedures. A total of 171 lower-limb problems were reported by the participants of these only 4% reported severe pain. The average pain severity across all participants was 6.0, (SD 7.7) on a scale of 0-100. The knee was the most affected location of pain (36%) and the highest number of problems were reported in week 6 (n = 18). Regarding the footwear asymmetry data, no large difference between means at any time point were found. Absolute footwear asymmetry scores (TAS) ranged from 1 mm-9 mm (mean 4 mm, 2 mm) at baseline and 1 mm to 6 mm at week 12. Preliminary statistics indicated that TAS for both the injured and non-injured limb have a significant effect on self-reported pain (p = 0.001; 0.000, respectively).

Conclusion: Conducting a full-sized prospective cohort study assessing the association of footwear TAS to RRI is possible after modifications to the recruitment methods to capture a greater number of participants to handle a drop-out rate of 44%. The use of objective footwear measurements allows specific information regarding footwear to be collected and analysed.
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NewsBot · Nov 29, 2019

Wearing Out Pattern of Sports Shoes and Muscle Imbalance in Lower Limb among Athletes-A Correlation Study
Motimath Basavaraj et al
Indian Journal of Physiotherapy and Occupational Therapy - An International Journal

Background

Muscle imbalance prevails among a lot of athletes. The most common muscle imbalances are seen in the lower limb. The muscle imbalances affect footwear. There are certain set of patterns which are seen in athletes. Hence we are trying to co-relate muscle imbalance and wearing out pattern of the shoes in athletes.

Aim/Objectives

To determine the correlation between pattern of wearing out of sports shoe and its relation with muscle imbalance in lower limb among athletes.

Method

Both male and female athletes between the age groups 18–35 years from various sports in the study. Wearing out pattern of the shoes will be noted down and athletes’ range of motion and strength of lower limb will be obtained.

Results

One way ANOVA was used for statistical analysis. The results showed that hip flexion ROM was significant with 81.59±4.47 (P<05) and external rotation with 0.24 9 (Fig 2) in relation with the wearing out pattern of the shoes. In ankle ROM, only dorsiflexion of right foot was significant with 7.50±3.82 (P<05). Muscle length of hamstring showed significance i.e. 81.02 (p<05). In case of strength of hip muscles, the internal rotation right and extensors left side were statistically significant i.e. 16.5±50 (P<.05).

Conclusion

Present study concludes that there is no single pattern of wearing out of footwear, it is the combination of two or more patterns that are seen in athletes with or without musculoskeletal problems.
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NewsBot · May 29, 2020

Effect of shoe design on distance running injury risk and performance
Richards, Craig Edward
University of Newcastle Research Higher Degree Thesis 2020

In the 1960s, the soles of distance running shoes began their structural evolution from flat uncushioned leather to multilayered synthetic rubber and foam. The defining feature of these modern running shoes was the introduction of a ramped cushioned midsole, and then later, the use of less compliant materials inserted medially into shoes worn by pronators and over-pronators. This combination of cushioning, ramp and varying degrees of pronation control remain the key features of shoe design today and the focus of running shoe prescription by health care professionals. In 2009, I co-authored a systematic review that asked whether this approach to running shoe prescription was evidence based. Whilst it came as a shock to many and was met with a degree of anger by some, the answer to this question was quite simply “No”. No longitudinal randomised controlled trials (RCTs) had been undertaken to assess the safety or efficacy of this approach despite having been considered the gold standard for several decades. This paper is presented in Chapter 2. In the 9 years that have followed, there has been a flurry of interest in filling this void of evidence and I provide an updated review of this literature in Chapter 1, as well as reviewing the epidemiology of running injuries, theories of injury causation including the barefoot hypothesis and further evolutions in shoe design. In Chapter 3 I present a cross-sectional survey of 1790 Australian recreational runner’s attitudes to research participation. Given the absence of randomised controlled trials studying running shoes in the literature I sought to assess what types of runners were prepared to participate in randomised controlled trials and the shoe types that they were prepared to test. I also wanted to know whether the cost barrier posed in purchasing shoes for such a study could be reduced by asking participants to contribute to the cost of the shoes they were asked to test. The responses to this survey suggested that a large adequately powered RCT is possible with an Australian cohort, but that interventions involving uncushioned shoes or barefoot running would be difficult to recruit for, as would studies of sub-populations of runners such as older runners, novices, orthotic wearers and runners with injuries involving sites other than the knee or calf. Promisingly, 85% of runners were prepared to contribute to the cost of their intervention shoes. The hypothesis that barefoot running may be superior to running in shoes is explored in Chapter 4. Presented are the findings of a pilot RCT of 28 novice distance runners, 17 who undertook the 12-week structured training program on a grass athletics track in bare feet with the remainder completing the training program in a ramped cushioned shoe with pronation control. In this study I asked (i) whether recruitment, compliance and retention could be achieved at sufficient levels to undertake a full scale barefoot running RCT, (ii) whether barefoot running on a grass track was hazardous in terms of injuries to the plantar surface of the foot, and (iii) to provide sample size estimates for future studies into the effects of barefoot running on injury rates enjoyment of running, motivation, and improvement in speed, endurance and running economy. The pilot RCT failed to meet its recruitment, compliance and retention targets and significant modifications to the study design are proposed to improve these outcomes. Barefoot running was found to be low risk for plantar surface injuries. Barefoot running was found to be associated with potentially beneficial effects on motivation and enjoyment of running. Chapter 5 presents the findings of a RCT of 41 recreational distance runners who self-identified as heel-strikers. They were randomly allocated to either receive advice to change their foot-strike to a non-rearfoot strike and wear a 4mm ramped cushioned shoe with a rubber membrane forefoot cushioning system, or continue their self-assessed heel strike gait in a 12mm ramped cushioned shoe. This study sought to collect preliminary data on the combined effects of this deliberate change in foot-strike and shoe type on 5km time trial performance, injury rates, motivation, comfort and enjoyment. No conclusions could be drawn as no statistically significant differences were observed and the lack of statistical power prevented conclusions being drawn from these negative findings. In Chapter 6 I ask whether flat uncushioned, flat cushioned, 1-5mm ramped and >5mm ramped cushioned differentially affect training volume, injury rates, 5km performance, motivation, enjoyment of running or shoe comfort when runners are given shoe group specific transition advice but control their own adaptation strategy. An RCT of 157 recreational distance runners is reported where participants were randomly allocated to transition into either a flat uncushioned, flat cushioned, 1-5mm cushioned or >5mm ramped cushioned running shoe over 12 months. Only the flat uncushioned group differed from the >5mm ramped cushioned group with a reduced distance run in the intervention shoe and a decreased rating of the comfort of the shoe. No conclusion could be drawn from the lack of statistically significant association between shoe group and injury rates, 5km performance, motivation, or enjoyment of running due to the study being under-powered. In Chapter 7 I present an updated synthesis of the best evidence to date for the role of cushioning, ramp, pronation control and barefoot running in injury prevention, distance running performance, enjoyment, motivation and shoe comfort. Areas of residual uncertainty are identified, and suggestions are made for both future research and re-negotiating the relationship between research and industry to ensure that running shoe science achieves its simplest objectives - helping runners to enjoy running fast and injury free.
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NewsBot · Jun 17, 2020

The effects of systematically altered footwear features on biomechanics, injury, performance, and preference in runners of different skill level: a systematic review
Fabian Hoitz et al
Footwear Science : 16 Jun 2020

Matching running footwear features to the functional needs of specific groups of runners stratified according to their training status or running experience has the potential to improve footwear preference, enhance running performance, and reduce the risk of running-related injuries. The complexity of modern running shoes in combination with the various functional needs of specific groups of runners, however, introduces many confounding factors, disguising what an appropriate shoe design should entail. As a result, it is crucial to identify and synthesise the effects of systematically modified running footwear features on lower extremity biomechanics, performance, injury risk, and footwear preference in runners of different skill levels to advance the knowledge of running biomechanics and footwear. The databases Scopus and PubMed were searched for related studies and 895 articles were identified. After the application of exclusion criteria, 68 articles remained and were arranged in a matrix that highlighted the investigated footwear feature and runner level. The effects of 20 footwear features on lower extremity biomechanics, injury, performance, and preference in novice, recreational, and high calibre runners were synthesised. Laced uppers with harder midsole materials in the forefoot/lateral regions of the shoe and softer materials in the rearfoot/medial regions increased comfort and thus likely preference. To increase performance, footwear should be constructed as lightweight as possible, and implement a range of different bending stiffness for individual needs. Injury risks at the knee joint were reduced in footwear with thinner midsoles. For high calibre runners, specifically, insoles should be custom moulded to the shape of the foot, and special attention needs to be payed to the elasticity of the upper, in order to avoid detrimental shifts in running patterns.
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NewsBot · Jan 7, 2022

Does choice of athletic footwear affect musculoskeletal injury risk in US Coast Guard recruits? A retrospective cohort study.
John J Fraser et al
preprint

Context: Musculoskeletal injuries (MSKIs) are ubiquitous during initial entry military training, with overuse injuries in the lower extremities the most frequent. A common mechanism for overuse injuries is running, an activity that is an integral part of United States Coast Guard (USCG) training and a requirement for graduation. Objective: Assess the effects of athletic footwear choice on lower quarter MSKI risk in USCG recruits. Design: Descriptive Epidemiological Study Setting: USCG Training Center, Cape May, NJ Participants: A retrospective cohort study was performed in which 1229 recruits (1038 males, 191 females) were allowed to self-select athletic footwear during training. A group of 2876 recruits (2260 males, 616 females) who trained under a policy that required obligatory wear of prescribed athletic shoes served as a control. Main Outcome Measures: Demographic data and physical performance were derived from administrative records. Injury data were abstracted from a medical tracking database. Multivariable logistic regression was used to assess group, age, sex, height, body mass, and run times on MSKI outcomes. Results: Ankle-foot, leg, knee and lumbopelvic-hip complex diagnoses were ubiquitous in both groups (experimental: 20.37 to 29.34 per 1000 recruits; control: 18.08 to 25.59 per 1000 recruits). Group was not a significant factor for any of the injuries assessed. Sex was a significant factor in all injury types, with female recruits demonstrating ~2.00 greater odds of experiencing running-related injuries (RRIs), overuse injuries, or any MSKI in general. When considering ankle-foot or bone stress injuries, the risk in female recruits was 3.73 to 4.11 greater odds than their male counterparts. Run time was a significant predictor in RRI, all overuse injuries, and for any MSKI in general. Conclusion: While footwear choice did not influence MSKI risk in USCG recruits, female sex was a primary, nonmodifiable intrinsic risk factor.
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NewsBot · May 22, 2022

An analytical framework to understand individual running-related injury risk response patterns to footwear
Patrick Mai, Leon Robertz, Johanna Robbin, ...
Proceedings of the Institution of Mechanical Engineers, Part P: Journal of Sports Engineering and Technology May 15, 2022

Running footwear is continuously being modified and improved; however, running-related overuse injury rates remain high. Nevertheless, novel manufacturing processes enable the production of individualized running shoes that can fit the individual needs of runners, with the potential to reduce injury risk. For this reason, it is essential to investigate functional groups of runners, a collective of runners who respond similarly to a footwear intervention. Therefore, the objective of this study was to develop a framework to identify functional groups based on their individual footwear response regarding injury-specific running-related risk factors for Achilles tendinopathy, Tibial stress fractures, Medial tibial stress syndrome, and Patellofemoral pain syndrome. In this work, we quantified the footwear response patterns of 73 female and male participants when running in three different footwear conditions using unsupervised learning (k-means clustering). For each functional group, we identified the footwear conditions minimizing the injury-specific risk factors. We described differences in the functional groups regarding their running style, anthropometric, footwear perception, and demographics. The results implied that most functional groups showed a tendency for a single footwear condition to reduce most biomechanical risk factors for a specific overuse injury. Functional groups often differed in their hip and pelvis kinematics as well as their subjective rating of the footwear conditions. The footwear intervention only partially affected biomechanical risk factors attributed to more proximal joints. Due to its adaptive nature, the framework could be applied to other footwear interventions or performance-related biomechanical variables.
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NewsBot · Oct 3, 2022

Does policy that provides choice in athletic footwear affect musculoskeletal injury risk in US Coast Guard recruits?
John J Fraser et al
BMJ Mil Health. 2022 Sep 29

Introduction: Musculoskeletal injuries (MSKIs) are ubiquitous during initial entry military training, with overuse injuries the most common. A common injury mechanism is running, an activity that is integral to US Coast Guard (USCG) training and a requirement for graduation. The purpose of this study was to assess the effects of a policy that allowed for athletic footwear choice on risk of lower quarter MSKI in USCG recruits.

Methods: A retrospective cohort study was performed that included 1230 recruits (1040 men, 190 women) who trained under a policy that allowed self-selection of athletic footwear and 2951 recruits (2329 men, 622 women) who trained under a policy that mandated use of prescribed uniform athletic shoes and served as controls. Demographic data and physical performance were derived from administrative records. Injury data were abstracted from a medical tracking database. Unadjusted risk calculations and multivariable logistic regression assessing the effects of group, age, sex, height, body mass and 2.4 km run times on MSKI were performed.

Results: Ankle-foot, leg, knee and lumbopelvic-hip complex injuries were ubiquitous in both groups (experimental: 13.13 per 1000 person-weeks; control: 11.69 per 1000 person-weeks). Group was not a significant factor for any of the injuries assessed in either the unadjusted or adjusted analysis, despite widespread reports of pain (58.6%), perceived injury attribution (15.7%), perceived deleterious effect on performance (25.3%), general dissatisfaction (46.3%) and intended discontinuance of use following graduation (87.7%).

Conclusion: MSKI continues to be a major source of morbidity in the recruit training population. The policy that allowed USCG recruits to self-select athletic footwear did not decrease or increase the risk of MSKI. While regulations pertaining to footwear choice did not influence injury outcomes, there was general dissatisfaction with the prescribed uniform athletic footwear conveyed by the recruits and widespread reports of discomfort, perceived deleterious effects from wear and intended discontinued use following training completion.
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NewsBot · Jan 5, 2023

Towards functionally individualized designed footwear recommendation for overuse injury prevention: A Scoping Review
Mai P, Robertz L, Robbin J, Bill K, Weir G, Kurz M, Trudeau MB, Hollander K, Hamill J, Willwacher S
Preprint from Research Square, 29 Dec 2022

Running shoes were categorized either as motion control, cushioned, or minimal footwear in the past. Today, these categories blur and are not as clearly defined. Moreover, with the advances in manufacturing processes, it is possible to create individualized running shoes that incorporate features that meet individual biomechanical and experiential needs. However, specific ways to individualize footwear to reduce individual injury risk are poorly understood. Therefore, the purpose of this scoping review was to provide an overview of (1) footwear design features that have the potential for individualization; (2) human biomechanical variability as a theoretical foundation for individualization; (3) the literature on the differential responses to footwear design features between selected groups of individuals. These purposes focus exclusively on reducing running-related risk factors for overuse injuries. We included studies in the English language on adults that analyzed: (1) potential interaction effects between footwear design features and subgroups of runners or covariates (e.g., age, gender) for running-related biomechanical risk factors or injury incidences; (2) footwear perception for a systematically modified footwear design feature. Most of the included articles (n = 107) analyzed male runners. Several footwear design features (e.g., midsole characteristics, upper, outsole profile) show potential for individualization. However, the overall body of literature addressing individualized footwear solutions and the potential to reduce biomechanical risk factors is limited. Future studies should leverage more extensive data collections considering relevant covariates and subgroups while systematically modifying isolated footwear design features to inform footwear individualization.
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Association Between Running Shoe Characteristics and Lower Extremity Injuries

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Association Between Running Shoe Characteristics and Lower Extremity Injuries

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Association between q-angle and foot posture with running-related injuries

Is there an association between plantar fasciitis and knee osteoarthritis?

Associations Between Calcaneal Enthesophytes and Osteoarthritis

Association between oral health and musculoskeletal injury

Association between overuse injury and biomechanics in runners

The Association Between Skin Blood Flow and Edema on Epidermal Thickness in the Diabetic Foot

Association between foot-care self efficacy beliefs and actual foot-care behaviour

Share This Page

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