Distance running is a popular recreational activity despite high rates of overuse injury.
The efficacy of wearing minimalist shoes to prevent injury has been debated. We
previously reported that minimalist runners are more likely to experience site-specific
lower extremity pain; however, no clear relationship has been established between shoe
type, forefoot (FF) shape (Egyptian, Morton’s, or square), and pain. Therefore, the
purpose of this study is to examine self-reported pain in the lower limbs in minimalist
and traditionally shod runners with various forefoot types. Methods: Following
consent, 48 experienced runners (age: 27.5 ±9.3 yrs, hgt: 172.2 ±10.2 cm, mass: 70.6
±15.6 kg, gender: 18M/30F) who reported running at least 10 miles a week for the past
three months, completed a visual analog scale (VAS) about pain they experience in
five common sites of injury: knee, ankle, calf, shin, and foot. A score of ≥3 on the VAS
was considered pain. Shoes were categorized as either minimalist (n=40 feet, midsole
drop <4mm) or traditional (n=56 feet, midsole drop>4mm). Superior view photographs
were taken of the FF and were categorized as Egyptian (EF) (n=73 feet, typical foot
with Hallux the most distal toe), Morton’s (MF) (n=10 feet, 2nd toe longer than Hallux),
or square (SQ) (n=13 feet, Hallux and 2nd toe equal length). Separate three-factor chisquare
analyses determined if shoe type (minimalist, traditional) and forefoot type (EF,
MF, SQ) were related to pain (yes, no). (α=0.05). Results: More minimalist runners
with EF reported pain (61.8%; p=0.004) when compared to MF (50%) or SQ (20%).
More minimalist runners with EF reported calf pain (77.8%; p=0.028) than those with
MF (0%) or SQ (20%). FF type did not relate to pain at any other site. Conclusion:
Runners with EF are more likely to report pain in at least one location, and specifically
in the calf, than runners with other FF shapes when wearing minimalist vs traditional
shoes. Minimalist shoes encourage the runner to strike the ground with the forefoot;
however, this requires more eccentric loading of the calf musculature and Achilles
tendon. Our minimalist runners with EF reported more calf pain than those with other
FF types. Other FF types may be better able to absorb the foot contact and muscle
forces better than a more typical foot when wearing minimalist shoes.
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