Zero drop running shoes increased injury risk for regular runners

NewsBot · Aug 9, 2016

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Influence of the Heel-to-Toe Drop of Standard Cushioned Running Shoes on Injury Risk in Leisure-Time Runners
A Randomized Controlled Trial With 6-Month Follow-up
Laurent Mailsoux, PhD, Nicolas Chambon, PhD, Axel Urhausen, Prof., MD and Daniel Theisen, PhD
Am J Sports Med August 8, 2016

Background: Modern running shoes are available in a wide range of heel-to-toe drops (ie, the height difference between the forward and rear parts of the inside of the shoe). While shoe drop has been shown to influence strike pattern, its effect on injury risk has never been investigated. Therefore, the reasons for such variety in this parameter are unclear.
Purpose: The first aim of this study was to determine whether the drop of standard cushioned running shoes influences running injury risk. The secondary aim was to investigate whether recent running regularity modifies the relationship between shoe drop and injury risk.
Study Design: Randomized controlled trial; Level of evidence, 1.
Methods: Leisure-time runners (N = 553) were observed for 6 months after having received a pair of shoes with a heel-to-toe drop of 10 mm (D10), 6 mm (D6), or 0 mm (D0). All participants reported their running activities and injuries (time-loss definition, at least 1 day) in an electronic system. Cox regression analyses were used to compare injury risk between the 3 groups based on hazard rate ratios (HRs) and their 95% CIs. A stratified analysis was conducted to evaluate the effect of shoe drop in occasional runners (<6 months of weekly practice over the previous 12 months) versus regular runners (≥6 months). Results: The overall injury risk was not different among the participants who had received the D6 (HR, 1.30; 95% CI, 0.86-1.98) or D0 (HR, 1.17; 95% CI, 0.76-1.80) versions compared with the D10 shoes. After stratification according to running regularity, low-drop shoes (D6 and D0) were found to be associated with a lower injury risk in occasional runners (HR, 0.48; 95% CI, 0.23-0.98), whereas these shoes were associated with a higher injury risk in regular runners (HR, 1.67; 95% CI, 1.07-2.62). Conclusion: Overall, injury risk was not modified by the drop of standard cushioned running shoes. However, low-drop shoes could be more hazardous for regular runners, while these shoes seem to be preferable for occasional runners to limit injury risk.
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Craig Payne · Aug 9, 2016

yep; blogged about this study here:
http://www.runresearchjunkie.com/is-the-drop-of-a-running-shoe-associated-with-injury-risk/

NewsBot · Feb 5, 2017

IS SHOE DROP A KEY FACTOR FOR INJURY PREVENTION IN RUNNING? PART 2: AN RCT ON RUNNING BIOMECHANICS
Daniel Theisen, Paul Gette, Nicolas Chambon, Axel Urhausen, Laurent Malisoux
BMJ

Background So far, only few biomechanical studies have specifically addressed the acute effect of the heel-to-toe drop in running shoes, but longitudinal studies are lacking.

Objective Our aim was to investigate if the drop of conventional cushioned shoes induces specific long-term adaptations in running technique.

Design Randomised controlled trial.

Setting Leisure-time distance runners were tested on a treadmill at their preferred running speed before and after a 6-month period.

Participants Study participants (n=59), unexperienced with minimalist shoes, were recruited via advertisements in local newspapers.

Intervention The participants received a pair of running shoes with a drop of 10 mm (D10, n=20), 6 mm (D6, n=17) or 0 mm (D0, n=22). Apart from the shoe drop, the 3 versions were strictly identical.

Main Outcome Measurements Kinematic and spatio-temporal variables of running trials were obtained using synchronized systems for three-dimensional motion analysis (200 Hz) and step cycle event detection. Joint angles were investigated at initial contact and mid-stance phase of 151±22 analysed steps per record. Two-way analysis of variance for repeated measures with the post hoc Bonferroni correction was used and accepted significance was set at p<0.05.

Results The participants performed on average a total of 332±178 km over 163±16 days between pre- and post-tests. No interaction between shoe drop and time was found for any of the spatio-temporal variables, or for any angles at initial contact. At mid-stance phase, a significant shoe drop by time interaction was found for knee abduction angle (p=0.032). For D0 group, knee abduction decreased (−0.3±3.1 vs. -1.3±2.6°) in contrast to D6 (0.3±2.7 vs. 1.3±3.1°) and D10 (−0.2±3.2 vs. 0.5±3.1°) groups. However, none of the pairwise comparisons was significant in the post-hoc analysis.

Conclusions Shoe drop of standard cushioned shoes does not seem to influence long term adaptation in running biomechanics.
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NewsBot · Mar 22, 2017

Adaptation of running pattern to the drop of standard cushioned shoes: a randomised controlled trial with a 6-month follow-up
Laurent Malisoux, Paul Gette, Nicolas Chambon, Axel Urhausen, Daniel Theisen
Journal of Science and Medicine in Sport ; Article in Press

Objectives
While several cross-sectional studies have investigated the acute effects of shoe drop on running biomechanics, the long-term consequences are currently unknown. This study aimed to investigate if the drop of standard cushioned shoes induces specific adaptations in running technique over a six-month period in leisure-time runners.

Design
Double-blinded randomised controlled trial.

Methods
The participants (n = 59) received a pair of shoes with a heel-to-toe drop of 10 mm (D10), 6 mm (D6) or 0 mm (D0) and were followed-up regarding running training over 6 months or 500 km, whichever came first. Spatio-temporal variables and kinematics (foot/ground, ankle and knee joint angles) were investigated while running at preferred speed on a treadmill before and after the follow-up.

Results
The participants ran 332 ± 178 km in the study shoes between pre- and post-tests. There was no shoe version by time interaction for any of the spatio-temporal variables nor for lower limb angles at initial ground contact. A small but significant shoe drop effect was found for knee abduction at mid-stance (p = 0.032), as it decreased for the D0 version (-0.3 ± 3.1 vs. −1.3 ± 2.6°) while it increased for the D6 (0.3 ± 2.7 vs. 1.3 ± 3.1°) and D10 version (-0.2 ± 3.2 vs. 0.5 ± 3.1°). However, none of the pairwise comparisons was significant in the post-hoc analysis.

Conclusions
Apart from knee abduction at mid-stance, no specific adaptation in spatio-temporal variables and kinematics was found between the three shoe versions during this 6-month follow-up. Thus, shoe drop of standard cushioned shoes does not seem to influence running biomechanics in the long term.
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NewsBot · May 30, 2018

Comparison of Varying Heel to Toe Differences and Cushion to Barefoot Running in Novice Minimalist Runners.
Moody D et al
Int J Exerc Sci. 2018 May 1;11(1):13-19. eCollection 2018.

There are many different types of footwear available for runners in today's market. Many of these shoes claim to help runners run more efficiently by altering an individual's stride mechanics. Minimalist footwear claims to aid runners run more on their forefeet whereas more traditional footwear provides more cushioning specifically for a heel first landing. The purpose of this paper was to determine if runners, who were accustomed to running in traditional footwear would alter their running mechanics while running acutely in various types of minimalist footwear. Twelve subjects, accustomed to running in traditional 12 mm heel/toe differential footwear, ran in five footwear conditions on a treadmill at a controlled pace for two minutes after warming up in each condition for 5 minutes. While running in 12 mm heel/toe differential footwear compared to barefoot, subjects ran with a significantly longer ground time, a lower stride rate and greater vertical oscillation. There were not any differences in variables when running in the shod conditions despite the varying heel/toe differentials. Running barefoot proved to be different than running in traditional 12 mm drop cushioned footwear.
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NewsBot · Apr 23, 2019

Influence of shoe drop on running kinematics and kinetics in female runners
Thibault Besson, Cédric Morio, Guillaume Y. Millet ORCID Icon & Jérémy Rossi
European Journal of Sport Science : 18 Apr 2019

Fifteen healthy female runners ran on a 15-m runway at their preferred speed with three different shoe-drop conditions: 0 (D0), 6 (D6) and 10 (D10) mm. Three-dimensional marker positions and ground reaction forces were recorded to analyse kinetic and kinematic parameters using zero- (0D) and one-dimensional (1D) metrics (statistical parametric mapping, SPM). Regarding 0D parameters, significantly higher loading rates and transient peaks were found in D0 compared to D6 and D10 conditions (both p < .01). For 1D analysis, significantly higher ankle dorsiflexion moments were found in D0 compared to D6 and D10 during the braking phase (p < .01). Lower knee extension moments between 52% and 55% and 61% and 65% of contact time (p < .05) were also found. No difference was found between D6 and D10 conditions (p > .05). As previously shown in men, this study demonstrates that shoe drop influences running kinematic and kinetic patterns. Using SPM analysis in conjunction with classical analysis, the study adds new understanding on the influence of shoes on joint moment during contact time.
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NewsBot · May 16, 2019

Influence of speed and heel-to-toe drop in running shoes for female recreational runners: A cross-sectional study.
Gijon-Nogueron G et al
Medicine (Baltimore). 2019 May;98(19)

In recent years, the popularity of running has boomed and the number of women runners has risen sharply. However, little research has been conducted into the running cycle as concerns female runners. The aim of this study is to analyse, in women runners, the relationships between spatiotemporal parameters in the running cycle, the heel drop in running shoes and a progressive increase in training speed, when running on a treadmill.Thirty-eight female runners were recruited from the Malaga University Athletics Club and Nerja Athletics Club. All were at least 18 years old, recreationally active (3-4 running sessions per week) and able to run 5 km in less than 25 min. Their running performance on a treadmill was recorded and spatiotemporal parameters assessed using the OptoGait system.As the running speed increased (8-12-15 km/h) the spatiotemporal parameters of the running cycle altered: the flight time increased (P < .001) and the contact time decreased (P = .05). Heel drop (4-12 mm) was not significantly associated with any of the parameters (phase 1: P = .198; phase 2: P = .191; phase 3: P = .242).A progressive increase in training speed on a treadmill directly influences the spatiotemporal parameters of the running cycle in women runners
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NewsBot · Jul 3, 2019

The effect of the heel-to-toe drop of standard running shoes on lower limb biomechanics
Florian C. Richert, Thorsten Stein, Steffen Ringhof & Bernd J. Stetter
Footwear Science: 01 Jul 2019

Running brings many health benefits, but can lead to injuries to the musculoskeletal system. Modern running shoes have been developed to improve running biomechanics, including the heel-to-toe-drop (HTD) which has been highlighted as a central feature in shoe design. The purpose of this study was to investigate impact force characteristics, joint kinematics and kinetics across three commonly-available HTDs, as well as between running with HTDs and barefoot. Fifteen recreational runners took part in this study. Full-body kinematics and ground reaction force (GRF) data were collected while the participants ran at a speed of 4 m/s in three different shoe conditions (4 mm, 8 mm, and 12 mm HTD) as well as barefoot. Comparisons between the four conditions were made for GRFs, joint kinematics and kinetics of the lower extremities. The results primarily showed that a 4 mm HTD led to increased vertical loading rate and maximum ankle moment and a decreased maximum knee moment compared to 8 mm and 12 mm HTD. In addition, differences in ankle and knee kinematics were seen between running in shoes and running barefoot. A lower HTD mainly altered the kinetics of the ankle and knee. Running with a low HTD did not lead to similar lower limb biomechanics as barefoot running. These findings are important because a deeper understanding of biomechanical responses may lead to more customized footwear, which could decrease the risk of running-related injuries.
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NewsBot · Mar 8, 2020

Effects of heel-toe drop on running biomechanics and perceived comfort of rearfoot strikers in standard cushioned running shoes
Shiwei Mo et al
Footwear Science: 03 Mar 2020

Effects of heel-toe drop, which is the height difference between the rearfoot and forefoot parts of the shoe, have been studied during running in minimalist shoe models. However, these types of shoes also feature low heel stack height. Effects of heel-toe drop remain largely unknown during running in cushioned shoes, which usually present a standard heel stack height (e.g. 21 mm). The purpose of this study was to investigate the isolated effect of heel-toe drop on running kinematics and kinetics and perceived footwear comfort of runners in standard cushioned shoes. Fifteen male habitual rearfoot strike runners ran in four shod conditions: no drop (0 mm, D0), 4-mm (D4), 8-mm (D8), and 12-mm drop (D12). Running kinematics and kinetics were collected using motion capturing system and instrumented treadmill, respectively. Footwear comfort was acquired immediately after each running trial using a visual analogue scale. Significant effects were demonstrated on footstrike angle (p < 0.001), stride length (p = 0.005), and cadence (p = 0.015). A greater footstrike angle was indicated during running in D8 compared with D4 (p = 0.034) and D0 (p = 0.006). However, such reduction was not sufficient to cause footstrike pattern transition towards a midfoot/forefoot strike pattern. Stride length in D8 was significantly larger than in D12 (p = 0.007). No significances were found on vertical loading rates, contact time and perceived footwear comfort (p > 0.05). The isolated effects of heel-toe drop on running biomechanics were demonstrated in shoe models with a standard heel stack height. A lower heel-toe drop of standard cushioned shoes may reduce footstrike angle and increase stride length during running.
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NewsBot · Apr 25, 2021

Effect of Running Shoe Heel Drop During Treadmill Running
Siow Cheng Chan; Sook Cheng Lee; Yin Qing Tan
2020 IEEE-EMBS Conference

The shoe heel drop is defined as the heel-to-toe drop of the shoe and becomes one of the characteristics for choosing a pair of suitable running shoes. Higher heel drops which has more cushioning system is postulated to improve runner performance and to protect runners against high impact force. However, there is currently no evidence that different heel drop developed for the modern-day running shoes emerging on the market could improve running efficiency and injury prevention. In this study, a biomechanical analysis will be performed on non-trained leisure runner to investigate the association between shoe heel drop and the alteration of the lower extremity kinematic and kinetic parameters. 15 male healthy subjects were recruited to run on H/P Cosmos Instrumented Treadmill with three different conditions: (i) barefoot, heel drops of (ii) 4mm (D4) and (iii) 10mm (D10). Wilcoxon signed-rank test was performed to compare the differences across the shoe heel drop. The result revealed that compared to barefoot condition, step length, stride length and cadence significant greater in the footwear with heal conditions ( p<0.05 ). There is no significant difference between conditions in the vertical ground reaction force (vGRF) and knee joint moments ( p>0.05 ).
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NewsBot · Feb 14, 2022

The effect of heel-to-toe drop of running shoes on patellofemoral joint stress during running
MasenZhang et al
Gait & Posture; 13 February 2022

Highlights
•Running shoes with > 5 mm heel-to-toe drops increase the peak patellofemoral stress.
•The increased patellofemoral stress is mainly due to increased knee extension moment.
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Background
Traditional running shoes with heel-to-toe drops is thought to be a contributor to increased patellofemoral joint stress, which is proposed as a mechanism of patellofemoral pain.

Research question: Is there an increase in patellofemoral joint stress when running in shoes with drops compared to running in shoes without a drop?

Methods
Lower limbs kinematics and ground reaction force were collected from eighteen healthy runners during over-ground running in shoes with 15 mm, 10 mm, 5 mm drops, and without a drop. Patellofemoral joint force and stress were calculated from the kinematic and kinetic data using a biomechanical model of the patellofemoral joint.

Results
The peak patellofemoral joint stress was increased by more than 15% when running in shoes with 15 mm and 10 mm drops compared to running in shoes without a drop (p = 0.003, p = 0.001). The knee flexion angle was significantly increased when running in shoes with 15 mm, 10 mm and 5 mm drops (p = 0.014, p = 0.003, p = 0.002), the knee extension moment (p = 0.009, p = 0.002) and patellofemoral joint force (p = 0.003, p = 0.001) were increased when running in shoes with 15 mm and 10 mm drops, compared to running in shoes without a drop.

Significance
Compared to running in shoes without a drop, running in shoes with > 5 mm drops increase the peak patellofemoral joint stress significantly, which is mainly due to the increased knee extension moment.
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NewsBot · Feb 15, 2022

Acute Effects of Heel-to-Toe Drop and Speed on Running Biomechanics and Strike Pattern in Male Recreational Runners: Application of Statistical Nonparametric Mapping in Lower Limb Biomechanics
Peimin Yu et al
Front. Bioeng. Biotechnol., 28 January 2022 | https://doi.org/10.3389/fbioe.2021.821530

With the increased popularity of running, many studies have been conducted into footwears that are highly related to running performance and running-related injuries. Previous studies investigated different shoe types and running shoes with different heel-to-toe drops (HTDs). However, no research was found in investigating shoes with negative values with HTD. Therefore, the aim of this study was to determine the acute effect of HTD and running speed on lower limb biomechanics and strike pattern in recreational runners. Thirteen male recreational runners wearing shoes with two different HTDs (−8 and 8 mm) performed running at three different speeds (preferred speed [PS], 90% of PS, 110% of PS). Lower extremity kinematics and ground reaction forces were synchronously captured via Vicon motion analysis system and AMTI force platform. Strike index (SI), vertical average loading rate (VALR), vertical instantaneous loading rate (VILR), excursion, eversion duration, joint angles, and range of motion (ROM) of metatarsophalangeal (MTP), ankle, knee, and hip joints were calculated. Joint angles during the entire stance phase were analyzed applying the statistical nonparametric mapping (SnPM) method. SI and VILR in shoes with −8 mm HTD significantly increased by 18.99% and 31.836 BW/s compared to those with 8 mm HTD (SI: p = 0.002; VILR: p < 0.001). Significant alterations of ROM occurred in the MTP, ankle, and knee joints (p < 0.05), and HTD factor primarily accounted for these changes. Joint angles (MTP, knee, and hip) during the entire stance phase altered due to HTD and speed factors. Running speed primarily influenced the kinematics parameters of knee and hip joints, increasing knee angles in the frontal plane and hip angle in the horizontal plane at PS (p > 0.05). Compared to shoes with 8 mm HTD, shoes with −8 mm HTD may be useful to storage and return energy because of the increased ROM of MTP in the sagittal plane. Besides, forefoot strike gait retraining was recommended before transition from normal running shoes to running shoes with −8 mm HTD.
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NewsBot · Jun 26, 2022

Effect of the Innovative Running Shoes With the Special Midsole Structure on the Female Runners' Lower Limb Biomechanics
Fengqin Fu et al
Front Bioeng Biotechnol. 2022 Jun 6

The study aimed to research the effects of innovative running shoes (a high heel-to-toe drop and special structure of midsole) on the biomechanics of the lower limbs and perceptual sensitivity in female runners. Fifteen healthy female runners were recruited to run through a 145-m runway with planted force plates at one peculiar speed (3.6 m/s ± 5%) with two kinds of shoe conditions (innovative running shoes vs. normal running shoes) while getting biomechanical data. The perception of shoe characteristics was assessed simultaneously through a 15-cm visual analog scale. The statistical parametric mapping technique calculated the time-series parameters. Regarding 0D parameters, the ankle dorsiflexion angle of innovative running shoes at touchdown was higher, and the peak dorsiflexion angle, range of motion, peak dorsiflexion velocity, and plantarflexion moment on the metatarsophalangeal joint of innovative running shoes during running were significantly smaller than those of normal running shoes (all p < 0.001). In addition, the braking phase and the time of peak vertical force 1 of innovative running shoes were found to be longer than those of normal running shoes (both p < 0.05). Meanwhile, the average vertical loading rate 1, peak vertical loading rate 1, peak braking force, and peak vertical force 1 in the innovative running shoes were lower than those of the normal running shoes during running (both p < 0.01). The statistical parametric mapping analysis exhibited a higher ankle dorsiflexion angle (0-4%, p < 0.05), a smaller knee internal rotation angle (0-6%, p < 0.05) (63-72%, p < 0.05), a decreased vertical ground reaction force (11-17%, p = 0.009), and braking anteroposterior ground reaction force (22-27%, p = 0.043) for innovative running shoes than normal running shoes. Runners were able to perceive the cushioning of innovative running shoes was better than that of normal running shoes. These findings suggested combining the high offset and structure of the midsole would benefit the industrial utilization of shoe producers in light of reducing the risk of running injuries for female runners.
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NewsBot · Jun 30, 2022

The Effects of Heel Spring on Lower Limb Muscular Activity and Running Economy
Shahin Ketabi , Uwe Gustav Kersting , Anderson De Souza Castelo Oliveira
IJMCL. 2022; 4 (1) :19-31

Highlights
Substantial mechanical energy will have returned by shoe integrated and that energy could be stored in the Muscle Tendon Units.
Heel spring potentially changes energy exchange in the triceps surae.
Running Economy is related to many factors such as running style and individually properties.
Ankle joint kinematics can be altered which potentially affects energy return within the musculoskeletal system.
Objective: Running economy (RE) is a performance variable for distance runners. It can be affected by parameters such as equipment, running technique and surface. It has been shown that substantial mechanical energy will return by shoe integrated and that energy could be stored in the Muscle Tendon Units (MTU). The purpose was to investigate the influence of three difference heel positions induced by insoles on lower limb muscular activity and VO2 and RE (performance variable) changes during steady state running. It was hypothesized that with decreasing heel spring a linear increase in RE would be observed.
Methods: Fifteen healthy trained male runners were tested on a treadmill submaximal pace while surface electromyography (EMG) from nine muscles of leg and thigh, the VO2 by spirometry and kinematics by 2D video camera was measured. Subjects had to run in three insoles Up Heel (UH) (14 mm heel spring), Flat insole/Heel (FH) and negative spring (DH) (Down Heel) (forefoot 5 mm higher). Data were analyzed with a repeated- measures ANOVA for significant differences between shoe insoles (p<0.05).
Results: Ankle kinematics was systematically altered in response to the inserts (expected) by VO2 and running economy was not changed. It was shown that not all subject followed the implied changes so when looking at 10 responders a higher activity for Tibialis Anterior (TA) was shown.
Conclusion: It was concluded that heel spring potentially changes energy exchange in the triceps-surae while changes in muscle coordination may compensate for these improvements. RE is related to many factors such as running style and individually properties.
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NewsBot · Mar 2, 2023

Heel-to-toe drop of running shoes: a systematic review of its biomechanical effects
Celso Sánchez-RamírezORCID Icon,Codi RamseyORCID Icon,Valentina Palma-Oyarce,Eduardo Herrera-Hernández &Esteban Aedo-Muñoz
Footwear Science 21 Mar 2022

Heel-to-toe drop (HTD) values may modify the running biomechanics. However, more than twenty additional footwear characteristics may contribute to this too. The aim of this review was to identify and systematise the specific effects caused by different HTDs on running biomechanics. A systematic search was carried out in seven online databases and Footwear Science according to PRISMA protocol for studies that included the practice of endurance running in running shoes with different HTD types. A modified Downs and Black checklist was used to assess the risk of bias. Characteristics of the studies and footwear, the equipment used, and biomechanical outcomes were extracted for qualitative synthesis. Twelve studies were included. Only one had a randomised control trial design, which was classified as ‘good’ (score = 24) quality. The studies reported thirty-nine kinematic and sixteen kinetic variables. HTD ranged between −8 to 16 mm. HTDs did not produce modifications in contact and flight time, stride frequency, and stride length. Some controversial evidence supports that the foot strike pattern changes towards forefoot strike only with HTD 0 compared to HTD 8–10. All evidence indicates that HTD values modified neither ankle, knee, or hip kinematics. Greater evidence supports that the modification of HTD in running shoes does not modify the values of GRF. Despite the controversial nature of the data, the trend is that a lower HTD shows a higher vertical loading rate. The different HTDs modified neither of the joint moments. The negative HTD could be an interesting variable to consider for future research. In addition, it is necessary to study the relationship between the HTD values and different combinations of heel height and forefoot height.
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