Can the "Appropriate" Footwear Prevent Injury in Leisure-Time Running? Evidence Versus Beliefs

Southeast Asian, African, and Middle East Expert Consensus on Structured Physical Activity-Dance, Exercise, and Sports

Physical inactivity (PIA) is a pressing public health issue globally, contributing significantly to the rise of non-communicable diseases (NCD), such as cardiovascular disease and type 2 diabetes. The World Health Organization emphasises the importance of regular physical activity (PA) for preventing and managing NCDs. Initiatives to promote active living have gained momentum, ranging from community programs to workplace wellness campaigns, all focused on reducing sedentary lifestyles in modern society. Structured Physical Activity-Dance, Exercise, and Sports (SPADES) has emerged as an innovative approach to addressing PIA and promoting holistic health. After thoroughly reviewing existing literature from PubMed and Google Scholar databases, a panel of experts developed consensus statements through in-depth discussions, and the strength of concurrence on these statements was voted on using a Likert scale. The panel reached a consensus on the best strategies for PA, dance, exercise, sports, and key factors to consider during PA. This consensus targets individuals with metabolic diseases, particularly in regions like South Asia, East Africa, the Gulf, and Latin America, where these conditions are highly prevalent. The SPADES guidelines emphasise overcoming the barriers people with metabolic disorders face in achieving adequate PA, providing tailored recommendations to improve health outcomes for this population.

Running-Centred Injury Prevention Support: A Scoping Review on Current Injury Risk Reduction Practices for Runners

Background: Runners have not benefited from the same reduction in injury rates seen in injury prevention studies conducted in other sports. Objectives: The purpose of this scoping review was to identify and map injury risk reduction practices for running-related injury (RRI), methods of delivery and understand the views of experts and runner's preferences in reducing RRI. Design: Scoping review. Methods: We conducted systematic database searches of MEDLINE, CINAHL and SPORTDiscus from 2000 to April 2024. Eligible studies included injury prevention strategies for RRI. Data synthesis was conducted according to PRISMA Extension for Scoping Reviews using Joanna Briggs Institute framework methodology. Extracted data were mapped and coded from intervention studies, expert opinions and reviews, and inductive thematic analysis created subthemes and themes from prospective cohorts, qualitative studies and surveys. Results: A total of 3777 studies were identified, and 106 studies met the inclusion criteria. In intervention studies, supervision and support appeared critical for better effect. Key injury prevention topics were strengthening, gait re-education and wearables, graduated running programmes, footwear, recovery and educational advice. A multifactorial approach considering individual risk profiles was recommended by experts, but there was a disparity in what runners do to reduce injury risk compared to expert advice, with actions appearing to be related to self-efficacy rather than avoidance. Conclusion: This scoping review highlighted runners require individualized, supported and multifactorial approaches for injury risk reduction, and runners seek knowledge on purpose. We found runners injury risk reduction practices should begin early with youth runners and facilitating this through coaching supervision is likely to support behaviour change. Strategies such as gait retraining, wearables and recovery need further exploration but provide promising strategies runners may engage with more. As runners are likely to choose familiar options minimally impacting lifestyle and running, they should be provided with education but need support with their choices to influence beliefs.

Advanced Footwear Technology in Non-Elite Runners: A Survey of Training Practices and Reported Outcomes

Background: Advanced footwear technology (AFT) has gained popularity among non-elite runners due to its potential benefits in training and competition. This study investigated the training practices and reported outcomes in non-elite runners using AFT. Methods: A cross-sectional observational study was conducted with 61 non-elite runners competing in distances ranging from 5 km to marathons. The survey collected data on demographics, training parameters, footwear usage, perceived changes in running mechanics, and self-reported injuries. Results: The results revealed a significant positive correlation (R = 0.6, p < 0.0001) between years of AFT use and weekly training volume, indicating that more experienced runners are likely to incorporate AFT consistently into their routines. Conversely, a significant negative correlation (R = -0.5, p < 0.0001) was found between training volume and the number of weekly sessions using AFT, suggesting a selective approach to footwear use. Participants reported biomechanical changes, such as increased forefoot support (49%) and higher calf muscle activation (44%), alongside a 16% self-reported injury rate, predominantly affecting the calves. Conclusions: These findings highlight the importance of proper guidance and gradual adaptation to maximize the benefits of AFT while minimizing injury risks. Future research should explore the long-term impact of AFT on performance and injury prevention through longitudinal studies.

Technologically advanced running shoes reduce oxygen cost and cumulative tibial loading per kilometer in recreational female and male runners

Technologically advanced running shoes (TARS) improve performance compared to classical running shoes (CRS). Improved race performance has been attributed to metabolic savings in male runners, but it remains unclear if these same benefits are experienced among females and in recreational runners. The mechanisms behind these benefits are still not fully understood despite the need for optimisation, and their influence on injury mechanisms has not been explored. Here we combined biomechanical, physiological, and modelling approaches to analyse joint mechanics, oxygen uptake, and tibial load in nineteen male and female recreational runners running with CRS and TARS at their individual lactate threshold speed (12.4 ± 1.9 km/h). Oxygen uptake was 3.0 ± 1.5% lower in TARS than in CRS. Ankle dorsiflexion, joint moment and joint power were reduced in TARS compared to CRS at various phases of stance including midstance, while knee joint mechanics were mostly similar throughout. There were no significant differences for tibial bending moment during the stance phase but cumulative tibial damage per kilometre was 12 ± 9% lower in TARS compared to CRS. Our results suggest that running with TARS reduces oxygen cost in recreational female and male runners, which may partly be explained by differences in lower limb joint mechanics. The lower cumulative tibial bone load with TARS may allow runners to run longer distances in this type of shoe compared to CRS.

Prescribed footwear and orthoses are not prophylactic in preventing lower extremity injuries in military tactical athletes: a systematic review with meta-analysis

INTRODUCTION

Military members are exposed to high cumulative physical loads that frequently lead to injury. Prescribed footwear and orthoses have been used to prevent injury. The purpose of this systematic review with meta-analysis was to assess if prescribed prophylactic footwear or foot orthoses reduced the risk of lower extremity injury in military tactical athletes.

METHODS

MEDLINE, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature, SportDiscus, and Defense Technical Information Center databases were searched for randomised controlled trials published at any time that compared foot orthoses or prescribed footwear (to include shock-absorbing insoles and socks) with a placebo intervention or a no-treatment control. Methodological quality was assessed and the number of injuries, population at risk and duration of the study epoch were extracted and relative risk (RR) calculated. An omnibus meta-analysis was performed assessing all prescribed footwear and orthoses intervention studies, with subgroup analyses conducted on studies with similar interventions (ie, basketball athletic shoes, athletic shoes (prescribed by foot type), foot orthoses, shock-absorbing insoles, socks, tropical combat boots).

RESULTS

Of 1673 studies identified, 22 were included. Three of eight studies that employed orthoses demonstrated significantly reduced overuse injuries compared with no-treatment controls (RR range: 0.34-0.68); one study showed neoprene insoles significantly decreased overuse injuries (RR: 0.75). There were no other significant effects in the individual studies and no protective effects observed in the omnibus meta-analysis or in the component subanalyses.

CONCLUSIONS

Prescribed footwear and orthoses do not appear to have a prophylactic effect on lower quarter musculoskeletal injuries in military members and cannot be recommended at this time.

Adolescents running in conventional running shoes have lower vertical instantaneous loading rates but greater asymmetry than running barefoot or in partial-minimal shoes

Footwear may moderate the transiently heightened asymmetry in lower limb loading associated with peak growth in adolescence during running. This repeated-measures study compared the magnitude and symmetry of peak vertical ground reaction force and instantaneous loading rates (VILRs) in adolescents during barefoot and shod running. Ten adolescents (age, 10.6 ± 1.7 years) ran at self-selected speed (1.7 ± 0.3 m/s) on an instrumented treadmill under three counter-balanced conditions; barefoot and shod with partial-minimal and conventional running shoes. All participants were within one year of their estimated peak height velocity based on sex-specific regression equations. Foot-strike patterns, peak vertical ground reaction force and VILRs were recorded during 20 seconds of steady-state running. Symmetry of ground reaction forces was assessed using the symmetry index. Repeated-measures ANOVAs were used to compare conditions (α=.05). Adolescents used a rearfoot foot-strike pattern during barefoot and shod running. Use of conventional shoes resulted in a lower VILR (P < .05, dz = 0.9), but higher VILR asymmetry (P < .05) than running barefoot (dz = 1.5) or in partial-minimal shoes (dz = 1.6). Conventional running shoes result in a lower VILR than running unshod or in partial-minimal shoes but may have the unintended consequence of increasing VILR asymmetry. The findings may have implications for performance, musculoskeletal development and injury in adolescents.

Measurement and reporting of footwear characteristics in running biomechanics: A systematic search and narrative synthesis of contemporary research methods

This review aimed to synthesise the methods for assessing and reporting footwear characteristics among studies evaluating the effect of footwear on running biomechanics. Electronic searches of Scopus®, EBSCO, PubMed®, ScienceDirect®, and Web of Science® were performed to identify original research articles of the effect of running footwear on running biomechanics published from 1^st January 2015 to 7^th October 2020. Risk of bias among included studies was not assessed. Results were presented via narrative synthesis. Eligible studies compared the effect of two or more footwear conditions in adult runners on a biomechanical parameter. Eighty-seven articles were included and data from 242 individual footwear were extracted. Predominantly, studies reported footwear taxonomy (i.e., classification) and manufacturer information, however omitted detail regarding the technical specifications of running footwear and did not use validated footwear reporting tools. There is inconsistency among contemporary studies in the methods by which footwear characteristics are assessed and reported. These findings point towards a need for consensus regarding the reporting of these characteristics within biomechanical studies to facilitate the conduct of systematic reviews and meta-analyses pertaining to the effect of running footwear on running biomechanics.

A escolha do calçado por corredores amadores: caracterização e associação com o histórico de lesão auto reportada

RESUMO O calçado é um elemento importante para a prática de corrida. As evidências sobre os impactos das características do calçado e de sua prescrição nas lesões de corredores são restritas. Dessa forma, os objetivos deste estudo foram investigar o processo de escolha do calçado por corredores e verificar se variáveis relacionadas ao calçado e seu processo de escolha estavam associadas à presença e recorrência de lesão no último ano. Foi realizado um estudo observacional com 254 corredores que responderam um questionário autoadministrado sobre características demográficas, a prática esportiva, o calçado e o processo de sua escolha, e lesões ocorridas nos últimos 12 meses. O teste qui-quadrado foi empregado para verificar se havia diferença na distribuição das respostas de cada questão, enquanto o teste de regressão logística para verificar se as variáveis relacionadas ao calçado e ao processo de escolha predizem a presença e recorrência de lesão no último ano. Os resultados indicaram que a maioria dos corredores possui tênis específico para a prática esportiva e considera algumas características ao adquiri-lo, como o amortecimento intermediário e a diferença na altura do solado entre a parte posterior e a anterior de aproximadamente 10mm. A maioria indica conhecer seu tipo de pisada, mas não a considera na escolha do calçado. Além disso, a maioria não usa palmilha e não recebeu orientação para a escolha do calçado. O modelo obtido com a regressão não foi significativo. Assim, apesar de os corredores considerarem as características do calçado ao adquiri-lo, essas características e o processo de escolha não foram associados à presença e recorrência de lesão nos últimos 12 meses.

Selection of running shoes by amateur runners: characterization and association with the self-reported history of injury

ABSTRACT Running shoes are an essential element for sports practice. Evidence on the effect of the shoe characteristics and prescription in running injuries are scarce. Thus, this study aimed to investigate runners's process of choosing running shoes and to verify whether the variables related to running shoes and their selection process are associated with the presence and recurrence of injuries in the previous year. An observational study was conducted with 254 runners who answered a self-reported questionnaire about demographics, sports practice, shoe characteristics and selection criteria, and injuries in the last 12 months. The chi-square test evaluated whether there was a difference in the distribution of answers to each question. The logistic regression evaluated whether the variables related to shoes and selection criteria predicted injury’s presence and recurrence in the previous year. The results showed that most runners had specific shoes for sports practice and considered some characteristics of the shoes to choose them, including intermediate cushioning and a difference in the heel-to-toe drop of approximately 10mm. Most respondents indicated knowing their foot type but not considering it when choosing shoes. Besides, most individuals did not use foot orthotics and did not receive guidance to select their shoes. The model obtained with the regression was not significant. Therefore, despite considering shoe characteristics when choosing it, these features and the selection criteria were not associated with the presence and recurrence of injuries in the previous 12 months.

A step towards dynamic foot classification: Functional grouping using ankle joint frontal plane motion in running

BACKGROUND

The premise behind static foot classification suggests structure dictate's function. However, the validity of this has been challenged, as weak association between static foot type and dynamic motion exists. This has led to calls for dynamic assessments and classification of feet based on functional motion, yet methods to do this have been seldom explored.

RESEARCH QUESTION

Within a group of runners do homogenous sub-groups of ankle joint complex (AJC) frontal plane motion exist?

METHODS

A k means clustering analysis was conducted on the frontal plane AJC motion patterns of a group of healthy adults running barefoot (n = 42) to identify functional movement groups. Once identified, statistical parametric mapping was employed to determine the differences between clusters across stance. The identified clusters were used to determine dynamic foot type; an agreement analysis was conducted between the newly defined foot types and the Foot Posture Index (FPI-6).

RESULTS

Two distinct clusters were identified. Waveform analysis identified that cluster 1 displayed significantly (p < 0.001) less AJC eversion between 0% and 97% of the stance phase compared to cluster 2, with the differences between clusters associated with large effect sizes (g > 1). Based on the displayed kinematic profiles, cluster 1 was defined as a Neutral Dynamic Foot Type (Neutral_DFT), and cluster 2 a Pronated Dynamic Foot Type (Pronated Dynamic_DFT). The newly defined foot type measure had only a slight agreement (κ = 0.08) with the FPI-6.

SIGNIFICANCE

We demonstrated a protocol to classify a runner's foot type derived directly from AJC motion during running. Poor agreement between the dynamic and static classification measures further evidence that these assessments are not analogous. Our results question the validity of static classification when looking to characterise the foot during running, suggesting dynamic assessments are more appropriate to reflect the foots functional response.

Biomechanics of running: A special reference to the comparisons of wearing boots and running shoes

Boots are often used in sports, occupations, and rehabilitation. However, there are few studies on the biomechanical alterations after wearing boots. The current study aimed to compare the effects of running shoes and boots on running biomechanics. Kinematics and ground reaction forces were recorded from 17 healthy males during running at 3.3 m/s with shoe and boot conditions. Temporal distance gait variables, ground reaction force components as well as lower limb joints angle, moment, and power were compared using Paired t-test and Statistical Parametric Mapping package for time-series analysis. Running with boots was associated with greater stride, step, flight, and swing times, greater flight length, and smaller cadence (p<0.05). The only effect of boots on lower limb joints kinematics during running was a reduction in ankle range of motion (p<0.05). Significantly greater hip flexor, abductor, and internal rotator moments, greater knee extensor and abductor moments, and ankle plantar flexor moments were observed at push-off phase of running as well as greater ankle dorsiflexor moment at early-stance in boot condition (p<0.05). Also, knee joint positive power was greater with a significant temporal shift in boot condition, suggesting a compensatory mechanism in response to limited ankle range of motion and the inability of the ankle joint to generate the required power. Our findings showed that running with boots is physically more demanding and is associated with a greater net contribution of muscles spanning hip and knee joints in order to generate more power and compensate for the ankle joint limitations, consequently, may increase the risk of both musculoskeletal injuries and degenerative joint diseases.

Factors Influencing Runner's Choices of Footwear

Until the mid-2000s, qualitative research has been virtually absent from running injury research. A handful of studies have been recently published regarding the attitudes and perceptions of runners and coaches toward injury development. Footwear is frequently perceived as a risk factor for running related injuries, but empeirical evidence fails to support such beliefs. The reasons why runners choose specific footwear warrants formal investigation to further understand the links between footwear and running related injuries. This study aimed to investigate the factors influencing runners choices of footwear. Interviews were conducted with 12 runners. Recordings from the interviews were transcribed verbatim and themes were developed using thematic analysis. Findings revealed 15 unique factors that influence runner's choices of footwear for running. These factors were grouped into three main themes: personal footwear characteristic preferences, other people and economic considerations. Runners largely gather information about their footwear choices from past experiences and people they trust and admire. They also emphasized the complexity of footwear choices due to availability and the constant changes preset within the footwear industry. This research adds to the growing body of knowledge to better understand the wider running injury system. Further studies are needed to establish how runners perceptions of their footwear impact injury rates and to develop effective injury prevention strategies.

Spatiotemporal and Ground-Reaction Force Characteristics as Risk Factors for Running-Related Injury: A Secondary Analysis of a Randomized Trial Including 800+ Recreational Runners

BACKGROUND

Running biomechanics may play a role in running-related injury development, but to date, only a few modifiable factors have been prospectively associated with injury risk.

PURPOSE

To identify risk factors among spatiotemporal and ground-reaction force characteristics in recreational runners and to investigate whether shoe cushioning modifies the association between running biomechanics and injury risk.

STUDY DESIGN

Case-control study; Level of evidence, 3.

METHODS

Recreational runners (N = 848) were tested on an instrumented treadmill at their preferred running speed in randomly allocated, standardized running shoes (with either hard or soft cushioning). Typical kinetic and spatiotemporal metrics were derived from ground-reaction force recordings. Participants were subsequently followed up for 6 months regarding running activity and injury. Cox regression models for competing risk were used to investigate the association between biomechanical risk factors and injury risk, including stratified analyses by shoe version.

RESULTS

In the crude analysis, greater injury risk was found for greater step length (subhazard rate ratio [SHR], 1.01; 95% CI, 1.00-1.02; P = .038), longer flight time (SHR, 1.00; 95% CI, 1.00-1.01; P = .028), shorter contact time (SHR, 0.99; 95% CI, 0.99-1.00; P = .030), and lower duty factor (defined as the ratio between contact time and stride time; SHR, 0.95; 95% CI, 0.91-0.98; P = .005). In the stratified analyses by shoe version, adjusted for previous injury and running speed, lower duty factor was associated with greater injury risk in those using the soft shoes (SHR, 0.92; 95% CI, 0.85-0.99; P = .042) but not in those using the hard shoes (SHR, 0.97; 95% CI, 0.91-1.04; P = .348).

CONCLUSION

Lower duty factor is an injury risk factor, especially for softer shoe use. Contrary to widespread beliefs, vertical impact peak, loading rate, and step rate were not injury risk factors in recreational runners.

REGISTRATION

NCT03115437 (ClinicalTrials.gov identifier).

Relevance of Frequency-Domain Analyses to Relate Shoe Cushioning, Ground Impact Forces and Running Injury Risk: A Secondary Analysis of a Randomized Trial With 800+ Recreational Runners

Cushioning systems in running shoes are used assuming that ground impact forces relate to injury risk and that cushioning materials reduce these impact forces. In our recent trial, the more cushioned shoe version was associated with lower injury risk. However, vertical impact peak force was higher in participants with the Soft shoe version. The primary objective of this study was to investigate the effect of shoe cushioning on the time, magnitude and frequency characteristics of peak forces using frequency-domain analysis by comparing the two study groups from our recent trial (Hard and Soft shoe group, respectively). The secondary objective was to investigate if force characteristics are prospectively associated with the risk of running-related injury. This is a secondary analysis of a double-blinded randomized trial on shoe cushioning with a biomechanical running analysis at baseline and a 6-month follow-up on running exposure and injury. Participants (n = 848) were tested on an instrumented treadmill at their preferred running speed in their randomly allocated shoe condition. The vertical ground reaction force signal for each stance phase was decomposed into the frequency domain using the discrete Fourier transform. Both components were recomposed into the time domain using the inverse Fourier transform. An analysis of variance was used to compare force characteristics between the two study groups. Cox regression analysis was used to investigate the association between force characteristics and injury risk. Participants using the Soft shoes displayed lower impact peak force (p < 0.001, d = 0.23), longer time to peak force (p < 0.001, d = 0.25), and lower average loading rate (p < 0.001, d = 0.18) of the high frequency signal compared to those using the Hard shoes. Participants with low average and instantaneous loading rate of the high frequency signal had lower injury risk [Sub hazard rate ratio (SHR) = 0.49 and 0.55; 95% Confidence Interval (CI) = 0.25–0.97 and 0.30–0.99, respectively], and those with early occurrence of impact peak force (high frequency signal) had greater injury risk (SHR = 1.60; 95% CI = 1.05–2.53). Our findings may explain the protective effect of the Soft shoe version previously observed. The present study also demonstrates that frequency-domain analyses may provide clinically relevant impact force characteristics.

Clinical Trial Registration:https://clinicaltrials.gov/, identifier: 9NCT03115437.

Evolution of distance running shoes: performance, injuries, and rules

Over the last 50 years, the development of running shoes has been mainly focused on improving the protection and comfort of the runner and her/his foot. Although there have been tentative attempts by companies to make shoes a tool for improving athletic performance, this goal has only recently been achieved. Indeed, the year 2016 was a real turning point when Nike launched its first shoe benefiting from the advanced footwear technology. Advanced footwear technology (AFT) mostly consists of an increased sole thickness, a curved and stiff plate embedded or below the shoe midsole, and an outsole with a marked concave shape. This innovation turned to a game changer in the world of distances running performance. Indeed, between 2016 and 2019, many male and female runners broke personal best times, national records, area, and world records in distance from 5 km to the marathon. The present article aimed at describing the magnitude of these performance enhancements in distance running as well as and the possible underlying performance-enhancement mechanisms associated with the advanced footwear technology. It also reviewed the existing literature on the safety aspects of "classical" construction shoes and AFT shoes. It concluded on a possible shoe mechanical tests-based protocol to maintain fair distance running competitions while not totally preventing manufacturers to innovate, and some thoughts on the nature and goals of further studies to be conducted to assess the safety (macro- and micro-traumatic) AFT in both elite and recreational runner populations.