Running Injury Paradigms and Their Influence on Footwear Design Features and Runner Assessment Methods: A Focused Review to Advance Evidence-Based Practice for Running Medicine Clinicians

Abstract

Many runners seek health professional advice regarding footwear recommendations to reduce injury risk. Unfortunately, many clinicians, as well as runners, have ideas about how to select running footwear that are not scientifically supported. This is likely because much of the research on running footwear has not been highly accessible outside of the technical footwear research circle. Therefore, the purpose of this narrative review is to update clinical readers on the state of the science for assessing runners and recommending running footwear that facilitate the goals of the runner. We begin with a review of basic footwear construction and the features thought to influence biomechanics relevant to the running medicine practitioner. Subsequently, we review the four main paradigms that have driven footwear design and recommendation with respect to injury risk reduction: Pronation Control, Impact Force Modification, Habitual Joint (Motion) Path, and Comfort Filter. We find that evidence in support of any paradigm is generally limited. In the absence of a clearly supported paradigm, we propose that in general clinicians should recommend footwear that is lightweight, comfortable, and has minimal pronation control technology. We further encourage clinicians to arm themselves with the basic understanding of the known effects of specific footwear features on biomechanics in order to better recommend footwear on a patient-by-patient basis.

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

“…Therefore, using the same shoe for other activities could accelerate the wear process, reducing its durability. Moreover, most participants choose their shoe based on its characteristics, a practice advised by recent reviews 4,15 . The second most frequent criterion for shoe selection was comfort.…”

“…The second most frequent criterion for shoe selection was comfort. Comfortable shoes are associated with lower oxygen consumption and lower frequency of motion-related injuries 11,15 . Because comfort is difficult to define and quantify, authors suggest that the runner use their own criteria 11 .…”

“…Most runners knew their foot type, which was identified by a physical therapist. Although shoe characteristics influence foot movement, a recent literature review found no evidence on shoe prescription based on the assessment of the static foot posture or rearfoot movement during the contact phase 15 . Another review suggests that despite limited evidence, shoe characteristics that favor minimal restriction of pronation movement could be favorable for the group of runners with excessively pronated feet 4 .…”

“…Most participants chose shoes with intermediate cushioning. A recent literature review indicated controversial results regarding the ability of cushioning to reduce impact forces 15 . A study observed that runners with lower body mass benefited from shoes with higher absorption properties, which was not observed in those with higher body mass 30 .…”

“…Nevertheless, the evidence supporting these recommendations is limited 4,5,11,12 . Recent reviews recommend lightweight shoe 15 with little restriction of pronation movement 4,15 and minimal difference in heelto-toe drop for casual runners 4 . Furthermore, immediate comfort may influence shoe choice, chances of injury, and energy expenditure more than specific characteristics of the shoe 11,12,15 .…”