Content uploaded by Laurent Malisoux
Author content
All content in this area was uploaded by Laurent Malisoux on Nov 15, 2020
Content may be subject to copyright.
Online First
Journal of Athletic Training 2020;55(11):000–000
doi: 10.4085/1062-6050-523-19
Óby the National Athletic Trainers’ Association, Inc
www.natajournals.org
Can the ‘‘ Appropriate’’ Footwear Prevent Injury in
Leisure-Time Running? Evidence Versus Beliefs
Laurent Malisoux, PhD*; Daniel Theisen, PhD†
*Physical Activity, Sport and Health Research Group, Luxembourg Institute of Health; †ALAN–Maladies Rares
Luxembourg
Leisure-time running is one of the most popular forms of physical
activity around the world. It can be practiced almost everywhere
and requires mainly a pair of ‘‘appropriate’’ running shoes.
However, the term appropriate is ambiguous, and the properties
of running footwear have always generated hot debates among
clinicians, coaches, and athletes, whatever the level of practice.
As the main interface between the runner’s foot and the ground,
the shoe potentially plays an important role in managing
repetitive external mechanical loads applied to the musculo-
skeletal system and, thus, in injury prevention. Consequently,
over the last decades, running shoes have been prescribed
based on matching shoe features to foot morphology. This
strategy aligns with the popular belief that footwear is one of the
main extrinsic factors influencing running-related injury risk.
Despite a seemingly sound strategy for shoe prescription and
constant progress in running-footwear technology, the injury rate
remains high. Therefore, our aim in this narrative literature
review is to clarify whether the prescription of appropriate
footwear to prevent injury in running is evidence based, the
result of logical fallacy, or just a myth. The literature presented in
this review is based on a nonsystematic search of the MEDLINE
database and focuses on work investigating the effect of shoe
features on injury risk in runners. In addition, key elements for a
proper understanding of the literature on running footwear and
injury risk are addressed. In this literature review, we outline (1)
the main risk factors and the mechanisms underlying the
occurrence of running-related injury, (2) important methodologic
considerations for generating high-level evidence, (3) the
evidence regarding the influence of running-shoe features on
injury risk, (4) future directions for research, and (5) final general
recommendations.
Key Words: sports injury, running shoes, epidemiology,
injury prevention
Leisure-time running is among the most popular
physical activities practiced around the world
1
and
has numerous health benefits.
2
However, one of its
main drawbacks is the high risk of developing a running-
related injury.
3,4
This is a serious concern, from both sports
performance and public health perspectives, given that a
running-related injury is the main reason to stop running
training.
5
The running shoe is at the interface between the
runner and the environment and potentially plays an
important role in injury prevention. The question of
whether the prescription of ‘‘appropriate’’ footwear can
prevent injury in leisure-time runners has always generated
hot debates and has already been addressed by previous
authors,
6,7
who called for caution against overstating the
benefits or harms of any shoe feature to runners.
8
Indeed,
experts have not reached consensus; different streams of
thought regarding the effect of footwear on injury
occurrence can be easily identified in the scientific
literature.
Anthropologic evidence supports the general idea that
humans adopted bipedal locomotion some 2 million years
ago and evolved into effective ‘‘endurance’’ runners over
time.
9
Given that our ancestors evolved without modern (or
with only minimal) footwear, one may assume that the most
natural form of running is the forefoot-strike pattern
observed in most modern barefoot runners.
10
Yet rearfoot
strike is also common in barefoot runners.
11
Thus, it has
been suggested that the current high incidence of running-
related injuries reflects a mismatch between the mechanics
with which humans evolved and adaptation to the modern
environment.
12
Although the mismatch theory provides
good and rational arguments, some assumptions are
questionable. Whether our ancestors really ran with a
forefoot-strike pattern and whether their running habits
were similar to the training patterns of modern runners (ie,
running for hours over long distances or in bouts of a few
minutes when hunting) is unknown. In addition, no
information is available on injury rates at that time.
Another expert opinion
13
is based on the idea that injury
frequency is perceived as remaining constant despite the
evolution of running footwear and that evidence of the
influence of shoe technology on injury occurrence is
limited. Thus, 2 new paradigms have been suggested: (1)
the musculoskeletal system strives to stay in the preferred
movement path for a given task and (2) the comfort filter, as
perceived by the runner, is the most critical aspect for both
injury prevention and running performance.
13
Even though
these are interesting ideas that are worth investigation, data
on the incidence of running injuries from previous decades
are sparse. Furthermore, comparisons between different
time periods are limited by the differences among studies in
designs, methods, populations, and injury definitions. Thus,
the absence of evidence is the main pillar of these newly
suggested paradigms. However, ‘‘absence of evidence is not
Journal of Athletic Training 0
Downloaded from http://meridian.allenpress.com/jat/article-pdf/doi/10.4085/1062-6050-523-19/2619977/10.4085_1062-6050-523-19.pdf by guest on 22 October 2020
Online First
evidence of absence,’’ and an argument stemming from
ignorance is a fallacy in informal logic that could lead one
to incorrectly conclude that minimalist shoes or the comfort
paradigm is superior to a traditional shoe prescription for
injury prevention.
8
In this narrative literature review, we propose that any
statement pertaining to the role that running footwear might
play on injury risk should be evidence based. Hence, we
aim to clarify what scientific evidence is available for
clinicians and coaches to provide runners with advice on
the choice of appropriate running shoes, with a view to
reducing injury risk. In addition, we will address several
important methodologic considerations for facilitating a
proper understanding of study results and avoiding common
pitfalls when interpreting and generalizing the findings. The
literature presented in this review results from a nonsys-
tematic search of the MEDLINE database performed in
October 2019 and specifically focuses on the effect of shoe
features on the injury risk in running.
THE CAUSES OF RUNNING-RELATED INJURY
Authors
3,4
of a vast literature reported the high incidence
of running-related injuries over the last 40 years. Depend-
ing on the study design and the population investigated, the
overall incidence rate ranged between 18.2% and 92.4%,
4
and injury incidence density ranged between 2.5 and 33.0
injuries per 1000 hours of running.
3
Overload injuries
accounted for about 75% to 85% of injuries.
14,15
The
majority of running injuries concerned mainly the lower
limbs and back regions
16
and developed over time due to an
imbalance between the repetitive loading of the musculo-
skeletal system and the tissue load capacity.
17
Much research has been directed at identifying potential
risk factors for running-related injury, including demo-
graphics, lower limb anatomy, training behavior, and the
type of running shoes used. Only a few factors have been
consistently found to be related to injury risk, most notably
previous running injury.
18,19
However, even if these factors
could help identify a subgroup of runners at greater or
lesser injury risk, this would not imply that they are
causally related to running-related injury.
17,20
By them-
selves, these factors might be insufficient to trigger an
injury.
20
For example, being overweight or wearing a
certain shoe type does not, per se, cause a running injury.
Performing running practice is a necessary condition and,
actually, the only necessary one.
Obviously, running-related injuries have a complex
multifactorial origin,
20,21
but most are thought to be caused
by training errors (eg, a sudden increase in training load),
although the authors
22,23
of recent systematic reviews were
unable to identify any trends from the existing literature.
Therefore, clinicians and coaches must be aware that if
certain factors are somehow related to running injury (ie, a
significant association appears in a regression model) and
may influence the relationship between running participa-
tion and injury risk, these factors might only be effect-
measure modifiers when considered within an etiologic
framework of running injury risk (Figure 1).
20
In line with
these considerations, a conceptual framework for the
complex, multifactorial causes of running injuries has been
suggested.
17
This framework implies that a running-related
injury does not occur because of footwear features but
when a runner increases his or her running, so that given the
other risk factors (eg, footwear features), the load capacity
of a body structure is exceeded. In conclusion, footwear
does not cause injury but can modify the global training
load a runner can tolerate before sustaining an injury.
20
METHODOLOGIC CONSIDERATIONS
Abundant scientific literature has focused on the
influence of footwear on running biomechanics and injury.
Consequently, clinicians and coaches may be confused
when reading the many study results, which are not always
consistent and are frequently subject to overinterpretation.
The reader should bear in mind that key methodologic
features such as the study design, the population investi-
gated, and the outcomes of interest will define the level of
evidence, the generalizability of the results, and the scope
of the conclusions supported by the study results,
respectively. Thus, to facilitate understanding and critical
appraisal of the current evidence on the relationship
between running footwear and injury, Theisen et al
7
presented a framework under the term Bermuda triangle,
which referenced the types of studies conducted within the
triangular relationship among running footwear, running
biomechanics, and running-related injury (Figure 2).
The most extensively studied axis of the framework has
been the influence of footwear on running biomechanics
and, more specifically, the effect of certain shoe features on
selected variables related to external ground reaction forces
and body motion during running.
24,25
These biomechanical
studies are mostly of cross-sectional design (rare exceptions
exist
26
), require a small number of healthy (ie, uninjured)
participants, involve data collection at a defined time in the
laboratory, and rely on the implicit assumption that the
recorded running technique represents the runners’ usual
running style (ecological validity). One of the main
limitations of this approach is that none of the differences
observed between shoe conditions could be related to injury
risk because injury was not the outcome of interest. As a
result, any conclusion of that kind is speculative.
The second axis of the framework is related to the field of
clinical biomechanics and focuses on the relationship
between running biomechanics and injury by comparing
recently injured runners with a healthy control group
(Figure 2). The methods used are similar to those
Figure 1. The causal relationship between running exposure
characteristics (eg, distance run, running velocity, training fre-
quency, sudden or chronic changes in these variables) and running
injuries; non–training-related characteristics (among other running
shoe features) are effect-measure modifiers that influence the
training load a runner can tolerate before injury occurs and that
may also modify training exposure characteristics (based on
Malisoux et al
20
).
0Volume 55 Number 11 November 2020
Downloaded from http://meridian.allenpress.com/jat/article-pdf/doi/10.4085/1062-6050-523-19/2619977/10.4085_1062-6050-523-19.pdf by guest on 22 October 2020
Online First
previously described, although designs can be cross-
sectional,
27
retrospective,
28
or prospective.
29
Also, groups
are usually matched on personal characteristics thought to
be related to injury risk (eg, age, sex, body mass, training
status, running experience), so that any differences in
running biomechanics could theoretically be associated
with the presence of injury. However, the direction of the
relationship cannot be determined via case-control and
retrospective studies, which strongly limits the scope of the
conclusions that can be drawn. Furthermore, many
unmeasured (eg, previous injuries, other physical activities,
fitness) or unknown factors for the groups being studied are
not necessarily matched and that may influence the results.
The third axis of the framework is based on epidemio-
logic studies in which the main outcome of interest is
running-related injury (Figure 2). These studies generally
involve much greater numbers of participants (at least
several hundred) and follow up over several months in an
observational study
14,30
or a randomized trial.
15,31,32
The
latter design has the advantage of randomization, which
allows for an equal distribution among study groups of all
other factors that may influence injury risk. Observational
cohort studies and randomized trials make it possible to
study the long-term effects of personal characteristics,
training behavior, or a given shoe type on running injury.
They also offer a greater level of evidence than cross-
sectional studies, which makes causal inference generally
more plausible. Unfortunately, in the absence of biome-
chanical analyses, they do not provide any explanations
about the underlying mechanisms of the risk factors
identified.
Given the limitations of each of these study types, we
could argue that a superior design would combine several
methods. The ideal approach would be to monitor a large
cohort of runners, analyzing their running technique in
standard conditions as well as in their own habitual
environment, and follow them over a sufficiently long
period to assess their exposure to running and injuries
sustained.
7,33
Such studies have never been performed due
to the numerous challenges that need to be overcome (ie,
cost, human resources required, sample size, study
duration), which explains why more pragmatic approaches
have been preferred, even though the level of evidence or
the generalizability of the findings is reduced.
Considering that the main objective of our literature
review was to identify the scientific evidence regarding the
effect of running shoes on injury risk, the next sections will
mainly focus on research in which injury was the outcome.
THE EVIDENCE RELATING RUNNING FOOTWEAR
AND INJURY RISK IN HEALTHY RUNNERS
Leisure-time runners usually pay a great deal of attention
to selecting their running shoes. Indeed, investigators
34
who
addressed leisure-time runners’ beliefs on running-related
injuries observed that next to training factors and body
limits, the runners largely attributed their injury risk to their
shoes, which were thought to be the main extrinsic risk
factor. Many of these strong beliefs probably related to the
selling arguments put forward by the running shoe industry.
Over the past decades, various characteristics have been
added to (and sometimes removed from) running footwear
to influence biomechanics and indirectly prevent running
injuries.
35
According to the authors
35
of a systematic
review, footwear characteristics studied in relation to
running injuries were heel-to-toe drop, midsole thickness,
minimalist index,
36
innersole thickness, mass, midsole
hardness, stability elements, and shoe age and usage.
Unraveling the contribution of each shoe feature to
running-related injury is extremely complex, given that
shoe models often differ in many aspects and footwear is
usually classified in 2 or 3 categories (eg, traditional,
partial-minimalist, and full-minimalist shoes; neutral,
stability, or motion-control shoes). In addition, shoe
features are not consistently reported in the scientific
literature.
35
In this section, we present the current state of
knowledge about the relationship between running shoe
features and injury risk and describe whether this
relationship varied across different populations.
Shoe Prescription According to Foot Morphology
Overuse injuries in runners result from an imbalance
between (1) training load and the body’s regenerative
capacity and (2) external and internal mechanical strains
generated by running training.
17
The rationale behind the
popular shoe-prescription approach, previously termed the
shoe-shop theory
7
and essentially based on expert opin-
ion,
6,37
relied on the assumptions that running injuries were
caused by excessive external ground reaction forces and
excessive foot motion. Therefore, running shoes should be
designed to reduce impact forces and attenuate excessive
foot pronation during the stance phase. Based on foot
morphology and mainly plantar shape, 3 main shoe types
have emerged.
38
Cushioned shoes have greater cushioning
properties and are advised for runners with high-arched,
rigid feet and reduced pronation. Stability shoes have some
cushioning and motion control and are suited for runners
with normal foot morphology. Finally, motion-control
shoes have arch-support features, dual-density midsoles,
or a rigid heel counter to limit rearfoot eversion. They are
recommended for runners with flat feet who display
excessive foot pronation and lower limb malalignment
during the stance phase. A decade ago, there was still no
scientific evidence to support the shoe-shop theory.
6
To test
Figure 2. The Bermuda triangle framework for interpreting studies
that focused on running footwear, running biomechanics, and
running-related injury (Reprinted from Sport-Orthopadie - Sport
Traumatologie - Sports Orthopaedics and Traumatology, 32(2),
Daniel Theisen, Laurent Malisoux, Paul Gette, Christian
N¨
uhrenb ¨
orger, Axel Urhausen, ‘‘Footwear and running-related
injuries – Running on faith?’’, 169-176, Copyright (2016), with
permission from Elsevier.)
Journal of Athletic Training 0
Downloaded from http://meridian.allenpress.com/jat/article-pdf/doi/10.4085/1062-6050-523-19/2619977/10.4085_1062-6050-523-19.pdf by guest on 22 October 2020
Online First
whether that strategy led to a decrease in injury risk, 3 trials
using the same methods were conducted in the US military
services, whereby 7203 recruits were randomly assigned to
the study groups.
38
Those in the experimental group were
provided with specific shoe types according to their plantar
shape, as previously described. Those in the control group
were assigned a stability shoe, irrespective of their plantar
shape. A meta-analysis combining the results from the 3
trials showed no difference in injury incidence rates
between the 2 groups for either men (global incidence rate
ratio ¼0.97; 95% confidence interval [CI] ¼0.88, 1.06) or
women (global incidence rate ratio ¼0.97; 95% CI ¼0.85,
1.08). Furthermore, injury rates did not differ across the 3
shoe types used, in those with either high-arched or low-
arched feet. Hence, it seems that this shoe-prescription
approach was not effective in reducing the injury risk in the
context of military training. A similar approach was applied
in a cohort of female runners, and again, the results did not
support the approach, although the sample size was limited
(n ¼81) and the outcome was pain level (measured on a
visual analog scale).
32
So far, no evidence indicates that prescribing shoes
according to foot morphology reduced the injury risk.
However, this does not mean that individual shoe features
such as motion-control and shock-absorption systems are
irrelevant in the context of injury prevention. Consequently,
an alternative approach is to separately investigate the
effect of different shoe characteristics on injury risk.
Shock-Absorption Properties
The shock-absorption properties of footwear mainly
result from the materials used in the sole (ie, the type,
density, structure, and combination), as well as from the
geometry of the shoe (ie, the midsole thickness and design
of inserts). One of the most popular approaches has been to
change the hardness of the shoe midsole.
15,25
The rationale
for promoting cushioning systems in running shoes is based
on the assumptions that external impact forces are
associated with injury risk, running on a hard surface is a
cause of high-impact forces, cushioning material can
reduce these impact forces, and the cushioning itself has
no detrimental effect on injury risk.
6
Whereas some
scientific evidence suggested that external impact forces
were associated with injury risk,
29,39
the influences of shoe
cushioning on impact-force characteristics were inconsis-
tent,
25,40,41
as opposed to, for example, running velocity
40
or
step rate.
42
This does not exclude a role of shoe cushioning
in injury risk, but the active mechanism is most likely not
via external impact forces.
Only 3 studies have examined the association between
cushioning properties and the risk of running-related injury.
Researchers
43
analyzed whether shock-absorbing insoles
influenced the interruption of training among 1205 Air
Force recruits due to lower limb injury during basic military
training. Rates of lower limb injuries were similar across
the 3 study groups (Sorbothane [Sorbothane, Inc, Kent,
OH], Poron [Rogers Corp, Chandler, AZ], and non–shock-
absorbing insoles), no support for the use of shock-
absorbing insoles was presented. A more recent trial
15
investigated injury risk in 247 recreational runners
randomly allocated to 1 of 2 groups, wearing either a
standard running shoe with a soft midsole or a shoe with a
harder midsole. The running shoes were prototypes
specifically designed for the trial and identical in all
aspects except for midsole hardness, with a 13% difference
in shock-absorption properties. Both the participants and
assessors were blinded to the shoe allocation. After a 5-
month follow-up period, no association was observed
between shoe cushioning and injury risk (hazard ratio
[HR] ¼0.92; 95% CI ¼0.57, 1.48). A plausible explanation
for these negative results could be that the runners adapted
their running technique to keep external impact forces
constant
44
and thereby mitigated the effect of the
cushioning properties. Another possibility is that the
difference in midsole hardness was too limited to reveal
any effect of the cushioning properties. The same research
team
33
addressed this aspect in a study of 848 leisure-time
runners. For this investigation, the difference in shock-
absorption properties between the 2 shoe versions was 35%.
The main finding was that the injury rate was greater in
those runners who received the hard shoes (HR ¼1.52; 95%
CI ¼1.07, 2.16). Because popular belief suggests that
heavier runners should use footwear with greater cushion-
ing properties, the authors also investigated whether this
association could be observed in both lighter and heavier
runners. The stratified analysis according to body mass
revealed that the effect of greater risk in hard shoes was
confined to light runners (HR ¼1.80; 95% CI ¼1.09,
2.98).
45
In other words, for the first time, these results
indicated a protective effect of shoe cushioning but only for
light runners (HR ¼1.23; 95% CI ¼0.75, 2.03). To what
extent this protective effect of shoe cushioning is related to
impact force attenuation during running is currently being
explored by the same team. To conclude, shoe cushioning
may play a role in injury prevention, but this finding must
be confirmed, and the populations that could benefit from
greater cushioning as well as the optimal level of
cushioning still need to be defined.
Foot Morphology and Shoe Types
Another popular belief is that foot posture is linked to the
risk of running-related injury to the lower extremity. The
rationale is that a pronated foot posture and excessive foot
eversion during the stance phase might compromise lower
extremity alignment and increase the risk of certain running
injuries. This idea was supported by a meta-analysis
46
that
showed a relationship between a pronated foot posture and
the risk of developing medial tibial stress syndrome in
different sports including running, although the effect size
was small. In contrast, a large 1-year prospective
observational study (DANORUN)
30
on more than 900
runners demonstrated that foot pronation was not associated
with injury risk in novice runners. Moreover, research
47
revealed that different shoe orthoses for supporting the
medial foot arch were not efficient in limiting foot eversion
during running and yielded only small and inconsistent
within-subject effects. If foot posture was only weakly
related to injury risk and if pronation-control features in
running shoes had little influence on foot motion, it is
legitimate to wonder whether this technology has any
influence at all on injury risk.
A randomized trial
31
with a 6-month follow-up was
specifically designed to address this question, as well as to
determine whether the association between motion-control
0Volume 55 Number 11 November 2020
Downloaded from http://meridian.allenpress.com/jat/article-pdf/doi/10.4085/1062-6050-523-19/2619977/10.4085_1062-6050-523-19.pdf by guest on 22 October 2020
Online First
technology and injury risk depended on the runner’s foot
posture. More than 400 regular recreational runners were
recruited for the study. Based on their foot category, the
participants were randomly allocated to 1 of 2 groups: 1
group received a pair of standard neutral shoes without any
motion-control technology, whereas the other received a
pair of motion-control shoes that had a dual-density
midsole and an arch-supporting element in the medial
midfoot. The primary analysis revealed that the group using
the motion-control shoes had a smaller injury risk,
regardless of foot type (HR ¼0.55; 95% CI ¼0.36, 0.85).
When looking in detail at foot posture, the authors found
that the positive effect was confined to those runners with
pronated feet (n ¼94; HR ¼0.34; 95% CI ¼0.13, 0.84).
Equally interesting was that motion-control shoes were not
harmful for those with neutral (n ¼218; HR ¼0.78; 95% CI
¼0.44, 1.37) or supinated (n ¼60; HR ¼0.59; 95% CI¼
0.20, 1.73) feet, although the sample size was too small to
draw a definitive conclusion. This was the first study to
provide some justification for the use of motion-control
technology in cushioned running shoes. It is worth noting
that the neutral shoes used in this trial had no motion-
control technology at all and that many standard cushioned
running shoes categorized as neutral or stability shoes did
have features of that type. This may also explain the
apparent contrast with the findings from the DANORUN
study that used a neutral shoe (model Supernova Glide 3;
Adidas AG, Herzogenaurach, Germany; this shoe included
a medial arch support) for all their novice runners. To
conclude, runners with pronated feet may be advised to
avoid shoes that lack motion-control technology.
Shoe Drop
One of the most popular shoe features investigated
recently has been the heel-to-toe drop (ie, the difference in
stack height between the heel and forefoot). The influence
of the heel-to-toe drop of standard cushioned running shoes
was tested in a randomized trial
48
with 6 months of follow
up among 553 leisure-time runners. Three versions of the
same shoe model that differed only in heel-to-toe drop (10,
6, and 0 mm) were compared. Overall, the injury risk was
not influenced by heel-to-toe drop in the whole cohort (HR
¼1.30; 95% CI ¼0.86, 1.98, and HR ¼1.17; 95% CI ¼
0.76; 1.80, for the 6- and 0-mm versions, respectively,
compared with the 10-mm version). However, the stratified
analysis showed that in occasional runners (ie, weekly
running for ,6 months over the 12 months before the
study), the injury risk was less among those using the 6- or
0-mm versions (HR ¼0.48; 95% CI ¼0.23, 0.98).
Conversely, the injury risk was greater in regular runners
who had received the low-drop versions (HR ¼1.67; 95%
CI ¼1.07, 2.62). Given these secondary analyses, it seems
safe to recommend low-drop footwear for occasional or
inexperienced runners. In contrast, regular runners who
received low-drop shoes appeared to be at greater risk than
those using conventional shoes. Because the participants
were required to use the study shoes for all their running
sessions, one could speculate that the transition from their
usual running shoes to the low-drop versions was not
progressive enough and increased the injury risk in the
regular runners.
Shoe Age
In a 2003 Canadian prospective study, researchers
49
collected data on running shoe age and injuries. The authors
observed an association, but the effect was in opposite
directions for men and women. In women, wearing running
shoes that were 4 to 6 months old was a risk factor for
injury (relative risk [RR] ¼1.74; 95% CI ¼1.01, 2.98),
whereas in men, running in shoes of that age was associated
with fewer injuries (RR ¼0.36; 95% CI ¼0.15, 0.83).
Therefore, no strong conclusion could be drawn. Indeed,
this question deserves further attention because shoe
degradation (200 mi [322 km]) induced modifications in
the running pattern (ie, an increase in stance time) to
maintain constant variables related to the external impact
forces acting on the body.
44
However, the adaptations to
shoe use were not influenced by different cushioning
technologies, which disqualifies shoe-cushioning technolo-
gy as a critical aspect in shoe degradation. To conclude, no
evidence-based recommendation on shoe age for prevent-
ing injury can be made at this stage.
Shoe Brands and Cost
A simple but pragmatic question might be whether any
advice on the brand or cost of the running shoes would help
prevent injury. In a retrospective study published in the
1980s, the authors
50
observed that among injured runners
with shin splints, a disproportionately high number wore
Adidas shoes, whereas few used Nike (Nike, Inc, Beaver-
ton, OR) shoes. Similarly, a disproportionately high number
of runners with the iliotibial band syndrome wore New
Balance (Boston, MA) shoes. The authors concluded that
the prescription of the most appropriate running shoes is an
important aspect of optimal treatment. Although this seems
to make sense, it is a highly speculative interpretation,
given that the study was not designed to support this
conclusion. Twenty years later, the same team investigated
whether this shoe-prescription strategy was effective.
51
They compared the injury incidences between runners who
had been advised on running shoes after a clinical
assessment with those who had received only general
advice. No difference was present between the groups,
suggesting that this strategy did not work. In another
retrospective investigation,
52
more than 4000 participants
filled out a questionnaire on training habits, injuries, and
running shoes the week before a popular 16-km race (Grand
Prix of Bern). The main findings were (1) injury incidences
did not differ between the runners who preferred 1 of the 3
most popular running shoes and those using other shoes, (2)
those who had no preference had significantly fewer
injuries, and (3) expensive shoes were associated with a
greater injury incidence.
52
These results are interesting, yet
caution is needed when interpreting these observations
because the study was retrospective by design and poorly
controlled for other important variables that could explain
these observations. Researchers
53
in another study focused
on shoe cost and analyzed whether more expensive shoes
(£70–£75 [US $94–$100]) improved plantar-pressure
attenuation and perceived comfort over low-priced models
(£40–£45 [US $53–$60] and £60–£65 [US $80–$87]).
Unfortunately, the association with injury risk was not
examined. Nevertheless, the authors concluded that cush-
ioning performance was not related to shoe cost and that the
Journal of Athletic Training 0
Downloaded from http://meridian.allenpress.com/jat/article-pdf/doi/10.4085/1062-6050-523-19/2619977/10.4085_1062-6050-523-19.pdf by guest on 22 October 2020
Online First
low- and medium-cost shoes provided equally good
subjective comfort as the high-cost models. In short, no
association between shoe brand or cost and injury risk has
been established.
Barefoot Running and Minimalist Shoes
The very first question that we should answer is whether
runners should be advised to wear running shoes at all. The
rationale is that running barefoot or in minimalist shoes is
often
54
but not always
11
associated with adopting a midfoot
or forefoot strike, simply because landing on the heel is
uncomfortable. The foot-strike pattern is associated with
other differences in running technique (eg, a greater step
rate) that may attenuate external ground reaction forces and
the physical load at the knee joint but also increase strain in
the foot region and put greater load on the ankle-extensor
complex.
55
Consequently, reduced impact forces should
logically decrease the physical load on the musculoskeletal
system and carry a reduced injury risk. However, the
redistribution of internal strain among different body parts
should increase the injury risk in those specific areas that
are suddenly overloaded.
56
To the best of our knowledge, only 1 team
56
addressed
whether barefoot running could reduce injury occurrence.
In a 1-year prospective study, they compared the injury
incidence and rate between shod runners (n ¼94) and those
who practiced at least 50% of their mileage barefoot (n ¼
107). Globally, no differences occurred between shod and
barefoot runners in the proportions reporting musculoskel-
etal injuries, but the total number of musculoskeletal
injuries per runner was less in the barefoot than in the shod
runners (1.17 versus 1.66 injuries/runner). Yet barefoot
runners demonstrated less weekly mileage. As a result, the
injury-incidence density was slightly greater in barefoot
runners, although the 2 groups displayed no statistical
differences.
The introduction of minimalist shoes and claims of
potentially decreasing injury risk have generated much
controversy,
57
although the current evidence is still weak.
In a prospective study,
58
participants who received a
minimalist (FiveFingers, Vibram, Albizzate, Italy) or
partial-minimalist (Nike Free) shoe were at a greater risk
of injury. Bone marrow edema was more common in
runners after a 10-week period of transitioning from
traditional to very minimalist running shoes, despite a
lower training volume in the minimalist than in the
traditional shoe group. The question remains whether the
main reason for this greater risk of injury was the
minimalist shoe itself or the transition to the minimalist
shoe.
59
In a more recent trial
60
with a 6-month follow-up
period, 61 habitual rearfoot strikers received either
conventional or minimalist shoes. Shoe type was not
associated with injury risk, but an interaction between shoe
type and body mass was observed. Among runners using
minimalist shoes, sustaining an injury became increasingly
more likely as body mass increased above 71.4 kg than in
runners using conventional shoes. It should, however, be
stressed that this study was underpowered (27 injuries) and
thus inconclusive. Unfortunately, no authors have conduct-
ed a large randomized controlled trial to investigate the
difference in injury risk between using minimalist and
conventional shoes after a transition period. Thus, no
current evidence supports recommendations on the use of
minimalist shoes in specific populations.
FUTURE DIRECTIONS
On October 12, 2019, Eliud Kipchoge became the first
person in history to run the marathon distance of 42 195 km
in under 2 hours. He wore the new Nike ZoomX Vaporfly
Next%. Although this shoe is promoted as the ‘‘ fastest
running shoe’’ and is already on the market (recommended
retail price: $250), the influence of its embedded new
technology on injury risk in elite runners, as well as in other
populations of runners, has not been evaluated. Indeed, the
evidence on the role of running footwear on injury risk
remains limited and fragmentary. Insufficient research has
been carried out regarding the multi–billion-dollar running-
footwear industry. For instance, the effects of shoe age and
wear on injury risk have never been properly assessed.
Therefore, the maximal distance for running shoes cited as
800 to 1000 km is based on mere popular belief, simply
following recommendations from the running shoe sector.
Comfort has been suggested to be an important factor,
13
even though it has never been seriously studied either.
Other footwear features—such as toe-box width, longitu-
dinal bending stiffness, or weight, to name but a few—have
never been explored with respect to injury. More research is
required to systematically investigate individual or com-
bined shoe features among large cohorts and runners with
different profiles to allow for scientifically sound conclu-
sions on matching shoe and runner. These studies should
focus on prospective long-term follow up of runners
training under usual conditions. Running-related injury
should be the main outcome of interest, whereas the metrics
related to running technique and biomechanics (eg, as
provided by smart wearables) may provide insights into the
underlying mechanisms.
Also, any radical change in running shoe features will
inevitably increase the injury risk.
8
Further work is needed
to provide evidence-based recommendations for transition-
ing to a new pair of shoes, taking into account the specific
shoe features that differ from the previously used model
(eg, cushioning, drop, motion control), as well as the
amount of change (eg, from maximalist to barefoot or from
standard cushioned shoes to partial-minimalist shoes). The
current lack of knowledge about shoe transitioning can be
circumvented to some degree by using several pairs of
running shoes in parallel, depending on the surface (ie,
road, forest, or mountain) or the purpose (ie, training or
competition).
14
A 5-month prospective trial
14
involving
about 250 recreational runners addressed whether regular
alternating between different pairs of running shoes might
play a role in injury prevention. The injury risk was less in
those using different pairs of running shoes concomitantly
versus those using a single pair (HR ¼0.61; 95% CI ¼0.39,
0.97). Of course, the optimal strategies for alternation in
terms of frequency, shoe features, and context of use still
must be defined.
Finally, the mechanisms relating shoe characteristics and
running injury may be specific to certain injury types. From
a methodologic viewpoint, to record sufficient events of
interest and achieve adequate statistical power, many more
participants than usual need to be recruited to determine the
0Volume 55 Number 11 November 2020
Downloaded from http://meridian.allenpress.com/jat/article-pdf/doi/10.4085/1062-6050-523-19/2619977/10.4085_1062-6050-523-19.pdf by guest on 22 October 2020
Online First
relationship between a particular shoe feature and a specific
running injury.
GENERAL RECOMMENDATIONS
Overall, it is still too early to formulate evidence-based
prescriptions regarding the choice of running shoe features.
Many statements and arguments advanced in favor of
certain footwear characteristics are simplistic and not
supported by scientific evidence. Nevertheless, authors of
some epidemiologic studies have suggested that certain
footwear characteristics may benefit particular subgroups of
runners. It seems that a minimum of motion control in
cushioned shoes, as provided in most standard models, is
relevant to the risk of running injury, especially for runners
with highly pronated feet. In addition, it appears safe to
recommend low-drop footwear for occasional or inexperi-
enced runners. Recent findings indicated that cushioning
had a preventive effect, especially in light runners.
Nonetheless, these results need to be confirmed before
any shoe prescription guidelines are scientifically justified.
Furthermore, the underlying mechanisms of these few
positive results are yet to be uncovered. Finally, the
ultimate question of how much running training (eg,
frequency, volume, running speed) in the presence of a
given anatomical predisposition, running technique, and
specific footwear can be tolerated without incurring injury
remains unanswered.
In short, it is possible that the role of running shoe
technology in injury prevention has been largely overrated.
Apart from these preliminary conclusions, it seems that
some basic rules are still valid, such as the subjective
feeling of comfort when choosing a pair of running shoes,
transitioning progressively and carefully into a new pair,
and listening to your body when training. Along the same
line, it is probably a good idea to alternate between pairs of
running shoes to avoid systematic mechanical overload and
allow progressive transitioning to new shoes. The most
important aspect of injury prevention may eventually be
athlete education that allows runners to develop their own
optimal self-management strategies. Indeed, researchers
tend to search for group effects, with a difference between
tested conditions that they feel confident about (ie,
statistically significant). However, each runner is unique
and may adapt in his or her own way to a given shoe type.
These individual adaptations do not necessarily translate
into significant group effects that would support any strong
scientific claim. In that respect, science can provide general
guidelines, but the final decision will always be an
individual one and should preferably be based on correct
and unbiased information. Although some will gladly
accept a simple lie regarding the role of footwear in injury
prevention, the truth is far more complex. Caution and
common sense should be exercised when generalizing
findings from research, as well as when considering
simplistic explanations.
REFERENCES
1. Hulteen RM, Smith JJ, Morgan PJ, et al. Global participation in
sport and leisure-time physical activities: a systematic review and
meta-analysis. Prev Med. 2017;95:14–25. doi: 10.1016/j.ypmed.
2016.11.027
2. Oja P, Titze S, Kokko S, et al. Health benefits of different sport
disciplines for adults: systematic review of observational and
intervention studies with meta-analysis. Br J Sports Med.
2015;49(7):434–440. doi: 10.1136/bjsports-2014-093885
3. Videbaek S, Bueno AM, Nielsen RO, Rasmussen S. Incidence of
running-related injuries per 1000 h of running in different types of
runners: a systematic review and meta-analysis. Sports Med.
2015;45(7):1017–1026. doi: 10.1007/s40279-015-0333-8
4. van Gent RN, Siem D, van Middelkoop M, van Os AG, Bierma-
Zeinstra SM, Koes BW. Incidence and determinants of lower
extremity running injuries in long distance runners: a systematic
review. Br J Sports Med. 2007;41(8):469–480. doi: 10.1136/bjsm.
2006.033548
5. Fokkema T, Hartgens F, Kluitenberg B, et al. Reasons and
predictors of discontinuation of running after a running program
for novice runners. J Sci Med Sport. 2019;22(1):106–111. doi: 10.
1016/j.jsams.2018.06.003
6. Richards CE, Magin PJ, Callister R. Is your prescription of distance
running shoes evidence-based? Br J Sports Med. 2009;43(3):159–
162. doi: 10.1136/bjsm.2008.046680
7. Theisen D, Malisoux L, Gette P, N ¨uhrenb¨
orger C, Urhausen A.
Footwear and running-related injuries: running on faith? Sports
Orthop Traumatol. 2016;32(2):169–176. doi: 10.1016/j.orthtr.2016.
03.047
8. Napier C, Willy RW. Logical fallacies in the running shoe debate:
let the evidence guide prescription. Br J Sports Med.
2018;52(24):1552–1553. doi: 10.1136/bjsports-2018-100117
9. Bramble DM, Lieberman DE. Endurance running and the evolution
of Homo.Nature. 2004;432(7015):345–352. doi: 10.1038/
nature03052
10. Lieberman DE. What we can learn about running from barefoot
running: an evolutionary medical perspective. Exerc Sport Sci Rev.
2012;40(2):63–72. doi: 10.1097/JES.0b013e31824ab210
11. Hatala KG, Dingwall HL, Wunderlich RE, Richmond BG. Variation
in foot strike patterns during running among habitually barefoot
populations. PLoS One. 2013;8(1):e52548. doi: 10.1371/journal.
pone.0052548
12. Davis IS, Rice HM, Wearing SC. Why forefoot striking in minimal
shoes might positively change the course of running injuries. J Sport
Health Sci. 2017;6(2):154–161. doi: 10.1016/j.jshs.2017.03.013
13. Nigg BM, Baltich J, Hoerzer S, Enders H. Running shoes and
running injuries: mythbusting and a proposal for two new
paradigms: ‘‘preferred movement path’’ and ‘‘ comfort filter.’’ Br J
Sports Med. 2015;49(20):1290–1294. doi: 10.1136/bjsports-2015-
095054
14. Malisoux L, Ramesh J, Mann R, Seil R, Urhausen A, Theisen D.
Can parallel use of different running shoes decrease running-related
injury risk? Scand J Med Sci Sports. 2015;25(1):110–115. doi: 10.
1111/sms.12154
15. Theisen D, Malisoux L, Genin J, Delattre N, Seil R, Urhausen A.
Influence of midsole hardness of standard cushioned shoes on
running-related injury risk. Br J Sports Med. 2014;48(5):371–376.
doi: 10.1136/bjsports-2013-092613
16. Lopes AD, Hespanhol Junior LC, Yeung SS, Costa LOP What are
the main running-related musculoskeletal injuries? A systematic
review. Sports Med. 2012;42(10):891–905. doi: 10.1007/
BF03262301
17. Bertelsen ML, Hulme A, Petersen J, et al. A framework for the
etiology of running-related injuries. Scand J Med Sci Sports.
2017;27(11):1170–1180. doi: 10.1111/sms.12883
18. Saragiotto BT, Yamato TP, Hespanhol Junior LC, Rainbow MJ,
Davis IS, Lopes AD. What are the main risk factors for running-
related injuries? Sports Med. 2014;44(8):1153–1163. doi: 10.1007/
s40279-014-0194-6
19. Hulme A, Nielsen RO, Timpka T, Verhagen E, Finch C. Risk and
protective factors for middle- and long-distance running-related
Journal of Athletic Training 0
Downloaded from http://meridian.allenpress.com/jat/article-pdf/doi/10.4085/1062-6050-523-19/2619977/10.4085_1062-6050-523-19.pdf by guest on 22 October 2020
Online First
injury. Sports Med. 2017;47(5):869–886. doi: 10.1007/s40279-016-
0636-4
20. Malisoux L, Nielsen RO, Urhausen A, Theisen D. A step towards
understanding the mechanisms of running-related injuries. J Sci
Med Sport. 2015;18(5):523–528. doi: 10.1016/j.jsams.2014.07.014
21. Meeuwisse WH, Tyreman H, Hagel B, Emery C. A dynamic model
of etiology in sport injury: the recursive nature of risk and causation.
Clin J Sport Med. 2007;17(3):215–219. doi: 10.1097/JSM.
0b013e3180592a48
22. Damsted C, Glad S, Nielsen RO, Sorensen H, Malisoux L. Is there
evidence for an association between changes in training load and
running-related injuries? A systematic review. Int J Sports Phys
Ther. 2018;13(6):931–942.
23. Nielsen RO, Buist I, Sorensen H, Lind M, Rasmussen S. Training
errors and running related injuries: a systematic review. Int J Sports
Phys Ther. 2012;7(1):58–75.
24. Squadrone R, Rodano R, Hamill J, Preatoni E. Acute effect of
different minimalist shoes on foot strike pattern and kinematics in
rearfoot strikers during running. J Sports Sci. 2015;33(11):1196–
1204. doi: 10.1080/02640414.2014.989534
25. Baltich J, Maurer C, Nigg BM. Increased vertical impact forces and
altered running mechanics with softer midsole shoes. PLoS One.
2015;10(4):e0125196. doi: 10.1371/journal.pone.0125196
26. Malisoux L, Gette P, Chambon N, Urhausen A, Theisen D.
Adaptation of running pattern to the drop of standard cushioned
shoes: a randomised controlled trial with a 6-month follow-up. J
Sci Med Sport. 2017;20(8):734–739. doi: 10.1016/j.jsams.2017.
01.238
27. Mann R, Malisoux L, Nuhrenborger C, Urhausen A, Meijer K,
Theisen D. Association of previous injury and speed with running
style and stride-to-stride fluctuations. Scand J Med Sci Sports.
2015;25(6):e638–e645. doi: 10.1111/sms.12397
28. Daoud AI, Geissler GJ, Wang F, Saretsky J, Daoud YA, Lieberman
DE. Foot strike and injury rates in endurance runners: a
retrospective study. Med Sci Sports Exerc. 2012;44(7):1325–1334.
doi: 10.1249/MSS.0b013e3182465115
29. Davis IS, Bowser BJ, Mullineaux DR. Greater vertical impact
loading in female runners with medically diagnosed injuries: a
prospective investigation. Br J Sports Med. 2016;50(14):887–892.
doi: 10.1136/bjsports-2015-094579
30. Nielsen RO, Buist I, Parner ET, et al. Foot pronation is not
associated with increased injury risk in novice runners wearing a
neutral shoe: a 1-year prospective cohort study. Br J Sports Med.
2014;48(6):440–447. doi: 10.1136/bjsports-2013-092202
31. Malisoux L, Chambon N, Delattre N, Gueguen N, Urhausen A,
Theisen D. Injury risk in runners using standard or motion control
shoes: a randomised controlled trial with participant and assessor
blinding. Br J Sports Med. 2016;50(8):481–487. doi: 10.1136/
bjsports-2015-095031
32. Ryan MB, Valiant GA, McDonald K, Taunton JE. The effect of
three different levels of footwear stability on pain outcomes in
women runners: a randomised control trial. Br J Sports Med.
2011;45(9):715–721. doi: 10.1136/bjsm.2009.069849
33. Malisoux L, Delattre N, Urhausen A, Theisen D. Shoe cushioning,
body mass and running biomechanics as risk factors for running
injury: a study protocol for a randomised controlled trial. BMJ
Open. 2017;7(8):e017379. doi: 10.1136/bmjopen-2017-017379
34. Saragiotto BT, Yamato TP, Lopes AD. What do recreational
runners think about risk factors for running injuries? A descriptive
study of their beliefs and opinions. J Orthop Sports Phys Ther.
2014;44(10):733–738. doi: 10.2519/jospt.2014.5710
35. Ramsey CA, Lamb P, Kaur M, Baxter GD, Ribeiro DC. How are
running shoes assessed? A systematic review of characteristics and
measurement tools used to describe running footwear. J Sports Sci.
2019;37(14):1617–1629. doi: 10.1080/02640414.2019.1578449
36. Esculier JF, Dubois B, Dionne CE, Leblond J, Roy JS. A consensus
definition and rating scale for minimalist shoes. J Foot Ankle Res.
2015;8:42. doi: 10.1186/s13047-015-0094-5
37. Davis IS. The re-emergence of the minimal running shoe. J Orthop
Sports Phys Ther. 2014;44(10):775–784. doi: 10.2519/jospt.2014.
5521
38. Knapik JJ, Trone DW, Tchandja J, Jones BH. Injury-reduction
effectiveness of prescribing running shoes on the basis of foot arch
height: summary of military investigations. J Orthop Sports Phys
Ther. 2014;44(10):805–812. doi: 10.2519/jospt.2014.5342
39. van der Worp H, Vrielink JW, Bredeweg SW. Do runners who
suffer injuries have higher vertical ground reaction forces than those
who remain injury-free? A systematic review and meta-analysis. Br
J Sports Med. 2016;50(8):450–457. doi: 10.1136/bjsports-2015-
094924
40. Nigg BM, Bahlsen HA, Luethi SM, Stokes S. The influence of
running velocity and midsole hardness on external impact forces in
heel-toe running. J Biomech. 1987;20(10):951–959. doi: 10.1016/
0021-9290(87)90324-1
41. Kulmala JP, Kosonen J, Nurminen J, Avela J. Running in highly
cushioned shoes increases leg stiffness and amplifies impact
loading. Sci Rep. 2018;8(1):17496. doi: 10.1038/s41598-018-
35980-6
42. Heiderscheit BC, Chumanov ES, Michalski MP, Wille CM, Ryan
MB. Effects of step rate manipulation on joint mechanics during
running. Med Sci Sports Exerc. 2011;43(2):296–302. doi: 10.1249/
MSS.0b013e3181ebedf4
43. Withnall R, Eastaugh J, Freemantle N. Do shock absorbing insoles
in recruits undertaking high levels of physical activity reduce lower
limb injury? A randomized controlled trial. J R Soc Med.
2006;99(1):32–37. doi: 10.1258/jrsm.99.1.32
44. Kong PW, Candelaria NG, Smith DR. Running in new and worn
shoes: a comparison of three types of cushioning footwear. Br J
Sports Med. 2009;43(10):745–749. doi: 10.1136/bjsm.2008.047761
45. Malisoux L, Delattre N, Urhausen A, Theisen D. Shoe cushioning
influences running injury risk according to body mass category: a
randomized controlled trial involving 800þrecreational runners. Am
JSportsMed. 2020;48(2):473–480. doi: 10.1177/
0363546519892578
46. Neal BS, Griffiths IB, Dowling GJ, et al. Foot posture as a risk
factor for lower limb overuse injury: a systematic review and meta-
analysis. J Foot Ankle Res. 2014;7(1):55. doi: 10.1186/s13047-014-
0055-4
47. Stacoff A, Reinschmidt C, Nigg BM, et al. Effects of foot orthoses
on skeletal motion during running. Clin Biomech (Bristol, Avon).
2000;15(1):54–64. doi: 10.1016/s0268-0033(99)00028-5
48. Malisoux L, Chambon N, Urhausen A, Theisen D. 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. Am J Sports Med. 2016;44(11):2933–2940. doi: 10.1177/
0363546516654690
49. Taunton JE, Ryan MB, Clement DB, McKenzie DC, Lloyd-Smith
DR, Zumbo BD. A prospective study of running injuries: the
Vancouver Sun Run ‘‘In Training’’ clinics. Br J Sports Med.
2003;37(3):239–244. doi: 10.1136/bjsm.37.3.239
50. Pinshaw R, Atlas V, Noakes TD. The nature and response to therapy
of 196 consecutive injuries seen at a runners’ clinic. S Afr Med J.
1984;65(8):291–298.
51. Schwellnus MP, Stubbs GE. Does running shoe prescription alter
the risk of developing a running injury? Int Sportmed J.
2006;7(2):138–153.
52. Marti B, Vader JP, Minder CE, Abelin T. On the epidemiology of
running injuries: the 1984 Bern Grand-Prix study. Am J Sports Med.
1988;16(3):285–294. doi: 10.1177/036354658801600316
53. Clinghan R, Arnold GP, Drew TS, Cochrane LA, Abboud RJ. Do
you get value for money when you buy an expensive pair of running
0Volume 55 Number 11 November 2020
Downloaded from http://meridian.allenpress.com/jat/article-pdf/doi/10.4085/1062-6050-523-19/2619977/10.4085_1062-6050-523-19.pdf by guest on 22 October 2020
Online First
shoes? Br J Sports Med. 2008;42(3):189–193. doi: 10.1136/bjsm.
2007.038844
54. Squadrone R, Gallozzi C. Biomechanical and physiological
comparison of barefoot and two shod conditions in experienced
barefoot runners. J Sports Med Phys Fitness. 2009;49(1):6–13.
55. Perkins KP, Hanney WJ, Rothschild CE. The risks and benefits of
running barefoot or in minimalist shoes: a systematic review. Sports
Health. 2014;6(6):475–480. doi: 10.1177/1941738114546846
56. Altman AR, Davis IS. Prospective comparison of running injuries
between shod and barefoot runners. Br J Sports Med.
2016;50(8):476–480. doi: 10.1136/bjsports-2014-094482
57. Tam N, Astephen Wilson JL, Noakes TD, Tucker R. Barefoot
running: an evaluation of current hypothesis, future research and
clinical applications. Br J Sports Med. 2014;48(5):349–355. doi: 10.
1136/bjsports-2013-092404
58. Ryan M, Elashi M, Newsham-West R, Taunton J. Examining injury
risk and pain perception in runners using minimalist footwear. Br J
Sports Med. 2014;48(16):1257–1262. doi: 10.1136/bjsports-2012-
092061
59. Ridge ST, Johnson AW, Mitchell UH, et al. Foot bone marrow
edema after a 10-wk transition to minimalist running shoes. Med Sci
Sports Exerc. 2013;45(7):1363–1368. doi: 10.1249/MSS.
0b013e3182874769
60. Fuller JT, Thewlis D, Buckley JD, Brown NA, Hamill J, Tsiros MD.
Body mass and weekly training distance influence the pain and
injuries experienced by runners using minimalist shoes: a
randomized controlled trial. Am J Sports Med. 2017;45(5):1162–
1170. doi: 10.1177/0363546516682497
Address correspondence to Laurent Malisoux, PhD, Physical Activity, Sport and Health Research Group, Luxembourg Institute of
Health, 76 rue d’Eich, L-1460 Luxembourg. Address e-mail to laurent.malisoux@lih.lu.
Journal of Athletic Training 0
Downloaded from http://meridian.allenpress.com/jat/article-pdf/doi/10.4085/1062-6050-523-19/2619977/10.4085_1062-6050-523-19.pdf by guest on 22 October 2020
