Medical Advice

CAN YOUR RUNNING SHOE AFFECT YOUR CHANCE OF INJURY?

25-50% of average recreational runners sustain an injury that causes a change in their training annually.1,2 Running related injuries almost exclusively involve the lower extremity.2 This is likely due to the repetitive nature of running. Injury from running can result from a runner’s physical make up, such as decreased strength, flexibility, or joint range of motion. Running related mechanical faults or training errors can also cause injury. Mechanical faults may include over striding or improper deceleration. Training errors may include inappropriate volume, intensity, frequency, or progression.

Studies show that the knee is the most common location of injury in the lower extremity. Common injuries include knee cap pain (patellofemoral stress syndrome), iliotibial (IT) band stress syndrome, heel pain (plantarfasciitis), meniscal injury, shin splints (tibial stress syndrome, and others.3 Studies have also shown that the age of running shoes may be the most important shoe wear factor that contributes to injury rate, more so than arch height, cushioning, or style.4

Initial contact with the ground during running occurs with the rearfoot or midfoot in most distance runners.5,6 Pronation of the foot is normal as it allows the foot to distribute energy from heel or mid-foot strike to entire mid- and fore-foot.5,7 Running footwear can range from bulky and heavier motion control shoes to the opposite end of the spectrum with a barefoot/minimalist approach. Barefoot and minimalist shoe runners often have a forefoot strike which has been shown to generate a smaller collision force at initial contact than rear-foot strikers wearing traditional running shoes.6 However, if this approach to footwear is attempted, caution should be taken to avoid a training related injury due to the change in training and running mechanics. It is recommended to utilize an appropriate progression to a barefoot/minimalist running approach.

Traditionally, runners with a high foot arch are urged to wear a neutral/cushion shoe, “normal” arch people a stability shoe, whereas runners with a low arch have been recommended a motion control shoe. Pronation control through shoe type as a protective effect against running related injury is based on the assumptions that overpronation is causally linked to overuse injuries. Studies actually show us that standing measurements of foot and ankle alignment (such as arch height) are not found to be related to lower extremity injury in recreational athletes.8 Furthermore, selecting shoes based on standing foot shape has not been shown to reduce injury risk during Army, Marine, and Air Force recruit basic training.9,10,11

The UW Sports Medicine clinic has specialty programs, such as Runners Clinic, available for athletes. Physical therapists perform video analysis of running mechanics for injury rehabilitation, prevention and performance. Biomechanical assessments are used in combination with a thorough musculoskeletal evaluation to address injury and performance issues. By combining targeted exercises with modifications to running form, individualized treatment plans are developed to get people back to running as soon as possible following injury. For patients interested in improving performance, running mechanics also can be evaluated. The staff at UW Health Sports Rehabilitation also collaborates with UW Health Sports Medicine physicians as needed for comprehensive and efficient care following injury.

Amy Schubert, MPT, DPT practices physical therapy at the UW Health Sports Rehabilitation Clinic. She specializes in treating athletes with lower-extremity injuries related to running and is a clinician in the Sports Medicine Runners Clinic. Amy sees patients upon referral and through Physical Therapy Direct Access (self referral).

References:
1. Novacheck, TF. The biomechanics of running. Gait and Posture; (7):77-95.
2. Richards CE, Megin PJ, Callister R. Is your prescription of distance running shoes evidence-based? Br J Sports Med; (43): 159-162.
3. Taunton JE, Ryan MB, et al. A retrospective case-control analysis of 2002 running injuries. Br J Sports Med; 2002 (36):95-101.
4. Taunton JE, Ryan MB, et al. A prospective study of running injuries: the Vancouver Sun Run “In Training” clinics. Br J Sports Med; 2003 (37):239-244.
5. Cavanagh, PR. The Biomechanics of Lower Extremity Action in Distance Running. Foot & Ankle; 1987 (7): 197-217.
6. Lieberman DE, Venkadesan M, et al. Foot strike patterns and collision forces in habitually barefoot versus shod runners. Nature; 2010 (463):531-535.
7. Adelaar, RS. The practical biomechanics of running. Am Jour Sport Med; 1986 (14): 497-500.
8. Lun V, Meeuwisse WH, et al. Relation between running injury and static lower limb alignment in recreational runners. Br J Sports Med; 2004 (38):576-580.
9. Knapik JJ, Swekler DI, et al. Injury Reduction Effectiveness of Selecting Running Shoes Based on Plantar Shape. Nat Strength Cond Research; 2009, 23(3):685-697.
10. Knapik JJ, Trone DW, et al. Injury Reduction Effectiveness of Assigning Running Shoes Based on Plantar Shape in Marine Corps Basic Training. Am J Sports Med; 2010, 38(9): 1759-1767.
11. Knapik JJ, Brosch LC, et al. Effect on Injuries of Assigning Shoes Based on Foot Shape in Air Force Basic Training. Am J Prev Med; 2010 (38):S197-S211.