Running shoes, pronation, and injuries: do beliefs of injury risk factors among running shoe salespersons and physiotherapy students align with current aetiology frameworks?

An exploration of footwear preferences, attitudes and beliefs in people with knee osteoarthritis: A qualitative study

BACKGROUND

Although footwear can improve pain and function in individuals with knee osteoarthritis (OA), perspectives about footwear in this population have not been explored.

OBJECTIVES

This qualitative study explored preferences, attitudes and beliefs about footwear in adults with knee OA.

METHODS

Twenty individuals with a clinical diagnosis of knee OA (aged 45-79 years, 65% women) participated in semi-structured interviews about factors which influence footwear selection, the effect of footwear on knee symptoms, and footwear modifications. Data were analysed thematically.

RESULTS

Four themes, with sub-themes, were identified: i) there are specific footwear characteristics people look for, with comfort as their top priority; ii) shoe appearance is important; iii) footwear can aggravate or ease symptoms; and iv) people with knee OA find footwear in a variety of ways. Participants related built-in arch support, a cushioned insole and low/no heel, without addition of foot orthoses, to comfort, and were willing to pay more for comfort and quality. Appearance was also a consideration, and participants indicated they would tolerate short periods of symptom aggravation for aesthetic shoes. Participants felt that footwear choice affected their knee symptoms and risk of slipping/twisting. Participants reported that their footwear choices were determined through trial-and-error, and sometimes on advice from health professionals or shoe store salespersons.

CONCLUSIONS

There are specific footwear features important to individuals with knee OA. Knowledge of these features can be used by health professionals to inform footwear discussions with knee OA patients and serve as considerations when developing footwear targeted for this population.

Does policy that provides choice in athletic footwear affect musculoskeletal injury risk in US Coast Guard recruits?

INTRODUCTION

Musculoskeletal injuries (MSKIs) are ubiquitous during initial entry military training, with overuse injuries the most common. A common injury mechanism is running, an activity that is integral to US Coast Guard (USCG) training and a requirement for graduation. The purpose of this study was to assess the effects of a policy that allowed for athletic footwear choice on risk of lower quarter MSKI in USCG recruits.

METHODS

A retrospective cohort study was performed that included 1230 recruits (1040 men, 190 women) who trained under a policy that allowed self-selection of athletic footwear and 2951 recruits (2329 men, 622 women) who trained under a policy that mandated use of prescribed uniform athletic shoes and served as controls. Demographic data and physical performance were derived from administrative records. Injury data were abstracted from a medical tracking database. Unadjusted risk calculations and multivariable logistic regression assessing the effects of group, age, sex, height, body mass and 2.4 km run times on MSKI were performed.

RESULTS

Ankle-foot, leg, knee and lumbopelvic-hip complex injuries were ubiquitous in both groups (experimental: 13.13 per 1000 person-weeks; control: 11.69 per 1000 person-weeks). Group was not a significant factor for any of the injuries assessed in either the unadjusted or adjusted analysis, despite widespread reports of pain (58.6%), perceived injury attribution (15.7%), perceived deleterious effect on performance (25.3%), general dissatisfaction (46.3%) and intended discontinuance of use following graduation (87.7%).

CONCLUSION

MSKI continues to be a major source of morbidity in the recruit training population. The policy that allowed USCG recruits to self-select athletic footwear did not decrease or increase the risk of MSKI. While regulations pertaining to footwear choice did not influence injury outcomes, there was general dissatisfaction with the prescribed uniform athletic footwear conveyed by the recruits and widespread reports of discomfort, perceived deleterious effects from wear and intended discontinued use following training completion.

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.

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

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.