Injuries and Footwear (Part 1): Athletic Shoe History and Injuries in Relation to Foot Arch Height and Training in Boots

The Impact of Footwear on Occupational Task Performance and Musculoskeletal Injury Risk: A Scoping Review to Inform Tactical Footwear

The aim of this scoping review was to investigate the impact of footwear on worker physical task performance and injury risk. The review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews protocol and registered in the Open Science Framework. Key search terms were entered into five academic databases. Following a dedicated screening process and critical appraisal, data from the final articles informing this review were extracted, tabulated, and synthesised. Of 19,614 identified articles, 50 articles informed this review. Representing 16 countries, the most common populations investigated were military and firefighter populations, but a wide range of general occupations (e.g., shipping, mining, hairdressing, and healthcare workers) were represented. Footwear types included work safety boots/shoes (e.g., industrial, gumboots, steel capped, etc.), military and firefighter boots, sports shoes (trainers, tennis, basketball, etc.) and various other types (e.g., sandals, etc.). Occupational footwear was found to impact gait and angular velocities, joint ranges of motion, posture and balance, physiological measures (like aerobic capacity, heart rates, temperatures, etc.), muscle activity, and selected occupational tasks. Occupational footwear associated with injuries included boots, conventional running shoes, shoes with inserts, harder/stiffer outsoles or thin soles, and shoes with low comfort scores-although the findings were mixed. Occupational footwear was also linked to potentially causing injuries directly (e.g., musculoskeletal injuries) as well as leading to mechanisms associated with causing injuries (like tripping and slipping).

Association Between Running Shoe Characteristics and Lower Extremity Injuries in United States Military Academy Cadets

BACKGROUND

Running-related overuse injuries are very common among recreational runners, with the reported annual injury rates ranging from 39% to 85%. Relatively few large prospective cohort studies have been conducted to investigate injury risk associated with different running shoe characteristics, and the results of the existing studies are often contradictory.

PURPOSE/HYPOTHESIS

The purpose was to investigate the relationship between running shoe characteristics and lower extremity musculoskeletal injury. It was hypothesized that the risk of injury would be increased in individuals wearing shoes with minimal torsional stiffness and heel height compared with those wearing shoes with greater levels of torsional stiffness and heel height.

STUDY DESIGN

Cohort study; Level of evidence, 2.

METHODS

The study included 1025 incoming cadets. Shoe torsional stiffness and heel height were calculated and recorded. Demographic data were recorded and analyzed as potential covariates. Lower extremity injuries sustained over 9 weeks during cadet basic training were documented by use of the Armed Forces Health Longitudinal Technology Application and the Cadet Illness and Injury Tracking System. Kaplan-Meier survival curves were estimated, with time to incident lower extremity injury as the primary outcome by level of the independent predictor variables. Risk factors or potential covariates were carried forward into multivariable Cox proportional hazards regression models. Absolute and relative risk reduction and numbers needed to treat were calculated.

RESULTS

Approximately 18.1% of participants incurred a lower extremity injury. Cadets wearing shoes with moderate lateral torsional stiffness were 49% less likely to incur any type of lower extremity injury and 52% less likely to incur an overuse lower extremity injury than cadets wearing shoes with minimal lateral torsional stiffness, both of which were statistically significant observations. Injury risk was similar among cadets wearing shoes with minimal and extreme lateral torsional stiffness.

CONCLUSION

Shoes with mild to moderate lateral torsional stiffness may be appropriate in reducing risk of lower extremity injury in cadets. Shoes with minimal lateral torsional stiffness should be discouraged in this population.