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. 2022 Aug 22;8(8):CD013368.
doi: 10.1002/14651858.CD013368.pub2.

Running shoes for preventing lower limb running injuries in adults

Nicola Relph  1 , Henrike Greaves  2 , Ross Armstrong  3 , Trevor D Prior  4 , Sally Spencer  5 , Ian B Griffiths  6 , Paola Dey  1 , Ben Langley  7
Affiliations

Running shoes for preventing lower limb running injuries in adults

Nicola Relph et al. Cochrane Database Syst Rev. .

Abstract

Background: Lower-limb running injuries are common. Running shoes have been proposed as one means of reducing injury risk. However, there is uncertainty as to how effective running shoes are for the prevention of injury. It is also unclear how the effects of different characteristics of running shoes prevent injury.

Objectives: To assess the effects (benefits and harms) of running shoes for preventing lower-limb running injuries in adult runners.

Search methods: We searched the following databases: CENTRAL, MEDLINE, Embase, AMED, CINAHL Plus and SPORTDiscus plus trial registers WHO ICTRP and ClinicalTrials.gov. We also searched additional sources for published and unpublished trials. The date of the search was June 2021.

Selection criteria: We included randomised controlled trials (RCTs) and quasi-RCTs involving runners or military personnel in basic training that either compared a) a running shoe with a non-running shoe; b) different types of running shoes (minimalist, neutral/cushioned, motion control, stability, soft midsole, hard midsole); or c) footwear recommended and selected on foot posture versus footwear not recommended and not selected on foot posture for preventing lower-limb running injuries. Our primary outcomes were number of people sustaining a lower-limb running injury and number of lower-limb running injuries. Our secondary outcomes were number of runners who failed to return to running or their previous level of running, runner satisfaction with footwear, adverse events other than musculoskeletal injuries, and number of runners requiring hospital admission or surgery, or both, for musculoskeletal injury or adverse event.

Data collection and analysis: Two review authors independently assessed study eligibility and performed data extraction and risk of bias assessment. The certainty of the included evidence was assessed using GRADE methodology.

Main results: We included 12 trials in the analysis which included a total of 11,240 participants, in trials that lasted from 6 to 26 weeks and were carried out in North America, Europe, Australia and South Africa. Most of the evidence was low or very low certainty as it was not possible to blind runners to their allocated running shoe, there was variation in the definition of an injury and characteristics of footwear, and there were too few studies for most comparisons. We did not find any trials that compared running shoes with non-running shoes. Neutral/cushioned versus minimalist (5 studies, 766 participants) Neutral/cushioned shoes may make little or no difference to the number of runners sustaining a lower-limb running injuries when compared with minimalist shoes (low-certainty evidence) (risk ratio (RR) 0.77, 95% confidence interval (CI) 0.59 to 1.01). One trial reported that 67% and 92% of runners were satisfied with their neutral/cushioned or minimalist running shoes, respectively (RR 0.73, 95% CI 0.47 to 1.12). Another trial reported mean satisfaction scores ranged from 4.0 to 4.3 in the neutral/ cushioned group and 3.6 to 3.9 in the minimalist running shoe group out of a total of 5. Hence neutral/cushioned running shoes may make little or no difference to runner satisfaction with footwear (low-certainty evidence). Motion control versus neutral / cushioned (2 studies, 421 participants) It is uncertain whether or not motion control shoes reduce the number of runners sustaining a lower-limb running injuries when compared with neutral / cushioned shoes because the quality of the evidence has been assessed as very low certainty (RR 0.92, 95% CI 0.30 to 2.81). Soft midsole versus hard midsole (2 studies, 1095 participants) Soft midsole shoes may make little or no difference to the number of runners sustaining a lower-limb running injuries when compared with hard midsole shoes (low-certainty of evidence) (RR 0.82, 95% CI 0.61 to 1.10). Stability versus neutral / cushioned (1 study, 57 participants) It is uncertain whether or not stability shoes reduce the number of runners sustaining a lower-limb running injuries when compared with neutral/cushioned shoes because the quality of the evidence has been assessed as very low certainty (RR 0.49, 95% CI 0.18 to 1.31). Motion control versus stability (1 study, 56 participants) It is uncertain whether or not motion control shoes reduce the number of runners sustaining a lower-limb running injuries when compared with stability shoes because the quality of the evidence has been assessed as very low certainty (RR 3.47, 95% CI 1.43 to 8.40). Running shoes prescribed and selected on foot posture (3 studies, 7203 participants) There was no evidence that running shoes prescribed based on static foot posture reduced the number of injuries compared with those who received a shoe not prescribed based on foot posture in military recruits (Rate Ratio 1.03, 95% CI 0.94 to 1.13). Subgroup analysis confirmed these findings were consistent between males and females. Therefore, prescribing running shoes and selecting on foot posture probably makes little or no difference to lower-limb running injuries (moderate-certainty evidence). Data were not available for all other review outcomes.

Authors' conclusions: Most evidence demonstrates no reduction in lower-limb running injuries in adults when comparing different types of running shoes. Overall, the certainty of the evidence determining whether different types of running shoes influence running injury rates was very low to low, and as such we are uncertain as to the true effects of different types of running shoes upon injury rates. There is no evidence that prescribing footwear based on foot type reduces running-related lower-limb injures in adults. The evidence for this comparison was rated as moderate and as such we can have more certainty when interpreting these findings. However, all three trials included in this comparison used military populations and as such the findings may differ in recreational runners. Future researchers should develop a consensus definition of running shoe design to help standardise classification. The definition of a running injury should also be used consistently and confirmed via health practitioners. More researchers should consider a RCT design to increase the evidence in this area. Lastly, future work should look to explore the influence of different types or running shoes upon injury rates in specific subgroups.

Trial registration: ClinicalTrials.gov NCT02567123 NCT04363476.

PubMed Disclaimer

Conflict of interest statement

NR: none HG: none RA: none TP: Contributer to a think tank for a sports equipment manufacturing company (expenses only) IG: none SS: none PD: none BL: Dr Ben Langley has previously undertaken research funded by Anima Sana in Corpore Sano (ASICS). However, the nature of Dr Langley’s previous work and the proposed work would not be eligible for inclusion within the review and focuses more on how running shoe modification or types of running shoes influence potential markers of injury risk or performance rather than injury occurrence.

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
4
4
Forest plot of comparison: 1 Neutral / cushioned versus minimalist, outcome: 1.1 Number of runners injured.
5
5
Forest plot of comparison: 6 Prescribed Running Shoes versus Non‐prescribed running shoes, outcome: 6.1 Rate Ratios of Injuries.
1.1
1.1. Analysis
Comparison 1: Neutral / cushioned versus minimalist, Outcome 1: Number of runners injured
1.2
1.2. Analysis
Comparison 1: Neutral / cushioned versus minimalist, Outcome 2: Running shoe satisfaction
2.1
2.1. Analysis
Comparison 2: Motion control versus neutral / cushioned, Outcome 1: Number of runners injured
3.1
3.1. Analysis
Comparison 3: Soft midsole versus hard midsole, Outcome 1: Number of runners injured
4.1
4.1. Analysis
Comparison 4: Stability versus neutral / cushioned, Outcome 1: Number of runners injured
5.1
5.1. Analysis
Comparison 5: Motion control versus stability, Outcome 1: Number of runners injured
6.1
6.1. Analysis
Comparison 6: Prescribed versus non‐prescribed, Outcome 1: Rate Ratios of Injuries
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD013368

References

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Ryan 2019a {published data only}
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References to ongoing studies

ACTRN12613000612718 {unpublished data only}ACTRN12613000612718
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References to other published versions of this review

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