Bone Stress Injuries in Runners Using Carbon Fiber Plate Footwear

Abstract

The introduction of carbon fiber plate footwear has led to performance benefits in runners. The mechanism for these changes in running economy includes altered biomechanics of the foot and ankle. The association of this footwear with injuries has been a topic of debate clinically, but not described in the literature. In this Current Opinion article, illustrated by a case series of five navicular bone stress injuries in highly competitive running athletes, we discuss the development of running-related injuries in association with the use of carbon fiber plate footwear. While the performance benefits of this footwear are considerable, sports medicine providers should consider injuries possibly related to altered biomechanical demands affecting athletes who use carbon fiber plate footwear. Given the introduction of carbon fiber plate footwear into athletics and other endurance sports, strategies may be required to reduce risk of injury due to altered foot and ankle mechanics. This article is intended (1) to raise awareness on possible health concerns around the use of carbon fiber plate footwear, (2) to suggest a slow gradual transition from habitual to carbon fiber plate footwear, and (3) to foster medical research related to carbon fiber plate technology and injuries.

Fig. 1

Lateral X-ray of a runner's left foot in a carbon-plated running shoe. Red arrows outline the embedded plate. The green arrow shows the fulcrum point of the plate. Note the relation of the curvature of the plate to the metatarsal locations (metatarsal phalangeal joints)

Fig. 2

Images from Case 1. Sagittal (a), coronal (b), and long axis (c) on T2 fat-suppressed sequences on magnetic resonance imaging demonstrate vertically oriented stress fracture. Corresponding views on CT visualize the fracture orientation (d–f) and classify as navicular Type III stress fracture [20]

Fig. 3

Images from Case 3. Long axis (a), sagittal (b), and coronal (c) on T2 fat-suppressed sequences on magnetic resonance imaging demonstrate vertically oriented stress fracture. Corresponding views on CT visualize the fracture orientation (d–f) extending through both plantar and dorsal cortices and classify as navicular Type III stress fracture [20]