Can Shoes Prevent Injuries? – Justin our Newcastle Podiatrist Explains
Motion-Control Shoes Reduce the Risk of Pronation-Related Pathologies in Recreational Runners: A Secondary Analysis of a Randomized Controlled Trial TINE MARIEKE WILLEMS, PT, PhD CHRISTOPHE LEYELS GOETGHEBEUR, DANIEL THEISEN LAURENT MALISOUX, PhD
Can Shoes Stop and reduce Injury?
Read on as our Newcastle Podiatrist Justin fills us in!
Cracking study which has been analysed by the above Authors. This study did cause a stir in the community, especially with elite runners. As you can see from reading the title and a small part of the results, ‘Motion-control shoes may reduce the risk of pronation-related running injuries, but not influence the risk of other running-related injuries’. There are always issues with research but lets see what we can find!
Lets dive in team!!
Pronation, foot type and footwear have all been identified as being possible risk factors for running related injuries. Not often we get to see a prospective study (one that follows people over time) with runners using different shoes and how that plays a role in injury. This study focuses on footwear, although it’s almost impossible to address that without considering foot type as we know the interplay between them is important.
Methods:
372 recreational runners were randomized to receive either standard neutral or motion-control shoes and were followed up for 6 months regarding running activity and injury. Participates had to be running at least once a week during the 6 months. An injury was defined as any pain in the lower limbs or low back region, sustained during or because of running, impeding planned running activity for at least 1 day. Running injuries that occurred were classified as pronation related injuries (Achilles tendinopathy, plantar fasciopathy, exercise-related lower-leg pain, and anterior knee pain) or other running-related injuries.
They also measured peoples foot type (using FPI index) at baseline and assigned them footwear blinded (motion V non). So... each foot type got an even distribution of footwear. See below.
The motion controlling shoes had a thermoplastic polyurethane structure located at the medial part of the midfoot, and a dual-density, ethylene vinyl acetate midsole located at the forefoot. The standard shoe did not have these features. Here at Achieve, we have examples of these shoes in the clinic. Newcastle is a great and popular place for runners and running groups.
Following 6 months after all injuries were reported (25%), the relationship between pronation related and other running-related injuries and shoe type were evaluated by estimating the cause-specific hazard, controlling for other possible confounders like age, sex, body mass index, previous injury, and sport participation pattern.
What did they find and what do they recommend?
They found that the probability of sustaining a pronation-related running injury with a motion control shoe is lower compared to that of a standard shoe.
They suggest that clinicians consider recommending motion control shoes to specifically target pronation related running injuries (hard to classify), as those shoes benefited the recreational runners in the trial.
Limitations:
- Difficult to classify a pronated related injury!!. It could be argued that all injures are caused by pronation as that is a normal movement of the foot. It’s hard to identify over-pronation.
- Analysis was underpowered to present stratified analysis results based on foot morphology (not Enough people + not enough varying foot types)
- Running one day a week was still classified as a run. I think distance is a better measure (E-g 2 runs a week with one being over 5km
- Misclassification of injuries could have resulted in bias. The number of events of interest (injuries) was limited, and the conclusions need to be confirmed by future work.
- Shoe manufactures differ between their definitions of motion controlling so to scale this study to the general population who wear plenty of different types of motion controlling shoes is tricky.
- There weren’t a lot of injuries overall and only a small percentage were injured. Generally, research points to a higher number being injured.
- We don’t know if this would be different between different types of runners.
Author Conclusion:
Wearing motion-control shoes reduced the risk of pronation related running injuries in middle aged recreational runners, but not the risk of other RRIs. Accounting for the underlying injury mechanism (using competing risk analysis) and specifically targeting injury types that might benefit from the intervention were more accurate for estimating treatment effect than lumping all injury types.
My conclusion:
I think this study plays into some bias of people who have always prescribed motion controlling footwear for injuries they think were caused by pronation. I believe that pronation plays a role in the exacerbation of pain and injury but not so much in the development of an injury. For example, if I have shin splints and pain associated with that + I have a pronated foot with a high magnitude of force coming through the medial part of my leg/foot due to dynamic pronation, I think that the pain I experience is made worse by that and causes the injury to take longer than if I had a neutral foot. This is due to the increased kinetic GRF through that area. Simply, more force/stress on tissue – increased recovery. However, that is case specific but that is what I see clinically and from the research.
Both myself and Blake see Runners in Newcastle as well as participating in many Running events. It's important as Podiatrists who see alot of sports, injuries and rehab patients to be active on those areas.