SLR - June 2020 - Tyler R. Prager

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

Reference: Helton, G. L., Cameron, K. L., Zifchock, R. A., Miller, E., Goss, D. L., Song, J., & Neary, M. T. (2019). Association Between Running Shoe Characteristics and Lower Extremity Injuries in United States Military Academy Cadets. The American Journal of Sports Medicine

Scientific Literature Review

Reviewed By: Tyler R. Prager, DPM
Residency Program: Bethesda Hospital East/West – Boynton Beach, FL

Podiatric Relevance: Patients presenting to the office of a podiatric physician often ask about shoe gear and whether what they are currently wearing is protective against injury. The active patients especially want to make sure they are giving themselves the best chance for success. This study measures different aspects of a traditional shoe and determines which aspects make it more protective against injury.  

Methods: A level II cohort study that was conducted over a nine-week period at the United States Military Academy. This was a large sample size of cadets, as 1025 responded to the study, and data was obtained for 827 participants. Individuals were 17 to 23 years of age and were healthy. If the cadet had a previous lower extremity or back injury within the last three months, they were excluded from the study. A baseline questionnaire was filled out to assess the activity level of each participant. Shoe torsional stiffness and heel height were evaluated, recording the make, model, and length of each participant’s R shoe. All injuries during the nine-week study period were evaluated by the military medical team.

Results: The incidence of lower extremity injury during cadet basic training in those who participated in the study was 18.1 percent, with 59 percent of those being overuse injuries. Regression models suggested that there were no significant differences in obtaining a lower extremity injury among participants wearing shoes with different levels of medial torsional stiffness. That being said, lateral torsional stiffness was significantly associated with lower extremity injuries. Individuals were moderate lateral torsional stiffness were 51 percent less likely to incur any lower extremity injury compared with those wearing shoes with minimal lateral torsional stiffness

Conclusions: When comparing cadets wearing shoes with mild to moderate lateral torsional stiffness, cadets that were wearing minimal lateral torsional stiffness endured a higher percentage of lower extremity injuries. Thus, shoes of that type should be discouraged in this particular setting. When diving further into specific injuries, the highest percentage of injuries fell into the category of lateral ankle sprains. Thinking about this in a clinical setting makes sense, as those patients with minimal lateral stiffness will be more likely to give out laterally when exercising which would often cause a lateral ankle sprain. One interesting topic to further study is implementing a supportive ankle brace to see if even with minimal lateral torsional stiffness, the brace would significantly combat that deficit. Shoes are gaining popularity each year and are becoming more minimalistic, so I thought this was a good study to gain some insight on the young, active patient in terms of shoe qualities that should be considered. 

Educational Opportunities