Relationships among self-reported shoe type, footstrike pattern, and injury incidence.

CONTEXT: Some runners are experimenting with barefoot or minimalist shoe running to reduce lower extremity overuse injuries. However, there has been little research to examine injury trends associated with barefoot or minimalist shoe running.

OBJECTIVE: To assess the association of self-reported shoe selection with reported foot strike patterns, compare overall injury incidence associated with different shoe conditions, and identify differences in injury location between different shoe conditions.

DESIGN: Retrospective descriptive epidemiology survey.

METHODS: We recruited 2,509 runners (1,254 male, 1,255 female) aged 18 to 50 to complete an anonymous online survey. The survey assessed running tendencies, footstrike patterns, shoe preferences, and injury history. Reported footstrike patterns were compared among 3 shoe groups: traditionally shod, minimalist shoes, and barefoot runners. Overall and specific anatomical injury incidence was compared between traditionally shod and minimalist shoe-wearing runners. We did not include 1,605 runners in the analyses due to incomplete data or recent changes in footstrike patterns and/or shoe selection.

RESULTS: Shoe selection was significantly associated with reported footstrike (χ² (4df) =143.4, P<.001). Barefoot and minimalist runners reported a more anterior footstrike than traditionally shod runners. Traditionally shod runners were 3.41 times more likely to report injuries than experienced minimalist shoe wearers (46.7% shod vs 13.7% minimalist, χ² (1df) =77.4, P<.001, n=888). Minimalist shoe wearers also reported fewer injuries at the hip, knee, lower leg, ankle, and foot than traditionally shod runners.

CONCLUSION: Barefoot and minimalist shoe wearers reported a more anterior footstrike than traditionally shod runners. Traditionally shod runners were more likely to report injuries of the lower extremities than runners who wear minimalist shoes. Additional longitudinal prospective research is required to examine injury incidence among various footstrike patterns and shoe preferences.