Study Suggests Running Shoes Could Damage Lower Extremity Joints

According to a study, The Effect of Running Shoes on Lower Extremity Joint Torques, running shoes may cause greater stress on hip, knee and ankle joints than running barefoot or walking in high-heels.

The objective of the study was to determine the effect of modern-day footwear on the lower extremity joints during running. A total of 68 adult runners, 37 women and 31 men, participated in the study. The participants had no history of musculoskeletal injury and ran at least 15 miles each week. They were given standard running shoes for the study.

Knee osteoarthritis (OA) occurs in approximately 6% of adults older than 30 years and 10% of adults older than 55 years, according to the study. Repetitive loading, experienced by runners, is believed to be an important factor in the development of OA. Running shoes are said to be the remedy by alleviating joint contact forces despite the lack of clinical evidence.

“Although the immediate health benefits of running are substantial and well recognized, there is no clinical evidence to support that the design of modern running footwear is most favorable to promote long-term health in runners,” the authors wrote.

The authors of the study hypothesized that certain attributes of the standard running shoe actually increase the distribution of contact forces on the joint.

“Current cushioning technologies in running shoes elevate the heel compared with the forefoot,” the authors wrote. “Further, motion control and stability technologies inherent in running shoe design essentially provide additional material under the medial aspect of the foot, via medial posting and arch supports.”

These design characteristics contribute to the increased torque to the external knee flexion and the torque of the external knee varus, the authors hypothesized.

Researchers found that the effects of the typical construction of the modern-day running shoe lead to increased joint torques at each of the three lower extremity joints, hip, knee and ankle. In fact, runners wearing running shoes had a 36%-38% increase in knee joint torque compared to participants running barefoot, according to the study. The 36%-38% increase is higher than the knee joint torque for participants in previous studies walking in high-heels, the authors wrote. For the hip joint, the study revealed a 54% increase in hip internal rotation torque for participants in running shoes compared to barefoot runners.

“Considering that lower extremity joint loading is of significantly greater magnitude during running than is experienced during walking, the current findings indeed represent substantial biomechanical changes,” the authors wrote.

D. Casey Kerrigan, MD, lead author of the study, did not anticipate the large percentage of joint torque increase.

“I was not surprised that the joint torques were increased as that is consistent with all my previous work demonstrating that certain shoe characteristics inherent in running shoes adversely increase these torques, Kerrigan told O&P Business News. “However, I was surprised at the sheer magnitude of the increases we observed, particularly the 38% increase in knee varus torque.”

The authors of the study point out that the 54% increase in hip internal rotation torque is significantly due to previous findings which suggest that competitive running may increase the risk of OA of the hip joint.

“The development of new footwear designs that encourage or mimic the natural compliance that normal foot function provides while minimizing knee and hip joint torques is warranted,” the authors concluded. “Reducing joint torques with footwear completely to that of barefoot running, while providing meaningful footwear functions, especially compliance, should be the goal of new footwear designs.” — Anthony Calabro


Art Smuckler, CPed
Art Smuckler

For years in our practice, we have promoted neutral, lightweight running shoes to imitate a more barefoot feel and running gait to reduce injuries. Furthermore, we have developed special orthotics for runners to promote forefoot landing and encourage the all-important five-toe push off. Using the toes helps make a better stride and promotes an aggressive running style, even in the weakest of runners.

In a study, led by Bernard Marti, MD a leading preventative medicine specialist at Switzerland’s University of Bern, runners wearing top of the line trainers with all the bells and whistles are 123% more likely to suffer injuries than runners who wear basic running shoes. Looking back allows us to look forward in developing new types of running shoes that will help limit injuries and improve running. I believe that runners would much prefer to feel natural, as in barefoot running, than to lose the feel and balance feedback the ground gives them.

Thinner, lighter, more durable soles with light forefoot rockers are needed for proper gait management and room for orthotics. This would promote tri-plane technology to lessen injuries and improve gait … It’s up to us – the professionals – to take the challenge and demonstrate the results.

— Art Smuckler, CPed
Owner, General Orthopedic Inc.

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