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Influence of midsole hardness of standard cushioned shoes on running-related injury risk
  1. Daniel Theisen1,
  2. Laurent Malisoux1,
  3. Joakim Genin1,
  4. Nicolas Delattre2,
  5. Romain Seil1,3,
  6. Axel Urhausen1,3
  1. 1Sports Medicine Research Laboratory, Public Research Centre for Health, Luxembourg, Grand-Duchy of Luxembourg
  2. 2Essensole, Oxylane Research, Villeneuve d'Ascq, France
  3. 3Sports Clinique, Centre Hospitalier de Luxembourg, Luxembourg, Grand-Duchy of Luxembourg
  1. Correspondence to Dr Daniel Theisen, CRP-Santé, 76 rue d'Eich, L-1460 Luxembourg, Grand-Duchy of Luxembourg; daniel.theisen{at}


Background In this double-blind randomised controlled trial, we tested if leisure-time runners using shoes with less compliant midsoles have a higher running-related injury (RRI) risk.

Method We provided 247 runners with standard running shoes having either a soft study shoes (soft-SS) or a hard study shoes (hard-SS) midsole and followed them prospectively for 5 months regarding RRI. All information about sports practice and injuries was uploaded on a dedicated internet platform and checked for consistency and completeness. RRI was defined as any first-time pain sustained during or as a result of running practice and impeding normal running activity for at least 1 day. Cox proportional hazards regressions were used to identify RRI risk factors.

Result The type of study shoes used for running was not associated with RRIs (HR=0.92; 95% CI 0.57 to 1.48). The hard-SS had a 15% greater overall stiffness in the heel region. The two study groups were similar regarding personal and sports participation characteristics, except for years of running experience, which was higher (p<0.05) in the hard-SS group. Global RRI incidence was 12.1 RRI/1000 h of running. No between-group differences were found regarding injury location, type, severity or category. Nevertheless, the adjusted regression model revealed positive associations with RRI risk for body mass index (HR=1.126; 95% CI 1.033 to 1.227), previous injury (HR=1.735; 95% CI 1.037 to 2.902) and mean session intensity (HR=1.396; 95% CI 1.040 to 1.874). Protective factors were previous regular running activity (HR=0.422; 95% CI 0.228 to 0.779) and weekly volume of other sports activities (HR=0.702; 95% CI 0.561 to 0.879).

Conclusions Midsole hardness of modern cushioned running shoes does not seem to influence RRI risk.

  • Injury Prevention
  • Running shoes
  • Running
  • Sporting injuries

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