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Foot pronation is not associated with increased injury risk in novice runners wearing a neutral shoe: a 1-year prospective cohort study
  1. Rasmus Oestergaard Nielsen1,2,
  2. Ida Buist3,
  3. Erik Thorlund Parner4,
  4. Ellen Aagaard Nohr5,
  5. Henrik Sørensen1,
  6. Martin Lind6,
  7. Sten Rasmussen2
  1. 1Section of Sport Science, Department of Public Health, Aarhus University, Aarhus, Denmark
  2. 2Orthopaedic Surgery Research Unit, Science and Innovation Center, Aalborg University Hospital, Denmark
  3. 3Center for Sports Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
  4. 4Section of Biostatistics, Department of Public Health, Aarhus University, Aarhus, Denmark
  5. 5Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
  6. 6Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark
  1. Correspondence to Mr Rasmus Oestergaard Nielsen, Section of Sport Science, Department of Public Health, Aarhus University, Dalgas Avenue 4, DK-8000 Aarhus C, Denmark: Roen{at}


Objective To investigate if running distance to first running-related injury varies between foot postures in novice runners wearing neutral shoes.

Design A 1-year epidemiological observational prospective cohort study.

Setting Denmark.

Participants A total of 927 novice runners equivalent to 1854 feet were included. At baseline, foot posture on each foot was evaluated using the foot-posture index and categorised into highly supinated (n=53), supinated (n=369), neutral (n=1292), pronated (n=122) or highly pronated (n=18). Participants then had to start running in a neutral running shoe and to use global positioning system watch to quantify the running distance in every training session.

Main outcome measure A running-related injury was defined as any musculoskeletal complaint of the lower extremity or back caused by running, which restricted the amount of running for at least 1 week.

Results During 1 year of follow-up, the 1854 feet included in the analyses ran a total of 326 803 km until injury or censoring. A total of 252 participants sustained a running-related injury. Of these, 63 were bilateral injuries. Compared with a neutral foot posture, no significant body mass index-adjusted cumulative risk differences (RD) were found after 250 km of running for highly supinated feet (RD=11.0% (−10% to 32.1%), p=0.30), supinated feet (RD=−1.4% (−8.4% to 5.5%), p=0.69), pronated feet (RD=−8.1% (−17.6% to 1.3%), p=0.09) and highly pronated feet (RD=9.8% (−19.3% to 38.8%), p=0.51). In addition, the incidence-rate difference/1000 km of running, revealed that pronators had a significantly lower number of injuries/1000 km of running of −0.37 (−0.03 to −0.70), p=0.03 than neutrals.

Conclusions The results of the present study contradict the widespread belief that moderate foot pronation is associated with an increased risk of injury among novice runners taking up running in a neutral running shoe. More work is needed to ascertain if highly pronated feet face a higher risk of injury than neutral feet.

  • Running
  • Running shoes
  • Injury Prevention
  • Lower extremity injuries
  • Gait analysis

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