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  1. D Theisen1,
  2. L Malisoux1,
  3. N Delattre3,
  4. R Seil1,2,
  5. A Urhausen1,2
  1. 1Sports Medicine Research Laboratory, Public Research Centre for Health, Luxembourg
  2. 2Clinique du Sport, Centre Hospitalier de Luxembourg, Luxembourg
  3. 3Essensole, Oxylane Research, Villeneuve d'Ascq, France


Background The shock absorption qualities of running shoes are thought to have an important influence on running-related injuries (RRIs). However, scientific evidence of this relationship is still lacking.

Objective To test if midsole hardness of standard running shoes was related to RRIs.

Design Double-blind randomized controlled trial.

Setting Free-roaming leisure-time distance runners.

Participants Study participants were recruited through newspaper advertisements, posts on specialized internet sites and via mouth-to-ear. They were required to report any running activity, sport practice and injury using a dedicated internet platform. Recorded information was systematically verified, if necessary through direct contacts with the participants.

Risk factor assessment Leisure-time runners were provided with identical running shoes, except for their midsole hardness which was either hard (H; n=113) or soft (S; n=134). They were followed prospectively for 5 months.

Main outcome measurements The primary outcome measure was exposure volume (hours) to running practice until first-time RRI (Cox proportional hazards regression analyses).

Results Overall, 12.1 RRIs were recorded per 1000 hours of running. There was a 15% difference between the shoe types regarding midsole stiffness. The type of shoe used for running was not related to RRI (hazard ratio (HR)=0.92; 95% confidence interval (CI)=0.57–1.48). Furthermore, no difference was detected regarding RRI patterns (location, severity, etc.). Significant risk factors for RRIs were body mass index (HR=1.13; 95% CI 1.03–1.23), injury in the 12 months preceding the study (HR=1.74; 95% CI 1.04–2.90) and average session intensity (HR=1.40; 95% CI 1.04–1.87). Previous regular running practice (HR=0.42; 95% CI 0.23–0.78) and volume of other sport activities (HR=0.70; 95% CI 0.56–0.88) were significant protective factors.

Conclusions RRI risk was not associated with running shoe midsole hardness in this study.

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