Running is the most visible expression of the continued interest in regular physical activities. Unfortunately injuries are common, primarily due to overuse, and a number of aetiological factors have been recognised. Of these, training errors can be responsible for up to 60% of injuries. The training surface, a lack of flexibility and strength, the stage of growth and development, poor footwear and abnormal biomechanical features have all been implicated in the development of running injuries. A thorough understanding of the biomechanics of running is a necessary prerequisite for individuals who treat or advise runners.
Clinically, the configuration of the longitudinal arch is a valuable method of classifying feet and has direct implications on the development and management of running problems. The runner with excessively pronated feet has features which predispose him/her to injuries that most frequently occur at the medial aspect of the lower extremity: tibial stress syndrome; patellofemoral pain syndrome; and posterior tibialis tendinitis. These problems occur because of excessive motion at the subtalar joint and control of this movement can be made through the selection of appropriate footwear, plus orthotic foot control. The runner with cavusfeet often has a rigid foot and concomitant problems of decreased ability to absorb the force of ground contact. These athletes have unique injuries found most commonly on the lateral aspect of the lower extremity; iliotibial band friction syndrome; peroneus tendinitis; stress fractures; trochanteric bursitis; and plantar fasciitis. Appropriate footwear advice and the use of energy-absorbing materials to help dissipate shock will benefit these individuals. Running shoes for the pronated runner should control the excessive motion. The shoes should be board-lasted, straight-lasted, have a stable heel counter, extra medial support, and a wider flare than the shoes for the cavusfoot. For these athletes a slip-lasted, curve-lasted shoe with softer ethylene vinyl acetate (EVA) and a narrow flare is appropriate. Orthotic devices are useful in selected runners with demonstrated biomechanical abnormalities that contribute to the injury. Soft orthotics made of a commercial insole laminated with EVA are comfortable, easily adjusted, inexpensive, and more forgiving than the semirigid orthotics which are useful in cases where the soft orthotic does not provide adequate foot control.
A review of injury data shows an alarming rise in the incidence of knee pain in runners — from 18% to 50% of injuries in 13 years. Errors in training judgement, with excessive loading, particularly in runners with compromised biomechanical features, represent the primary aetiological factors. These errors cannot be accommodated by running shoe design. Similarly, orthotic devices alone will not control the injury pattern of most runners. Although footwear and biomechanical control may represent a significant therapeutic intervention in some individuals, they must remain part of a comprehensive rehabilitation programme that considers the other aetiological factors that contribute to running injuries.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Bates, B.T.; James, S.L. and Osternig, L.R.: Foot function during the support phase of running. Running 3: 24–29 (1978).
Bates, B.T.; Osternig, L.R.; Mason, B. and James, S.L.: Foot orthotic devices to modify selected aspects of lower extremity mechanics. American Journal of Sports Medicine 7 (6): 338–342 (1979).
Bates, B.T.; Osternig, L.R.; Sawhill, J.A. and James, S.L.: An assessment of subject variability, subject-shoe interaction, and the evaluation of running shoes using ground reaction force data. Journal of Biomechanics 16 (3): 181–191 (1983).
Brody, D.M.; Running injuries; in Brass (Ed.) Clinical Symposia, Vol. 32, No.4 (Ciba Pharmaceutical Company, USA 1980).
Brody, D.M.: Techniques in the evaluation and treatment of the injured runner. Orthopedic Clinics of North America 13: 541–558 (1982).
Cavanagh, P.R.: The Running Shoe Book, pp. 262 (Anderson World, Mountain View, 1980).
Cavanagh, P.R. and Lafortune, M.A.: Ground reaction forces in distance running. Journal of Biomechanics 13(5): 397–406 (1980).
Cavanagh, P.R.: The shoe-ground interface in running; in Mach (Ed.) American Academy of Orthopedic Surgeons Symposium on The Foot and Leg in Running Sports, pp. 30–44 (Mosby, St Louis 1982).
Cavanagh, P.R.; Valiant, G.A. and Miserich, K.W.: Biological aspects of modeling shoes/foot interaction during running; in Frederick (Ed.) Sport Shoes and Playing Surfaces, pp. 24–46 (Human Kinetics, Champaign 1984).
Clement, D.B. and Taunton, J.E.: A guide to the prevention of running injuries. Canadian Family Physician 26: 543–548 (1980).
Clement, D.B.; Taunton, J.E.; Smart, G.E. and McNicol, K.L.: A survey of overuse runing injuries. Physician and Sportsmedicine 9: 47–58 (1981).
Clement, D.B.; Taunton, J.E.; Wiley, J.P.; Smart, G. and McNicol, K.: The corrective orthotic devices on O2 uptake during running; in Bachl, Prokop and Suckert (Eds) Current Topics in Sports Medicine, pp. 930–940 (Urban and Schwarzenberg, Baltimore 1984).
Frederick, E.C.; Hagy, J.L. and Mann, R.A.: The prediction of vertical impact force during running. Journal of Biomechanics 14:498 (1981).
Frederick, E.C.; Clarke, T.E. and Hamill, C.L.: The effect of running shoe design on shock attenuation; in Frederick (Ed.) Sport Shoes and Playing Surfaces, pp. 190–198 (Human Kinetics, Champaign, 1984).
Gudas, C.J.: Patterns of lower extremity injury in 224 runners. Comprehensive Therapy 6: 50–59 (1980).
James, S.L. and Brubaker, C.E.: Running mechanics. Journal of the American Medical Association 221: 1014–1016 (1972).
James, S.L.; Bates, B.T. and Osternig, L.R.: Injuries to runners. American Journal of Sports Medicine 6: 40–50 (1978).
Krissoff, W.B. and Ferris, W.D.: Runner’s injuries. Physician and Sportsmedicine 7(12): 55–64 (1979).
Lutter, L.D.: Cavus foot in runners. Foot and Ankle 1(2): 225–228 (1981).
MacLellan, G.E.: Skeletal heel strike transients, measurement, implications and modification by footwear; in Frederick (Ed.) Sport Shoes and Playing Surfaces (Human Kinetics, Champaign 1984).
Mann, R.A.: Biomechanics of running; in Mack (Ed.) American Academy of Orthopaedic Surgeons Symposium, The Foot and Leg in Running Sports, pp. 1–29 (Mosby, St. Louis 1982).
Mann, R.A.; Baxter, D.E and Lutter, L.D.: Running symposium. Foot and Ankle 1(4): 190–224 (1981).
McKenzie, D.C.; Taunton, J.E.; Clement, D.B.; Smart, G.W. and McNicol, K.L.: Calcaneal epiphysitis in adolescent athletes. Canadian Journal of Applied Sport Science 6(3): 123–125 (1981).
Nigg, B.M.; Denoth, J. and Neukomm, P.A.: Quantifying the load on the human body; in Morecki and Fidelus (Eds) Biomechanics VII, pp. 88–105 (University Park Press, Baltimore 1982).
Nigg, B.M.; Denoth, J.; Luethi, S. and Stacoff, A.: Methodological aspects of sport shoe and sport floor analysis; in Matsui and Kobayashi (Eds) Biomechanics VIII-B, pp. 1041–1052 (Human Kinetics, Champaign 1983).
Newell, S.G. and Bramwell, ST.: Overuse injuries to the knee in runners. Physician and Sportsmedicine 12(3): 80–92 (1984).
Radin, E.L.; Orr, R.B.; Kelman, J.L.; Paul, I.L. and Rose, R.M.: Effect of prolonged walking on concrete on the knees of sheep. Journal of Biomechanics 15 (7): 487–492 (1982).
Smith, L.; Clarke, T.; Hamill, C. and Santopietro, F.: The effects of soft and semi-rigid orthoses upon rearfoot movement in running. Medicine and Science in Sports and Exercise 15 (2): 171 (1983).
Sperryn, P.N. and Rostan, L.: Pediatry and sport physician; Bachl, Prokop and Suckert (Eds) Current Topics in Sports Medicine, pp. 930–940 (Urban and Schwarzenberg, Baltimore 1984)
Stanish, W.D.: Overuse injuries in athletes: A perspective. Medicine and Science in Sports and Exercise 16: 1–7 (1984).
Subotnick S.: Podiatric Sports Medicine (Futura, New York 1975)
Subotnick, S.I.: The biomechanics of running. Implications for the prevention of foot injuries. Sports Medicine 2: 144–153 (1985)
Taunton, J.E.; Clement, D.B.; Smart, G.W.; Wiley, J.P. and McNicol, K.L.: A triplanar electrogoniometer investigation of running mechanics in runners with compensatory overpronation. Canadian Journal of Applied Sports Science (In press, 1985)
About this article
Cite this article
McKenzie, D.C., Clement, D.B. & Taunton, J.E. Running Shoes, Orthotics, and Injuries. Sports Medicine 2, 334–347 (1985). https://doi.org/10.2165/00007256-198502050-00003
- Ground Reaction Force
- Subtalar Joint
- Plantar Fasciitis
- Ethylene Vinyl Acetate
- Ethylene Vinyl Acetate