pronation is not associated with increased injury risk in novice runners
wearing a neutral shoe: a 1-year prospective cohort study.

Neilsen RO, Buist I, Parner ET, Nohr
EA, Sorensen H, Lind M, and Rasmussen S. Br J Sports Med. 2013; [Epub Ahead of

Home Message: Novice runners with pronated feet may sustain fewer injuries than
neutral feet, when they wear neutral running shoes.

Among runners foot pronation is believed
to be a strong predictor for athletic injury. While certain athletic shoes are
commonly prescribed for individuals with pronated and supinated feet, there has
been conflicting evidence to support this. Therefore, Neilsen and colleagues
completed a
prospective cohort study “to investigate if running distance to
first running-related injury varies between foot postures in novice runners
wearing neutral shoes.” Investigators recruited participants through
posters and mailings distributed to local companies to target participants
interested in taking up running. Potential participants completed an online
questionnaire to screen gender, age, running experience, health, previous
running-related injuries, and previous injuries not related to running.  Participants were included if they were (a)
healthy, (b) between 18-65 years of age, (c) had no injury of the lower
extremity for at least 3 months prior to the start of the study, (d) able to
access the internet, and (e) not running on a regular basis. Participants were
excluded if they (a) participated in another sport for more than 4 hours per
week, (b) used insoles during training, (c) were pregnant, (d) reported a
history of strokes, heart disease or chest pain during training, or (e) were
unwilling to participate in the study. Investigators classified 1,854 feet from
927 participants into 1 of 5 foot posture groups based on the
Foot Posture Index (FPI): highly supinated (53 feet), supinated
(369 feet), neutral (1292 feet), pronated (122 feet), or highly pronated (18
feet). Investigators issued neutral running shoes and a GPS watch to the
participants and instructed participants to upload data from every training
session, via the GPS watch, to an
online personal training diary. If an injury occurred, participants
contacted the research team and they scheduled an appointment for a clinical
examination. The investigators classified injuries as either “running-related”
or “other”.  At a 1-year follow-up, the
rate of first-time injury was 17.4% for neutral feet, 17.9% for supinated feet,
24.5% for highly supinated feet, 13.1% for pronated feet, and 33.3% for highly
pronated feet. Overall, the investigators found no differences among highly
supinated, supinated, pronated, and highly pronated feet when comparing to
neutral feet with regards to injury rates at different running distances – 0 to
500 km. Conversely, pronated feet were less likely to sustain injury per 1000
km of running than neutral feet.

Overall, the investigators found that a
person with a pronated foot, in a neutral shoe, was less likely to incur an
injury compared to neutral feet in the same shoe. Unfortunately, this was not
the case for other foot types (supinated or highly pronated); however, this
study provides clinicians with some good information. During evaluation, when
clinicians observe foot type, they should also evaluate the athlete’s shoe type
and condition to better advise the patient with regards to proper foot wear. Since
the current study only used neutral shoes it is difficult to only recommend neutral
shoes to patients as future research may find another shoe type more beneficial.
Secondly, the data in the current study leaves to door open for other foot
types to be paired with an equally effective type of shoe. This is where future
research can greatly impact injury prevention. Currently, only part of the
puzzle is complete. More research should look to focus on different levels of running
experience and other shoes types. Conceivably, one can see a gold standard of
shoe type that is recommended based on the athlete’s foot type and level of
running experience.  

for Discussion: Do you currently screen athletes for foot type prior to
activity or as part of your preparticipation physical exam? If not, would you
consider doing this now that you have seen that this could impact the number of
running injuries?

Written by: Kyle Harris
Reviewed by: Jeffrey Driban

Related Posts:

Nielsen RO, Buist I, Parner ET, Nohr EA, Sørensen H, Lind M, & Rasmussen S (2013). Foot pronation is not associated with increased injury risk in novice runners wearing a neutral shoe: a 1-year prospective cohort study. British Journal of Sports Medicine PMID: 23766439