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Changing running gait could reduce injury risk

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Runners who change their gait pattern may decrease their likelihood of injury, according to a literature review published in the Journal of the American Academy of Orthopaedic Surgeons (JAAOS).

Reporting on the study, the American Academy of Orthopaedic Surgeons said that advances in running shoe technology in the last 40 years have not reduced injuries, but racing “barefoot” in shoes with minimal cushioning could help runners change their strides and landing patterns to prevent repetitive heel pain and stress fractures.

The researchers highlighted a movement towards barefoot and minimalist running in recent years, and said that advocates believe a lack of cushion and support promotes a forefoot or midfoot strike rather than a rearfoot strike, decreasing the impact transient and stress on the hip and knee.

Sceptics, meanwhile, are concerned that, barefoot running could lead to additional, unforeseen injuries because of the effects of the natural environment and the lack of a standardised transition programme.

“Injury patterns among long-distance runners are unacceptably high, and while some research in minimalist running seems promising regarding injury prevention, there still are a lot of unknowns, and the debate continues,” commented lead author Dr. Jonathan Roth, an orthopaedic surgeon at Fort Belvoir Community Hospital in Virginia. “Evidence to date shows that changing gait patterns, not shoe selection, is the best intervention to lower the injury prevalence in runners. Minimalist shoes may give better feedback to runners and allow them to focus on changing their gait, but not everyone does, and this could lead to more injury.”

Dr. Roth added that increasing acceptance of minimalist running has outpaced medical evidence of its benefits. But he noted that orthopaedic literature has demonstrated that with less-cushioned footwear, runners spontaneously transition from the rearfoot strike (RFS) to the forefoot strike (FFS) gait pattern.

It´s still not certain that landing forefoot can truly reduce injuries, but a 2012 study involving a collegiate cross-country team found that FFS runners were 1.7 times less likely to sustain repetitive injuries than RFS runners.

The JAAOS literature review pointed out, however, that barefoot and minimalist running is not injury-proof and poses risks for metatarsal (toe) stress fractures, plantar fasciitis and puncture wounds.

Dr. Roth advised runners interested in exploring minimalist running shoes to transition from a RFS to FFS gait pattern to consider themselves as non-runners and start by walking and gradually adding running distance week to week.

This helps to build strength, flexibility, stability, and endurance around the foot and ankle and avoid an increase in other repetitive stress injuries.