Why changing running shoes could triple your injury risk

New study reveals critical flaw in how runners choose their shoes

GAINESVILLE, Fla. — Picture yourself running down a trail or treadmill. Do you land on your heel first (rearfoot strike), or do you land on the middle or front of your foot (non-rearfoot strike)? If you’re like most runners in a new, comprehensive study of 710 participants, you might be wrong about your answer – and that misconception could be setting you up for injury.

The eye-opening study published in Frontiers in Sports and Active Living, concludes that most runners are surprisingly unaware of how their feet hit the ground when they run. This lack of awareness, particularly among those wearing thick-heeled shoes, could be contributing to running-related injuries and hampering efforts to improve running form.

Led by researchers at the University of Florida, this investigation revealed that only 42.7% of runners could accurately identify their foot strike pattern. Of all participants, 28.3% self-reported as rearfoot strikers, 47% as non-rearfoot strikers, and 24.6% admitted they didn’t know their pattern. However, biomechanical analyses showed that among those who didn’t know their strike pattern, 81% were actually rearfoot strikers, and 19% were non-rearfoot strikers.

“The shoe lies between the foot and the ground, and features like a large heel-to-toe drop make it more challenging for runners to identify how they’re striking the ground. That clouds how we retrain people or determine if someone is at risk for future injury,” explains Heather Vincent, Ph.D., director of the UF Health Sports Performance Center and lead author of the study, in a media release.

What makes this finding particularly significant is that foot strike patterns have garnered considerable attention over the last 15 years as potential contributors to running-related injuries and the running economy. Cross-sectional and prospective evidence suggests that running-related injury prevalence ranges from 49% to 92%, depending on the study. The paper notes that rearfoot strikers have running-related repetitive injury prevalence that is twice that of forefoot strikers, along with lower variability of foot contact angle which may amplify localized tissue loading and injury risk.

The research team leveraged their unique position at UF Health’s Sports Performance Center and Running Medicine Clinic, which sees hundreds of runners annually. This allowed them to analyze data from over 700 runners across six years, making it one of the largest and most comprehensive studies of its kind.

Beyond simple awareness, shoe characteristics emerged as a crucial factor in both injury rates and foot strike detection accuracy. After accounting for several variables, shoe heel-to-toe drop proved to be a consistent predictor of both accurate strike detection and running-related injuries. Higher heel-to-toe drops were associated with a lower likelihood of accurate foot strike detection and increased injury risk.

“I had to teach myself to get out of the big, high-heeled shoes down to something with more moderate cushioning and to work on foot strengthening,” says Dr. Vincent. “It may take up to six months for it to feel natural. It’s a process.”

Among the study’s most intriguing findings, runners who admitted they “didn’t know” their strike pattern had the highest prevalence of running-related injuries – 73% compared to 56% and 58% for self-reported non-rearfoot and rearfoot strikers, respectively. This suggests that body awareness might play a crucial role in injury prevention.

The study included a diverse sample of runners ranging from 12 to 77 years-old, with an average age of 35.4 years. Women made up 51.5% of participants, and 51.6% were training competitively at the time of testing. The minimum average weekly program typical running distance was 33.2 kilometers.

Shoe characteristics proved particularly revealing. Non-rearfoot strikers who accurately identified their pattern typically wore lighter shoes with lower heel-to-toe drops. These runners also reported the lowest injury rates among all groups. This finding suggests that minimalist shoes might enhance ground feel and promote better running awareness.

Recent shoe changes emerged as another significant risk factor for injury. Regression analyses showed that runners who had changed their footwear in the previous six months were nearly three times more likely to report running-related injuries. This statistical finding highlights the critical importance of careful transition periods when switching to new running shoes.

While the associations between high-heeled shoes and injury were clear in the data, establishing direct causation requires further investigation. The scientists plan to conduct controlled studies examining whether changing shoe type affects runners’ accuracy of foot strike detection and injury rates.

“We want to translate what we find to meaningful ways to help runners modify their form to reduce injury risk and keep them healthy for the long term,” Dr. Vincent explains.

For runners attempting to modify their running form – perhaps to prevent injury or improve efficiency – accurate detection of their current foot strike pattern appears crucial for successful gait modification. The study found that purposefully trying to change foot strike type was associated with increased odds of accurately detecting actual foot strike pattern.

These findings could influence how running stores fit shoes and how physical therapists approach gait retraining. Rather than relying solely on a runner’s self-reported strike pattern, professionals might need to incorporate objective observation or analysis before making recommendations.

Just as a driver needs to know where they’re starting before programming their GPS, runners need accurate awareness of their running form before they can effectively modify it. This study suggests that what you wear on your feet might be clouding that essential self-awareness.