‘Super Shoes’ Can Improve Running Performance but May Contribute to Injury

Researchers at Mass General Brigham have found that although advanced footwear technology (AFT), commonly known as “super shoes,” may improve performance in elite runners, they also cause subtle changes in running mechanics linked to bone stress injuries. The findings are published in PM&R, the official scientific journal of the American Academy of Physical Medicine and Rehabilitation.

“Our study highlights the need for careful integration of AFT into training and underscores the importance of further research to better understand long-term strategies to modify risk for injury while recognizing the exciting gains related to this footwear on performance,” said senior author Adam Tenforde, MD, director of Running Medicine at Mass General Brigham and attending physician at Spaulding Rehabilitation.

For the study, 11 female and 12 male healthy elite distance runners ran in three different shoes—neutral, lightweight responsive foam, and AFT with highly cushioned foam and a stiff embedded plate. They did this in a randomized order at three self-selected speeds: training effort, a tempo run, and 5-kilometer race speed.

During each speed and shoe condition, investigators assessed various movement and force patterns that have been associated with bone stress injuries, which are overuse injuries that can lead to bone swelling or stress fractures.

Overall, AFT shoes were associated with biomechanical changes linked to bone stress injury risk, including decreased cadence (fewer steps per minute, which forces overstriding) and arches collapsing inwards more than in neutral shoes. Although these changes were small, they may accumulate over time to contribute to injury. Interestingly, in AFT shoes, runners pushed off less with their ankles, suggesting a potential protective effect, even as other risk-related variables increased.

“AFT improves performance, but runners should balance this benefit with the possibility of subtle changes in loading on the body. Rotating shoes and gradually adapting to AFT may help reduce potential injury risk while optimizing running performance,” said lead author Michelle M. Bruneau, PT, DPT, PhD, a postdoctoral research fellow in the Department of Physical Medicine and Rehabilitation at Spaulding.

Authorship: In addition to Tenforde and Bruneau, Mass General Brigham authors include Logan W. Gaudette, Evan Sirls, Federico De Carlo, Andrew Fodera, Violet Sullivan, Asher Bean, Alan Lussner, and Zachary Baxter. Additional authors include Karsten Hollander, Amol Saxena, and Tim Hoenig.

Disclosures: Adam Tenforde serves as Senior editor for PM&R Journal. He gives professional talks such as grand rounds and medical conference plenary lectures and receives honoraria from conference organizers. He has participated in research funded by Arnold P. Gold Foundation (physician and patient care disparities), Football Player Health Study at Harvard (health in American-Style Football players), American Medical Society for Sports Medicine (bone density research), Uniform Health Service and Enovis (Achilles tendinopathy) and MTEC/Department of Defense (bone stress injuries with shockwave). He is a paid consultant for State Farm Insurance and Strava. He receives industry support from Enovis, Sanuwave and Storz for equipment use for research studies on treatment of tendinopathy, knee osteoarthritis and bone stress injuries.

Funding: Shoes were donated by New Balance.

Paper cited: Bruneau MM et al. “Biomechanics associated with bone stress injuries while using advanced footwear technology in elite distance runners” PM&R DOI: 10.1002/pmrj.70153