Research shows why these shoes can lead to more runner injuries

Runners who wore sneakers with thick heels were at greater risk of injury than those who wore flatter shoes, according to a recent study from the University of Florida. The paper is published in the news Limits in sports and active life.

The study, one of the largest and most comprehensive of its kind, also found that runners with thicker heels could not accurately identify how their foot landed with each step, a likely factor in the high injury rates. Because flatter shoes are associated with fewer injuries, researchers say they are likely the best option for most runners to improve ground feel and learn to land in a controlled manner. But switching to a different shoe type or foot pattern can also put you at risk of injury and should be done gradually, something lead author Heather Vincent, Ph.D., knows from personal experience.

“I had to teach myself to move from the big, high-heeled shoes to something with more moderate cushioning and work on foot strengthening,” says Vincent, director of the UF Health Sports Performance Center. “It can take up to six months before it feels natural. It’s a process.”

Both foot movement pattern and shoe type have been linked to running injuries in previous studies, but the interaction between the two has been difficult to identify in small groups of runners. UF Health’s Sports Performance Center and Running Medicine Clinic sees hundreds of runners each year. This allowed the researchers to draw on more than 700 runners and six years of information on runners’ shoe type and injury history, as well as objective gait data obtained with specialized treadmills and motion capture videos.

What became clear after controlling for factors like age, weight, running volume and competitiveness was that shoes with thicker heels confused runners about their gait – confusion that was strongly linked to injuries.

“The shoe sits 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 hitting the ground. That clouds how we retrain people or determine whether someone is working.” risk of future injuries,” Vincent said. “The runners who correctly detected a mid- or forefoot strike had very different shoes: lower heel-to-toe drop; lighter; wider toe box.”

Heather Vincent collaborated on the study with Ryan Nixon, Ph.D., Kevin Vincent, Ph.D. and others from the UF Colleges of Medicine and Public Health and Health Professions.

Although the associations between high-heeled shoes and injuries were clear, it is difficult to prove that heel-to-toe falls directly cause these injuries. In the future, the scientists plan to conduct controlled studies to see if changing shoe type affects foot strike detection accuracy and injury rates in runners. That would help identify the true cause of these common injuries and suggest the best solutions.

“We want to translate what we find into meaningful ways to help runners adjust their form to reduce their risk of injury and keep them healthy in the long term,” Vincent said.