Running injury paradigms and their influence on footwear design features and runner assessment methods: a focused review to advance evidence-based practice for running medicine clinicians

Review written by Tom Goom info

Key Points

  1. This narrative review explores running injury theories and their influence on footwear development and selection.
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Let’s start this review with a hypothetical case study – a runner presents to your clinic with insertional Achilles tendinopathy. They arrive clutching a bag of different running shoes including 3 pairs: a motion control shoe, a ‘neutral’ shoe and a minimalist shoe. Which pair should you recommend them to wear to help with their Achilles pain? Could footwear selection have helped prevent this injury in the first place? Can the shoes also influence their performance?

These questions sit at the heart of the footwear selection issue for runners and this new review examined 4 running injury paradigms and how they’ve been used to guide footwear development and selection. We’ll return to answer these questions in the clinical implications section.

This paper was a narrative review of the literature examining how footwear selection may influence running injury and performance. In the following sections we’ll examine each of the 4 key injury paradigms and summarize the findings of this review.

Footwear selection is a common issue for runners.
It seems sensible to adapt our guidance to suit each individual and test our theories to see if they help symptoms.


The pronation control paradigm theorizes that excessive pronation during running may increase stress on tissues and lead to injury. To prevent this, shoes were developed with features to limit the range of pronation such as ‘motion control shoes’. These often

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