Page 118 - Journal of Special Operations Medicine - Winter 2015

Figure 6 Running shoe models and injury incidence among Biomechanical studies have shown that the relationships
men in Army basic combat training. between arch height, foot joint mobility, and rearfoot
motion (including foot pronation) are complex, vari-
able, and frequently not as strong as often assumed. 34–36
Thus, the premise upon which these shoe types (mo-
tion control, stability, and cushioned) have been based
would appear to be inadequate and this weakness may
well explain the observed lack of benefits accruing from
wearing running shoes that have been fitted on the basis
of arch height. Interestingly, one study found that arch
34
mobility may be more important than arch height in de-
termining the degree of rearfoot motion and that a high
arch alone was not necessarily predictive of a rigid foot
that might benefit from cushioning.
running-shoe models worn by at least 40 recruits, there
was little difference in injury incidence regardless of the Physical Training in Boots Versus Shoes
make and model of the shoe. 32
Prior to 1982, the US Army performed all physical
Another study tracked injuries among 1,332 male Sol- training and physical fitness testing in a modified duty
33
diers in the 4th Brigade, 4th Infantry Division at Fort Car- uniform and combat boots. 37,38 In September 1982,
son, Colorado. Shoe models and brands were recorded by General Glenn Otis, Commander of the Army Train-
the investigating team and the Soldier was included in the ing and Doctrine Command, issued a communiqué
study only if he indicated that the shoe examined was his to commanders permitting commercial running shoes
39
regular training shoe. The types of shoe (motion control, for all physical training and testing. The use of run-
stability, cushioning) were determined by the manufac- ning shoes was codified into Army doctrine with the
turer descriptions. Injuries to the Soldiers were examined publication of the 1985 edition of Army Field Manual
40
in a 12-month period. Figure 7 shows that there was very 21-20. The reason for the change was the belief of
little difference in injury incidence between the Soldiers many that running in boots was the cause of many of
wearing the different types of shoes. the injuries that were seen in the military. 41–43 How-
ever, when the doctrine was changed, there had been
While the three basic training studies were randomized no study comparing injury rates among groups per-
controlled investigations, the Fort Carson study was forming physical training in shoes versus boots, and,
only an observational study. In the Fort Carson study , to date, no such study has been conducted. If the be-
33
Soldiers’ foot types were not assessed and it cannot be lief that injuries were associated with the use of boots
determined if the Soldiers wore shoes based on arch for physical training were true, it was reasonable to
height. Further, Soldiers might have switched shoe types expect a decrease in injuries after Army doctrine was
over the course of the year. Nonetheless, taken together, changed to mandate the use of running shoes, provid-
the studies indicate that (1) choosing or assigning shoes ing that other factors (e.g., running mileage, speed,
on the basis of foot arch height had very little influence and the like) remained extant following the change in
on injury incidence in basic training, and (2) regardless footwear.
of foot arch height, wearing motion control, stability, or
44
cushioned shoes did not influence injury incidence over One study looked at the available literature to exam-
a 1-year period in active-duty Soldiers. ine injury incidence in US Army basic combat training
(BCT) before and after the switch from boots to running
Figure 7 Association between shoe types and injuries in the shoes. Care was taken to ensure that (1) the injury defi-
Fort Carson study. nitions were similar in the two periods (pre-1982 versus
post-1982), and (2) that the length of basic training was
the same in the studies included in the analysis so that
the recruits were exposed to injury risks over the same
period of time (8 weeks). Figure 8 shows the injury in-
cidence when the injury definition included all injuries
and when the injury incidence involved only lower ex-
tremity injuries. There was very little difference in injury
rates between the two periods. This suggested that the
switch from boots to running shoes did not influence
injury rates in BCT.

106 Journal of Special Operations Medicine Volume 15, Edition 4/Winter 2015