The following E-Letter is a response to The effect of three different levels of footwear stability on pain outcomes in women runners: a randomised control trial . Abstract | Full article

Ryan et al (1) provide empirical evidence that standards for running shoes in relation to foot posture are far from convincing. In particular, a sophisticated and expensive motion-control design intended for highly pronated feet was less effective than more basic shoes in minimizing injuries and pain to all categories of foot. This outcome echoes Richards et al’s (2) recent negative review regarding the role of shoe design in reducing injury.

I wrote a rapid response (3) to the latter paper suggesting that the origin of the conundrum may not reside only in biomechanics, but rather there may be a psychological element concerning the individual’s interpretation of risk. The extreme form of this conceptualisation is “risk homeostasis”, whereby it is argued that the individual “targets” a fixed level of perceived risk to govern his/her performance on any given activity (4,5). The psycholigical mechanisms by which risk is perceived and affects behaviour remain speculative; one model is based on low-level learning of the outcomes of competing tendencies in beviour (6). The typical activity to which the conceptualisation is applied has been road- travel and reflects the observation that may safety features do not maintain their benefit over time: drivers squander safety benefits in less careful driving, as reflected for example in greater and more erratic speeds. Two examples concern seat-belts and ABS brakes (5,6,7).

As applied to running, the implication is that greater sophistication in shoe design reduces the perceived likelihood of potential injury; however, the consequence may be an increase in risky running behaviour. For example, the runner may pay more attention to uneven surfaces when wearing a less sophisticated design of shoe, but determine that a more sophisticated design deals adequately in equivalent circumstances; if this is not the case then more pain and injuries will result from the more sophisticated design.

Tony H. Reinhardt-Rutland
Reader in Psychology
University of Ulster

References

1. Ryan MB, Valiant GA, McDonald K, Taunton JE. The effect of three different levels of footwear stability on pain outcomes in women runners: a randomised control trial. Br J Sports Med doi:10.1136/bjsm.2009.069849.

2. Richards CE, Magin PJ, Callister R. Is your prescription of distance running shoes evidence-based? Br J Sports Med 2009; 43: 159-162.

3. Reinhardt-Rutland AH. Negating the safety advantage in running shoe design: perceived risk affecting performance? Br J Sports Med 2009 [http://bjsm.com/cgi/eletters/43/3/159]

4. Wilde GJS, Robertson LS, Pless IB. Does risk homeostasis theory have implications for road safety? BMJ 2002; 324: 1149-1152.

5. Adams JGU. Risk. London: UCL, 1995.

6. Reinhardt-rutland AH. Seat-belts and behavioural adaptation: the loss of looming as a negative reinforcer. Safety Sci 2001; 39: 145-155.

7. Aschenbrenner M, Biehl B. Improved safety through improved technical measures? Empirical studies regarding risk compensation processes in relation to anti-lock brake systems. In RM Trimpop, GJS Wilde (eds). Changes in accident prevention: The issue of risk compensation. Groningen: Styx, 1994.

Evolutionist Dan Lieberman raised the question of barefoot running in the ACSM‘s Wolfe Memorial Lecture in 2009. Here the New York Times enters the debate by interviewing renowned biomechanist Benno Nigg (University of Calgary) and weaving in data from a recent BJSM paper on what happens as shoes wear out over time.