bioengineering

Systematic Review
The Implications of Sports Biomechanics Studies on the Research
and Development of Running Shoes: A Systematic Review
Shuangshuang Lin 1 , Yang Song 1,2 , Xuanzhen Cen 1,2 , Kovács Bálint 1 , Gusztáv Fekete 3 and Dong Sun 1, *

1 Faculty of Sports Science, Ningbo University, Ningbo 315211, China

2 Doctoral School on Safety and Security Sciences, Óbuda University, 1034 Budapest, Hungary
3 Savaria Institute of Technology, Faculty of Informatics, Eötvös Loránd University, 9700 Szombathely, Hungary
* Correspondence: [email protected]; Tel.: +86-17855848559

Abstract: Although various sports footwear demonstrated marked changes in running biomechanical
variables, few studies have yielded definitive findings on the underlying mechanisms of shoe
constructions affecting running-related performance and injuries. Therefore, this study focused
on examining the effect of basic shoe constructions on running biomechanics and assessing the
current state of sports shoe production in terms of injury and efficiency. Relevant literature was
searched on five databases using Boolean logic operation and then screened by eligibility criteria. A
total of 1260 related articles were retrieved in this review, and 41 articles that met the requirements
were finally included, mainly covering the influence of midsole, longitudinal bending stiffness,
heel-toe drop, shoe mass, heel flare, and heel stabilizer on running-related performance and injuries.
The results of this review study were: (1) The functional positioning of running shoe design and
the target groups tend to influence running performance and injury risk; (2) Thickness of 15–20 mm,
hardness of Asker C50-C55 of the midsole, the design of the medial or lateral heel flares of 15◦ , the
curved carbon plate, and the 3D printed heel cup may be beneficial to optimize performance and
Citation: Lin, S.; Song, Y.; Cen, X.;
reduce running-related injuries; (3) The update of research and development concepts in sports
Bálint, K.; Fekete, G.; Sun, D. The
biomechanics may further contribute to the development of running shoes; (4) Footwear design and
Implications of Sports Biomechanics
optimization should also consider the influences of runners’ strike patterns.
Studies on the Research and
Development of Running Shoes: A
Systematic Review. Bioengineering
Keywords: running shoes; biomechanics; performance; injuries; development
2022, 9, 497. https://doi.org/
10.3390/bioengineering9100497

Academic Editor: Franz Konstantin

1. Introduction
Fuss
Footwear can be a highly effective instrument for manipulating human movement [1,2].
Received: 26 August 2022 By promoting core technology and refining material property, major shoe companies have
Accepted: 19 September 2022 been marked as high-tech bellwethers of the global athletic footwear industries [1]. In
Published: 22 September 2022 the past 40 years of rapid development, many sports shoe manufacturers have tried to
Publisher’s Note: MDPI stays neutral incorporate specific functions into their prototypes, including cushioning, stability, energy
with regard to jurisdictional claims in return, and motion control [1,2]. At present, scientific research has paid considerable
published maps and institutional affil- attention to the practicality of footwear, inspired by numerous assertions of running shoe
iations. companies when marketing products that are intended to optimize performance or block
sports injuries. Despite decades of efforts in sports shoe design, the prevalence of lower
limb injuries related to running has not seen a dramatic decline [3,4].
Running loads ranging from 1.5 to 3 times the body weight are repeatedly consumed
Copyright: © 2022 by the authors. by each leg. Such continuous loading and subsequent force shocks may inflict microtrauma
Licensee MDPI, Basel, Switzerland. and muscle fatigue, resulting in impaired function [5]. Given that repeated loading of
This article is an open access article
the musculoskeletal system is often regarded as a predictor of damage occurrence, shoes
distributed under the terms and
with softer, more shock-absorbing soles have been highlighted as tactics responsible for
conditions of the Creative Commons
mitigating the ground reaction force [6,7]. Nigg [3], in contrast, proposed that impact
Attribution (CC BY) license (https://
forces may not be a major factor in the development of injuries. According to relevant
creativecommons.org/licenses/by/
epidemiological data, Hao [4] verified that modern running shoe technology appears
4.0/).

Bioengineering 2022, 9, 497. https://doi.org/10.3390/bioengineering9100497 https://www.mdpi.com/journal/bioengineering

Bioengineering 2022, 9, 497 2 of 29

ineffective in reducing runners’ lower limb and foot injuries. In addition, among the most
striking patterns arising from studies of sports shoe biomechanics, many results are the
indirect product of shoe-induced kinematic changes. Since a comprehensive upgrade in
athletic footwear is warranted, recognizing biomechanical adaptations aligned with shoe
technologies is vital to understanding the mechanism of any potential outcomes.
As one of the most notable footwear elements, the sole has undergone massive adjust-
ments (e.g., sole geometry and properties). In the previous articles, the role of sole shoe
characteristics on running biomechanics was discussed. Chambon [8] stated that increased
midsole thickness had no effect on foot-strike patterns or kinematics but influenced stance
phase duration. A broad range of heel-to-toe drops applied in running shoes has been
found to stimulate distinct foot-strike patterns and injury potentials among different run-
ning crowds (i.e., regular, occasional, or untrained) [9]. Moreover, Willwacher et al. [10]
deduced that variable stiffness shoes could increase anterior ground reaction force, which
supports athletes’ forward propulsion and potentially improves running efficiency. By
offloading foot joints during locomotion, an enhanced forefoot bending stiffness can serve
a preventative role in running injuries [11]. On the other hand, Law et al. [12] concluded
that individuals might respond inconsistently to the modification of sole stiffness owing to
the disparity of gait and muscle activation patterns.
Although there are also various sports shoe constructions that have demonstrated
marked changes in running biomechanical variables, such as shoe mass, heel flare, and heel
stabilizer [1,4], few studies have yielded definitive findings on the mechanisms underlying
shoe features affecting running-related performance and injuries. To underpin modern
sports shoe designs, this study focused on examining the effect of differing sole features on
running biomechanics and assessing the current state of the production of sports shoes in
terms of injury and efficiency.

2. Materials and Methods

2.1. Protocol Registration
This review was conducted in accordance with the Preferred Reporting Items for
Systematic Reviews and Meta-Analyses (PRISMA) statement (INPLASY202280107).

2.2. Search Strategy

The following keyword combinations were used in a standardized electronic literature
search process: “running shoes” OR “running footwear” AND (“midsole” OR “midsole
stack height” OR “cushioning” OR “stiffness” OR “bending stiffness” OR “heel-to-toe
drop” OR “shoe weight” OR “heel flare” OR “heel cup” OR “heel counter”) from 1 January
1980 to 1 June 2021, via the five electronic literature databases (Google Scholar, PubMed,
ScienceDirect, Scopus, and Web of Science). A snowballing procedure was conducted to
review the reference list and identify new papers. The search and selection processes are
summarized in Figure 1.

2.3. Eligibility Criteria

Eligibility criteria of the literature in this study: (1) Original research from peer-
reviewed English journals was included. Conference papers, review papers, master (doc-
toral) graduation papers, case studies, and non-full text articles were excluded. (2) The
research must be related to the midsole (hardness, thickness, and material), bending stiff-
ness, heel-to-toe drop, shoe mass, heel flare, and heel stabilizer (heel cup, heel counter) of
running shoes. (3) The research must involve the corresponding statistical analysis and offer
quantitative results on the influences of shoe construction in biomechanical changes during
running that are associated with performance and/or running injuries; non-biomechanical
related studies were excluded.
Bioengineering 9,x497
2022, 9,
Bioengineering 2022, FOR PEER REVIEW 3 of 30 3 of 29

Figure
Figure PRISMA
1. 1. Flow
PRISMA Chart
Flow for Systematic
Chart review.
for Systematic review.

2.4.Eligibility
2.3. Data Extraction
Criteria and Management
Eligibility criteriain
All the articles ofthis
the study
literature
were in downloaded
this study: (1)by Original
the sameresearch
authorfrom
and peer-re-
imported into
viewed
MendeleyEnglish journalsManagement
Reference was included. Conference
Software papers,
(Elsevier review
Ltd., papers, master
Amsterdam, (doc-
The Netherlands)
toral) graduation
for duplicate papers, casearticles
elimination, studies, and non-full and
management, text articles
citation.were
Theexcluded.
other two(2) The con-
authors
research
ductedmust
data be related toand
extraction the midsole
analysis(hardness, thickness,
of the literature, and material),
mainly including bending stiff-
the first author’s
ness,
name,heel-to-toe
researchdrop, shoe mass,
publication heelcountry,
year, flare, andresearch
heel stabilizer
design,(heel cup, heel
athletic counter) of
performance-related
running
and/orshoes. (3) The research
injuries-related must involve
biomechanics the corresponding
variables, and the primarystatistical analysis
results. and
Disagreements
offer quantitative
regarding data results on the
extraction influences
were resolved of by
shoe construction
the correspondingin biomechanical changes The
authors if happened.
during
PRISMA running that are
checklist was associated
followedwith performance
to synthesize and/or running injuries; non-biome-
data.
chanical related studies were excluded.
2.5. Quality Assessment
2.4. Data Extraction and Management
Cochrane Risk of Bias Assessment Tool was used to assess the risk of bias in each study
All the
by two articlesDisagreements
authors. in this study were downloaded
of quality by the same
assessment were author andbyimported
resolved into
the corresponding
Mendeley Reference Management Software (Elsevier Ltd., Amsterdam, The Netherlands)
authors if happened. Seven domains were evaluated (random sequence generation, alloca-
for duplicate
tion elimination,
concealment, articles
blinding management,
of participants andand citation. The
personnel, other of
blinding two authorsassessment,
outcome con-
ducted data extraction and analysis of the literature, mainly including the first author’s
incomplete outcome data, selective reporting, and other biases) and each domain has three
name, research publication year, country, research design, athletic performance-related
grades, i.e., low risk of bias, unclear risk of bias, and high risk of bias.
and/or injuries-related biomechanics variables, and the primary results. Disagreements
regarding data extraction were resolved by the corresponding authors if happened. The
3. Results
PRISMA checklist was followed to synthesize data.
3.1. Basic Characteristics of Included Studies
The comprehensive research generated 1230 articles (as shown in Figure 1). After
removing duplicated articles, a total of 596 articles was included. After two authors
Bioengineering 2022, 9, 497 4 of 29

conducted a title and abstract screening, a total of 125 articles was included. The articles
were further screened through the three eligibility criteria, and 41 related articles were
finally used in this study.
According to the authors’ country/region, 17 studies were from Europe, including
4 from France, 3 from Germany, 3 from Luxembourg, 2 from the United Kingdom, 2
from Austria, 1 from Belgium, 1 from Spain, and 1 from Switzerland; a total of 19 studies
were from North America, including 10 from Canada and 9 from the United States, and
6 from Asia, including 5 from China and 1 from South Korea. The proportion of research
literature published in 1980–1999, 2000–2009, and 2010–2021 was 11.90%, 23.81%, and
64.29%, respectively, which clearly shows that the interest in this area is increasing. The
effects of various shoe characteristics on running performance and/or injury will be further
discussed below.

3.2. Risk of Bias

The risk of bias in the 41 studies was assessed, and the consensus was reached after
discussion. The overall results are shown in Figure 2, and 64% of the studies reported
participants’ randomization. A total of 47% of the studies reported the method of allocation
concealment (subject random assignment), 17% of the studies did not fully describe it, and
the rest did not include allocation concealment. Only 5% of the studies were double-blind,
83% were not fully reported, and only one study made it clear that double-blind was not
used. A total of 74% of the studies described the blind method used in the evaluator, which
was not fully reported in other studies. Only one study did not fully report whether the
data were missing. All the studies recorded their research plan and researched according
to the program.

3.3. Effects of the Midsole on Running Performance/Injury

The main design aspects of running shoes are shown in Figure 3. A total of 12
articles (Table 1) investigated the impact of midsole hardness designs on running perfor-
mance/injury [5,6,9,13–21]. A total of two articles investigated the effect of midsole thick-
ness designs on running performance/injury [8,12]. A total of three articles investigated
the impact of midsole designs (materials and structures) on running performance/sports
injury [22–24].

3.3.1. Midsole Hardness

In the running, the increase in midsole hardness (i.e., from Asker C40 to Asker C65)
was linked to sports performance as specified by less energy expended at the metatar-
sophalangeal and less peak rearfoot eversion velocity [13,20]. In contrast, other studies
found that increased midsole hardness of running shoes had no significant effect on peak
tibial acceleration, running speed, walking time, and lower limb muscle activity (medial
femoris, biceps femoris, and gastrocnemius) [5,16]. In terms of running-related injuries,
findings remain inconclusive. Contradicting the general concept that softer midsole shoes
can prevent damage in running by dispersing impact mass, Baltich et al. [20] claimed that
the peak value of the vertical ground reaction force and the stiffness of the knee and ankle
joints were found reduced as the midsole hardness of running shoes increased. Similarly,
after tracking 247 runners for 5 months, Theisen et al. [18] deduced that the injury inci-
dence associated with applying a softer midsole might be higher than using a more rigid
midsole. However, the present finding indicated that regardless of the injury’s location,
type, or severity, there are no statistically significant differences between running shoes
with varying midsole hardness.
Bioengineering 2022, 9, x FOR PEER REVIEW 5 of 30
Bioengineering 2022, 9, 497 5 of 29

Theresult
Figure2.2.The
Figure result
ofof
thethe risk
risk of bias
of bias assessment.
assessment.

3.3. Effects of the Midsole on Running Performance/Injury

The main design aspects of running shoes are shown in Figure 3. A total of 12 articles
(Table 1) investigated the impact of midsole hardness designs on running performance/in-
jury [5,6,9,13–21]. A total of two articles investigated the effect of midsole thickness de-
signs on running performance/injury [8,12]. A total of three articles investigated the
 Bioengineering 2022, 9, x FOR PEER REVIEW 6 of 30

Bioengineering 2022, 9, 497 6 of 29

impact of midsole designs (materials and structures) on running performance/sports in-
jury [22–24].

3. The
Figure 3.
Figure Themain
maindesign
designaspects
aspectsofof
running shoes.
running shoes.

3.3.1.The
Midsole
otherHardness
three studies emphasized the impact of hardness in different midsole areas
In the running,
on running the increase ininjuries.
performance/sports midsoleSterzing
hardnesset(i.e., from
al. [6] Asker C40
evaluated thetoeffect
AskerofC65)
running
was linked
shoes to sportsmidsole
with varying performance as specified
hardness by less and
on the rearfoot energy expended
forefoot. at thesuggested
Findings metatar- that
sophalangeal
the cushioning and less peak of
properties rearfoot eversion
the rearfoot velocity
almost [13,20].determine
entirely In contrast, theother studies
vertical ground
found that
reaction increased
forces midsoleextremity
and lower hardness kinematics.
of running shoes had no significant
Moreover, running shoes effectthat
on peak
combine
atibial
softacceleration,
forefoot andrunning speed, walking
a stiff rearfoot midsole time,
canand lower limb
effectively musclethe
improve activity (medial char-
cushioning
femoris, biceps
acteristics. femoris, and
By examining thegastrocnemius)
effects of the [5,16].
medialInand terms of running-related
lateral stiffness of theinjuries,
midsole on
findings remain inconclusive. Contradicting the general concept that
lower limb running biomechanics, Dixon et al. [21] found that the hindfoot valgus softer midsole shoesangle
and peak loading rate of ground reaction force were significantly increased whenthat
can prevent damage in running by dispersing impact mass, Baltich et al. [20] claimed running
thethe
in peak valuehardness
lateral of the vertical ground
shoes. Oriolreaction forceevaluated
et al. [17] and the stiffness of the
the effect ofknee and ankle
randomly varying
joints were
medial found reduced
dual-density as the
midsole midsole in
elements hardness of running
the running. Theyshoes increased.
concluded thatSimilarly,
although the
after tracking
midsole 247 runners
hardness for 5 the
varies from months,
lengthTheisen et al. [18]
and position, deduced
there is no that the injury
significant inci- in
difference
dence associated with applying a softer midsole might be higher
the biomechanical parameters, i.e., vertical impact force peak during running. than using a more rigid
midsole. However, the present finding indicated that regardless of the injury’s location,
type, or
3.3.2. severity,
Midsole there are no statistically significant differences between running shoes
Thickness
with varying midsole hardness.
Contrary to the previous hypothesis, different running shoe midsole thicknesses
The other three studies emphasized the impact of hardness in different midsole areas
did not change the running patterns because of the impact of relevant biomechanical
on running performance/sports injuries. Sterzing et al. [6] evaluated the effect of running
parameters (e.g., landing angle, ground reaction force). Chambon et al. [8] found that
shoes with varying midsole hardness on the rearfoot and forefoot. Findings suggested
greater midsole
that the cushioning thickness has little
properties impact
of the on kinematics,
rearfoot force,determine
almost entirely and acceleration variables,
the vertical
but
ground reaction forces and lower extremity kinematics. Moreover, running shoes that Law
it will significantly enhance the stance-phase duration. In line with this view,
et al. [12]areported
combine thatand
soft forefoot increased midsolemidsole
a stiff rearfoot thicknesscan might reduce
effectively the vertical
improve loading rates
the cushioning
and growth in By
characteristics. theexamining
contact time. Moreover,
the effects of theit medial
appears that
and footwear
lateral with
stiffness of varying midsole
the midsole
thickness has little
on lower limb effect
running on foot strike
biomechanics, pattern,
Dixon et al. stride duration,
[21] found or hindfoot
that the cadence.valgus an-
gle and peak loading rate of ground reaction force were significantly increased when run-
3.3.3.
ning inMidsole Material
the lateral hardnessand Structure
shoes. Oriol et al. [17] evaluated the effect of randomly varying
medial dual-density midsole
Ethylene-vinyl elements in(EVA)
acetate copolymer the running. They concluded
and polyurethane (PU)that
arealthough
currentlythe
widely
midsole
used hardness materials
in midsole varies fromofthe length shoes
running and position, there is no
[24]. Different significant
materials difference
have varyingincush-
the biomechanical
ioning parameters,
and resilience i.e., which
properties, verticalmay
impact force
affect peak during
running running.
efficiency and injuries. Wang
et al. [22] compared the sports performance of midsole running shoes made of EVA and
3.3.2.respectively.
PU, Midsole Thickness
The results showed that PU midsole running shoes lead to higher durabil-
Contrary
ity, while EVAtomidsole
the previous hypothesis,
running different running
shoes reinforced energyshoe midsole
returns morethicknesses did in a
than PU ones
not change
running the running
distance patterns
of 0–500 km. because of the impact of relevant biomechanical param-
eters (e.g., landing angle, ground reaction force). Chambon et al. [8] found that greater
midsole thickness has little impact on kinematics, force, and acceleration variables, but it
will significantly enhance the stance-phase duration. In line with this view, Law et al. [12]
Bioengineering 2022, 9, 497 7 of 29

Table 1. The influence of running shoes’ midsole on running performance and related injuries.

Results
Author and Year Country Experimental Shoes Participants Methods
Performance Injury
1. The influence of midsole hardness on running performance/injury

1. Soft ankle joint stiffness

1. The peak value of
1. Shaw C40 (soft) ↑ (medium-hard)
93 soft vertical
2. Shaw C52 Running speed: 3.33 ± 0.15 m/s; 2. Soft knee joint stiffness ↑
Baltich et al. [20] Canada Male 47, Female 46 ground reaction
(medium) Heel strike; Ground running (female, medium-hard)
16–75 years old force
3. Shaw C65 (hard) 3. Stiffness of the soft knee
(medium-hard)
joint ↑ (male, medium)

1. There is no
difference between
1. Shaw C 52 (CON) knee abduction
2. Shaw C52 + lateral peak torque and
midsole Shaw C60 10 Running speed: 3 m/s; Ground hindfoot valgus
1. LAT1 knee adduction
Dixon et al. [21] Britain (LAT1) Female running angle peak
angle ↓ (CON)
3. Shaw C52 + over 50 years old NA 2. LAT2 ground
midsole and reaction force
outsole loading rate and
hindfoot valgus
angle (CON)

1. Shaw A 40 (soft)
24 1. There is no difference in
2. Shaw A55 Running speed: 3.4 m/s; Treadmill
Hardin et al. [5] America Male peak acceleration of the NA
(medium) downhill running; Heel strike
NA tibia
3. Shaw A70 (hard)

12 1. Peak velocity of
1. Shaw A 40 (soft) Running speed: 3.4 m/s; Treadmill
Hardin et al. [14] America Male dorsiflexion of stiff ankle NA
2. Shaw A70 (hard) running; Heel strike
NA ↑ (soft)
Bioengineering 2022, 9, 497 8 of 29

Table 1. Cont.

Results
Author and Year Country Experimental Shoes Participants Methods
Performance Injury

1. Shaw C40 (soft)

2. Shaw C55 12 1. Peak velocity of valgus
Maclean et al. [15] America (medium) Female Running speed: 4.0 ± 5% m/s of the hard hindfoot ↓ NA
3. Shaw C70 (hard) 19–35 years old

1. There was no difference

in muscle activity
1. Shaw C40 (soft)
54 (frequency and time) of
2. Shaw C52
Nigg et al. [16] Canada Male 36, Female 18 Running speed: 3.33 ± 0.17 m/s the biceps femoris NA
(medium)
33.9 ± 20.1 years old muscle and
3. Shaw C65 (hard)
gastrocnemius muscle of
the lower extremities

1. The harder the

metatarsophalangeal
joint, the more energy
loss ↓
1. General midsole
2. There was no difference
2. Normal midsole +
in energy production
3 mm carbon 5
Running speed: 4.0 ± 0.4 m/s; and absorption of the
Stefanyshyn et al. [13] Canada fiberboard Male NA
Ground running hip, knee, and ankle of
3. Normal midsole + 32.0 ± 13.8 years old the lower extremities
5 mm carbon
3. There is no difference
fiberboard
between energy storage
and reuse of the
metatarsophalangeal
joint
Bioengineering 2022, 9, 497 9 of 29

Table 1. Cont.

Results
Author and Year Country Experimental Shoes Participants Methods
Performance Injury

1. Midsole 50 ± 1
1. SH, SS, & MM first
Asker C
peak loading rate
Soft-RF/soft-FF 1. The softer the maximum
(HH & HS)
(SS) metatarsal flexion and
2. SH second peak
2. Medium- the internal rotation
loading rate “(MM,
RF/medium-FF 28 speed ↓ (the harder)
Running speed: 3.3 ± 0.1 m/s; HH, & HS)
Sterzing et al. [6] German (MM) Male 2. MM sagittal plane
Ground running; Heel strike 3. SS second peak
3. Hard-RF/hard-FF 23.8 ± 2.0 years old landing angle ↓
loading rate” (HH
(HH) (SH&HS)
& HS)
4. Soft-RF/hard-FF 3. There is no difference in
4. MM second peak
(SH) stance time
loading rate ↓
5. Hard-RF/soft-FF
(HH)
(HS)

1. There is no
1. Shaw C, 57.02 ± difference in the
2.96 (soft) 247 male 136, female 111, Running speed: 2.61–2.69 m/s; location, type, and
Theisen et al. [18] Luxembourg 2. Shaw C, 64.47 ± NA severity of
41.8 years old Ground running; NA
2.22 (hard) running-related
injuries

6 male 3, female 3 male: 1. There is no difference in

1. Shaw C41 (soft) 26.0 ± 2.5 years old, Running speed: 2.5–4.2 m/s;
Wakeling et al. [9] Canada running speed and step NA
2. Shaw C61 (hard) female: Ground running; NA length.
23.3 ± 4.1 years old
Bioengineering 2022, 9, 497 10 of 29

Table 1. Cont.

Results
Author and Year Country Experimental Shoes Participants Methods
Performance Injury

1. Normal midsole
1. Medium-high overall
(0.76 ± 0.01
support period time &
N/mm)
pedal time ↑ (ordinary)
2. Medium hardness
2. High
midsole (7.11 ±
metatarsophalangeal
0.22 N inch mm,
19 male 25.3 ± 2.2 years Running speed: 3.5 ± 5% m/s; joint energy negative
Willwacher et al. [10] Germany 1.9 mm carbon NA
old Ground running; Heel strike function ↓ positive
fiberboard)
function ↑
3. High hardness
(normal-medium)
midsole (16.16 ±
3. There is no difference
0.20 N inch mm,
between contact time
3.2 mm carbon
and braking time
fiberboard)

1. Shaw C52 (M1)

2. Shaw C52 + 36 mm
(Shaw C62) (M2)
3. Shaw C52 + 52 mm
(Shaw C62) (M3)
4. Shaw C52 + 58 mm
1. There was no difference
(Shaw C62) (M4) 16 male 29.4 ± 6.8 years Running speed: 3.5 ± 0.1 m/s;
Oriwol et al. [17] Germany in all hindfoot motion NA
5. Shaw C52 + 79 mm old Ground running; Heel strike variables
(Shaw C62) (M5)
6. Shaw C52 + 89 mm
(Shaw C62) (M6)
7. Shaw C52 + 104
mm (Shaw C62)
(M7)
Bioengineering 2022, 9, 497 11 of 29

Table 1. Cont.

Results
Author and Year Country Experimental Shoes Participants Methods
Performance Injury
2. The influence of midsole thickness on running performance/injury

1. There is no
1. Barefoot difference between
2. 0 mm midsole the peak value of
1. Barefoot and 0 mm
3. 2 mm midsole 15 males 23.9 ± 3.2 years Running speed: 3.3 m/s vertical ground
Chambon et al. [8] France midsole stance time ↓
4. 4 mm midsole old Ground running; NA reaction force and
(16 mm midsole)
5. 8 mm midsole the peak
6. 16 mm midsole acceleration of the
tibia

1. 1 mm midsole 1. 1 mm & 5 mm support

2. 5 mm midsole interval ↓ (25 mm & 29 1. 1 mm & 5 mm
3. 9 mm midsole 15 Run-on a treadmill and follow the mm) Vertical loading
Law et al. [12] China 4. 21 mm midsole Male ground after testing the optional 2. There is no difference in rate ↑ (25 mm & 29
5. 25 mm midsole 31.4 ± 13.2 years old speed. landing angle and step mm)
6. 29 mm midsole length

3. The influence of the midsole material/structure on running performance/injury

1. EVA & PU1 peak force

1. EVA midsole
after all running
(EVA)
15 distances (PU2)
2. Polyurethane Outdoor ground running; Heel
Wang et al. [22] China male 2. PU1 200–300 km after NA
midsole (PU1) strike
21.2 ± 1.8 years old peak strength (0 km)
3. Polyurethane
3. EVA energy regression
midsole (PU2)
(PU1 & PU2)

1. Spring step length, step

1. Standard foam
10 frequency, and oxygen
bottom (foam)
Wunsch et al. [24] Austria Male Ground running; NA consumption ↑ NA
2. Leaf spring
33.1 ± 7.1 years old 2. There is no difference in
midsole (spring)
strike pattern
Bioengineering 2022, 9, 497 12 of 29

Table 1. Cont.

Results
Author and Year Country Experimental Shoes Participants Methods
Performance Injury

1. Spring hip joint energy

1. Standard foam absorption and ankle
bottom (foam) 9 energy production ↓
Running speed: 3.0 ± 0.2 m/s; Heel
Wunsch et al. [23] Austria 2. Leaf spring Male 2. Spring soleus muscle, NA
strike
midsole (spring) 32.9 ± 6.1 years old gastrocnemius muscle
strength ↓

Note. NA: not available; LAT: lateral hardness; CON: control group; SS: soft rearfoot/ soft forefoot, soft heel/soft front palm; MM: medium rearfoot/medium forefoot, medium
heel/medium front palm; HH: hard rearfoot/hard forefoot, hard heel / hard front palm; SH: soft rearfoot/hard forefoot, soft heel/hard front palm; HS: hard rearfoot/soft forefoot, hard
heel/soft front palm, ↑indicates higher while↓indicates lower.
Bioengineering 2022, 9, 497 13 of 29

In addition to EVA and PU materials, more attention has been paid to the leaf spring-
structured midsole shoe (which replaces the traditional midsole construction by leaf spring)
in recent years. By comparing the difference between leaf spring-structured midsole
shoe (LEAF) and standard foam shoe (FOAM) on Spatio-temporal variables and running
economy, Wunsch et al. [24] found that the midsole running shoes with leaf spring structure
can significantly increase the step length, which accounts most for an improved running
economy. In the same year, the effect of a LEAF on joint mechanics and lower limb muscle
forces during overground running was contrasted to a FOAM. Wunsch et al. [23] stated that
LEAF could improve running performance by substantially reducing energy absorption at
the hip joint and energy production at the ankle joint.

3.4. Effects of the Bending Stiffness on Running Performance/Injury

Seven articles (Table 2) examined the impact of bending stiffness of running shoes on
running performance and related damages [13,19,25–29].
The adjustment of the bending stiffness of running shoes was associated with running
performance and running economy. According to Hoogkamer et al. [29], by applying shoes
with increased bending stiffness, all 18 tested participants have decreased the energetic
cost of running. Similarly, Roy et al. [26] clarified that by increasing the bending stiffness of
running shoes, the running economy is significantly improved (1% energy saving). How-
ever, there was no significant difference in the energy absorbed by metatarsophalangeal
(MTP) joints and activities of muscles such as soleus, gastrocnemius, and rectus femoris
in running. Stefanyshyn et al. [13] found that the increase of bending stiffness reduces
the energy loss of the MTP joint and improves the performance of the MTP joint during
running and vertical jumping (improved vertical jump height). A similar view is held by
Willwacher et al. [19], who demonstrated that as the bending stiffness of a running shoe
increases, the negative work of the MTP joints decreases. In contrast, the positive result
increases significantly during running. By analyzing the influence of different bending
stiffness of running shoes on sprint performance, Stefanyshyn et al. [25] concluded that
speed efficiency could be improved by increasing the shoe bending stiffness.
Other researchers hold an opposite standpoint towards bending stiffness of running
shoes on the running economy. As Madden et al. [27] proposed, increasing the forefoot
bending stiffness of the running shoes did not significantly affect the overall running
economy. Moreover, they believed that improved running economy with increased forefoot
bending stiffness is not due to a decrease in negative work at the MTP joint. There are
two main influences on the foot caused by the relative increase in the bending stiffness
of running shoes: (1) the metatarsal-phalangeal joint’s bending was diminished (i.e., less
mechanical energy was lost at the joint); (2) the lever between the resulting ground reaction
force and the ankle joint was increased, allowing for the production of more extraordinary
ankle joint moments if the triceps surae was sufficiently robust [30]. Nigg et al. [30] further
stated that the increase in the ankle joint moment was the dominant effect brought about
by the change in the bending stiffness of running shoes. The increase of ankle torque was
the dominant effect caused by the bending stiffness of running shoes. This theory has been
extended further by Roy et al. [26], who supported that the increase in bending stiffness of
running shoes leads to a raised peak moment of the ankle joint during running.
Furthermore, the two articles implied that increases in the bending stiffness of running
shoes result in substantial increases in running propulsion and stance duration [19,28],
which is consistent with the previous findings of Nigg et al. [30], who indicated that
increasing the ground contact time and the propulsive force by altering the bending stiff-
ness of running shoes could effectively reduce the energy loss, thereby promoting the
running economy.

3.5. Effects of Heel-to-Toe Drop on Running Performance/Injury

Seven articles (Table 3) discuss the impact of the heel-to-toe decline of running shoes
on running performance and injury [7,11,31–35].
Bioengineering 2022, 9, 497 14 of 29

Table 2. The influence of longitudinal bending stiffness on running performance and related injuries.

Results
Author and Year Country Experimental Shoes Participants Methods
Performance Injury

1. Nike Zoom Vaporfly (NV,

Mechanical test deformation
11.9 mm)
2. Nike Zoom Streak 6 (NS, 18 Running speed: 3.89, 1. NV Energy loss ↓ (NS &
Hoogkamer et al. [29] America Mechanical test deformation Male 4.44 & 5.0 m/s; Ground NA
AB)
6.1 mm) 23.7 ± 3.9 years old running
3. Adidas BOOST 2 (AB,
Mechanical test deformation
5.9 mm)

1. Ordinary running shoes 1. There is no difference in

(CON) Running speed: starts the running economy.
2. 185% stiffer running shoes 10 with 2.2 ± 0.2 m/s, 2. STI1 & STI2 Peak
Madden et al. [27] Canada (STI1) Male increases every two bending and maximum NA
3. 335% stiffer running shoes NA minutes; Indoor track dorsiflexion rate of
(STI2) running; Heel strike MTPJ ↓ (CON)

1. 1.5 Nm/rad Rigid running 1. The greater the stiffness,

shoes the time of support
2. 10 Nm/rad Rigid running period and pedal
shoes Running speed: extension period ↑
3. 24.5 Nm/rad Rigid running 19 2. The greater the stiffness,
treadmill runs below the
Oh et al. [28] South Korea shoes NA the flexion angle of the NA
anaerobic threshold;
4. 32.1 Nm/rad Rigid running 24.7 ± 3.8 years old MTPJ ↓
Ground running
shoes 3. The greater the stiffness,
5. 42.1 Nm/rad Rigid running the average angular
shoes impulse of the MTPJ ↓
Bioengineering 2022, 9, 497 15 of 29

Table 2. Cont.

Results
Author and Year Country Experimental Shoes Participants Methods
Performance Injury

1. STI Maximum oxygen

consumption rate ↓
(CON)
1. 18 N/mm Rigid running
2. STI 1 % Energy
shoes (CON)
13 metabolism ↓ (CON)
2. 38 N/mm Rigid running Treadmill running; Heel
Roy et al. [26] Canada NA 3. EST Peak torque of ankle NA
shoes (STI) strike
27.0 ± 5.1 years old joint ↑ (STI& CON)
3. 45 N/mm Rigid running
4. There was no difference
shoes (STIEST)
in energy absorption
and muscle activation of
the MTPJ

1. STI Energy loss of MTPJ

↓ (MED & CON)
1. 0.04 N·m·deg rigid running
2. There is no difference in
shoes (CON)
5 energy storage and reuse
2. 0.25 N·m·deg Rigid running Running speed: 4.0 ± 0.4
Stefanyshyn et al. [13] Canada Male of MTPJ and energy NA
shoes (MED) m/s; Ground running
32.0 ± 13.8 years old production and
3. 0.38 N·m·deg Rigid running
absorption of the hip,
shoes (STI)
knee, and ankle joints of
the lower extremities

1. Ordinary running shoes

(CON)
2. 42 N/mm Rigid running 34
shoes (S42) Running speed: 20 m 1. S42, S90 & S120 Sprint
Male
Stefanyshyn et al. [25] Canada 3. 90 N/mm Rigid running Sprint, Maximum speed; time ↓ (CON) NA
30, Female 4
shoes (S90) Ground running
NA
4. 120 N/mm Rigid running
shoes (S120)
Bioengineering 2022, 9, 497 16 of 29

Table 2. Cont.

Results
Author and Year Country Experimental Shoes Participants Methods
Performance Injury

1. MED & STI Lever arm of

the ground reaction
force of all joints ↑
(CON)
2. MED Average torque of
ankle joint ↓ (CON &
1. 0.65–0.76 N/mm Rigid STI)
running shoes (CON) 3. STI Negative work of
2. 5.29–7.11 N/mm Rigid 19 MTPJ ↓, Positive work ↑
Running speed: 3.5 ± 5
Willwacher et al. [19] Germany running shoes (MED) Male (CON & MED) NA
% m/s; Ground running
3. 16.16–17.10 N/mm Rigid 25.3 ± 2.2 years old 4. MED & STI Support
running shoes (STI) period and pedal
extension period
↑(CON)
5. CON Range of motion
and maximum
dorsiflexion angle of
MTPJ ↑ (MED & STI)

Note. NA: not available; CON: control; STI: stiff; STIEST: stiffest; MTPJ: metatarsophalangeal joint, ↑indicates higher while ↓indicates lower.
Bioengineering 2022, 9, 497 17 of 29

Table 3. The influence of running shoes heel-toe drop on running performance and related injuries.

Results
Author and Year Country Experimental Shoes Participants Methods
Performance Injury

1. D0 ground contact angle, ankle

dorsiflexion angle at the
beginning of the support period,
and the last 40% period ↓
(D6&D10)
2. Before and after the first stage of
1. metacarpal heel
the D0 support period, the
difference 0 mm (D0)
14 Running speed: ground reaction force ↑ (D6&D10)
2. metacarpal heel
Besson et al. [35] France female self-selected; Ground 3. D0 pedal and stretch time ↑ NA
difference 6 mm (D6)
21.4 ± 4.7 years old running; Heel strike Braking time ↓ (D6 & D10)
3. metacarpal heel
4. D0 Net moment of ankle flexion
difference 10 mm (D10)
during braking ↑ Net moment of
ankle flexion during pedal and
extension ↓ (D6&D10)
5. There is no difference in the angle
of the hip and knee joint and the
time of support period.

1. metacarpal heel
difference 0 mm (D0) 1. BF Loading
2. metacarpal heel Running speed: rate of
12
difference 4 mm (D4) Self-selected speed; ground
Chambon et al. [11] France male NA
3. metacarpal heel Treadmill & ground reaction
21.8 ± 2.0 years old
difference 8 mm (D8) running; Heel strike force ↑ (D8)
4. barefoot (BF)
Bioengineering 2022, 9, 497 18 of 29

Table 3. Cont.

Results
Author and Year Country Experimental Shoes Participants Methods
Performance Injury

1. D6 & D0
Injury risk
of
occasional
1. metacarpal heel
runners ↓,
difference 0 mm (D0)
553 Running speed: 2.64 injury risk
2. metacarpal heel
Malisoux et al. [7] Luxembourg Male 341, female 212 m/s; Outdoor ground NA of regular
difference 6 mm (D6)
18–65 years old running; Heel strike runners ↑
3. metacarpal heel
2. There is no
difference 10 mm (D10)
difference
in overall
damage
risk.

1. metacarpal heel 1. D6 & D10 Adduction angle of the

difference 0 mm (D0) knee joint ↑ D0
2. metacarpal heel 59 Running speed: 2. There is no difference in support
Malisoux et al. [34] Luxembourg difference 6 mm (D6) Male 42, female 17 Self-selected; Treadmill time, flight time, step frequency, NA
3. metacarpal heel 18–65 years old and follow the ground step size, and vertical
difference 10 mm (D10) displacement of the hip joint.

1. metacarpal heel 1. D8 & D12 Maximum pressure

difference 0 mm (D0) center offset in front and rear
2. metacarpal heel direction ↑ (D4)
difference 4 mm (D4) 14 2. D8 Range of pressure center in
Ground running; Heel
De Minds et al. [33] Belgium 3. metacarpal heel male front and rear direction ↑ (D0) NA
strike
difference 8 mm (D8) 27.0 ± 10.0 years old 3. There is no difference in the
4. metacarpal heel parameters of the pressure center
difference 12 mm (D12) in the inner and outer directions.
Bioengineering 2022, 9, 497 19 of 29

Table 3. Cont.

Results
Author and Year Country Experimental Shoes Participants Methods
Performance Injury

1. Barefoot & Angle of ankle

dorsiflexion with thin touch to the
ground ↓ (medium & thick)
2. Barefoot & Thin Verticality of
lower limbs at the moment of
touching the ground ↑ (thick)
metacarpal heel difference 3. Medium & Thick Flexion and
1. 3–3 mm (thin) 10 Running speed: 3 m/s; offset angle of the knee joint ↑
TenBroek et al. [31] America 2. 9–14 mm (medium) male Treadmill running; Heel (thin & Barefoot) NA
3. 12–24 mm (thick) 18–55 years old strike 4. Thickness joint offset angle ↑
4. barefoot (Barefoot)
5. Thin Support period time ↑
(Medium & Thick)
6. Barefoot & thin Peak acceleration
of tibia ↑ (Other circumstances)
7. Medium Peak acceleration of tibia
↑ (Thick)

1. Thin & Medium Angle of

metatarsal flexion of ankle joint
touching the ground ↑ (thick)
2. Thin Extension angle of
The difference between palms touchdown knee joint ↑ (Medium
and heels & Thick)
10 Running speed: 3 m/s;
TenBroek et al. [32] America 1. 3–3 mm (thin) male Treadmill running; Heel 3. Thick Flexion angle of the knee NA
2. 9–14 mm (medium) 18–55 years old strike joint in the middle of bracing ↑
3. 12–24 mm (thick) (Medium)
4. Thickness joint offset angle ↑
(Thin& Medium)
5. Thick Support period time ↑ (Thin
& Medium)

Note. NA: not available; BF: barefoot, ↑indicates higher while ↓indicates lower.
Bioengineering 2022, 9, 497 20 of 29

As a brand-new “barefoot” running shoe, minimalist shoes have favored the public and
scientific researchers in the last decade. A minimalist shoe with a lower drop might result in
a biomechanical change toward a forefoot strike pattern. According to Chambon et al. [11],
the 0 mm drop shoe version generated a striking design comparable to a forefoot strike at
touchdown in the 8 mm drop shoe version. Moreover, an opposite ground reaction was
found on wearing running shoes with different shoe drops on overground and treadmill
running, which may be caused by the kinematic changes at the moment of landing.
It has been suggested that a higher shoe drop may increase knee abduction at the mid-
stance phase, influencing sagittal plane and flexion angle, and decrease tibial acceleration,
metatarsal, and knee extension angle in landing [31–33]. By investigating the influences of
shoe drop on running mechanics, Besson et al. [35] indicated that larger heel-to-toe drop
conditions would increase net knee flexion moment (p < 0.001) in the push-off phase, but
also decrease net joint ankle flexion moment during the braking phase (p < 0.001). Thus, a
more significant drop may benefit women with a stiff Achilles tendon, such as high-heeled
shoe wearers, while a shoe with no drop can be an excellent option for women who suffer
from knee pain or fatigue.
The other two articles included a long-term follow-up survey on the effects of different
shoe drops on sports performance and sports injuries. Among 553 participants examined,
Malisoux et al. [7] found no significant relationship between the overall risk of sports
injury and the difference between shoe drops of running shoes. However, low drop
running shoes were found to reduce the injury rate of occasional runners, but it seems
risky for regular runners. In the following year, Malisoux et al. [34] investigated the
long-term consequences of wearing varying height heel-to-toe drop shoes in the following
year. The results showed that apart from knee abduction during the mid-stance phase,
no discrepancies in spatiotemporal variables or kinematics were observed between shoe
versions of varying drop heights during this 6-month follow-up.

3.6. Effects of Shoe Mass on Running Performance/Injury

Three articles (Table 4) examined the impact of running shoe mass on running-related
performance and damages [36–38].
While determining whether shoe mass accounts for the increased oxygen consumption
associated with shod running or barefoot running, Divert et al. [36] proposed that the
increased metabolic cost associated with shoe running was attributable to the added mass
on the shoe. This idea has been developed further by Franz et al. [37]. They reported that
submaximal oxygen uptake (VO2) increases by approximately 1% for each 100 g applied
per foot, although there were no significant differences in VO2 or metabolic power between
barefoot and shod running. Similarly, the metabolic rate grew about 1.11% per 100 g per
shoe by adding mass to the shoes. In addition, each additional 100 g per shoe decreases
running economy and proportionately slows 3000 m time trials results [38].

3.7. Effects of Heel Flare on Running Performance/Injury

Three articles (Table 5) included the impact of lateral heel flare (flared heel) on running
performance and related injuries [39–41]. By analyzing the influence of different heel
flares on rearfoot movement during running, Clarke et al. [39] found that shoes with 0◦
heel flare made for considerably more maximum pronation and total rearfoot motion
than shoes with 15◦ or 30◦ heel flares. Moreover, there were few noticeable variations
between the 15◦ and 30◦ flare conditions. Nigg et al. [40] further studied the association
between lateral heel flare, impact forces, and pronation. Results revealed that increasing
the heel flare improves initial pronation, and it has no effect on the magnitude of total
pronation or the importance of the impact force peaks. Additionally, the study of Stacoff
et al. [41] aimed at quantifying the effects of lateral heel flares on the stance phase of running.
Findings showed that altering the lateral heel flares had no impact on talocalcaneal rotations.
Moreover, a possible relationship or coupling effect was found between the heel flares and
bone eversion.
Bioengineering 2022, 9, 497 21 of 29

Table 4. The influence of running shoes’ weight on running performance and related injuries.

Results
Author and Year Country Experimental Shoes Participants Methods
Performance Injury

1. Barefoot;
2. Ultra-thin diving socks
3. Ultra-thin diving socks
+150 g/piece 12 1. Shoe weight increases oxygen
Running speed: 3.61
Divert et al. [36] France 4. Ultra-thin diving socks male consumption ↑ NA
m/s; Treadmill running
+350 g/piece 24.0 ± 5.0 years old
5. sports shoes 150 g/piece
6. sports shoes 350 g/piece

1. Barefoot
2. Barefoot + 150 g/piece
3. Barefoot + 300 g/piece
1. There is no difference in oxygen
4. Barefoot + 450 g/piece
consumption between bare feet
5. Nike Mayfly 14 Running speed: 3.35 and shoes
Franz et al. [37] America 6. Nike Mayfly + male m/s; Treadmill running; NA
2. Oxygen consumption increases by
150 g/piece 29.8 ± 7.3 years old Heel strike 1% for every 100 g shoe weight
7. Nike Mayfly +
increase
300 g/piece
8. Nike Mayfly +
450 g/piece

1. Oxygen consumption increases by

1.11% for every 100 g weight
1. Ordinary sports shoes increase.
2. Ordinary sports shoes + 18 2. The running time of ordinary
100 g/piece Running speed: 3.5 m/s; sports shoes is less than 3000 m (+
Hoogkamer et al. [38] America male NA
3. Ordinary sports shoes + Treadmill running 100 g/ only & + 300 g/only)
24.2 ± 3.3 years old
300 g/piece 3. For every 100 g weight increase, it
increases by 0.78% during 3000 m
running.

Note. NA: not available, ↑indicates higher while ↓indicates lower.

Bioengineering 2022, 9, 497 22 of 29

Table 5. The influence of running shoes’ heel flare on running performance and related injuries.

Results
Author and Year Country Experimental Shoes Participants Methods
Performance Injury

1. The heel inclination angle reduces

1. The inclination of both the maximum internal rotation
heels 30◦ 10 Running speed: 3.8 m/s; angle and the total amount of
Clarke et al. [39] Britain 2. The inclination of both NA Treadmill running; Heel hindfoot movement ↑ NA
heels 15◦ NA strike 2. Heel inclination reduces the
3. No heel inclination arrival time of maximum internal
rotation velocity ↓

1. Outside heel inclination 1. The heel inclination angle 1. There is no

16◦ Running speed: increases the initial internal difference
14
2. No outside heel 4.0 ± 0.2 m/s; Ground rotation angle of the foot ↑ in vertical
Nigg et al. [40] Canada male
inclination running 2. There is no difference in total impact
NA
3. Round heel Heel strike internal rotation angle. force.

1. No difference in internal and

1. Outside heel inclination
Running speed: external rotation between the tibia
25◦ 5
2.5–3.0 m/s; Ground and calcaneus.
Stacoff et al. [41] Canada 2. No outside heel male NA
running; 2. There is no difference in the speed
inclination 28.6 ± 4.3 years old
Heel strike of hindfoot valgus and maximum
3. Round heel
valgus.

Note. NA: not available, ↑indicates higher while ↓indicates lower.

Bioengineering 2022, 9, 497 23 of 29

3.8. Effects of Heel Stabilizer on Running Performance/Injury

Five articles (Table 6) explored the impact of heel cups on running performance and
related damages. Among them, two focused on the effects of running shoes heel cup on
running performance/sports injury [42,43], and three focused on the impact of running
shoes heel stabilizers on running performance and related injuries [44–46].
Findings of Li et al. [43] showed that after four weeks of wearing the individualized
heel cup, it was found to help secure the skeletal system and soft tissue of the plantar
heel when walking and jogging and significantly minimize self-reported discomfort. Fur-
thermore, the cushioning effect of heel cups has been proved by Wang et al.’s [42] study.
As results suggested, rubber and plastic heel cups have achieved their cushioning effect
through various mechanisms. Therefore, the heel cup selection process should be driven by
the pathogenesis of the heel pain, i.e., rubber heel cups were suggested for inflammation
patients; plastic heel cups were indicated for heel pad atrophy patients.
According to Alcantara et al. [46], shoe markers greatly underestimated calcaneus
range of motion (ROM) across all planes of action, representing inadequately reflecting
calcaneus motion. Moreover, there were no improvements in tibial transverse plane ROM
following heel counter modifications, implying that any changes in heel counter rigid-
ity produced by the amendments did not affect tibial rotation. By examining the effects
of upper vamp components on pronation and torsion of the foot, Ferrandis et al. [45]
found that prototype 2 (with an external heel counter) and prototype 4 all have a lower
rearfoot angular difference (with a rear lace anchor from the last eyelet of the lacing to
the midsole embracing the tarsus). However, the rearfoot angles closest to the ground
correspond to prototype 3 (with a rear lace anchor from the last eyelet of the lacing to
the midsole embracing the tarsus). Jorgensen [44] examined the effect on muscle load
of the cumulative effect of increased shock absorption and stabilization provided by the
heel counter. The results indicated that a properly installed rigid heel counter in the shoe
resulted in a 2.4% substantial decrease in VO2, decreased musculoskeletal transients, and de-
creased triceps surae and quadriceps muscle function at heel attack, both of which increase
running economy.
Bioengineering 2022, 9, 497 24 of 29

Table 6. The influence of running shoes’ heel stabilizers on running performance and related injuries.

Results
Author and Year Country Experimental Shoes Participants Methods
Performance Injury

16 1. HC heel
1. No heel cup (N-HC) 1. Load of plantar fascia and
Li et al. [43] China Male 10, Female 6 Ground running pain ↓
2. Heel cup. (HC) calcaneus after HC4 ↓ (N-HC)
NA (N-HC)

1. Rubber heel cup

1. Plastic heel pad thickness ↑
(Tender-Stride) 16
Running speed: 2.78 m/s; (rubber)
Wang et al. [42] China 2. Rubber heel cup (Tuli’s) Male 10, Female 6 NA
Treadmill running 2. Rubber-plastic heel shock
3. Plastic heel cup NA absorber ↑ (no heel cup)
4. No heel cup

14 Running speed: 3.35 m/s; 1. There is no difference in the range

1. Heel stabilizer
Alcantara et al. [46] America Male 9, Female 5 Treadmill running; of heel motion and tibial NA
2. Heel-less stabilizer
29 ± 17.4 years old Heel strike horizontal motion.

1. Heel-less stabilizer (P1)

2. Heel stabilizer (P2)
3. Heel stabilizer + vertical
10 Running speed: 3.57 m/s; 1. Heel stabilizer + vertical foot
sticker (P3)
Ferrandis et al. [45] Spain Male 7, Female 3 Treadmill running; Heel valgus angle peak ↓ (Other NA
4. Tighten the heel laces
NA strike circumstances)
(P4)
5. Tighten the shoelace on
the front foot (P5)

1. The maximum oxygen uptake of

1. Bear foot 11 heel stabilizer, tibial acceleration,
2. Heel stabilizer Running speed: 2.5 m/s & and the activity of triceps and
Jorgensen, [44] Switzerland Male 6, Female 5 NA
3. Heel-less stabilizer 3.1 m/s; Treadmill running quadriceps femoris at the moment
25.5 years old
of landing ↓

Note. NA: not available; NMEC: non-heel cup; HC: heel cup, ↑indicates higher while ↓indicates lower.
Bioengineering 2022, 9, 497 25 of 29

4. Discussion
The purpose of this study was to outline the impact of various sole features on running
biomechanics associated with performance and injury risk.

4.1. Midsole Properties

Given existing evidence, the influence of midsole hardness on running-related per-
formance and injury remains controversial. The current study results show that running
shoes with a reasonable range of midsole hardness (i.e., 50–52 Asker C) seem more feasible
since it mitigates injury risk and improves running efficiency. Moreover, the midsole hard-
ness can be distinguished regarding individual differences between posterior-anterior and
mediolateral segmented cushions to improve perceived comfort [6,21].
Shoes with thicker midsole were more effective in mitigating impact because it allows
more material deformation; in this case, they can also prolong the stance phase of running,
which facilitates energy storage and return [8,12]. However, the findings of how much
energy can be stored and produced during support periods of 6–13 months have not been
quantified, and the appropriate time and frequency of energy return on the take-off moment
remain inconclusive [47–49]. This study, therefore, implied that medium-thickness running
shoes (e.g., 15–20 mm) seem more credible for the present application.
From the existing research, EVA midsole material represents the lighter weight and ex-
cellent energy return ability, optimizing performance while helping prevent injuries [22,50].
What is more, the blends of EVA and other polymer materials, such as PHYLON, also
known as secondary foaming materials, are more effective than EVA materials in damping
performance, elasticity, and durability. In addition, in recent decades, BASF has jointly
launched new midsole materials, E-TPU (foamed TPU) and Elastopan® Sports Light, in co-
operation with top international sports shoe manufacturers (e.g., Adidas (Herzogenaurach,
Germany) and Brooks, (Seattle, WA, USA)), to improve the cushioning capacity and dura-
bility. Since there is a significant price difference in the midsole materials mentioned above,
it is necessary to select appropriate midsole materials regarding the actual functionality of
running shoes [23,24].

4.2. Longitudinal Bending Stiffness

The optimization of the bending stiffness of running shoes is inseparable from the
individual runner characteristics. It not only depends on the runner’s weight, ankle joint
extensor strength, etc., but is also closely related to the running speed, the ground reaction
force, and the lever arm length of the lower limb joints [10].
A “U-shaped” curve relationship implied an ideal longitudinal bending stiffness for
improving the running economy. For example, running shoes with 38 N/mm bending stiff-
ness might have higher overall benefits than running shoes with 18 N/mm and 45 N/mm
bending stiffness [26]. Moreover, the “teeter-totter effect” proposed by Nike Vaporfly may
help renew the bending stiffness design of running shoes. Compared to the previous
prototype shoe with curved carbon fiber plates, Nike Vaporfly used a stiff curved plate,
which can increase the force given to the foot’s heel at take-off and gain performance up to
4–6% over standard footwear [30].

4.3. Heel-To-Toe Drop

The findings of the impact of the heel-to-toe drop on the landing patterns of running
remain inconclusive. However, from the existing studies, the design of heel-to-toe drops
of running shoes needs to consider the positioning of running shoes and the target group.
Malisoux et al. [7] suggested that a slight decrease of heel-to-toe drop (e.g., 0–4 mm) is
more feasible for the general population, supporting sports efficiency and keeping runners’
safety. Meanwhile a higher heel (e.g., 6–10 mm) should be considered in the design of
professional competitive running shoes, or it may be customized according to the runner’s
habits and biomechanical parameter changes in running. In addition, it is worth noting
that there is also a running shoe demand difference for runners with different foot strike
Bioengineering 2022, 9, 497 26 of 29

pattern for heel-to-toe drop since hindfoot running relies more on a positive drop while
forefoot running relies on a negative one. More studies concerning this point are warranted
for further clarification.

4.4. Shoe Mass

The increase in shoe mass will affect the perceived comfort and significantly affect the
ankle joint angle, force moment, and plantar pressure during running [51]. Moreover, the
increase in the shoe mass can increase energy consumption and reduce the economy of
running [36–38]. Therefore, this study suggests that the shoe mass should be minimized
after running shoes meet other design demands, or apply new materials with low weight
and consistent ability to reduce the overall shoe mass.

4.5. Heel Flare

The increase of the heel flare at the medial side can reduce the rearfoot movement
during running, especially excessive foot pronation, which has been described as a sig-
nificant indicator of ankle joint injuries [39]. However, there is no clear conclusion about
the relationships between running performance/injuries and different heel flares. This
study proposes that the heel flare should adopt the standard angle of about 15◦ , which
might initially increase certain foot pronation, but it had little effect on the peak value of
vertical impact force [40,41]. In addition, the increase of the lateral heel flare can provide
more support for the rearfoot at the moment of running landing, thus reducing the vertical
impact force per unit area. Furthermore, such an increase in heel flare can reduce the ankle
joint sprain risk by promoting the outward movement of the contact point between the
ground and the shoe, increasing the length of the moment arm, and the rapid internal
rotation of the subtalar joint at the landing moment [52].

4.6. Heel Stabilizer

The clinical significance of a personalized heel cup made by combining 3D scanning
and 3D printing for plantar heel pain has been proven. Accordingly, it can serve as a
treatment or intervention for foot disorders [43]. However, the material of the heel cup
must be personalized regarding the patient’s conditions to find out the most significant
benefits [42]. Furthermore, the perfectness of heel cup design among the public or even
professional sports running shoes needs to be further verified.
The heel stabilizer of running shoes is mainly used to strengthen the function of the
heel cup and control the stability of the rearfoot during running. As the heel cup cooperates,
the heel stabilizer can effectively minimize rearfoot eversion and torsion, thereby reducing
the risk of potential running injuries. For different groups of people/patients, the use of a
heel stabilizer + vertical attachment or further combination with heel tightening can fully
ensure the stability of the hindfoot during running [45,53,54].

5. Conclusions
In summary, most of the studies have focused on investigating the impact of running
shoe midsoles, bending stiffness, and heel-to-toe drop on running performance and injuries,
while few studies on running shoe mass, heel flare, and heel stabilizer have been estab-
lished. Existing studies have initially found the impact of these structural parts on running
economy and stability, and it was found that thickness of 15–20 mm, hardness of Asker
C50-C55 of the midsole, the design of the medial or lateral heel flares of 15◦ , the curved
carbon plate, and the 3D printed heel cup may be beneficial to optimize performance and
reduce running-related injuries. Nevertheless, it is valuable to conduct more examinations
regarding these exclusive features to enhance the credibility of research results and offer
additional insights into running shoe designs. Overall suggestions for future studies are
as follows: (1) More attention on the long-term effects of running shoe constructions on
running and the underlying biomechanical mechanism of running-related injuries. (2)
Concerning the specificity, runners’ basic information should be collected (e.g., anthropo-
Bioengineering 2022, 9, 497 27 of 29

metric parameters, foot morphology, and running experience) for footwear design; (3) The
update of research and development concepts in sports biomechanics (e.g., “teeter-totter
effect” of curved carbon fiber plate) may further contribute to the development of running
shoes; (4) Footwear design and optimization should also consider the influences of runners’
strike patterns.

Author Contributions: Conceptualization, S.L. and D.S.; methodology, Y.S. and X.C.;
writing—original draft preparation, S.L., Y.S., X.C. and D.S.; writing—review and editing, K.B. and
G.F.; supervision, K.B., G.F. and D.S.; funding acquisition, D.S. All authors have read and agreed to
the published version of the manuscript.
Funding: This study was sponsored by Zhejiang Key Research and Development Program (Grant
number: 2021C03130), Zhejiang Province Science Fund for Distinguished Young Scholars (Grant
number: LR22A020002), Philosophy and Social Sciences Project of Zhejiang Province, China (Grant
number: 22NDQN223YB), Public Welfare Science and Technology Project of Ningbo, China (Grant
number: 2021S134), Basic Scientific Research Funds of Provincial Ningbo University (SJWY2022014),
and K. C. Wong Magna Fund in Ningbo University.
Institutional Review Board Statement: Not applicable.
Informed Consent Statement: Not applicable.
Data Availability Statement: All data generated or analyzed during this study are included in this
published article.
Conflicts of Interest: The authors declare no conflict of interest.

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