# Association of Shoe Cushioning Perception and Comfort With Injury Risk in Leisure‐Time Runners: A Secondary Analysis of a Randomised Trial

## TL;DR

This study found that runners who perceive more cushioning and overall comfort in their shoes have a lower risk of injury.

## Contribution

The study is the first to prospectively investigate the 'comfort filter' paradigm linking shoe cushioning perception to injury risk.

## Key findings

- Moderate and high perceived cushioning in shoes were associated with significantly lower injury risk.
- Higher global appreciation of the shoe was also linked to reduced injury risk.
- The findings suggest that cushioning perception may be a useful approach for selecting injury-preventive running shoes.

## Abstract

The attenuation of impact forces was related to lower injury risk. However, runners cannot easily assess these biomechanics when testing new running shoes. Alternatively, the comfort filter has been suggested as a new paradigm relating running shoes and injury risk. This secondary analysis of a large randomised trial aimed to investigate whether the perception of cushioning and global appreciation of running shoes were associated with injury risk. Running exposure and injury data were prospectively collected in healthy recreational runners over 6 months. Study participants completed a questionnaire during follow‐up on shoe cushioning perception at the heel, ideal shoe cushioning level at the heel and global appreciation of the study shoe using numerical rating scales. Values were subsequently categorised in tertiles. A Cox proportional hazards model was used to estimate adjusted hazard rate ratios (HRs). The analysis includes 527 participants (35.3% females), and 60 of them reported at least one running‐related injury. Compared to the reference group (first tertile), participants with perception of moderate shoe cushioning (HR [95% CI] = 0.35 [0.19–0.66]) and those with perception of high shoe cushioning (HR = 0.24 [0.10–0.57]) had a lower injury risk. Similarly, participants with medium values (HR = 0.44 [0.25–0.78]) and highest values (HR = 0.33 [0.16–0.68]) for perceived‐ideal cushioning difference had a lower injury risk. Injury risk was also lower in participants with the highest global appreciation of the shoe (HR = 0.47 [0.26–0.85]). This study shows that greater perceived shoe cushioning and global appreciation are associated with lower injury risk, which suggests that cushioning perception, and potentially comfort filter, may be a valuable approach for shoe selection to prevent running‐related injuries.

ClinicalTrials.gov: NCT03115437, 11/04/2017.

The comfort filter has been proposed as a new paradigm for the selection of running shoes to reduce injury risk, but no study has prospectively investigated this relationship.Greater perceived shoe cushioning and global appreciation of the shoe are associated with lower injury risk.Perceived cushioning, and potentially the comfort filter, may be valuable approaches for shoe selection to prevent running‐related injuries, although the validity of this paradigm deserves further research and the causal pathway has yet to be explained.

The comfort filter has been proposed as a new paradigm for the selection of running shoes to reduce injury risk, but no study has prospectively investigated this relationship.

Greater perceived shoe cushioning and global appreciation of the shoe are associated with lower injury risk.

Perceived cushioning, and potentially the comfort filter, may be valuable approaches for shoe selection to prevent running‐related injuries, although the validity of this paradigm deserves further research and the causal pathway has yet to be explained.