Minimalist Footwear and Softer Running Technique Alter Injury Location but Not Incidence in Recreational Endurance Runners

Background: Minimalist footwear and running retraining are often recommended by running coaches to reduce the risk of running-related injuries (RRIs) in endurance runners. However, despite the growing popularity of minimalist footwear and running retraining, there is limited scientific evidence supporting their effectiveness. Purpose: To investigate the impact of minimalist footwear and running retraining on the incidence rate (primary outcome) and location (secondary outcome) of RRIs in recreational endurance runners. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 140 rearfoot runners were randomly assigned to 3 groups: minimalist footwear (n = 47), running retraining (n = 47), and control (n = 46). The minimalist footwear group received minimalist footwear, while the running retraining group completed 6 retraining sessions aimed at running softer, adopting a nonrearfoot strike, and increasing the initial step rate by 7.5%. The control group followed a stretching program. Running biomechanics were assessed at baseline and at 2, 6, and 12 months. RRIs were recorded according to recent consensus guidelines. The primary outcome was the RRI incidence rate, analyzed by adjusted (injury history) and unadjusted Cox regression models across 3 analyses: intention to treat, as treated, and per protocol. Results: Sixty-four RRIs were reported: 55 overuse and 9 acute. No significant differences in the incidence rate of RRIs (primary outcome) were observed among groups across all analyses. There were also no differences in injury duration across groups in all analyses. However, the secondary outcome showed that injury distribution varied among groups in the as-treated and per-protocol analyses, with more hip injuries in the control group ( P = .015 and P = .01, respectively) and more foot injuries in the running retraining group ( P = .018 and P = .04). Conclusion: Contrary to popular belief, neither minimalist footwear nor a softer running technique reduced the overall incidence rate of RRIs. However, running retraining altered injury patterns, decreasing hip injuries but increasing foot injuries. Registration: NCT05499871 (ClinicalTrials.gov).