Running-related injury occurrence decreases with shoe minimalism

Running-related injuries affect up to 79% of distance runners annually. Minimal shoes, promoting natural foot motion and strength, may influence injury occurrence, but their influence across a spectrum of minimalism remains unclear. This study investigated the relationship between shoe minimalism and running-related injury occurrence among distance runners. A total of 507 regular runners (≥10 km/week, age ≥ 18 years) were recruited via an online survey. Participants provided information on their demographics, running experience, training habits, usual footwear, and injury history over the past 12 months. Shoe minimalism was quantified using the Minimalism Index and running-related injuries were defined as injuries resulting in ≥7 training days lost and requiring medical diagnosis. Statistical analyses included binary logistic regression to assess factors associated with injury occurrence and injured body region. Of the participants, 181 (35.7%) reported at least one running-related injury in the past year, resulting in 389 injuries. Binary logistic regression identified Minimalism Index (p < 0.001) and weekly mileage (p = 0.028) as significant predictors of injury occurrence, with increased Minimalism Index inversely associated with injury likelihood (22% reduction per 10% Minimalism Index increase). Injury occurrence varied significantly across Minimalism Index categories (p = 0.003), with lower minimalist categories linked with greater injury occurrence, particularly knee injuries (p = 0.020). These findings suggest a potential association between the use of more minimal footwear and a lower occurrence of running-related injuries. These findings may have implications for footwear considerations in injury prevention strategies, although further research, particularly in populations with greater representation across the minimalism spectrum, is warranted.