Increased Vertical Impact Forces and Altered Running Mechanics with Softer Midsole Shoes

To date it has been thought that shoe midsole hardness does not affect vertical impact peak forces during running. This conclusion is based partially on results from experimental data using homogeneous samples of participants that found no difference in vertical impact peaks when running in shoes with different midsole properties. However, it is currently unknown how apparent joint stiffness is affected by shoe midsole hardness. An increase in apparent joint stiffness could result in a harder landing, which should result in increased vertical impact peaks during running. The purpose of this study was to quantify the effect of shoe midsole hardness on apparent ankle and knee joint stiffness and the associated vertical ground reaction force for age and sex subgroups during heel-toe running. 93 runners (male and female) aged 16-75 years ran at 3.33 ± 0.15 m/s on a 30 m-long runway with soft, medium and hard midsole shoes. The vertical impact peak increased as the shoe midsole hardness decreased (mean(SE); soft: 1.70BW(0.03), medium: 1.64BW(0.03), hard: 1.54BW(0.03)). Similar results were found for the apparent ankle joint stiffness where apparent stiffness increased as the shoe midsole hardness decreased (soft: 2.08BWm/º x 100 (0.05), medium: 1.92 BWm/º x 100 (0.05), hard: 1.85 BWm/º x 100 (0.05)). Apparent knee joint stiffness increased for soft (1.06BWm/º x 100 (0.04)) midsole compared to the medium (0.95BWm/º x 100 (0.04)) and hard (0.96BWm/º x 100 (0.04)) midsoles for female participants. The results from this study confirm that shoe midsole hardness can have an effect on vertical impact force peaks and that this may be connected to the hardness of the landing. The results from this study may provide useful information regarding the development of cushioning guidelines for running shoes.     

Gender and Age-Related Differences in Bilateral Lower Extremity Mechanics during Treadmill Running

Female runners have a two-fold risk of sustaining certain running-related injuries as compared to their male counterparts. Thus, a comprehensive understanding of the sex-related differences in running kinematics is necessary. However, previous studies have either used discrete time point variables and inferential statistics and/or relatively small subject numbers. Therefore, the first purpose of this study was to use a principal component analysis (PCA) method along with a support vector machine (SVM) classifier to examine the differences in running gait kinematics between female and male runners across a large sample of the running population as well as between two age-specific sub-groups. Bilateral 3-dimensional lower extremity gait kinematic data were collected during treadmill running. Data were analysed on the complete sample (n = 483: female 263, male 220), a younger subject group (n = 56), and an older subject group (n = 51). The PC scores were first sorted by the percentage of variance explained and we also employed a novel approach wherein PCs were sorted based on between-gender statistical effect sizes. An SVM was used to determine if the sex and age conditions were separable and classifiable based on the PCA. Forty PCs explained 84.74% of the variance in the data and an SVM classification accuracy of 86.34% was found between female and male runners. Classification accuracies between genders for younger subjects were higher than a subgroup of older runners. The observed interactions between age and gender suggest these factors must be considered together when trying to create homogenous sub-groups for research purposes.     

Increased hip adduction during running is associated with patellofemoral pain and differs between males and females: A case-control study

Patellofemoral pain is common amongst recreational runners and associated with altered running kinematics. However, it is currently unclear how sex may influence kinematic differences previously reported in runners with patellofemoral pain. This case-control study aimed to evaluate lower limb kinematics in males and females with and without patellofemoral pain during running. Lower limb 3D kinematics were assessed in 20 runners with patellofemoral pain (11 females, 9 males) and 20 asymptomatic runners (11 females, 9 males) during a 3 km treadmill run. Variables of interest included peak hip adduction, internal rotation and flexion angles; and peak knee flexion angle, given their previously reported association with patellofemoral pain. Age, height, mass, weekly run distance and step rate were not significantly different between groups. Mixed-sex runners with patellofemoral pain were found to run with a significantly greater peak hip adduction angle (mean difference = 4.9°, d = 0.91, 95% CI 1.4–8.2, p = 0.01) when compared to matched controls, but analyses for all other kinematic variables were non-significant. Females with patellofemoral pain ran with a significantly greater peak hip adduction angle compared to female controls (mean difference = 6.6°, p = 0.02, F = 3.41, 95% CI 0.4–12.8). Analyses for all other kinematic variables between groups (males and females with/without PFP) were non-significant. Differences in peak hip adduction between those with and without patellofemoral pain during running appear to be driven by females. This potentially highlights different kinematic treatment targets between males and females. Future research is encouraged to report lower limb kinematic variables in runners with patellofemoral pain separately for males and females.     

Comparison of Minimalist Footwear Strategies for Simulating Barefoot Running: A Randomized Crossover Study

Possible benefits of barefoot running have been widely discussed in recent years. Uncertainty exists about which footwear strategy adequately simulates barefoot running kinematics. The objective of this study was to investigate the effects of athletic footwear with different minimalist strategies on running kinematics. Thirty-five distance runners (22 males, 13 females, 27.9 ± 6.2 years, 179.2 ± 8.4 cm, 73.4 ± 12.1 kg, 24.9 ± 10.9 km.week^-1) performed a treadmill protocol at three running velocities (2.22, 2.78 and 3.33 m.s^-1) using four footwear conditions: barefoot, uncushioned minimalist shoes, cushioned minimalist shoes, and standard running shoes. 3D kinematic analysis was performed to determine ankle and knee angles at initial foot-ground contact, rate of rear-foot strikes, stride frequency and step length. Ankle angle at foot strike, step length and stride frequency were significantly influenced by footwear conditions (p<0.001) at all running velocities. Posthoc pairwise comparisons showed significant differences (p<0.001) between running barefoot and all shod situations as well as between the uncushioned minimalistic shoe and both cushioned shoe conditions. The rate of rear-foot strikes was lowest during barefoot running (58.6% at 3.33 m.s^-1), followed by running with uncushioned minimalist shoes (62.9%), cushioned minimalist (88.6%) and standard shoes (94.3%). Aside from showing the influence of shod conditions on running kinematics, this study helps to elucidate differences between footwear marked as minimalist shoes and their ability to mimic barefoot running adequately. These findings have implications on the use of footwear applied in future research debating the topic of barefoot or minimalist shoe running.     

Effects of various midsole densities of basketball shoes on impact attenuation during landing activities

The purpose of this study was to examine effects of shoe midsole densities and mechanical demands (landing heights) on impact shock attenuation and lower extremity biomechanics during a landing activity. Nine healthy male college athletes performed 5 trials of step-off landing in each of 9 test conditions, i.e., a combination of landings in shoes of 3 midsole densities (soft, normal, hard) from each of 3 landing potential energy (PE) levels (low, median, high). Ground reaction forces (GRF), accelerations (ACC) of the tibia and forehead, and sagittal kinematic data were sampled simultaneously. A 3 x 3 two-way (surface x height) repeated-measures analysis of variance (ANOVA) was performed on selected kinematic, ACC, and GRF variables; a 3 x 3 x 3 three-way (surface x height x joint) ANOVA was performed on variables related to eccentric muscular work. The GRF results showed that the forefoot peak GRF in the normal and hard midsoles was significantly greater than the soft midsole at the low and median PEs. Rearfoot peak GRF was significantly greater for the hard midsole than for the soft and normal midsoles at the median and high PEs, respectively. The peak head and tibia peak ACC were also attenuated in similar fashion. Kinematic variables did not vary significantly across different midsoles, nor did energy absorbed through lower extremity extensors in response to the increased shoe stiffness. Knee joint extensors were shown to be dominant in attenuating the forefoot impact force across the landing heights. The results showed limited evidence of impact-attenuating benefits of the soft midsole in the basketball shoes.     

The influence of running velocity and midsole hardness on external impact forces in heel-toe running

The purpose of this study was to investigate the influence of midsole hardness and running velocity on external impact forces in heel-toe running. Fourteen subjects were assessed with a force platform and high speed film while running at speeds of 3, 4, 5 and 6 m s-1. The result showed that running velocity does influence external impact force peaks (linear connection) and that midsole hardness does not influence magnitude and loading rate of the external vertical impact forces. Changes in kinematic and kinetic data can be used to explain this result mechanically. However, the neuromuscular control mechanisms to keep external impact forces constant are not known.     

Support vector machines for detecting age-related changes in running kinematics

Age-related changes in running kinematics have been reported in the literature using classical inferential statistics. However, this approach has been hampered by the increased number of biomechanical gait variables reported and subsequently the lack of differences presented in these studies. Data mining techniques have been applied in recent biomedical studies to solve this problem using a more general approach. In the present work, we re-analyzed lower extremity running kinematic data of 17 young and 17 elderly male runners using the Support Vector Machine (SVM) classification approach. In total, 31 kinematic variables were extracted to train the classification algorithm and test the generalized performance. The results revealed different accuracy rates across three different kernel methods adopted in the classifier, with the linear kernel performing the best. A subsequent forward feature selection algorithm demonstrated that with only six features, the linear kernel SVM achieved 100% classification performance rate, showing that these features provided powerful combined information to distinguish age groups. The results of the present work demonstrate potential in applying this approach to improve knowledge about the age-related differences in running gait biomechanics and encourages the use of the SVM in other clinical contexts.     

Running kinematics and shock absorption do not change after brief exhaustive running

Because of the nature of running, the forces encountered require a proper coordination of joint action of the lower extremity to dissipate the ground reaction forces and accelerations through the kinetic chain. Running-related muscle fatigue may reduce the shock absorbing capacity of the lower extremity and alter running kinematics. The purpose of this study was to determine if a bout of exhaustive running at a physiologically determined high intensity, changes running kinematics, impact accelerations, and alters shock attenuating capabilities. It was hypothesized that as a result of fatigue induced by an exhaustive run, running kinematics, impact accelerations at the head and shank, acceleration reduction, and shock attenuation would change. A within-subject, repeated-measures design was used for this study. Twelve healthy, competitive male and female distance runners participated. Subjects performed 2 testing sessions consisting of a VO2max treadmill protocol to determine the heart rate at ventilatory threshold and a fatigue-inducing running bout at the identified ventilatory threshold heart rate. Kinematic data included knee flexion, pronation, time to maximum knee flexion, and time to maximum pronation. Acceleration data included shank acceleration, head acceleration, and shock attenuation. No significant differences resulted for the kinematic or acceleration variables. Although the results of this study do not support the original hypotheses, the influence of running fatigue on kinematics and accelerations remains inconclusive. Future research is necessary to examine fatigue-induced changes in running kinematics and accelerations and to determine the threshold at which point the changes may occur.     

The influence of footwear on foot motion during walking and running

There are evidences to suggest that wearing footwear constrains the natural barefoot motion during locomotion. Unlike prior studies that deduced foot motions from shoe sole displacement parameters, the aim of this study was to examine the effect of footwear motion on forefoot to rearfoot relative motion during walking and running. The use of a multi-segment foot model allowed accurate both shoe sole and foot motions (barefoot and shod) to be quantified. Two pairs of identical sandals with different midsole hardness were used. Ten healthy male subjects walked and ran in each of the shod condition.The results showed that for barefoot locomotion there was more eversion of the forefoot and it occurred faster than for shod locomotion. In this later condition, the range of eversion was reduced by 20% and the rate of eversion in late stance by 60% in comparison to the barefoot condition. The sole constrained both the torsional (eversion/inversion) and adduction range of motion of the foot. Interestingly, during the push-off phase of barefoot locomotion the rate and direction of forefoot torsion varied between individuals. However, most subjects displayed a forefoot inversion direction of motion while shod. Therefore, this experiment showed that the shoes not only restricted the natural motion of the barefoot but also appeared to impose a specific foot motion pattern on individuals during the push-off phase. These findings have implications for the matching of footwear design characteristics to individual natural foot function.     

The influence of iliotibial band syndrome history on running biomechanics examined via principal components analysis

Iliotibial band syndrome (ITBS) is a common knee overuse injury among female runners. Atypical discrete trunk and lower extremity biomechanics during running may be associated with the etiology of ITBS. Examining discrete data points limits the interpretation of a waveform to a single value. Characterizing entire kinematic and kinetic waveforms may provide additional insight into biomechanical factors associated with ITBS. Therefore, the purpose of this cross-sectional investigation was to determine whether female runners with previous ITBS exhibited differences in kinematics and kinetics compared to controls using a principal components analysis (PCA) approach. Forty participants comprised two groups: previous ITBS and controls. Principal component scores were retained for the first three principal components and were analyzed using independent t-tests. The retained principal components accounted for 93–99% of the total variance within each waveform. Runners with previous ITBS exhibited low principal component one scores for frontal plane hip angle. Principal component one accounted for the overall magnitude in hip adduction which indicated that runners with previous ITBS assumed less hip adduction throughout stance. No differences in the remaining retained principal component scores for the waveforms were detected among groups. A smaller hip adduction angle throughout the stance phase of running may be a compensatory strategy to limit iliotibial band strain. This running strategy may have persisted after ITBS symptoms subsided.     

Effects of Forefoot Shoe on Knee and Ankle Loading during Running in Male Recreational Runners

Objectives: Although overuse running injury risks for the ankle and knee are high, the effect of different shoe designs on Achilles tendon force (ATF) and Patellofemoral joint contact force (PTF) loading rates are unclear. Therefore, the primary objective of this study was to compare the ATF at the ankle and the PTF and Patellofemoral joint stress force (PP) at the knee using different running shoe designs (forefoot shoes vs. normal shoes). Methods: Fourteen healthy recreational male runners were recruited to run over a force plate under two shoe conditions (forefoot shoes vs. normal shoes). Sagittal plane ankle and knee kinematics and ground reaction forces were simultaneously recorded. Ankle joint mechanics (ankle joint angle, velocity, moment and power) and the ATF were calculated. Knee joint mechanics (knee joint angle velocity, moment and power) and the PTF and PP were also calculated. Results: No significant differences were observed in the PTF, ankle plantarflexion angle, ankle dorsiflexion power, peak vertical active force, contact time and PTF between the two shoe conditions. Compared to wearing normal shoes, wearing the forefoot shoes demonstrated that the ankle dorsiflexion angle, knee flexion velocity, ankle dorsiflexion moment extension, knee extension moment, knee extension power, knee flexion power and the peak patellofemoral contact stress were significantly reduced. However, the ankle dorsiflexion velocity, ankle plantarflexion velocity, ankle plantarflexion moment and Achilles tendons force increased significantly. Conclusions: These findings suggest that wearing forefoot shoes significantly decreases the patellofemoral joint stress by reducing the moment of knee extension, however the shoes increased the ankle plantarflexion moment and ATF force. The forefoot shoes effectively reduced the load on the patellofemoral joint during the stance phase of running. However, it is not recommended for new and novice runners and patients with Achilles tendon injuries to wear forefoot shoes.     

Comparison of lower extremity kinematic curves during overground and treadmill running

Researchers conduct gait analyses utilizing both overground and treadmill modes of running. Previous studies comparing these modes analyzed discrete variables. Recently, techniques involving quantitative pattern analysis have assessed kinematic curve similarity in gait. Therefore, the purpose of this study was to compare hip, knee and rearfoot 3-D kinematics between overground and treadmill running using quantitative kinematic curve analysis. Twenty runners ran at 3.35 m/s ± 5% during treadmill and overground conditions while right lower extremity kinematics were recorded. Kinematics of the hip, knee and rearfoot at footstrike and peak were compared using intraclass correlation coefficients. Kinematic curves during stance phase were compared using the trend symmetry method within each subject. The overall average trend symmetry was high, 0.94 (1.0 is perfect symmetry) between running modes. The transverse plane and knee frontal plane exhibited lower similarity (0.86-0.90). Other than a 4.5 degree reduction in rearfoot dorsiflexion at footstrike during treadmill running, all differences were ≤1.5 degrees. 17/18 discrete variables exhibited modest correlations (>0.6) and 8/18 exhibited strong correlations (>0.8). In conclusion, overground and treadmill running kinematic curves were generally similar when averaged across subjects. Although some subjects exhibited differences in transverse plane curves, overall, treadmill running was representative of overground running for most subjects.     

Modeling muscle activity to study the effects of footwear on the impact forces and vibrations of the human body during running

A previously developed mass-spring-damper model of the human body is improved in this paper, taking muscle activity into account. In the improved model, a nonlinear controller mimics the functionality of the Central Nervous System (CNS) in tuning the mechanical properties of the soft-tissue package. Two physiological hypotheses are used to determine the control strategies that are used by the controller. The first hypothesis (constant-force hypothesis) postulates that the CNS uses muscle tuning to keep the ground reaction force (GRF) constant regardless of shoe hardness, wherever possible. It is shown that the constant-force hypothesis can explain the existing contradiction about the effects of shoe hardness on the GRF during running. This contradiction is emerged from the different trends observed in the experiments on actual runners, and experiments in which the leg was fixed and exposed to impact. While the GRF is found to be dependent on shoe hardness in the former set of experiments, no such dependency was observed in the latter. According to the second hypothesis, the CNS keeps the level of the vibrations of the human body constant using muscle tuning. The results of the study show that this second control strategy improves the model such that it can correctly simulate the effects of shoe hardness on the vibrations of the human body during running.     

Stiffness adaptations in shod running

When mechanical parameters of running are measured, runners have to be accustomed to testing conditions. Nevertheless, habituated runners could still show slight evolutions of their patterns at the beginning of each new running bout. This study investigated runners' stiffness adjustments during shoe and barefoot running and stiffness evolutions of shoes. Twenty-two runners performed two 4-minute bouts at 3.61 m.s-1 shod and barefoot after a 4-min warm-up period. Vertical and leg stiffness decreased during the shoe condition but remained stable in the barefoot condition, p < 0.001. Moreover, an impactor test showed that shoe stiffness increased significantly during the first 4 minutes, p < 0.001. Beyond the 4th minute, shoe properties remained stable. Even if runners were accustomed to the testing condition, as running pattern remained stable during barefoot running, they adjusted their leg and vertical stiffness during shoe running. Moreover, as measurements were taken after a 4-min warm-up period, it could be assumed that shoe properties were stable. Then the stiffness adjustment observed during shoe running might be due to further habituations of the runners to the shod condition. To conclude, it makes sense to run at least 4 minutes before taking measurements in order to avoid runners' stiffness alteration due to shoe property modifications. However, runners could still adapt to the shoe.     

The number of strides required for treadmill running gait analysis is unaffected by either speed or run duration

Participation in running events has increased recently, with a concomitant increase in the rate of running related injuries (RRI). Mechanical overload is thought to be a primary cause of RRI, it is often detected using motion analysis to examine running mechanics during either overground or treadmill running. In treadmill running, no clear consensus for the number of strides required to establish stable kinematic data exists. The aim of this study was to establish the number of strides needed for stable data when analysing gait kinematics in the stance phase of treadmill running. Twenty healthy, masters age group, club runners completed a high intensity interval training run (HIIT) and an energy-expenditure matched medium intensity continuous run (MICR). Thirty consecutive strides at start and end of each run were identified. Sequential averaging was employed to determine the number of strides required to establish a stable value. No significant differences existed in the number of strides required to achieve stable values. Twenty consecutive strides are required to be 95% confident stable values exist for maximum angle, angle at initial foot contact, and range of motion at the ankle, knee, and hip joints variables at the ankle, knee, and hip joints, in all three planes of motion, and spatiotemporal regardless of running speed and time of capture.     

A little bit faster: Lower extremity joint kinematics and kinetics as recreational runners achieve faster speeds

There appears a linear relationship between small increases in running speed and cardiovascular health benefits. Encouraging or coaching recreational runners to increase their running speed to derive these health benefits might be more effective if their joint level kinematic and kinetic strategy was understood. The aim of this investigation was to compare the peak sagittal plane motions, moments, and powers of the hip, knee and ankle at 85%, 100%, 115% and 130% of self-selected running speed. Overground running data were collected in 12 recreational runners (6 women, 6 men) with a full body marker set using a 12-camera Vicon MX system with an AMTI force plate. Kinematics and kinetics were analyzed with Vicon Nexus software. Participants chose to run at 2.6 ± 0.5 m/s (85%); 3.0 ± 0.5 m/s (100%); 3.3 ± 0.5 m/s (115%); and 3.7 ± 0.5 m/s (130%); these four speeds approximately correspond to 6:24-, 5:33-, 5:03-, and 4:30-min kilometer running paces. Running speed had a significant effect (P < 0.05) on peak kinematic and kinetic variables of the hips, knees and ankles, with peak sagittal hip moments invariant (P > 0.54) and the peak sagittal ankle power generation (P < 0.0001) the most highly responsive variable. The timing of the peak sagittal extensor moments and powers at the hip, knee and ankle were distributed across stance in a sequential manner. This study shows that running speed affects lower limb joint kinematics and kinetics and suggests that specific intersegmental kinetic strategies might exist across the narrow range of running speeds.     

Biomechanical analysis of the stance phase during barefoot and shod running

This study investigated spatio-temporal variables, ground reaction forces and sagittal and frontal plane kinematics during the stance phase of nine trained subjects running barefoot and shod at three different velocities (3.5, 4.5, 5.5 m s(-1)). Differences between conditions were detected with the general linear method (factorial model). Barefoot running is characterized by a significantly larger external loading rate than the shod condition. The flatter foot placement at touchdown is prepared in free flight, implying an actively induced adaptation strategy. In the barefoot condition, plantar pressure measurements reveal a flatter foot placement to correlate with lower peak heel pressures. Therefore, it is assumed that runners adopt this different touchdown geometry in barefoot running in an attempt to limit the local pressure underneath the heel. A significantly higher leg stiffness during the stance phase was found for the barefoot condition. The sagittal kinematic adaptations between conditions were found in the same way for all subjects and at the three running velocities. However, large individual variations were observed between the runners for the rearfoot kinematics.     

Biomechanical predictors of retrospective tibial stress fractures in runners

Both kinematics and kinetics of the lower limb have been shown separately to be related with a history of tibial stress fractures (TSFs) in female runners. However, it is likely that these factors interact together to increase the risk of a TSF. This study was conducted to determine which combination of kinematic and kinetic factors are the best predictors of retrospective TSF in female distance runners. Total 30 female runners who had previously sustained a TSF were recruited, along with an age and mileage matched control group (n=30). Subjects ran overground at 3.7m/s while kinematic and kinetic data were recorded. Five trials from each subject were used for data analysis and ensemble means were calculated for both groups. The kinematic variables of peak hip adduction (HADD), peak knee internal rotation (KIR) and knee adduction (KADD), peak rearfoot eversion (RFEV) were entered into a binary logistic regression along with the kinetic variables of vertical instantaneous load rate (VILR) and absolute free moment (FM). The variables HADD, FM and RFEV were able to correctly predict a history of TSF in 83% of cases. Increases in HADD, FM and RFEV (odds ratios of 1.29, 1.37 and 1.18) were associated with an elevated risk of having a history of TSF. The addition of VILR, KIR and KADD did not improve the ability to predict previous injury. Based on these results, HADD, FM and RFEV appear to be the most important of the variables of interest in terms of predicting retrospective TSF in female runners.     

Kinematics and muscle activity when running in partial minimalist,traditional, and maximalist shoes

While several studies have examined kinematic and kinetic differences between maximalist (MAX), traditional (TRAD), or partial minimalist (PMIN) shoes, to date it is unknown how MAX shoes influence muscle activity. This study compared lower extremity kinematics and muscle activity when running in PMIN, TRAD, and MAX shoes. Thirteen participants ran in each shoe while whole body kinematics were recorded using motion capture and electromyography was recorded from seven leg muscles. Differences in kinematics and root mean square amplitudes (RMS) were compared between shoe conditions. There were small differences in sagittal and frontal plane ankle kinematics between shoe conditions, with the MAX shoes resulting in less dorsiflexion at foot strike (p = .002) and less peak dorsiflexion (p < .001), and the PMIN shoes resulting in greater peak eversion (p = .012). Gluteus medius (p.006) and peroneus longus (p = .007) RMS amplitudes were greater in the MAX shoe then the TRAD or PMIN shoes while tibialis anterior RMS amplitudes were higher in the PMIN shoes (p = .005) than either the TRAD or MAX shoes. Consistent with previous findings, these results suggest there are small differences in kinematics when running in these three shoe types. This may partly be explained by the changes in muscle activity, which may be a response in order to maintain a preferred or habitual movement path. Implications for these difference in muscle activity in terms of fatigue or injury remain to be determined.     

Tibiocalcaneal kinematics of barefoot versus shod running

Barefoot running kinematics has been described to vary considerably from shod running. However, previous investigations were typically based on externally mounted shoe and/or skin markers, which have been shown to overestimate skeletal movements. Thus, the purpose of this study was to compare calcaneal and tibial movements of barefoot versus shod running using skeletal markers. Intracortical bone pins with reflective marker triads were inserted under standard local anesthetic into the calcaneus and tibia of five healthy male subjects. The subjects ran barefoot, with a normal shoe, with three shoe soles and two orthotic modifications. The three-dimensional tibiocalcaneal rotations were determined using a joint coordinate system approach. Test variables were defined for eversion and tibial rotation. The results showed that the differences in bone movements between barefoot and shod running were small and unsystematic (mean effects being less than 2 degrees ) compared with the differences between the subjects (up to 10 degrees ). However, differences may occur during midstance when extreme shoe modifications (i.e. posterior orthosis) are used. It is concluded that calcaneal and tibial movement patterns do not differ substantially between barefoot and shod running, and that the effects of these interventions are subject specific. The result of this in vivo study contrasts with previous investigations using skin and shoe mounted markers and suggests that these discrepancies may be the result of the overestimation with externally mounted markers.