Does choice of athletic footwear affect musculoskeletal injury risk in US Coast Guard recruits? A retrospective cohort study

Abstract

ABSTRACTContextMusculoskeletal injuries (MSKIs) are ubiquitous during initial entry military training, with overuse injuries in the lower extremities the most frequent. A common mechanism for overuse injuries is running, an activity that is an integral part of United States Coast Guard (USCG) training and a requirement for graduation.ObjectiveAssess the effects of athletic footwear choice on lower quarter MSKI risk in USCG recruits.DesignDescriptive Epidemiological StudySettingUSCG Training Center, Cape May, NJParticipantsA retrospective cohort study was performed in which 1229 recruits (1038 males, 191 females) were allowed to self-select athletic footwear during training. A group of 2876 recruits (2260 males, 616 females) who trained under a policy that required obligatory wear of prescribed athletic shoes served as a control.Main Outcome MeasuresDemographic data and physical performance were derived from administrative records. Injury data were abstracted from a medical tracking database. Multivariable logistic regression was used to assess group, age, sex, height, body mass, and run times on MSKI outcomes.ResultsAnkle-foot, leg, knee and lumbopelvic-hip complex diagnoses were ubiquitous in both groups (experimental: 20.37 to 29.34 per 1000 recruits; control: 18.08 to 25.59 per 1000 recruits). Group was not a significant factor for any of the injuries assessed. Sex was a significant factor in all injury types, with female recruits demonstrating ∼2.00 greater odds of experiencing running-related injuries (RRIs), overuse injuries, or any MSKI in general. When considering ankle-foot or bone stress injuries, the risk in female recruits was 3.73 to 4.11 greater odds than their male counterparts. Run time was a significant predictor in RRI, all overuse injuries, and for any MSKI in general.ConclusionWhile footwear choice did not influence MSKI risk in USCG recruits, female sex was a primary, nonmodifiable intrinsic risk factor.Key PointsSelf-selection of athletic footwear was not a significant factor for MSKI in USCG recruits, despite widespread reports of discomfort and perceived deleterious effects of wear.MSKI continues to be a major source of morbidity in the recruit training population, with female sex found to be a robust and significant factor regardless of footwear choice.While there is no indication that prescribed athletic footwear is associated with MSKI, policymakers should factor in individual preference when considering the mandate for wear.