Feet and Footwear: Applying Biological Design and Mismatch Theory to Running Injuries

The Endurance-Running hypothesis proposes that natural selection has shaped humans into endurance-running specialists. Running-related-injury rates between 20-79% suggests modern humans are prone to injury in this species-specific movement pattern. This opinion piece offers a novel perspective on high-injury prevalence in human endurance running, focussing on evolutionary mismatch between modern athletic footwear and evolved foot structure and function. We propose that non-anatomically shaped, structured, cushioned footwear can lead to maladapted foot structure and loss of biologically-normal function including stability, elasticity, sensory feedback and subsequent movement control. The structure and function of the human foot and its possible impairment by modern footwear has received little attention in running-related literature, but could provide a new area of enquiry and potential solutions for many running-related injuries.