Leg and Joint Stiffness Adaptations to Minimalist and Maximalist Running Shoes

in Journal of Applied Biomechanics
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  • 1 Indiana University
  • | 2 Boise State University
  • | 3 Georgia Southern University

The running footwear literature reports a conceptual disconnect between shoe cushioning and external impact loading: footwear or surfaces with greater cushioning tend to result in greater impact force characteristics during running. Increased impact loading with maximalist footwear may reflect an altered lower-extremity gait strategy to adjust for running in compliant footwear. The authors hypothesized that ankle and knee joint stiffness would change to maintain the effective vertical stiffness, as cushioning changed with minimalist, traditional, and maximalist footwear. Eleven participants ran on an instrumental treadmill (3.5 m·s−1) for a 5-minute familiarization in each footwear, plus an additional 110 seconds before data collection. Vertical, leg, ankle, and knee joint stiffness and vertical impact force characteristics were calculated. Mixed model with repeated measures tested differences between footwear conditions. Compared with traditional and maximalist, the minimalist shoes were associated with greater average instantaneous and average vertical loading rates (P < .050), greater vertical stiffness (P ≤ .010), and less change in leg length between initial contact and peak resultant ground reaction force (P < .050). No other differences in stiffness or impact variables were observed. The shoe cushioning paradox did not hold in this study due to a similar musculoskeletal strategy for running in traditional and maximalist footwear and running with a more rigid limb in minimalist footwear.

The introduction of ultracushioning or maximalist running footwear has reignited the debate regarding the influence of cushioning on running mechanics. Running shoe cushioning was designed to protect the runner from potentially hazardous impact loading. However, reports from the running shoe literature indicate a conceptual disconnect between shoe cushioning (ie, the degree of midsole hardness) and external impact loading. That is, greater shoe or surface cushioning tends to result in the runner landing with similar13 or greater47 peak vertical impact force magnitude and vertical loading rates compared with harder footwear or surfaces.

This conceptual disconnect between footwear cushioning and external impact loading has been further scrutinized in the comparison of traditional running footwear to minimalist footwear or barefoot running. Specifically, traditional running footwear typically results in similar or greater impact peak magnitudes when compared with barefoot running with a nonrearfoot strike pattern.810 Traditional running footwear can also result in greater vertical loading rates compared with minimalist footwear, even when the footstrike pattern is maintained in some studies,11 but not others,12,13 and when participants included habituated minimalist or barefoot runners.14 The trend that impact metrics increase with greater shoe cushioning is also observed when comparing traditional with maximalist running footwear.1518 Nigg et al3 suggested that runners respond to varying midsole hardnesses by changing their joint and segment kinematic strategy at initial contact to maintain external impact loading. Landing with greater external impact loading in more cushioned footwear or surface conditions may be a mechanism to change the biomechanical strategy to maintain internal conditions. Although maximalist footwear was designed to reduce the internal effect of external impact loading, relatively little is known regarding how the musculoskeletal system responds to maximalist footwear concerning a change in joint strategy.

Changes in the leg and joint stiffness may explain the conceptual disconnect between cushioning and external impact loading. Leg stiffness represents the stiffness of the musculoskeletal system19 and is modulated by the musculoskeletal response adopted at a specific joint of the lower extremity.1921 Individuals may select leg and joint stiffness as a result of the inherent properties of the musculoskeletal system to maintain dynamic stability and be more responsive to the environment.22 In response to greater shoe or surface hardness, the body decreases leg and joint stiffness so that the combined system stiffness remains constant.19,20,22,23 This system stiffness represents the combined stiffness of the surface, shoe, and body. It is modeled as a series of springs and is quantified by calculating effective vertical stiffness.22,24,25 Effective vertical stiffness reflects the combined system stiffness of the surface, shoe, and limb because it is calculated from the change in center of mass vertical position.22 Landing with a more compliant limb and joint on harder footwear or surfaces results in reduced external impact loading. Thus, when running on more cushioned footwear or surfaces, the runner may increase leg and joint stiffness to maintain this combined system stiffness, which results in greater external impact loading from the collision of the stiff limb upon the ground. The change in leg and joint stiffness may be a biomechanical strategy to regulate the passive internal response to an increase in external loading.3,26

Both maximalist and minimalist footwear can be considered to protect the runner against external loading, but with differing mechanisms. Maximalist footwear can be considered to protect the runner from external loading by dampening impacts between the ground and the runner, while minimalist footwear takes the opposite approach by reducing the magnitude of external impact loading generated, thus eliminating the need for bulky footwear. The different mechanisms for which maximalist and minimalist footwear modulate the effects of loading may manifest as a change in joint strategy to maintain an optimal system–stiffness solution. Kulmala et al18 recently confirmed that an increase in leg stiffness at fast but not slow (4.0 vs 2.8 m·s−1) speeds accompanies the increase in peak vertical impact force and loading rate with maximalist compared with traditional footwear. Although leg stiffness represents the body’s behavioral response to different cushioning conditions, leg stiffness is dependent on the stiffness of the ankle, knee, and hip.21 As shown by Borgia and Becker,27 leg stiffness remained similar when running near 3.0 m·s−1 in maximalist, minimalist, and traditional footwear because of an altered ankle and knee joint stiffness strategy between footwear types, which has also been found between barefoot, barefoot-inspired, and traditional footwear.28 However, the joint strategy for changing leg stiffness has yet to be examined in concert with impact characteristics across minimalist, traditional, and maximalist footwear. Neither of these previous studies examined if the biomechanical strategy adopted with different footwear was successful at maintaining a similar effective vertical stiffness. Computational methods to calculate leg stiffness differed between these previous studies, so it is unclear if the varying results between studies are due to leg stiffness calculation or some other factor.

The purpose of this study was to compare the variations in leg and joint stiffness strategy when running with different footwear. Similarly to Ferris et al,22 it was hypothesized that, as shoe cushioning increases between minimalist, traditional, and maximalist footwear, leg stiffness would increase to maintain effective vertical stiffness, indicating similar running mechanics (ie, manner of running22) between footwear conditions. Our second hypothesis was that ankle and knee joint stiffness would differ between footwear conditions to reflect the changes in leg stiffness required to maintain the same manner of running. The last hypothesis was that external impact loading would increase as midsole cushioning increased between minimalist, traditional, and maximalist footwear. A secondary analysis was performed to evaluate the footstrike pattern given that footstrike may change between footwear types1214 and influence joint stiffness strategy.29

Methods

Participants had to meet the following inclusion criteria: 18–30 years old, had not sustained a running injury within the past 12 months, and had at least 3 years of experience running ≥9.7 km·wk−1. Eleven individuals (all male) were included (mean [SD]: 80.1 [13.8] kg; 1.75 [1.2] m; 23.0 [2.9] y; 24.9 [10.8] km·wk−1). The participants reported experiencing no pain on the day of testing. The institutional review board at Georgia Southern University approved this study, and the participants gave written informed consent before enrolling in the study.

The participants ran in each of the 3 footwear conditions provided by the lab: minimalist (Nike Flex 2014 Run), traditional (Saucony Ride 7), and maximalist (Hoka One One M Bondi 4) (Supplementary Material 1 [available online]). The minimalist index30 score was 68%, 34%, and 24% for the minimalist, traditional, and maximalist footwear, respectively. The participants wore tight shorts and the assigned, randomized running footwear. The participants were blinded to the type of shoes and the presented order by placing the shoes in identical shoe boxes, in the order selected for the given participant. Reflective marker placement over anatomical landmarks followed the Istituto Ortopedico Rizzoli lower-limb model.31

For each randomized footwear condition, the participants ran on the treadmill for a 5-minute warm-up and familiarization period9 at their preferred running speed. The treadmill was stopped to check marker positions and collect the static trial. Next, the treadmill speed was increased to 3.5 m·s−1 or, for the purposes of a larger study, their preferred speed (mean = 3.3 m·s−1; SE = 0.1; SD = 0.5). The order of the speed conditions was randomized. The participants ran for 2 minutes, and the last 10 seconds were recorded for analysis, which allowed at least 10 stance phases of the right limb to be captured. The participants rested for at least 5 minutes between the speed and footwear conditions. The participants completed both speeds in a single footwear before completing the next footwear condition. The treadmill protocol (ie, 5-min familiarization, break, 2-min run at speed A, break, 2-min run at speed B) was completed for each footwear condition. The data from the preferred speed condition were excluded from the analysis, given the wide range of speeds selected (range = 2.7–4.5 m·s−1) and that footwear by speed interaction with leg stiffness has been observed previously.18

Three-dimensional kinematics were recorded with an 8-camera Vicon motion capture system (TX60; Vicon, Oxford, United Kingdom) sampling at 100 Hz. Ground reaction force (GRF) and center of pressure data were recorded by an instrumented treadmill (AMTI force-sensing tandem treadmill, MA) with a sampling rate of 1000 Hz. Synchronized kinematic and kinetic data were captured simultaneously with Nexus software (version 1.8.5; Nexus, Oxford, United Kingdom). A CalTester rod (C-Motion Inc, Germantown, MD) was used to confirm the accuracy of the center of pressure location for the inverse dynamic analysis, following the manufacturer-recommended protocol.

The marker positions of the right limb were initially processed with Nexus software and then exported with the force platform data for data processing with Visual3D (C-Motion, Inc, Germantown, MD). The marker position and GRFs were filtered with a low-pass, zero-lag, Butterworth filter with cutoff frequencies of 14 Hz and 50 Hz, respectively. The GRFs were exported for impact metric calculation and then filtered at a cutoff frequency of 14 Hz prior to the calculation of the joint moments to remove artifacts within the joint moment time series that do not reflect the dynamics of the task.32,33 Mass-normalized sagittal plane internal joint moments were calculated using a Newton–Euler inverse dynamics procedure, with the proximal segment set as the reference segment. The data were extracted from the stance phase, defined as the period between the initial contact and toe off, which were determined with a 20 N threshold.

Stiffness, or quasi-stiffness, is a computational model to describe the spring-like behavior of the lower extremity. Computational methods vary, the effects of which are described elsewhere.3437 For this study, vertical stiffness was calculated as the peak vertical GRF divided by the change in center of mass vertical displacement.38 To remove the effect of shoe deformation from the leg stiffness calculation, leg length was calculated as the 3-dimensional vector between the hip and ankle joint centers.18 Leg compression was then calculated as the change in leg length between the initial contact and the time of peak resultant GRF. Three-dimensional leg stiffness was calculated as the ratio between the peak resultant GRF and leg compression.18,35 A secondary analysis using the leg stiffness calculation38 was completed to compare with the results of Borgia and Becker27 (Supplementary Material 2 [available online]). Knee and ankle joint stiffness were both calculated as the linear fit of the slope of the joint moment–joint angle plot from the initial ground contact to the instant of maximum ankle dorsiflexion.29 The instant of maximum ankle dorsiflexion was selected so that knee and ankle joint stiffness would be calculated over the same portion of the stance phase.29,39

Impact force peak magnitude (IP) was the magnitude of the first local maximum of the vertical GRF component. However, the magnitude at 13% of the stance phase was extracted if a prominent impact force was not visible within the timeseries,40 which is common with nonrearfoot strike patterns. Three vertical loading variables were calculated from 20% to 80% of the time between the initial contact and the instant of IP.41 The average vertical loading rate (AVLR) was calculated as the slope of the line from 20% to 80% of the time to IP. The instantaneous vertical loading rate (IVLR) was calculated by differentiating the vertical GRF with respect to time. The maximum IVLR was the maximum instantaneous value between 20% and 80% of the time to IP. The average instantaneous vertical loading rate (AIVLR) was the average of all instantaneous values from 20% to 80% of the time to IP.

A secondary analysis was performed to assess footstrike pattern and stride frequency, variables known to change with footwear and affect the primary dependent variables, stiffness,29,42,43 and vertical impact characteristics.13,44 Strike index and sagittal plane ankle angle at initial contact were calculated to evaluate changes in the footstrike pattern. The strike index was calculated as the location of the center of pressure at initial contact relative to the length of the foot (rearfoot = 0%–33%; midfoot = 34%–66%; forefoot = 68%–100%).12,14,45 Hip and knee angles at initial contact were also extracted. Stride frequency was calculated as the number of right strides performed during the motion capture, expressed as strides per minute.

Differences in stiffness variables (effective vertical, leg, knee, and ankle), leg compression, impact variables (IP, AVLR, IVLR, and AIVLR), and secondary analysis variables (stride frequency, strike index, and joint angles at initial contact) between the 3 footwear conditions were each assessed with linear mixed models with repeated measures (α= .050). Normality of the residual for each variable was assessed by examining the skewness (–2.0 to 2.0) across subjects and footwear conditions.46 All variables were normally distributed. Post hoc analyses were performed with Fisher least significant difference to assess the main effects of footwear conditions (α = .050). Cohen d effect sizes for repeated measures47 were used to interpret the effect of footwear on the dependent variables (small, d = 0.2; medium, d = 0.5; large, d = 0.8).48 The P values and effect sizes are reported in the results; descriptive statistics for each variable and comparison are provided in Supplementary Material 2 (available online). IBM SPSS software was used for all statistical tests (version 25.0; IBM Corp, Armonk, NY).

Results

Only vertical stiffness (P = .007), stiffness, and leg compression (P = .011) were statistically different between footwear conditions (Figure 1A and 1B). Post hoc analyses revealed that minimalist footwear resulted in significantly greater vertical stiffness than both maximalist (P = .009, d = 1.199) and traditional (P = .003, d = 1.408). No difference was observed in vertical stiffness between the maximalist and traditional footwear (P = .647, d = 0.906). The leg compression with minimalist footwear was significantly less than the maximalist (P = .049, d = 1.106) and traditional footwear (P = .003, d = 1.847), but similar between the maximalist and traditional footwear (P = .227, d = 1.166). There was no difference in leg (P = .062), ankle (P = .194), or knee (P = .576) stiffness between footwear conditions (Figure 1B and 1C). Although the differences were not significant, the effect sizes for all other stiffness comparisons were large (d ≥ 0.844; Supplementary Material 2 [available online]).

Figure 1
Figure 1

—Stiffness variables. Mean ± SE vertical and (A) 3-dimensional leg stiffness, (B) 3-dimensional leg compression, and (C) joint stiffness for each footwear condition. *Significantly different from maximalist footwear (P < .05). Significantly different from traditional footwear (P < .05).

Citation: Journal of Applied Biomechanics 37, 5; 10.1123/jab.2020-0284

There was a significant difference in AVLR (P = .014) and AIVLR (P = .005) between footwear conditions (Figure 2A). The minimalist footwear resulted in significantly greater AVLR and AIVLR compared with both the traditional (P < .010; d = 1.998) and maximalist footwear (P < .010; d = 1.098). No differences in ALVR and AIVLR between the maximalist and traditional were observed (P > .949, d = 1.725). The IP (P = .825) and IVLR (P = .309) were statistically similar between footwear conditions (Figure 2A and 2B), but large effect sizes were observed (d = 1.324, Supplementary Material 2 [available online]).

Figure 2
Figure 2

—Impact variables. Mean + SE (A) maximum instantaneous VLR, average instantaneous VLR, average VLR, and (B) peak impact force for each footwear condition. * indicates a significant difference between footwear conditions, P < .05.

Citation: Journal of Applied Biomechanics 37, 5; 10.1123/jab.2020-0284

In the traditional footwear, 9 participants were rearfoot strikers and 2 participants were midfoot strikers. The average strike index indicated a rearfoot strike across footwear conditions, but it was significantly different between footwear (P = .002; d = 1.036). The strike index was smaller (more rearfoot) in traditional footwear compared with maximalist (P = .001, d = 1.182) and minimalist footwear (P = .006; d = 0.800). The similarity in footstrike classification across footwear conditions was confirmed by similar ankle angles at the initial contact between footwear conditions (P = .403; d = 0.352). The hip (P = .010) angle at initial contact was significantly greater with traditional compared with maximalist (P = .015; d = 1.276) and minimalist (P = .004; d = 1.323) footwear, but the minimalist and maximalist were similar (P = .600; d = 1.014). The stride frequency was similar across footwear conditions (P = .119; d = 0.548). The descriptive statistics for the kinematic data and additional strike index information are provided in Supplementary Materials 2 and 3 (available online), respectively.

Discussion

The purpose of this study was to compare the strategy for adjusting leg stiffness when running in different footwear. The hypotheses were not supported by our observations. Adjustments in leg stiffness are required to maintain a similar effective vertical stiffness under different cushioning conditions.22 However, in the present study, leg stiffness was unaffected by footwear but vertical stiffness was different between minimalist and the other 2 footwear conditions. No differences in ankle or knee joint stiffness were observed. Minimalist footwear resulted in greater vertical loading rates than maximalist and traditional footwear. Large effect sizes were observed for all stiffness and impact variables (ie, d = 0.844; Supplementary Material 2 [available online]), which suggests that a reasonably larger sample size may reveal significant footwear main effects, especially for 3-dimensional (P = .062) and planar leg stiffness (P = .088).

Leg stiffness adjustments have been hypothesized to occur when running on a compliant surface or footwear to maintain an effective vertical stiffness and manner of running.22 Given that the vertical stiffness represents the combined stiffness of the treadmill, footwear, and the runner's lower extremity, our participants appear to respond to the altered cushioning of minimalist footwear by changing their leg compression and vertical stiffness, but not the leg, ankle, or knee joint stiffness. The change in leg compression may be driven in part by changes in the hip flexion angle at initial contact (Supplementary Material 2 [available online]). However, the statistical outcome between footwear for leg compression and vertical stiffness did not follow the differences in the hip flexion angle at initial contact. Maintaining stride frequency between footwear conditions may explain the similar leg stiffness observed between footwear conditions, since stride frequency changes may be required to elicit leg stiffness adjustments at a given running speed.22

Larger effect sizes were observed with the nonbodyweight normalized then the data normalized to bodyweight, with near-consistent statistical outcomes (Supplementary Material 5 [available online]). That is, the nonbodyweight normalized data resulted in less intersubject variability in stiffness and impact variables, which may be related to recent findings that cushioned footwear's injury-prevention benefits may depend on bodyweight.49 Therefore, the potential interaction between bodyweight and stiffness response to footwear should be investigated in future studies.

The cushioning difference between minimalist, traditional, and maximalist footwear may have been insufficient (Supplementary Material 1 [available online]) to elicit a change in the leg, ankle, or knee stiffness to maintain a constant combined system stiffness. Depending on the materials testing metric, either the minimalist or the traditional shoe could be considered the intermediate footwear. Or, the interparticipant joint strategy or response to each condition, as observed in other studies,22,27,28 was too varied to detect a difference in the leg or joint stiffness (Supplementary Material 4 [available online]). Nonsignificant changes in ankle stiffness but large effect sizes may be evidence for attempting to adjust joint and leg stiffness to maintain the manner of running and combined system stiffness between footwear conditions. The statistical similarity in knee stiffness between footwear conditions may contribute to the nonsignificant difference in leg stiffness observed in the present study, given that knee stiffness may have the greatest influence to leg stiffness during running.50 The observed similarity in ankle or knee joint stiffness was inconsistent with previous studies,4 including a study with similar footwear conditions.27

Most previous studies show that greater cushioning does not necessarily decrease the external impact experienced by the body.46,1518 The greater vertical loading rates observed with minimalist footwear as opposed to maximalist or traditional footwear conflicts with previous studies of maximalist footwear,1518 but are similar to 2 recent studies.51,52 Decreased leg compression observed with the minimalist footwear indicates a straighter limb at initial contact19 and occurs when running on a compliant surface.22 However, our minimalist condition had the thinnest midsole with the least amount of cushioning (Supplementary Material 1 [available online]). Therefore, the decreased leg compression, smaller hip flexion angle at contact, and a more anterior (but still rearfoot) strike index with minimalist footwear may indicate a maladaptive strategy that increased vertical loading rates12 compared with traditional or maximalist. Given that shifts in strike index within a footstrike classification may affect impact variables,53,54 future footwear studies should measure changes in footstrike patterns or, more specifically, strike index,12,53,54 rather than only report the habitual footstrike pattern or recruit one footstrike group. These factors and interactions may result in similar impact loading, rather than one type of footwear being “bad” or “good” based on external impact metrics alone.

The results of the present study resemble the footstrike pattern and leg stiffness results of Borgia and Becker27 and the leg stiffness, cadence, and AVLR results from the slow speed condition of Kulmala et al.18 The running speeds ranged between 2.8 and 4.0 m·s−1 across these studies. Kulmala et al18 explained that a significant speed by footwear interaction with traditional and maximalist footwear was likely due to a speed-dependent effect of maximalist footwear on vertical ground reaction forces that were not consistent between footwear conditions. Conflicting statistical results between studies could also be explained by whether differences in stride frequency were observed in addition to between-study differences in the speeds tested, footwear models tested, calculation of vertical loading rate and stiffness metrics, and treadmill versus overground running. The contrasting results between the present and previous studies also emphasize the large degree of interindividual variability common in running footwear research,5557 which may be influenced by age and sex.4 These contrasting and comparable results between studies also highlight potential interindividual properties of the musculoskeletal system that determine runners' choice or response to stiffness metrics22,58,59 among footwear types and the potential importance of individual choice in footwear selection that prioritizes comfort for preventing running injury.60

As measured in this study, stiffness is a model that does not represent the true mechanical stiffness of the system.39,61 Vertical, leg, and joint stiffness are influenced by computational methods and are sensitive to leg compression calculation.3437 As such, comparing stiffness between studies is difficult. Kulmala et al18 and the present study calculated leg compression as the change in leg length measured between the hip and ankle. Borgia and Becker27 used a planar method,38 which differs from the 3-dimensional method used in Kulmala et al18 and the present study. However, we found no difference in statistical outcome in leg stiffness between minimalist, traditional, and maximalist footwear between these 2 computational methods (Supplementary Material 2 [available online]). This similarity between computational methods likely reflects the research questions specific to this study and thus statistical similarity may not occur necessarily for studies investigating stiffness between different biomechanical conditions, such as differences in stiffness between speeds.36,38,50

The shoe cushioning paradox emerged from studies reporting that cushioned footwear does not reduce external impact loading,46,1518 and so the benefits of cushioning came into question. It is important to highlight that internal loading or impact attenuation cannot be inferred from the present results or by any study reporting loading rates or impact shock alone. Shorten and Mientjes62 reported that, despite greater impact forces, cushioned footwear attenuated frequencies, representing the impact force by 35% compared with a shoe without cushioning. Therefore, a stiffer limb and harder landing of maximalist footwear may reflect a reduced need for impact absorption by active mechanisms because the cushioning material and thicker midsole are accomplishing some attenuation (Supplementary Material 1 [available online]). Indeed, maximalist footwear previously resulted in greater tibial shock and shock attenuation than minimalist, but neither variable was statistically different from traditional footwear.63 The footstrike pattern was not consistent across footwear conditions in that study, so footwear versus footstrike effects cannot be differentiated. Modeling studies are needed to evaluate the internal effects of maximalist footwear. The footwear types may have a greater influence on internal musculoskeletal loads related to lower extremity joint work, limb posture at initial contact, and joint excursion during stance26,64 compared with vertical GRFs.65

The implication of these results and the effects of different footwear cushioning categories on injury development are unknown and should not be deduced from this or any cross-sectional study. Messier et al66 reported that neither footwear nor GRF variables were predictors of future overuse running injury development, but the odds of developing an overuse running injury increased by 18% for every 1 Nm·deg−1 increase in knee joint stiffness. In the present study, knee joint stiffness between footwear conditions differed by <1 Nm·deg−1 on average. Footwear may not influence overuse injury development if the mechanism for injury involves knee joint stiffness. As described by Borgia and Becker,27 footwear influences multiple biomechanical gait variables—including lower extremity joint work and the distance of the GRF vector to the joints—which may provide benefits for different types of injuries. Some intervention studies have reported that the use of shock-absorbing insoles reduced the incidence of injury in military populations,67,68 but footwear midsole hardness did not influence injury risk in 2 large-scale prospective randomized control trials of recreational runners.69,70

In contrast to some47,1518,27 but not all previous studies,18 we found that the shoe-cushioning paradox did not hold in this study. That is, runners in this study ran with greater average vertical loading rates in the footwear with the greatest average midsole stiffness, minimalist footwear, compared with maximalist and traditional footwear. The musculoskeletal strategy for running in maximalist and traditional footwear was similar. However, the strategy for running in minimalist footwear involved reduced leg compression and hip flexion at initial contact, leading to greater vertical stiffness and vertical loading rates. Our results indicate inconsistent individual responses to modulating lower extremity stiffness and external impact across footwear types compared with previous studies.1518,27,51 The shoe-cushioning paradox may be influenced by individual variation in limb and joint stiffness adjustments and affected by footstrike pattern, stride frequency, and bodyweight.

Acknowledgments

The authors thank Jacob Vollmar and John J. Davis IV for their assistance with the data analysis and Lillian Golzarri Arroyo and Stephanie Dickinson from the Biostatistics Consulting Center at Indiana University Bloomington for providing statistical consulting for the present study. The authors have no conflicts of interest to disclose.

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Gruber is with the Department of Kinesiology, School of Public Health, Indiana University, Bloomington, IN, USA. Zhang and Pan are with the Department of Kinesiology & Center for Orthopaedic & Biomechanics Research, Boise State University, Boise, ID, USA. Li is with the Department of Health Sciences and Kinesiology, Waters College of Health Professions, Georgia Southern University, Statesboro, GA, USA.

Gruber (ahgruber@indiana.edu) is corresponding author.
  • View in gallery

    —Stiffness variables. Mean ± SE vertical and (A) 3-dimensional leg stiffness, (B) 3-dimensional leg compression, and (C) joint stiffness for each footwear condition. *Significantly different from maximalist footwear (P < .05). Significantly different from traditional footwear (P < .05).

  • View in gallery

    —Impact variables. Mean + SE (A) maximum instantaneous VLR, average instantaneous VLR, average VLR, and (B) peak impact force for each footwear condition. * indicates a significant difference between footwear conditions, P < .05.

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