The injury question is open, not answered: AFT shifts several biomechanical variables associated with bone stress injury, but this study did not measure whether injuries actually increase
Protocol
Cross-sectional cohort in an academic multisite hospital system, n=23 healthy elite distance runners (11 women, 12 men; age 25.4 ± 2.7). Three shoe types — neutral, responsive (lightweight) foam, and AFT with a carbon-fibre plate — in randomized order at three self-selected speeds: training effort, tempo, and 5-km race speed.
Measured: rearfoot eversion excursion and velocity, vertical ground reaction force, ankle plantarflexion moment, vertical centre-of-mass excursion, cadence and duty factor (two-factor repeated-measures ANOVA, Bonferroni-corrected). Actual bone stress injuries were not assessed.
Key Findings
Higher ankle plantarflexion moment in neutral versus foam and AFT.
Lower rearfoot eversion excursion in neutral versus foam and AFT.
Higher rearfoot eversion velocity in responsive foam versus neutral and AFT.
Lower cadence in AFT than in foam and neutral shoes. No other spatiotemporal variables differed.
Authors' conclusion: increases in several biomechanical variables associated with bone stress injury were observed with AFT, and cumulative effects "could contribute to injury". The authors describe the changes as small.
Practical Application
In 23 elite distance runners, AFT versus neutral and responsive-foam shoes lowered cadence and changed rearfoot eversion excursion and ankle plantarflexion moment; the authors call the changes small but say cumulative effects could contribute to bone stress injury. No injuries were measured. This is a mechanistic reason for caution, not a finding that super shoes cause injury.
Not from this paper: the base holds no study that measured whether AFT increases injury rates; the Cochrane review of shoe types found no type reliably changes injury (REF-716). Absence of evidence is not permission either — the loading pattern is measurably different.
Not from this paper; the base's own practice: introduce AFT the way any shoe-category change is introduced — a few sessions, low volume first, watching for forefoot and midfoot pain (REF-715) — and keep most training volume in conventional shoes while the cumulative-loading question is open.
Limitations
No injury outcomes were measured. This is a biomechanical association study; it cannot establish that AFT increases bone stress injury.
n=23, cross-sectional. No prospective follow-up, no cumulative exposure.
The authors themselves characterise the biomechanical differences as small, and several differences favoured AFT over other shoe types rather than against it.
Biomechanical variables "associated with" bone stress injury are surrogate markers; the link from surrogate to injury is exactly what remains untested.
Journal-supplement publication; the design cannot answer the question its title raises, and should not be cited as if it does.
How this entry was checked and changed
Content correction 2026-09-27
Lead rewritten as the study's measured finding (n=23 elite runners, lower cadence and altered rearfoot/ankle variables in AFT, small changes, no injury outcome).
Title and practical claim "no study has yet measured / shown more injuries" -> "this study did not measure injuries"; the broader claim relabelled as not from this paper; transition and race-day-only advice relabelled as the base's own practice.
REF-621 cross-reference corrected (it is a cushioning RCT, not transition-speed evidence); "LEA is the dominant risk factor / matters more than shoes" removed; added the randomized shoe order, measured variables and "no other spatiotemporal differences".