The sport of running has been revolutionised by technologically advanced running shoes (TARS) that combine cushioning with a resilient midsole and a carbon fibre plate.1 These have become the footwear of choice for almost all high-level distance runners. Based on clinical observations and anecdotal evidence, concerns about running-related injuries have been raised.2 However, we are yet to have a discussion about these risks guided by an evidence base. We hope that this editorial increases awareness of potential medical issues related to TARS and encourages a scientific process to determine how best to ensure safety for our athletes.

Shoe innovation is not uncommon, with the earliest running shoes used for cross-country running dating back to the 19th century. In the early 20th century, rubber companies created mass-produced vulcanised sneakers especially for sports activities. In the 1960s and 1970s, with distance running becoming more popular, ethylene vinyl acetate foam technology and other shock-absorbing features found widespread application. More modern shoe design was based on assumptions that pronation may be harmful or that footwear should match foot posture. Subsequently, minimalist footwear became trendy, with an opposing push to supramaximal cushioning in recent years.

TARS that use a curved carbon-fibre plate …