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Does policy that provides choice in athletic footwear affect musculoskeletal injury risk in US Coast Guard recruits?
  1. John J Fraser1,2,
  2. R Pommier3,
  3. A J MacGregor4,
  4. A Silder2 and
  5. T C Sander5
  1. 1Operational Readiness and Health Directorate, Naval Health Research Center, San Diego, California, USA
  2. 2Warfighter Performance Department, Naval Health Research Center, San Diego, California, USA
  3. 3Samuel J Call Health Services Center, US Coast Guard Training Center, Cape May, New Jersey, USA
  4. 4Medical Modelling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, USA
  5. 5Department of Physical Therapy and Athletic Training, Grand Valley State University, Grand Rapids, Michigan, USA
  1. Correspondence to Dr John J Fraser, Operational Readiness & Health Directorate, Naval Health Research Center, San Diego, CA 92152, USA;{at}


Introduction Musculoskeletal injuries (MSKIs) are ubiquitous during initial entry military training, with overuse injuries the most common. A common injury mechanism is running, an activity that is integral to US Coast Guard (USCG) training and a requirement for graduation. The purpose of this study was to assess the effects of a policy that allowed for athletic footwear choice on risk of lower quarter MSKI in USCG recruits.

Methods A retrospective cohort study was performed that included 1230 recruits (1040 men, 190 women) who trained under a policy that allowed self-selection of athletic footwear and 2951 recruits (2329 men, 622 women) who trained under a policy that mandated use of prescribed uniform athletic shoes and served as controls. Demographic data and physical performance were derived from administrative records. Injury data were abstracted from a medical tracking database. Unadjusted risk calculations and multivariable logistic regression assessing the effects of group, age, sex, height, body mass and 2.4 km run times on MSKI were performed.

Results Ankle-foot, leg, knee and lumbopelvic-hip complex injuries were ubiquitous in both groups (experimental: 13.13 per 1000 person-weeks; control: 11.69 per 1000 person-weeks). Group was not a significant factor for any of the injuries assessed in either the unadjusted or adjusted analysis, despite widespread reports of pain (58.6%), perceived injury attribution (15.7%), perceived deleterious effect on performance (25.3%), general dissatisfaction (46.3%) and intended discontinuance of use following graduation (87.7%).

Conclusion MSKI continues to be a major source of morbidity in the recruit training population. The policy that allowed USCG recruits to self-select athletic footwear did not decrease or increase the risk of MSKI. While regulations pertaining to footwear choice did not influence injury outcomes, there was general dissatisfaction with the prescribed uniform athletic footwear conveyed by the recruits and widespread reports of discomfort, perceived deleterious effects from wear and intended discontinued use following training completion.

  • Musculoskeletal disorders

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Contributors JJF contributed to study design, data analysis and interpretation, and drafting the manuscript. RP contributed to data collection. RP, AJM, AS and TCS contributed to data interpretation. All authors have reviewed and approved this manuscript. JJF is responsible for the overall content as the guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer The authors are military service members or employees of the US Government. This work was prepared as part of their official duties. Title 17, USC §105 provides that copyright protection under this title is not available for any work of the US Government. Title 17, USC §101 defines a US Government work as work prepared by a military service member or employee of the US Government as part of that person’s official duties. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, US Coast Guard, Department of Homeland Security nor the US Government.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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