Toe Box Shape of Running Shoes Affects In-Shoe Foot Displacement and Deformation: A Randomized Crossover Study

Background: Long-distance running is popular but associated with a high risk of injuries, particularly toe-related injuries. Limited research has focused on preventive measures, prompting exploration into the efficacy of raised toe box running shoes. Purpose: This study aimed to investigate the effect of running shoes with raised toe boxes on preventing toe injuries caused by distance running. Methods: A randomized crossover design involved 25 male marathon runners (height: 1.70 ± 0.02 m, weight: 62.6 + 4.5 kg) wearing both raised toe box (extended by 8 mm along the vertical axis and 3 mm along the sagittal axis) and regular toe box running shoes. Ground reaction force (GRF), in-shoe displacement, and degree of toe deformation (based on the distance change between the toe and the metatarsal head) were collected. Results: Wearing raised toe box shoes resulted in a significant reduction in vertical (p = 0.001) and antero–posterior (p = 0.015) ground reaction forces during the loading phase, with a notable increase in vertical ground reaction force during the toe-off phase (p < 0.001). In-shoe displacement showed significant decreased movement in the forefoot medial (p < 0.001) and rearfoot (medial: p < 0.001, lateral: p < 0.001) and significant increased displacement in the midfoot (medial: p = 0.002, lateral: p < 0.001). Impact severity on the hallux significantly decreased (p < 0.001), while impact on the small toes showed no significant reduction (p = 0.067). Conclusions: Raised toe box running shoes offer an effective means of reducing toe injuries caused by long-distance running.