Research Says
A Current Opinion article titled “Bone Stress Injuries in Runners Using Carbon Fiber Plate Footwear” by Adam Tenforde and colleagues (2023), published in Sports Medicine, examined the potential link between carbon fiber plate (CFP) racing shoes and navicular bone stress injuries. The authors presented a case series of five highly competitive runners—ranging from 17 to 38 years old—who developed navicular bone stress injuries while using CFP footwear. All five athletes experienced acute midfoot pain during or after running in these shoes. The article also reviewed how CFP shoes alter foot and ankle biomechanics, including reduced toe joint movement and changes in how forces are distributed through the foot, which may place new stress on bones like the navicular.
Why It Matters
Carbon fiber plate shoes—often called “super shoes”—have revolutionized distance running, contributing to every world record from 5K to the marathon since 2016. But faster shoes may come with a tradeoff. The stiff plate and thick foam midsole change how your foot moves, reducing motion at the toe joints and shifting how energy is absorbed and returned. The navicular is a small bone in the midfoot that sits in a zone of high shear stress and has limited blood supply, making it vulnerable to overuse injuries. This article is the first published report to formally document navicular stress injuries linked to CFP shoes and raises an important caution: the same technology that makes you faster may also put new, unfamiliar demands on your feet—especially if you switch to these shoes too quickly.
Applied Insights
How to use this research in your training:
- Transition Gradually: Don’t race in brand-new carbon-plated shoes without first building up mileage in them. Several athletes in this study were injured during their first or early uses of CFP shoes at race intensity.
- Watch for Warning Signs: Pay attention to midfoot or top-of-foot pain during or after running in super shoes. Persistent pain—especially at the top of the navicular bone—warrants prompt medical evaluation.
- Reserve for Key Sessions: Consider limiting CFP shoes to specific races or workouts rather than using them for all training. This reduces the total volume of altered loading on your feet.
- Know Your History: If you’ve had a previous navicular stress injury, be especially cautious. Two of the five athletes in this study had prior navicular injuries, suggesting these individuals may be at higher risk.
I’m Thinking
This article raises an important cautionary note that runners need to take seriously, though it’s important to keep the evidence in perspective. A case series of five athletes doesn’t prove that CFP shoes cause navicular stress injuries, but it can suggest a possible association. The injuries described here could be influenced by many factors, including training load, biomechanics, prior injury history, and even the specific demands of steeplechase events (two athletes competed in that discipline). That said, the parallel to minimalist footwear is striking: when barefoot-style shoes became popular, runners who transitioned too quickly developed metatarsal bone stress injuries, eventually leading shoe companies to recommend gradual transitions. The lack of a control group or incidence data makes it hard to know whether these injuries occur more often with CFP shoes or simply reflect the normal background rate among competitive runners. Still, the biomechanical rationale is plausible, and the practical advice costs nothing to follow: transition gradually and listen to your body.
Reference
Tenforde, Adam, Tim Hoenig, Amol Saxena, and Karsten Hollander. 2023. “Bone Stress Injuries in Runners Using Carbon Fiber Plate Footwear.” Sports Medicine 53: 1499–1505.https://doi.org/10.1007/s40279-023-01818-z
