Context: Musculoskeletal injuries (MSKIs) are ubiquitous during initial entry military training, with overuse injuries in the lower extremities the most frequent. A common mechanism for overuse injuries is running, an activity that is an integral part of United States Coast Guard (USCG) training and a requirement for graduation. Objective: Assess the effects of athletic footwear choice on lower quarter MSKI risk in USCG recruits. Design: Descriptive Epidemiological Study Setting: USCG Training Center, Cape May, NJ Participants: A retrospective cohort study was performed in which 1229 recruits (1038 males, 191 females) were allowed to self-select athletic footwear during training. A group of 2876 recruits (2260 males, 616 females) who trained under a policy that required obligatory wear of prescribed athletic shoes served as a control. Main Outcome Measures: Demographic data and physical performance were derived from administrative records. Injury data were abstracted from a medical tracking database. Multivariable logistic regression was used to assess group, age, sex, height, body mass, and run times on MSKI outcomes. Results: Ankle-foot, leg, knee and lumbopelvic-hip complex diagnoses were ubiquitous in both groups (experimental: 20.37 to 29.34 per 1000 recruits; control: 18.08 to 25.59 per 1000 recruits). Group was not a significant factor for any of the injuries assessed. Sex was a significant factor in all injury types, with female recruits demonstrating ~2.00 greater odds of experiencing running-related injuries (RRIs), overuse injuries, or any MSKI in general. When considering ankle-foot or bone stress injuries, the risk in female recruits was 3.73 to 4.11 greater odds than their male counterparts. Run time was a significant predictor in RRI, all overuse injuries, and for any MSKI in general. Conclusion: While footwear choice did not influence MSKI risk in USCG recruits, female sex was a primary, nonmodifiable intrinsic risk factor.
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