We have seen a big shift in the construction of football boots over the past 15-20 years. The day of robust and durable leather boots are a thing of the past and are fast being replaced with lightweight synthetic materials. Revolutionary cleat placements have also changed the dynamics and functionality of these boots drastically. The first signs of change were implemented by Adidas in the 1950’s with the introduction of interchangeable cleats. This allowed for customization of the boots based on underfoot conditions and the sport being played. In the following decades, further changes were made to reduce mass and increase flexibility of boots to assist sports performance. However, with the increased benefits for sports performance came higher incidences of injury. Adidas were once again the innovators of the 90’s when they introduced blades in place of studs with the launch of the renowned “Predator” model.  As a health practitioner you are faced with providing recommendations of types of boots which are constantly evolving. This brief overview is aimed at providing you with basic prescription guidelines for various types of boots for sporting activities.

Boot Construction

Cleats

Having enough traction for fast start-and-stop movements or for performing quick changes of direction is a key component for performance of modern field sports. As a result, manufacturers provide many different cleat designs promising the athlete a large amount of traction. Cleats refers to additional material added to the sole of boots to provide increased traction underfoot. They are available in a multitude of types including studs, blades and dimples, all of which are available in materials such as metal, plastic and rubber. Cleat selection is based generally on three surface classifications; Firm Ground (FG) such as summer grass pitches, Soft Ground (SG) muddier winter pitches and Hard Ground (HG) such as astro turf.

The bladed cleat has an increased surface area when compared with a conical stud and is designed to increase traction and reduce slip. A study by Bentley et al (2011), investigated the impact of various types of cleats on lower limb biomechanics during cutting maneuvers. The authors found that;

• conical studs more closely replicated the normal function of the foot
• cleated blades which placed higher pressures on the lateral aspect of the foot
• bladed cleats produced a greater risk of 5^th Met stress fracture

These injuries are most often due to chronic stress experienced partly as a result of poor cushioning and cleat positioning in minimalist styled football boots. Another study published in The Lower Extremity Review found that:

"Bladed soccer cleats were associated with increased forefoot loading during a jump-landing task, which may lead to a higher risk of fifth metatarsal stress fractures.”

With increased traction comes the added risk of torsional injuries. Excessive traction can cause injury by fixing the players’ foot to the surface and increasing both linear and angular forces on the body. The football boot undersurface and foot fixation has been shown to play key roles in knee injury development (Kaila, 2006).

Bladed cleats have also resulted in some quite gruesome laceration injuries in sport. In August 2012, Wayne Rooney was left requiring ten stitches in his thigh following a collision with Fulham’s Hugo Rodellega. These types of injuries resulted in a call for a ban on such footwear, with former Manchester United F.C. manager Alex Ferguson famously banning his own players from wearing them.

RECOMMENDATIONS

Firm Ground

• Circular rubber moulded studs
• Higher incidence of pressure related chronic injuries with bladed cleats
• For rehab work post-injury, running shoes are advised where possible

Soft Ground

• Avoid the use of deep plastic blades as they increase the risk of knee ligament sprains
• 6 stud placement optimal for injury prevention. However, for optimal traction, hybrid cleats may be optimal

“Anti-Clog Traction” is the latest revolutionary design from Nike which was launched in recent months. Nike Anti-Clog Traction sole plates include an adaptive polymer that becomes compliant when exposed to water. This results in mud falling away from the studs during sports performance. This is a very interesting concept and hopefully one which will prove successful as this would have great implications for both injury prevention and sports performance.

Uppers

Soft, flexible leather uppers were traditionally the most utilized style of upper for all types of football boots. This material is weather resistant, relatively lightweight and highly durable. However, as mentioned earlier, football boots have evolved to become ultra-lightweight with the increasing use of synthetic alternative materials. One of the most striking examples of this is Nike’s latest flagship model the “Magista”. This boot incorporates a one-piece, tongueless, synthetic (Flynit) upper which is manufactured from a single weave of fabric and wraps around the ankle to increase proprioception and support.

RECOMMENDATIONS

• While lightweight uppers may increase feel and enhance a player’s ball control they also increase the risk of impact injury. This type of upper should be avoided where possible.
• Soft leather uppers will stretch over time to accommodate most foot shapes, whereas synthetic materials will only stretch a mild amount.
• Some boots are available in wider last fittings to cater for bulkier feet (images below)

Heel Pitch

Most modern football boots are constructed with a flat sole with very minimal insoles. This design may exacerbate injuries associated with posterior chain soft tissue strains/sprains such as Achilles Tendinopathy and Plantar Fasciosis. Asics have incorporated a 10mm heel pitch in their range of “Lethal” football boots with the aim of redistributing pressure to the forefoot. This raise also alters the amount of dorsiflexion at heel strike. Alternatively, you could source deeper fitting boots with a removable insole allowing you to incorporate a heel raise.

Sole Plate

Stiffness of the sole plate can play an important role in injury prevention for patients with stiff, painful MPJs. As mentioned earlier, most modern boots tend to be highly flexible, however there are a number of stiffer models which would be suited to this type of patient.

Conclusions

The primary goals of sports participation are arguably enjoyment and success, consequently there will always be a drive for performance enhancement. Unfortunately, we have seen from this article that this performance enhancing footwear can play a significant role in the aetiology of lower limb injuries. However, not all of these types of footwear increase injury risk and it is up to you as a practitioner to identify the risk factors involved in their sports performance and prescribe appropriately. While your job is to rehabilitate your patients, you must also consider their overall sports goals. If we played sport solely with the intention of not getting injured, would there really be any point??

The choice of boot should be very much dependent on the individual, their sport and the playing surface. Every athlete should have at the very least, two pairs of boots to choose from, dependent on these parameters. Lower mass, fast and skillful forwards will require lightweight boots with higher traction to allow them to accelerate and decelerate sharply. Conversely, rugby forwards would require a more robust boot which offers greater foot protection and deep traction on softer ground in scrums and mauls.

Choose boots based on your patient’s foot type, sporting activities and playing surface. Once you have identified these key parameters there will still be a multitude of styles for them to choose from.

References

1. Bentley JA, Ramanathan AK, Arnold GP, et al. Harmful cleats of football boots: a biomechanical evaluation. Foot Ankle Surg 2011;17:140–4. 
2. http://lermagazine.com/news/in-the-moment-sports-medicine/prepare-for-landing-bladed-cleats-may-put-fifth-met-at-risk
3. Kaila, R., Irwin, G. and Kerwin, D.G. (2006). Side-step cutting using studded soccer boots affects knee rotational and valgus moments and injury potential. Medicine & Science in Sports & Exercise, 38(5), 41.
4. Nigg, B.M. and Segesser, B. (1992). Biomechanical and orthopaedic concepts in sport shoe construction. Med Sci. Sports Exerc, 24, 595-602
5. http://www.independent.co.uk/sport/football/news-and-comment/blades-of-gory-the-story-of-lethal-hybrid-boots-that-caused-injury-to-wayne-rooney-8842663.html
6. http://news.nike.com/news/anti-clog
7. http://news.nike.com/news/mercurial-superfly
8. http://news.bbc.co.uk/sport2/hi/health_and_fitness/4970176.stm
9. http://www.soccercleats101.com/2013/10/14/boot-tech-soleplate-flexibility
10. Sporting injuries to the foot and ankle, An Issue of Foot and Ankle Clinics, By James D F Calder