BACKGROUND: Running-related injuries (RRIs) are a pervasive menace that can interrupt or end the participation of recreational runners in this healthy physical activity. To date, no satisfactory treatment has been developed to prevent RRIs. PURPOSE: To investigate the efficacy of a novel foot core strengthening protocol based on a ground-up approach to reduce the incidence of RRIs in recreational long-distance runners over the course of a 1-year follow-up. STUDY DESIGN: Randomized controlled trial; level of evidence, 1. METHODS: The participants, 118 runners, were assessed at baseline and randomly allocated to either an intervention group (n = 57) or a control group (n = 61). The intervention group received an 8-week training course focused on the foot-ankle muscles, followed by remotely supervised training thereafter. Assessments consisted of 3 separate biomechanical evaluations of foot strength and foot posture and a weekly report on each participant's running distance, pace, and injury incidence over 12 months. RESULTS: The control group participants were 2.42 times (95% CI 1.98 to 3.62) more likely to experience an RRI within the 12-month study period than participants in the intervention group (p = 0.035). Time to injury was significantly correlated with Foot Posture Index (p = 0.031; r = 0.41) and foot strength gain (p = 0.044; r = 0.45) scores. This foot exercise program showed evidence of effective RRI risk reduction in recreational runners at 4 to 8 months of training. CONCLUSION: Recreational runners randomized to the new foot core strengthening protocol had a 2.42-fold lower rate of RRIs compared with the control group. Further studies are recommended to better understand the underlying biomechanical mechanisms of injury, types of injuries, and subgroups of runners who might benefit maximally. REGISTRATION: NCT02306148 (ClinicalTrials.gov identifier).

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