title: The search for the best infantry boot.
abstract: BACKGROUND
  The combat role of the twenty-first century infantry soldier has changed and accordingly their boots should evolve to meet these new needs and maximize soldier performance.
  
  
  OBJECTIVE
  To evaluate injuries and durability of the hot weather infantry boots (HWIB) in elite infantry training and assess the initial performance of newly designed Israeli infantry boots (NDIB).
  
  
  METHODS
  In Phase 1, the durability of the HWIB during elite infantry training was evaluated at weeks 10, 19 and 64 in a cohort of 67 recruits. At each exam recruits removed their boots which were assessed for wear and integrity and photographed. The number of times recruits changed their boots was recorded. In Phase 2, foot injuries were assessed in a cohort of 73 elite infantry recruits wearing HWIB. In Phase 3, 65 infantry recruits were issued the NDIB. Recruits feet were measured for width and shoe size using the Brannock device and then followed for problems associated with their boots. Foot lesions were document by photographs.
  
  
  RESULTS
  Phase 1: The mean longevity of HWIB in training was 5.2 ± 0.2 (SE) months, (95 % CI 4.83-5.61). Phase 2: 38 % of the elite infantry recruits wearing HWIB had at least one complaint and 31 (42 %) were found to have boot related injuries in a total of 56 injured areas. Phase 3: The mean predicted boot size (42.8 ± 1.7) based on Brannock measurements, was less than the size of the NDIB actually worn, 43.1 ± 1.6. Only 34.8 % of the feet were width D (the standard shoe width). At 9 day follow up, 55 of the 65 recruits who wore NDIB reported at least one problem with them (85 %, p < 0.0001, compared to HWIB). By 3 weeks, all but five recruits had returned to wearing the HWIB. Of the recruits wearing NDIB, 47 (72 %) were found to have had at least one boot related injury with a total number of 180 injured foot areas (p = 0.0004, compared to HWIB).
  
  
  CONCLUSIONS
  The HWIB was well tolerated by the elite infantry recruits and associated with significantly less foot injuries than the NDIB. The longevity of the HWIB in demanding elite infantry training was five months.Trial registration: NCT02810002 retrospectively registered June 22, 2016.
authors.affiliation: Hebrew University Medical School, 91120 Ein Kerem, Jerusalem, Israel ; IDF Medical Corps, Active Reserve, Jerusalem, Israel.
authors.forename: Charles
authors.identifier: 0000-0001-8653-2240
authors.initials: C
authors.lastname: Milgrom
authors.affiliation: IDF Medical Corps, Jerusalem, Israel.
authors.forename: Alex
authors.initials: A
authors.lastname: Sorkin
authors.affiliation: Orthopaedic Surgery Service, IDF Medical Corps, Jerusalem, Israel.
authors.forename: Arnon
authors.initials: A
authors.lastname: Gam
authors.affiliation: Orthopaedic Surgery Service, IDF Medical Corps, Jerusalem, Israel.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Singer
authors.affiliation: Tzameret Military Medical Track, Hebrew University Medical School, Jerusalem, 91120 Israel.
authors.forename: Itamar
authors.initials: I
authors.lastname: Nir
authors.affiliation: Technological and Logistics Branch, IDF, Jerusalem, Israel.
authors.forename: Boris
authors.initials: B
authors.lastname: Kogan
authors.affiliation: Assaf HaRofeh Medical Center, Affiliated to The Sackler Faculty of Medicine, Tel Aviv University, 70300 Zerifin, Israel ; IDF Medical Corps, Active Reserve, Jerusalem, Israel.
authors.forename: Aharon S
authors.initials: AS
authors.lastname: Finestone
keywords: Boot comfort; Boot longevity; Foot injuries; Infantry boots; Recruits