As a PT with a strong interest in running, I am always asked about running shoes. I love to talk about running as well as teach people about the world of running research. There is a boat load of research on running shoes. Through this blog, I hope to explore some common questions as well as provide recommendations to help you chose your next pair of shoes.

I have ____ arches (insert your arch height in the blank).

The wet foot test is a model used to prescribe footwear. When you step on a floor with a wet foot, you can see a silhouette of your foot. Specifically, you can see how much of your arch presses into the floor. From this test, your arch would be determined to be high, medium or low. A shoe is then given to you based on your arch height.

High arches may mean you have poor shock absorption and would benefit from a cushioned shoe. A medium arch indicates “appropriate” alignment and does not need much in a shoe. These folks would be given a neutral shoe. Lastly a low or flat arch suggests a person who overpronates and needs motion control technology to correct their dysfunction (more on this soon).

Although this model is logical it does not hold up under study. A group of researchers worked with thousands of military recruits from the Army, Air Force and Marine Corps. These men and women were prescribed a running shoe for basic training based on their foot type. In the end, the authors concluded assigning a shoe based on a persons static foot posture does not reduce their risk of injury.

“Well, I’ve been told I pronate…” said every runner ever!

Foot pronation is simply a movement much like turning your head side to side. It allows the foot to flatten on the ground. This is necessary and important. It aides in absorbing shock as well as connecting the big toe to the earth- our major source of foot stability.

The postulation that a pronated foot type, or low arched foot, needs added control has been given much review. The large studies from the military dismiss matching a motion control shoe to an over-pronator, but how does that group function in other shoe types?

What if people with low arches were given a neutral shoe? A 2014 study in Denmark assessed if new runners in neutral shoes regardless of arch height had different injury rates. Amongst the 900 runners who participated in the study, there was no association with injuries and foot types. (Nielsen)

Nike then got in on the action. They funded a study of female runners training for a half marathon. The runners were randomly given a neutral, cushioned or motion control shoe regardless of their foot posture. Nike, the worlds largest shoe company, concluded “our current approach of prescribing in-shoe pronation control systems on the basis of foot type is overly simplistic and potentially injurious.” (Ryan- https://bjsm.bmj.com/content/45/9/715)

Next researchers compared how all foot types in experienced runners performed in a neutral or motion control shoe. It was a randomized trial- meaning the participants did not know the type of shoe they received. Interestingly, The runners who used a motion control shoe developed the least amount of injuries. This certainly can give us pause in abandoning the motion control shoe category.

Overall, what I take away from reviewing these studies- if you have a low arched foot you are not at a higher risk of injury. You do not need a motion control shoe as there is more evidence to suggest you would do just as well in a neutral shoe. When deciding what shoe is right for you a low arch may be one consideration but it should not be the primary driver of selecting a shoe.

I just Read “Born to Run”

The postulation from Born to Run and furthered by a paper from Lieberman et al is the modern running shoe provides much more cushioning, it contributes to most runners adopting a heel strike; therefore, everyone should run in a minimalist shoe landing on the ball of their foot.

Seventy percent of runners who have worn shoes their entire lives will not change their form when running barefoot. Instead, most folks will continue to land on their heels. There may be some changes in where the workload is occurring in the leg. Typically, there is less force on the knee, but more on the calf and foot. As a result, making a quick change from a neutral or cushioned shoe to a minimalist shoe or none at all, places a higher injury risk on the foot, achilles and calf.

In runners with knee or hip issues, one could make the argument to change to minimalist footwear. However, this change must be gradual- months vs. weeks. This approach should be accompanied by interventions to strengthen the foot and calf as well as alter running mechanics to promote landing on the ball of the foot.

Moving up to maximalist footwear is less dramatic for most runners. Interestingly, it will increase the impact of running even though the shoe provides more cushioning. Maximalist shoes will decrease the workload on the Achilles but increase it on the knee. A change here may be warranted for runners looking to off load tissues below the knee but it should be on a case by case basis.

Lastly, If you have a need for speed, then a minimalist shoe will speed you up. A lighter shoe leads to less energy expenditure while running; therefore, for racing or faster workouts the less shoe, the better. Should this be the only shoe you run in? No way! In fact, runners who rotate more than one shoe in their weekly training reduce their injury rates by 39%.

How comfortable is your shoe?

When a foot is observed while running without and without shoes, its motion does not drastically change. A pronating foot will pronate regardless of the shoe or insert even orthotics. Footwear will not correct movement of a foot; therefore, the desired shoe is one that allows the most natural motion of the foot. When military recruits selected their footwear on the basis of comfort their injury rates reduced by as much as 13%.

Alas:

In selecting a shoe, you do not need to worry about arch height or pronation. Rather, the shoe should be comfortable. When your foot is inside of the shoe it should feel at home. Additionally, you must take the shoes on a run before making a purchase. The run should feel free and natural.

I recommend trying on a variety of styles and brands to find 2 different pairs that feel the most comfortable. If you are injured, then work with a PT who specializes in running injuries. They will help figure out what is causing your pain and create a plan to get you back to running, which may include modifying footwear.

If you are dealing with an injury and need help, the first step is contacting me.

References:

1. Knapik JJ. Injury-Reduction Effectiveness of Prescribing Running Shoes on the Basis of Foot Arch Height: Summary of Military Investigations. JOSPT. 2014

2. https://pubmed.ncbi.nlm.nih.gov/23766439/

3. https://bjsm.bmj.com/content/45/9/715

4. https://bjsm.bmj.com/content/50/8/481

5. https://www.nature.com/articles/nature08723)

6. https://www.sciencedirect.com/science/article/pii/S0021929015007034

7. https://bjsm.bmj.com/content/48/16/1257.long

8. https://www.jsams.org/article/S1440-2440(19)30473-6/fulltext

9. https://pubmed.ncbi.nlm.nih.gov/24286345/

10. https://journals.lww.com/acsm-msse/Fulltext/2001/11000/Relationship_between_footwear_comfort_of_shoe.21.asx.