Runners and athletes of various sports alike know that the type of shoe you wear is very important. Runners everywhere try to find shoes that will cause them the least pain and protect their feet from overuse injuries. Common complaints and injuries among runners include patellofemoral pain, tibial stress fractures, and plantar fasciitis. Other than actually working on running mechanics, a tool to prevent these injuries is wearing the proper footwear for your foot.
Running shoes generally used to be classified into three categories based on their cushioning and support: neutral, stability and motion control. Those who had a lot of pronation (i.e. falling arches, turning in of the foot ) generally required a motion control shoe. Runners with a moderate amount of pronation required a stability shoe. Finally, those with minimal amount of pronation or those who tend to supinate required a neutral shoe.
However, in the past nine years or so, the shoes started to be divided into minimalist shoe, maximal shoe and a neutral shoe. This separation is based on the amount of heel-toe drop (greater than 10mm), referring to the difference between the heel elevation and forefoot elevation of the midsole.
Let’s look at a study for examples of how different types of shoes can effect runners differently. In 2018, The Orthopedic Journal of Sports Medicine published “Influence of Maximal Running Shoe on Biomechanics Before and After a 5K Run”, by Christine D. Pollard, PhD,PT and her colleagues from Oregon State University-Cascades. This study compared the effects of a neutral and maximal shoe on fifteen female recreational runners, all of which considered themselves to be heel strikers (the most common foot strike pattern amongst rec. runners).
First a little shoe history. The Minimalist Shoe, which had very little cushion and a heel drop, less than 10mm, became very popular in 2009. It was believed that this shoe would promote a more natural forefoot strike pattern and therefore, decrease the amount of running related injuries. This shoe did not last in its popularity as the research came out proving that the forefoot strike pattern does NOT: decrease the risk of injury, improve running economy, or reduce the impact peak or loading rate of the vertical ground-reaction force (Pollard et al, 2018). So this is why the researchers didn’t even look at this type of shoe. It was old news!
Around the same time, we also started to see the Maximal Shoe which has a highly cushioned midsole. This shoe design was intended for the cushion to improve the “shock absorption” by decreasing the vertical impact and therefore, decrease the risk of injury. Since 2010 maximal shoes “have slowly gained popularity, with more than 20 variations of maximal running shoes now in the market,”( Pollard et. al, 2018).
This study concluded that the runners wearing the maximal shoe performed with increased impact forces compared to the decreased impact force of the neutral shoe. This was unexpected, as the researchers had hypothesized the opposite! Where was this shock absorption? The cushion did not decrease the force impact as advertised and widely believed at the time.
Maximal shoes had another unfortunate effect on the runners: increasing loading rates while running. Both increased impact force and increased loading rates are thought to increase likelihood of running injuries. For these reasons, the researchers found that a runner who was new to running in a maximal shoe msy be at an increased risk of injury. Thus, they recommended the NEUTRAL shoe OVER the MAXIMAL shoe for a safer running experience.
The takeaway? Shoes are advertised to do things that when tested in real life, don’t always happen. Wearing a pair of Jordan’s dosen’t guarantee a slam dunk. Just like super soft shoes may feel supportive but as this study has shown a highly cushioned midsole does NOT decrease the risk of injuries while running, at least for heal striking runners. However this study is very limited, having had a small sample size, only female runners and limited information on past injuries. Pollard et. al only required test subjects to be injury free within the past month before the study. Therefore, this study doesn’t rule out the possibility that the maximal shoe may be the right shoe for a different population. Even minimal shoe types are still sold and praised by some as feeling like they’re more natural like “running barefoot.”
So what’s the right shoe for you?
Our advice, if you’re a serious runner or have a job where you’re on your feet all the time, or just care about the comfort of your feet, make an appointment for a sneaker fitting at a specialty store or at a specialist such as a podiatrist. Just like a dancer, a runner’s shoe needs to fit in the right places to prevent rubbing, ankle injuries, and more.
A specialist will ask you about your activities, watch how you walk in the shoes you try on and make sure there is enough space at the front of your foot. They will also look at how yor heel and ankle moves while you walk. Some shoes stretch out and others do not, a shoe that is too narrow or two wide both cause injury. Also, trust your own instincts on what feels right and bring socks the thickness you usually wear.
You may decide to put insoles or other types of padding in your shoes. A podiatrist is a doctor who’s specialty is feet so going to one might be a good idea. A podiatrist can make custom fit orthotic insoles. Many health insurance policies cover one pair of orthotics per year at no cost to you. These are made by getting an imprint of both of the runner’s feet by stepping onto foam or similarly malleable material. In a few weeks, you get your insoles at your podiatrist’s office, where he or she will cut the insole to fit your shoe. The podiatrist will tell you it will take a couple weeks of wearing the orthotic insoles to break in, so they will likely schedule a follow up appointment yo see you again in another 2 to 6 weeks. Orthotics can be put into any sneaker or shoe and while they may feel weird at first, they ultimately increase foot health, support arches and help runners from being pigeoned-toed or unbalanced, decreasing risk of injury.
BeneFIT PT is always here to help! If you’re experiencing unusually sore feet, ankles or calves after running, don’t hesitate to call and schedule your free medical screening with one of BeneFIT’s Doctors of Physical Therapy at our Chester ( 908.879.5700) or Bridgewater (908.203.5200) location to make sure you’re running in the right foot wear, to see how your foot mechanics can be improved, and if PT is the right choice for you!