By Cara Nichols, PT, DPT, OCS
As a physical therapist, I receive a lot of questions regarding running shoes. When should I toss them? What about heel-to-toe drop? What kind of support is best? Should I add an orthotic or heel lift? Athletic shoes have literally run the gamut of forms (pun intended) from a barefoot or minimalist shift, initially brought on by the Nike Free 5.0 in 2004, to the maximalist shoes of HOKA in 2009. So maximalist or minimalist, which is best? Ultimately, it depends on the runner. I once read that you could run in a shoe until the upper pulled away from the sole, if you ran with correct form. Not many of us possess the strength, mobility, or patience to get to that level of barefoot running, and many who try become injured along the journey. But, it is telling that there is not a single study that has shown using running shoes while running reduces the risk of injury.1 Injury rates while running have not decreased since the 1970s, which is when the running shoe industry started gaining noticeable traction.
Some background about shoe support
I mentioned that I get a lot of questions about orthotics and or arch support. In the 1990s, the running shoe industry grouped running shoes into three categories —stability, neutrality, and motion control. The stability and motion control shoes were designed specifically to limit excessive collapse of weight at the medial arch. But, all running shoes began to change the materials used in production to find the perfect combination of cushioning and support for the smoothest ride. This added weight to the shoe. Brands began making shoes with a weighted rocker — a block of foam that assists the foot in moving from heel to toe. Whether this feature created sufficient support is debatable, but we still see this type of support in shoes today.
Should we brace feet or fix the root of the problem?
Despite the rigid nature of today’s running shoes, physical therapists and orthopedists recommend more bracing through the form of orthotics. However, when you brace a part of the body, the muscles and joints around it become weaker. Which begs the question, should we continue to brace parts of the foot indefinitely? Rather than continue to add support and bracing, would it not be more prudent to address deficits in order to restore function? With that being said, the progression from even a 12mm to an 8mm heel-to-toe drop in some runners can result in injury.
Ultimately, the type of shoe depends on the runner.
The dilemma of transitioning to a shoe that more closely resembles the natural biomechanics of our feet is complicated on many levels. It brings me back to my question above, regarding which shoe is best, and the answer remains the same—it depends on the person. Ultimately, runners need to focus on addressing injuries, not running through them or thinking that a new shoe or insert will solve the issue. There are many reasons the majority of runners suffer injuries every year, and shoes can be counted in that list. However, shoes are a necessity for all of us. Finding the best fit for you depends on many factors — running gait, strength, mobility, goals, and motivation. This is where a PT evaluation and running analysis is vital to resolving injuries and providing recommendations based on the individual.
- Lopes AD, Hespanhol LC, Yeung SS, Pena Costa LO. What are the main running related musculoskeletal injuries? Sports Med. 2012; 42(10):892-905.
- Photo by Karl Solano.