Thanks to the English, the first running shoes were developed about 200 years ago. Fast forward to modern day, and now the selection of running shoes available to runners are endless. The most common types of running shoes available are categorized into neutral, motion control, cushion, and minimalist shoes. The luxury of having many options is great, however for most people picking the correct shoe can be difficult. More difficult if the runner is unsure as to what their deviations and weaknesses are comprised of.
The goals of this article is to provide information as to what recent research is saying about shoes and their role in injury prevention.
Now before we go into shoe specifics, I will say that working foot and ankle strength is essential! If you are running, you should WANT to have strong hips, ankles, and feet. When these supporting areas are strong enough then your risk for injury does decrease. However, if you are solely relying on shoes to help prevent aches and pains, the truth is, you will probably experience them.
In a study conducted by Knapik Et al, the researchers found no correlation between the reduction in running injuries and “sophisticated footwear design and shoe prescription.” (3) That is something you take with a grain of salt, but also something that should creep around in the back of your head. Shoes are important, but you have to take into account the strength that you already have, your mechanics, and the supplemental support needed from a shoe.
When it comes to picking the right shoe, most of us look at comfort, fit, and use.
In the last couple of years there has been a surge of interest in minimal shoes and barefoot running, and well as the heavily supportive rocker shoes like the HOKAs and Altras. Both types of shoes land on the very ends of the spectrum and are designed for very different runners. Rose, et al. looked at the effects of motion control shoes and neutral shoes and found that, yes, there was a significant decrease in midfoot pronation during running in runner that wore motion control shoes vs. the neutral shoes. They described the improvement in foot positioning due to the higher and sturdier midsole design. The searches also found a reduction in ITB pain in the runners that exhibited midfoot pronation and made a switch to motion control shoe, which is fantastic. However, then we go back to the question of, would it be possible to reach the same outcome with just strengthening of the hips and feet or even core? I would answer that as probably YES, but it would take much more time to gain the same effect.
In a another study by Sobhani et al, they looked at running economy in a rocker shoe, minimalist shoe, and a standard shoe (neutral) and found that the runners demonstrated increase energy expenditure with the rocker Altra shoe compared to the standard and minimalist shoe (6). The outcome was believed to have developed due to the increase in shoe weight and change in mechanics specifically in reducing ankle range of motion. The people that actually may benefit from this type of shoe are runners who truly have deficits in dorsiflexion range of motion, or big toe extension deficits. The problem with a very cushioned and supportive shoe is that it does promote a rearfoot strike. Mechanics can actually play a great deal, and we will get into that in the next post next week.
In terms of running with minimalist shoes, there has been a greater effort into researching the benefits or risks of these types of footwear. David et al discuss that the more cushioned the shoes are, the more likely runners will change to a rear foot strike which alters the load on the lower extremity leading to higher incidence of injury (2). They also state that 95% of non minimalist runners strike with the heel and only 1% with the forefoot. While on the other hand, most minimalist runners land with the forefoot. To coincide, Chen et al found that when they transitioned a group of runners to running in a minimalist shoes over the course of a 6 month period, there was an increase in muscle volume of the foot intrinsics by 7-9%. There was also a change to from rear foot to forefoot striking, compared to no change in muscle volume or strike in the runners who continued to run in the traditional neutral shoe (1). Similarly in another study conducted by Miller et al, the researcher found that after a 12 week program of running in minimalist shoes (0 deg drop shoe) the runners demonstrated an increase in the foot intrinsics, stimulating the arch of the foot to become more springy AND stiffer (4). Both of these components are needed for shock absorption and foot support. The researchers ended their article with the hypothesis that a more supportive shoe doesn’t allow the foot to actually function properly and minimalist shoes force the foot to work harder, therefore creating an environment for strength development.
Personally, the moment I started wearing more minimalist shoes, not necessarily a zero drop, more so around the 4-6 mm drop I have noticed a huge change in foot injuries. I have had 2 in the last 6 years. In college I suffered 2 stress fractures and countless sprains. I have changed a lot, mostly working on ankle stability and foot strength, so I can tolerate running in a minimalist shoe much better than someone who does not work on those component or transition slowly enough.
At the end of the day, you should know what works best for you. You take in information, make changes and make decisions accordingly. Not every runner runs the same, not every runner has the exact same issues, but it is good to take into account what research is coming out with. Facts are facts. Implement some good changes in order to improve your training and performance.
JESSICA MENA PT, DPT, CSCS
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1. Chen T, Sze, L.K., Davis, I.S., Cheung R. TH. Effects of training in minimalist shoes on the intrinsic and extrinsic foot muscle volume. Clinical Biomechanics 36 (2016) 8-13
2. Davis I.S., Rice, H>M., Wearing S.C. Why forefoot striking in minimalist shoes might positively change the course of running injuries. Journal of Sports and Health Sciences 2017. 1-9
3. Knapik J.J., Trone D.W., Tchandja J., Jones B.H. Injury- Reduction Effectiveness of Prescribing Running Shoes on the Basis of Foot Arch Height: Summary of Military Investigations. Journal of Orthopaedic and Sports Physical Therapy. 2014 44:10, pgs 805-812
4. Miller E., Whitcome K., Lieberman D. E., Norton H.L., Dyer R.E. The Effect of minimal shoes on arch structure and instrinsic foot muscle strength. Journal of Sports and Health Sciences. 2014, 3; 74-85
5.Rose A, Birch I, Kuisma R. Effect of motions control running shoe compared with neutral shoes on tibial rotation during running. Physiotherapy . 97 (2011) 250-255
6. Sobhan S, Bredeweg, S. Dekker R., Kluitenberg B., van den Heuvel E, Hijman J, Postema. K. Rocker shoe, minimalist shoe, and standard running shoe: A comparison of running economy. Journal of Science and Medicine in Sport. 2014 , 312-316