Imagine you’re in the process of buying a new car. If you’re like me, you’ve done ample research online, made a list of what features you need, considered safety and miles per gallon, and then headed to the dealership for a test drive to finalize your decision. I would never purchase a car without taking it for a spin, as I think is true for most people. I want to know how the car feels and handles the road. The same rules should apply when selecting your running shoes.
Many of my patients often ask what shoes they should be running in. My answer? It depends on what you need…I know, that’s probably not the answer you were looking for. Let me explain. There are four main categories of running shoes: minimalist, neutral, stability and motion control. I’ve listed these in order of least supportive to most supportive with respect to arch composition and how much the shoe is designed to influence the way your foot makes contact with the ground. The majority of people need either a neutral or stability shoe. However, there are a variety of factors I discuss with my patients before making any running shoe recommendations. Here’s my checklist:
- What is my patient’s prior history of injury and current injury?
- What is my patient’s primary running surface and how often do they replace their shoes?
- What types of wear patterns exist on their current running shoes?
- What is their natural arch structure and do they use orthotics?
- How does my patient move in their shoes while running?
Only after gathering all of this information can I make an informed decision about what is the best running shoe for each runner, individually. Now you may be wondering, what specific information am I looking for with each point I listed above? Great question. Let’s talk.
What is my patient’s prior history of injury and current injury?
As I mentioned in a previous post, the best predictor of future injury is your previous history of injury. It’s important to know where your weak links are and how your shoes may be contributing to your condition and/or repeat offenses. Aches and pains change the way we move. The body is smart and adapts around these sensitive areas as needed. However, when left untreated, the body maintains these dysfunctional patterns even after being fully healed, which leads to reoccurring injuries later on. This is why I always ask my runners about their previous running related injuries (RRI) in addition to their current injuries; both play a role in my decision making process about running shoe recommendations. There are times when inappropriate footwear is to blame for injuries and/or the continuation of faulty movement strategies. So how do you know if your shoes are helping or hurting? Let’s keep going…
What is my patient’s primary running surface and how often do they replace their running shoes?
It’s important to know what type of surface a runner is logging the majority of their weekly miles on. Most runners are road-runners. Concrete and asphalt are the least forgiving surfaces (in comparison to trails, track, sand and grass) and can contribute to overuse injuries as a result. This is why it’s important to have proper cushioning to help absorb those higher impact forces while you’re pounding the pavement. With that being said, I encourage my runners to have at least two pairs of running shoes to alternate between. This enables the shock absorbing material, located primarily in the midsole of your running shoe, to have adequate time to rebound between workouts. Research shows that cushioning material found in running shoes needs at least 22hrs to recover, and becomes less efficient at this process with each use, losing all rebounding properties after nine months [1,2]. It’s also important to replace your shoes before the 300mile mark since peak pressures have been shown to increase >50% beyond that distance due the irreversible changes that occur in the cushioning material with cumulative loads [1,2]. Most people use their running shoes far beyond their shelf life. Yes, I know, running shoes are expensive, but so it getting hurt. Investing in proper footwear alleviates unnecessary stresses from being placed on your bones, joints, and soft tissues. I recommend my runners use 275miles or six months, whichever comes first, as their benchmark for when to replace their shoes. Think of these reference points like the light that appears on your car’s dashboard when you’re getting low on gas. You wouldn’t wait till you’re completely on empty and stalled on the side of the road to refill your tank, hopefully! New shoes should be added to your routine before they reach their expiration date, not after.
What types of wear patterns exist on their current running shoes?
Wear patterns provide me with a lot of valuable information. I examine the sole of both shoes for any asymmetries and take note of where increased wearing is occurring. This gives me insight into how the runner is striking the ground and where they’re generating their push-off. Over-pronator and supinator patterns can influence what types of injuries a runner will be more likely to develop. This is important for me to keep in mind when considering what type of shoe to recommend.
Pronation pattern of a neutral runner
Over-pronation pattern; common among people with low arches
Supination (aka under-pronation) pattern; common in people with high arches
I also take a look inside the shoe to assess for abnormal wear patterns along the inner lining and finally look for signs of breakdown through the upper toe box. Both of these areas give me information about how the runner’s foot is moving through the gait cycle and how their body may be trying to compensate for weak links and/or accommodate around injuries. If my runner has been using orthotics in their running shoes, I remove them from their shoes and assess for wear patterns on the orthotics as well. There are a variety of reasons why abnormal wear patterns occur. Sometimes it’s the shoe and/or orthotic that’s causing or exacerbating these movement imbalances; but again, they are usually a contributing factor rather than the source of the problem. My goal for all of my runners is to achieve a symmetrical neutral pronation pattern (first image above) that promotes a midfoot strike and push-off through their first and second toe in order to reduce impact loading forces at the hip and knee [4,5]. If my runner isn’t able to achieve this movement pattern, is it because of their shoes? Or is it because of something else that’s happening further up their kinetic chain? Or both? At this point in my evaluation, I have some hypotheses but I still need more information. I have to keep investigating…
What is their natural arch structure and do they use orthotics?
Natural arch composition falls into one of three categories: low arches or flat footed (pes planus), neutral, or high arches (pes cavus). Most people have low or neutral arches. Does this automatically mean that they should be wearing a certain type of shoe and/or orthotic? Not necessarily…Many of my runners with low arches tell me the same story: that they’ve been told by their ____________ (podiatrist, coach, friend, running store salesman) that they over-pronate and therefore need to be wearing a stability or motion control shoe, and that they should consider using orthotics to help decrease their risk for developing a RRI. This is the moment when I politely dispel this myth by explaining the following: the word over-pronate is overused and overprescribed to explain why RRIs occur. Our natural gait cycle involves a certain amount of pronation. Our feet need to pronate! That’s how our body is designed to accept and transfer loads with each step. When I encounter people that have been told they over-pronate, they tend to assume that any amount of pronation is a bad thing and that they should do everything to avoid that type of movement (insert special shoes & orthotics here). Surprisingly, research shows that there is no significant evidence to support the theory that an individual’s natural arch structure should be the determining factor for footwear recommendations [6-8]. There’s also no significant evidence to support the theory that orthotics decrease one’s risk for injury [9,10]. In fact, when orthotics are combined with stability or motion control shoes, they typically overcorrect a runner’s gait pattern, taking what was once an over-pronator, and now making them a supinator. This combination doesn’t help solve their original problem, but rather transfers their problem into a different type of RRI. Ever experience too much of a good thing? That’s exactly what’s happening with the over correction recommendation. The best way to evaluate whether or not a shoe and/or orthotic is appropriate for someone is to watch them run with that equipment and observe how their body moves. Which brings me to my last point…
How does my patient move in their shoes while running?
This is the most important step in determining what shoes are the best shoes. A runner must be observed while moving in their shoes in order to evaluate whether or not they have the right equipment. This type of video gait analysis is often done on a treadmill and is especially helpful for patient’s to see how their own body is moving. I have my runners warm-up on a treadmill at a comfortable self-selected running speed for a two min acclimation period . Then I record them using a motion capture app (I use CoachMyVideo) for 30sec in four different positions: front, side, back, and down at their feet. If my runner wears orthotics, I record a second video of them running without their orthotics. As I mentioned in the previous section, comparing both videos helps to determine if an over correction issue is present. Once the videos are recorded, I re-watch them in slow motion. The naked eye can’t detect all the fine details of high-speed movement in real time. This is why slow motion capture is so important for running assessments in order to properly determine what’s happening throughout the kinetic chain [12,13]. Most runners want to blame their running shoes for their RRIs and think that by simply changing their shoes, all problems will be solved. Unfortunately, it’s not usually that simple, and often requires taking a deeper look at what’s happening above the shoes as well. Running mechanics can be significantly improved when adjustments are made to running speed, cadence, and posture [14, 15]. Those changes impact what’s happening at the foot and ankle, which can oftentimes eliminate the need for orthotics and/or the need to change the runner’s footwear altogether. This is why it’s so important to watch a runner move in their shoes! That’s the only way to properly evaluate the footwear they currently have and make the necessary recommendations for what type of footwear (and/or orthotic) they need moving forward.
As you can see, there are a lot of factors that influence how a runner moves. This is why determining the best running shoe for each person individually requires thoughtful consideration and an evaluation of the runner in motion. If you’re still unsure about how to determine the right running shoes for you, follow these three tips when purchasing your next pair:
- Purchase your shoes from a retailer that will let you run in them – and I mean through a workout not just around the parking lot – and return them without penalty if you don’t like them or if your PT doesn’t think they’re the right shoes for you. Yes, there are stores that let you do that! Fleet Feet Sports and Road Runner Sports are two examples.
- Appropriate size and comfort are important factors when choosing your running shoes. I know that might sound like a – “no duh!” – kind of comment, but you’d be surprised at how many patients I’ve worked with that were trying to run in shoes that were not their size or simply uncomfortable. Make sure you have plenty of room across the toe box. If you tend to get blisters on the inside of your big toe or on the outside of your pinky toe, your toe box is probably too narrow for your foot. You also need at least a ¼ inch space between the front of your shoe and your longest toe. Your feet need room to spread while you run; be sure to give them the space they need. Incorrect sizing will negatively impact the way you move.
- Compare the wear pattern found on the bottom of your current running shoes to the pictures I listed above. If it looks like you have a neutral pronator pattern, then you’re probably using the right shoe already. If you notice more of an over-pronator or supinator pattern, you should consult with your local physical therapist for a running assessment to help you determine if you need to wear a different type of shoe and/or if your running mechanics need to be addressed. If you live near the Santa Barbara area, you have the opportunity to schedule a running assessment with me – lucky you!
- Verdejo, R., and N. J. Mills. “Simulating the effects of long distance running on shoe midsole foam.” Polymer Testing5 (2004): 567-574
- Verdejo, R., and N. J. Mills. “Heel–shoe interactions and the durability of EVA foam running-shoe midsoles.” Journal of biomechanics9 (2004): 1379-1386.
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- Cheung RT, and Davis IS. Landing pattern modification to improve patellofemoral pain in runners: a case series. J Orthop Sports Phys Ther. 2011;41(12):914-9.
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- Pipkin, Andrew, et al. “Reliability of a Qualitative Video Analysis for Running.”Journal of Orthopaedic & Sports Physical Therapy0 (2016): 1-34.
- Damsted, C., L. H. Larsen, and R. O. Nielsen. “Reliability of video-based identification of footstrike pattern and video time frame at initial contact in recreational runners.” Gait & posture1 (2015): 32-35.
- Heiderscheit, Bryan C., et al. “Effects of step rate manipulation on joint mechanics during running.” Medicine and science in sports and exercise. 2011;43(2):296
- Allen, Darrell J., et al. “THE EFFECT OF STEP RATE MANIPULATION ON FOOT STRIKE PATTERN OF LONG DISTANCE RUNNERS.” International journal of sports physical therapy1 (2016): 54.