Running Shoes, Foot Type, & Injuries

April 28th, 2020

In my previous blog post regarding running and running related injuries, we discussed how training errors are a significant cause of injury. We spoke about reducing the risk of injury by incorporating a variety of different types of activities into your exercise routine and gradually progressing with your running. 

I want to piggyback off of the running topic and discuss how running shoes have evolved over the years and their goal of injury reduction. Running shoes are a dominant force in the running world. There seem to be endless options for beginners through advanced runners. A lot of these options are geared towards and categorized by the type of feet that the prospective wearer has. I’d like to explore how, and why, running shoes have such a prominent influence on how we perceive running –– and if we can simplify the shoe selection process. 

Did you ever wonder why shoes are called “sneakers”? 

Well, in the 19th century the process called vulcanisation was developed which allowed rubber to be melted to fabric1. In the early 20th century this process was applied to the shoe industry and led to a much more comfortable shoe to be manufactured and allowed the wearer to move around without being heard. Thus the term “sneakers” was born. 

Shoes, specifically running shoes, have changed a lot since then. They started out resembling what we would now consider dress shoes. They were clunky, stiff, and not very functional.  Since the 1970s running has become significantly more popular. Running shoes have changed drastically to accommodate the change in running population.

Prior to the increase in running popularity, the primary group of runners were dedicated, competitive and essentially ran to win races2. They were your stereotypical runners. Thin, long legged, and graceful. They were the runners you see in the lead pack during your local marathon or on the college cross country team. 

In the 1960s running injuries seemed rare, or at least were rarely reported1. However, as running became more popular in the 1970s, a variety of demographics started entering this world2. Some were people who sat at a desk all day, some were overweight, others were looking for a change from their normal exercise routine, and yet others were exercising for the first time. 

Will Ferrel’s character Ron Burgundy from Anchorman famously said “Veronica and I are trying this new fad called, uh, jogging. I believe it’s ‘jogging’ or ‘yogging.’ it might be a soft j. I’m not sure but apparently you just run for an extended period of time! It’s supposed to be wild.”

That is the great thing about running. It is a readily accessible tool that can be used to exercise and start working on your fitness goals. 

With this new population entering the running world, injuries started to increase1. Some of the first surveys regarding running related injuries were initiated around this time by Runner’s World Magazine. This increase in running related injuries prompted the newly formed Nike to team up with three sports podiatrists who were starting to see an increase in these injuries. 

Dr. Steven Subotnick, Dr. Harry Hlavick and Dr. Dennis Vixie provided insight to Nike in shoe development and design to try and address the running related injuries that they were seeing in the clinic. Though there was no evidence to suggest specific causes of running injuries, these sports podiatrists felt that excessive impact forces and over pronation, excessive foot collapse, were the culprits that needed to be addressed1. Thus, cushion and motion control were introduced to the shoe world, and the rest is history.

When Drs. Subotnick, Hlavick, and Vixie teamed up with Nike, they felt that increases in foot motion and excessive impact forces were the cause of this new wave of running related injuries. They hypothesized that if you can correct, or limit, these forces then injuries will decrease. 

Impact force essentially is the amount of force that your legs experience while impacting the ground. It makes sense that you would have more impact force with running and jumping as opposed to walking.

Overpronation means that when you are bearing weight through your feet, your arch becomes flatter and your ankle tends to roll in. If you are impacting the ground with a flat foot or lower arch, it was thought that this was placing the extremities into a less efficient and effective position. However, pronation is a natural movement that the foot progresses through when a load is applied via walking, running, or jumping.

To combat impact forces and over pronation shoes became more cushioned and more “stable”. Cushioning added to the sole and heel of the shoe would attempt to decrease the shock that the leg felt, while increased arch support tried to address the overpronation aspect of running. 

This makes sense. Develop shoes to decrease the impact while also providing more stability. While shopping for shoes, you may see them broken down into three different categories. Cushioned shoes, stability shoes, and motion control shoes. Cushioned shoes are for the high arches, or the “supinator”. Neutral shoes are for the “normal arches” without excessive pronation. Motion control shoes are for the overpronator.

So it would be safe to assume after the development of these shoes running related injuries decreased, correct? Not exactly. Running injuries continue to be prevalent.  There have been studies that show increase in shoe cushioning does not lead to a reduction in running related injuries. A study looking at maximalist cushioned shoes showed that the runners legs become stiffer and less compliant compared to conventional shoes when landing because they can rely on the cushioning to absorb the impact3. Essentially it’s a trade off. Running with highly cushioned shoes leads to increased leg stiffness, thus nullifying the effect of the cushion.

How about picking shoes based on foot type?

The evidence on this seems to be changing as well. There have been several studies performed by the United States military to determine if providing specific shoe types would reduce injury. A review of these studies was performed and concluded “Selecting running shoes based on arch height had little influence on injury risk in military basic training”4. Another study suggests that using foot type to prescribe in shoe pronation control is overly simplistic5

This article was not meant to confuse or discourage you when looking for new running shoes, which can already be a daunting experience. I wanted to educate you on how running shoes have been developed and the continuing research on their effectiveness on injuries. Injuries are a constant occurrence in the running world, but it is necessary to understand that your running shoe type is not the magic bullet in reducing your risk of injury. Training smart, participating in strength and coordination exercises, and allowing your body to recover are the most important aspects of reducing the risk of injuries related to running.

So how do you pick shoes then?

Try them on. As many as you want. Pick the ones that feel the most comfortable. There should not be a “break in period”. Studies have shown that comfortable shoes are “associated with lower movement-related injury frequency”, decreased O2 consumption, and that different people need different features in their shoes to feel comfortable2.

The frequency of running related injuries has not changed much since it’s popularity boom in the 1970s2. Running shoes have changed significantly over that time to try and reduce the injury rate, without much success. Shoes are an important aspect of the running world but are not the magic bullet in reducing the risk of injuries. Smart training, appropriate rest, and strength and coordination training are all keys to staying a healthy runner. 

Before you begin increasing your mileage and speed to prepare for race season take advantage of our Gait and Running Analysis service. Included are TWO 30-minute sessions with one of our doctors of physical therapy with an in -depth assessment, video analysis, and individualized cross training program to stay ahead of your injuries. Contact us or call The FIT Institute 773.799.2795

Written by Thomas Dyke: Physical Therapist and Orthopedic Clinical Specialist on April 25, 2020.

References:

1. “The Re-emergence of the Minimal Running Shoe – jospt.” 30 Sep. 2014, https://www.jospt.org/doi/full/10.2519/jospt.2014.5521. Accessed 27 Apr. 2020.

2.  “Running shoes and running injuries: mythbusting and … – NCBI.” 28 Jul. 2015, https://www.ncbi.nlm.nih.gov/pubmed/26221015. Accessed 27 Apr. 2020.

3.  “Running in highly cushioned shoes increases leg … – Nature.” 30 Nov. 2018, https://www.nature.com/articles/s41598-018-35980-6. Accessed 27 Apr. 2020.

4. “Injury-Reduction Effectiveness of Prescribing Running … – jospt.” 30 Sep. 2014, https://www.jospt.org/doi/10.2519/jospt.2014.5342. Accessed 27 Apr. 2020.

5. “The effect of three different levels of footwear stability on pain ….” 27 Jun. 2010, https://www.ncbi.nlm.nih.gov/pubmed/20584759. Accessed 27 Apr. 2020.