Choosing the Right Running Shoe for You

A few days ago I got up after sleeping off the bottles of wine and bubbly my wife and I enjoyed to ring in the 2016 New Year and ritualistically headed to the gym. My focus today was sweating out as much of the retained water and sodium from my delicious Ruth’s Chris steakhouse dinner as I could.  As I walked into the local big box gym where I get my workouts in, I couldn’t help but notice that the treadmills were unusually full of New Year’s resolution exercise enthusiasts pounding away on the hamster wheels we fondly refer to as treadmills. Secondarily, my eyes fixed on the fact that almost every single one of these people had on brightly colored highly expensive running shoes. Could this be a factor of getting some new shoes for Christmas from mom and dad? Or, could it be that these temporarily gung ho runners went out and purchased a pricey pair of high end running shoes fit just to their foot, in order to help them stay healthy and achieve greek god status by spring time?

Over the last couple of decades running has exploded in popularity. A phenomenon I personally can’t begin to understand. I hate running distances further than from the couch to the fridge, and my version of cardio means lifting weights faster, long walks, and the occasional sprint interval session of the bike.

I was never much of distance runner myself, as I’m sure you can tell from the above pictures. Always felt myself to be more of a sprinter as my best event was the 400m. Additionally my lack of scientific understanding didn’t want to interfere with “my weightlifting gainzzz”. On top of that, I seem to have never reached a “runner’s high” in my life and hate the way pounding the pavement makes me feel.

Never less, tons of people love to run, and every day more people are setting goals to run 10ks or marathons despite never having run much in their lives. With this big influx of individuals into the running world it’s a better time than ever before for shoe manufacturers to sick their creative marketing wizards on the job to make sure people know that their shoe is the best, will improve your performance, reduce risk for injury, get you all the chicks, and increase your odds of Mark Zuckerberg giving you a billion dollars on Facebook.  

I have to admit a new pair of shoes always makes me feel a little better, cooler, faster, etc. I know this is completely due to my favorite childhood movie The Sandlot. Benny “The Jet” Rodriquez got his new PF flyers to be able to run faster and jump higher in order to steal the “Baby Ruth” baseball back from the Beast’s yard. From that point on, every time I got a new pair of shoes as a kid I would immediately sprint off in all directions jumping, juking, cutting, and almost flying with this found agility and speed that only THESE new shoes could provide me.

As I stated above I’m not much of a distance runner myself, however, I’ve done quite a bit of reading and presented on the topic at the local Cowtown Marathon headquarters. When I went to the research; legitimate published RCTs (not runner this and that magazine) what I found was very interesting. I came across a multitude of literature, some published more than 10 years ago, that contradicted what I had just been taught a couple of years ago in physical therapy school. When I was in school, I was taught that basically all people who has feet with “fallen arches” and an observed pronation during stance and gait were at a higher risk for injury due all of the poor force distribution up “the kinematic chain”. I was taught that I needed to measure the feiss line, navicular drop, sub-talar neutral, calcaneal valgus, etc. Once I had these measurements I was to decide if someone needed a medial post, lateral post, semi-rigid or rigid arch support, and so on in order to correct the biomechanics of their foot, ankle, knee, and hip. Next, I was taught that people needed to choose a shoe that had a certain amount of inherent stability and that was biased towards fitting their “type of foot”.

Footwear has become quite the hot topic in recent years with emergence of the minimalist Born to Run crowd and the complete opposite crowd of super cushion motion control Hoka fanatics.

Both groups seem to have a good theory and be able to argue their points until they are blue in the face, but what does the literature have to say on the matter?

In the first study I examined by Ryan et al. (2011) 81 female runners were categorized into three different foot posture types (39 neutral, 30 pronated, 12 highly pronated) and randomly assigned a neutral, stability or motion control running shoe. The runners then underwent baseline testing to record training history and leg alignment before commencing a 13-week half marathon training program. Outcome measures included number of missed training days due to pain and three visual analogue scale (VAS) items for pain during rest, activities of daily living and with running. In conclusion they found:

·         “194 missed training days were reported by 32% of the running population with the stability shoe reporting the fewest missed days (51) and the motion control shoe (79) the most.”

·         “No significant effects were reported for the highly pronated foot, although this was limited by an inadequate sample size.”

·         “The findings of this study suggest that our current approach of prescribing in-shoe pronation control systems on the basis of foot type is overly simplistic and potentially injurious.”

In the next study Knapik et al. (2010) was able to recruit over 700 military personnel as the experimental group and almost 700 age and gender matched controls making this a fairly large and powerful study. The military subjects were provided motion control, stability, or cushioned shoes for plantar shapes indicative of low, medium, or high arches, respectively. The control group received a stability shoe regardless of plantar shape.  Both groups’ injury reports were then followed over the next 12 weeks. In conclusion, it was found that:

·         “Cox regression indicated little difference in injury risk between the E and C groups or among men and women”

·         “This prospective study demonstrated that assigning shoes based on the shape of the plantar foot surface had little influence on injuries even after considering other injury risk factors.”

In 2009 Ramskov et al. (Keep in mind this study was published before I even entered PT school) decided to look at foot posture and Q- angle as risk factors for running related injury. Ramskov was a able to recruit fairly small sample in this instance of 59 novice runners of mixed gender. The subjects were put through a 10 week study in which baseline foot posture was evaluated using the foot posture index (FPI) and the Q-angle was measured. Based on the FPI and Q-angle, right and left feet / knees of the runners were categorized into exposure groups. All were instructed to run a minimum of two times per week in a conventional, neutral running shoe. Of the 59, 13 sustained a running-related injury.

·         “No significant difference in cumulative relative risk between persons with pronated feet and neutral feet was found after 125 km of running. Similarly, no difference was found between low and neutral Q-angle.”

·         “Static foot posture as quantified by FPI and knee alignment as quantified by Q-angle do not seem to affect the risk of injury among novice runners taking up a running regimen wearing a conventional neutral running shoe.”

·         “These results should be interpreted with caution due to a small sample size.”

The next study focused primarily on the panacea of foot pronation. Nielson et al. (2014) performed a 1-year epidemiological observational prospective cohort study with a total of 927 novice runners (equivalent to 1854 feet). This was a fairly large study in comparison to the previous Ramskov study. At baseline, foot posture on each foot was evaluated using the foot-posture index and categorized into highly supinated (n=53), supinated (n=369), neutral (n=1292), pronated (n=122) or highly pronated (n=18). Participants then had to start running in a neutral running shoe and to use global positioning system watch to quantify the running distance in every training session. After looking at the data it was found that:

·         “The incidence-rate difference/1000 km of running, revealed that pronators had a significantly lower number of injuries/1000 km of running of −0.37 (−0.03 to −0.70), p=0.03 than neutrals.”

·         “The results of the present study contradict the widespread belief that moderate foot pronation is associated with an increased risk of injury among novice runners taking up running in a neutral running shoe.”

So what type of shoe should you choose if you decide to take up running? According to the recently published study by Nigg et al. (2015) you should choose the shoe that feels the most comfortable to your foot:

“In the past 100 years, running shoes experienced dramatic changes. The question then arises whether or not running shoes (or sport shoes in general) influence the frequency of running injuries at all. This paper addresses five aspects related to running injuries and shoe selection, including (1) the changes in running injuries over the past 40 years, (2) the relationship between sport shoes, sport inserts and running injuries, (3) previously researched mechanisms of injury related to footwear and two new paradigms for injury prevention including (4) the 'preferred movement path' and (5) the 'comfort filter'. Specifically, the data regarding the relationship between impact characteristics and ankle pronation to the risk of developing a running-related injury is reviewed. Based on the lack of conclusive evidence for these two variables, which were once thought to be the prime predictors of running injuries, two new paradigms are suggested to elucidate the association between footwear and injury. These two paradigms, 'the preferred movement path' and 'the comfort filter', suggest that a runner intuitively selects a comfortable product using their own comfort filter that allows them to remain in the preferred movement path. This may automatically reduce the injury risk and may explain why there does not seem to be a secular trend in running injury rates.”

So there you have it; the most recent research on foot and shoe type and how they correlate to running related injuries. It appears based on the current state of the literature that foot type, shoe type, and interventions to address these variants do little if anything to decrease rates of running related injuries. What does seem to carry some value is choosing a shoe that feels good to you personally. If you decide you want to start running, choose a shoe that feels the most comfortable to you, is large enough to capture your entire foot, has a wide enough toe box to not squish your feet, and doesn't seem to have any abrasive stitching or fabric on the inside of the shoe. Also, a very important factor regardless of shoes, is to remember to use a very gradual increase in mileage. Running injuries are almost always overuse type injuries that occur due to overloading a system that hasn’t yet adapted to the increased demands of your training/activity. For this reason, strength training is also an important factor to decrease running injury rates. A stronger system that can tolerate increased load will often be more resilient to imposed demands.

Please don’t hear what I’m not saying. I do think that shoe choice should have some thought behind it. Running in old worn out shoes with thousands of miles is likely not a good idea. Changing to a different type of shoe if you consistently have an injury may help you out, but it is unlikely that someone can tell what type of shoe you NEED based on your foot type. It is likely that choosing a wide base shoe with good medial/lateral support is safer and more effective for cross training type activities, so it doesn’t roll over and allow your foot to slide off of the sole with medial/lateral movements. Chris Johnson uses a nice shoe tap test among other advice here that illustrates this. We also know that choosing a weight lifting shoe with a solid base and good heel toe drop can improve anterior tibial tracking allowing for a more upright torso during deep squatting.

This particular post was just meant to address shoe choice for distance running and get people to stop scaring patients by telling them they are destined to get injured and have foot, knee, and hip pain as a result of their “pronated feet”.  As always, thank you for taking the time to read!

Jarod Hall, PT, DPT, CSCS

1.       Ryan MB, Valiant GA, Mcdonald K, Taunton JE. The effect of three different levels of footwear stability on pain outcomes in women runners: a randomised control trial. Br J Sports Med. 2011;45(9):715-21.

2.       Knapik JJ, Trone DW, Swedler DI, et al. Injury reduction effectiveness of assigning running shoes based on plantar shape in Marine Corps basic training. Am J Sports Med. 2010;38(9):1759-67.

3.       Ramskov D, Jensen ML, Obling K, Nielsen RO, Parner ET, Rasmussen S. No association between q-angle and foot posture with running-related injuries: a 10 week prospective follow-up study. Int J Sports Phys Ther. 2013;8(4):407-15.

4.       Nielsen RO, Buist I, Parner ET, et al. Foot pronation is not associated with increased injury risk in novice runners wearing a neutral shoe: a 1-year prospective cohort study. Br J Sports Med. 2014;48(6):440-7.

5.       Richards CE, Magin PJ, Callister R. Is your prescription of distance running shoes evidence-based?. Br J Sports Med. 2009;43(3):159-62.

6.       Nigg BM, Baltich J, Hoerzer S, Enders H. Running shoes and running injuries: mythbusting and a proposal for two new paradigms: 'preferred movement path' and 'comfort filter'. Br J Sports Med. 2015;49(20):1290-4.















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