Recently I was asked the question, “Do you have a recommendation for a running shoe for my daughter? She tends to over-pronate”. This came from a fellow runner and friend (who by the way is a physician) in the form of a text which makes it even harder to answer as there is not simple explanation. It’s not even easy to answer this hour consuming question in the office for patients who try to slip it in as I’m finishing their visit for an unrelated problem.

The question of “what’s the best running shoe for me?” plagues an overwhelming majority of runners and there is no correct way of answering this. The best answer I can honestly give is, “stop focusing on footwear” and spend more time on training patterns and form. The below quotes should preface any book on running and, if they were not in existence for economical reasons, be seen on the walls of every running shoe store:

“Shoes do no more for the foot than a hat does for the brain.”

—Dr. Mercer Rang, legendary orthopedic surgeon and researcher in pediatric development.

“How one runs is probably more important than what is on one’s feet, but what is on ones feet may effect how one runs.”

—Dr. Daniel Lieberman, Harvard Professor who studies running and movement patterns of humans.

Our feet, as put by Leonardo DiVinci, were masterfully engineered to allow our bodies to move throughout the motions of walking and running. It’s when we disrupt this normal process that we see abnormal biomechanics which presumably lead to injury. Does excessive pronation itself create injury? It’s never been demonstrated scientifically. And, even if a foot’s musculature has become underdeveloped as a result of being shod for most of its life, placing it in a shoe with an elevated cushioned heel will lead to increased pronation and Achilles’ tendon injuries as demonstrated Baycroft and Jarvinen. (Many other studies have also demonstrated these findings.)

Baycroft CM, Culp V. Running shoes – Design facts and functional fantasies. Chiropractic Sports Medicine 1993;7(1):6-8.

Jarvinen T, Kannus P, Maffulli N et al. Achilles tendon disorders: etiology and epidemiology. Foot Ankle Clin 2005;10(2):255-66.

We even know from biomechanics 101 that placing the foot in a slightly plantarflexed position (as like that which occurs in a running shoe) will uncover the head of the talus bone in the foot which makes the subtalar joint become hypermobile leading to excessive pronation. Thus, if one is concerned about excessive pronation, then selecting a running shoe with an elevated cushion heel is not indicated.

Answer 1- No Elevated Cushion Heel

Should I choose a shoe based on foot type?

For the past 15 years or so, running shoes fell into three distinct categories. They were created for either a high arch, a normal arch, or a flat foot. The description sometimes will vary depending on the manufacturer and may be referred to as a shoe for controlling excessive motion or one for the foot which needs more cushion. The problem with this paradigm is that it is not evidence based. Scientific studies which attribute a reduction in injury based on this methodology do not exist.

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

Knapik JJ, Trone DW, Swedler DI, Villasenor A, Bullock SH, Schmied E, Bockelman T, Han P, Jones BH. Injury reduction effectiveness of assigning running shoes based on plantar shape in Marine Corps basic training. Am J Sports Med. 2010 Sep;38(9):1759-67.

Yeung SS, Yeung EW, Gillespie LD. Interventions for preventing lower limb soft-tissue running injuries. Cochrane Database Syst Rev. 2011 Jul 6;(7).

Answer 2: A Shoe should not be selected according to foot type.

How much cushion should it have?

There is no single answer to this question. Although, the literature speaks for itself in regards to cushioning. The more cushion there is below ones foot, the more proprioception is hindered leading to abnormal biomechanics. Proprioception refers to the ability of the foot to sense what it comes in contact with, and then signal the brain which fires the nerves to contract the appropriate muscles to position the foot and leg during locomotion. When this pathway is disrupted, we see a disruption of shock absorption capacity which leads to an increased rate of injury.

Sekizawa K, Sandrey MA, Ingersoll CD et al. Effects of shoe sole thickness on joint position sense. Gait Posture 2001;13(3):221-228.

Robbins S, Waked E. Foot position awareness: The effect of footwear on instability, excessive impact, and ankle spraining. Critical Reviews in Physical and Rehabilitation Medicine. 1997;9(1):53-74.

Robbins SE, Gouw GJ. Athletic footwear: unsafe due to perceptual illusions.
Med Sci Sports Exerc. 1991 Feb;23(2):217-24.

Robbins SE, Gouw GJ. Athletic footwear and chronic overloading. A brief
review. Sports Med. 1990 Feb;9(2):76-85.

Robbins S, Waked E. Hazard of deceptive advertising of athletic footwear. Br J
Sports Med. 1997 Dec;31(4):299-303.

Cushion should probably be varied depending on workout and distance. Runs that are under 8-10 miles for a conditioned runner probably doesn’t require much cushion. Longer runs may require more as the foot and leg musculature will fatigue over time. Barefoot runs over 2-3 or even more miles can help strengthen the foot and even facilitate a more efficient and natural form. Bottom line, the shoe should be comfortable and flexible.

Answer 3. Soft,flexible, and able to roll up.

There are many options available for what has been described above. Since the boom in minimalist running shoes occurred after the popularity of Vibram FiveFingers and Chris McDougall’s Born to Run, virtually every shoe company has introduced a minimalist shoe. We have even seen new shoe companies emerge such as Altra which recently passed Adidas in terms of sales of running shoes. The shoe should feel comfortable and allow your foot to move freely and natural. There should be plenty of room in the toe box for the toes to move. If the shoe store sales person says, “this is the shoe for you” and it doesn’t feel good, it’s not the shoe for you.

Click to read entire review of the Skechers GOmeb Running Shoe.
Moral of the story. Focus on training patterns, get adequate recovery, and allow your body to use its natural stride and form. Shoes should be secondary.