Here are some thoughts on running shoes that I recently wrote for the periodical Podiatry Today.
People tend to think the first step to fixing any pain in the foot involves changing their shoe or finding the right shoe for them. This is even more apparent in runners.
Jenny Sanders, DPM, made reference to the Hoka One One in her Podiatry Today Blog post titled “Hoka One One: Marketing Hype Or (Another) Running Shoe Revolution?” (see http://tinyurl.com/p2vad3m ). She made reference to both the Hoka One One and the Vibram FiveFingers shoes and how these shoes became huge trends in the running community. We all know that Vibram had settled a lawsuit involving claims the company had made about its shoes that were at the time not scientifically proven or based on research. (On a side note, my colleagues and I have research to show otherwise and this has been accepted for publication in the Journal of the American Podiatric Medical Association sometime in 2015.)
Have you ever wondered how these trends in shoes develop? I spend a large amount of time reading about and researching running injuries as well as treating an enormous number of runners in my practice. Here’s my hypothesis, which is the result of my experience over the last five years.
In my experience over the last five years, there are two driving forces that play a huge role in making shoes become popular. One is the runners themselves and the second is the advertising from the shoe companies in high volume periodicals such as Runner’s World and Running Times. As I previously mentioned, runners tend to look at their shoes when it comes to an injury and think that changing them may help resolve it. So they simply start trying “new” shoes.
As an example of this, let us use the Hoka One One. It is a “new” shoe that appeals to runners because it offers a ton of cushioning. Is it clinically proven or is there research that demonstrates that it prevents or helps treat injuries? Absolutely not. Without pointing any fingers, running shoe companies may use the term “research” in their advertising or shoe descriptions but this typically refers to the research that goes into the materials and construction of the shoe itself.
Runners suffering from an injury try this shoe and may experience pain relief. They then tell their friends in the running community how they love this shoe and the trend begins. More people try the shoe and the trend builds to what author Malcolm Gladwell would refer to as a tipping point. The shoe “tips” so to speak and begins ending up in more shoe stores, running magazines, marathon expos and so on until it becomes this exciting new shoe to more than just runners.
As this happens, we see more and more shoe stores stocking this shoe on their shelves. Why? It is selling. Why is it selling? People like it and it is the new trend. Is it fixing, resolving, or treating injuries? Yes, according to the consumers buying them. Is there any research or evidence-based articles to defend the prescribing of this shoe to patients? Not yet. In fact, it takes several years for studies to start looking at specific shoe gear and evaluating whether it has any effect on injury patterns. Even then, it is difficult because there are many variables to control when evaluating injury patterns.
So how do we give advice to our patients who ask what shoe they should be wearing? Is this new “maximally cushioned” shoe a good option for them? In my practice, shoes go toward the bottom of the list when it comes to discussing a patient’s injury. We discuss form, particularly foot strike patterns, cadence, training patterns and training intensity. In my experience, these factors tend to play a greater role in resolving injuries than the shoe itself.
When patients ask me about the latest and greatest shoe, I respond by explaining the shoes may or may not work for them. In terms of helping their running, I remind patients to focus on the aforementioned factors that we discussed.