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What Shoe Talkin’ Bout? A Guide to Picking and Prescribing Footwear.

    It’s safe to say the world of running has been an ever-changing one. But the running shoe itself is somewhat of a newer invention that has evolved drastically, specifically over the last several decades. Whether ultra cushioned or minimalist, stability or neutral, modifications have been praised, cursed, and recreated drastically over the years, each with its own cult following. So how did we take what should be the world’s cheapest sport and turn it into potentially one of the most expensive? We created the running shoe.

    “Mom, Where Do Shoes Comes From?”

    The long version:

    While many credit Bill Bowerman, Nike co-founder and Oregon Track and Field coach, as father of the modern running shoe, running shoe production came to be as early as the 1850’s when running spikes were created by Joseph William Foster the founder of what is now known as Reebok. Running shoe customization came much later in the 1920s when Adolf Dassler, founder of Adidas, changed spike design based on race distance. It was however, Bill’s creativity with a waffle iron and some rubber that birthed the design of the waffle sole that exploded the running shoe market in the 1970’s, making Nike the athletic apparel powerhouse it is today.

    Since the waffle sole, the market has continued to transform as shoes became more “customized”. Shoe customization was predominately based on running style, forming the three big categories virtually all runners are placed in still today: neutrals, supinators, or pronators. With the fear of “overpronation” rising, shoes for “motion control” became popular making them denser, rigid, and heavier, up until that late 90’s and early 2000’s. In 2009, Christopher McDougal’s bestseller Born to Run surged the popular minimalist movement making shoes like Nike Frees, Vibram 5 fingers, and Newton running shoes more popular as they marketed for increased intrinsic foot muscle activation, decreased heel strike, and a more “natural” running posture.

    As with most trends, the pendulum swung back, leading from minimalist to the maximalist movement, a popular surge in ultra cushioned shoes, most well known being the Hoka. With this shoe design touting improved force distribution. The market now offers us anywhere from zero cushioned toe socks to Michelin man space boots, motion control, neutral, zero drop, rocker bottom, any color, style, the possibilities are endless!

    The short version:

    Picture Short Version Annie.png 

    Shoeology 101: Anatomy of the Foot and What We Put On It.

    The Foot

    The foot is divided into 3 main parts: hindfoot or rearfoot, midfoot, and forefoot, each with its own set of bones. These segments of the foot move to accommodate both supination and pronation mechanics. With a typical gait pattern, the entirety of the foot will go through a cycle of supination, pronation, then supination again. Supination is useful for locking and stabilizing while pronation is useful for load distribution and shock absorption. We need both for mechanical efficiency. So yes, you are a supinator. And yes, you are a pronator. Now, if someone “over-pronates” or “over-supinates” how can this guide our shoe selection?

    Foot Annie.png

     

    The Shoe

     The design and recommendation of a running shoe has, for several years, been based on the idea that a runner should accommodate their pronation or supination mechanics or lack there of. This breaks us down into the three main types of running footwear types.

    1. The Neutral: More cushioning, less support

    • Softer, more shock absorbent material
    • Cushioned lateral heel with consistent foam throughout
    • For those “typical” runners with “normal” foot posture, pronation mechanics, and joint mobility
    • High arched, or rigid feet are sometimes also recommended for a neutral to accommodate lack of foot movement with allotted cushioning

    Neutral Shoe.png

     

    1. The Stability: Less cushioning, more support

    • Pronation control component to counter arch collapse
    • Dual density or multi-density sole with high density in the arch (note the dark gray)
    • Typically for those with slightly more mobile foot or pronated foot posture
    • Not for excessive pronators or “floppy feet”

    Stability Shoe

     

    1. The Motion Control

    • For those with significant pronation
    • Typically have a plastic component placed on the inside of the heel
    • High-density foam in the arch that extends into the rearfoot
    • Significantly less cushioning and more rigidity

    Motion Control

     

    Shoe Prescription and Side Effects

    So what does the research show? Well, for the most part it shows that shoe prescription doesn’t actually work. At least not consistently.

    That’s not to say shoe prescription is irrelevant.

    Some studies have shown minimalist shoes can help decrease heel strike (landing on your heel) which can actually can decrease force at the knee, inherently decreasing knee injury rate. But this foot strike pattern has also been associated with increased strain on the foot and ankle structures, putting the runner at risk of injury… but elsewhere.

    Another study showed motion control shoes, when issued to those with pronated feet, did actually decrease injury rate versus those in a neutral shoe. Several other studies, however, have shown no difference in running injury rate based on shoe prescription. Some studies have even shown increased injury risk when overprescribing motion control shoes in hopes of based on faulty assumptions about one’s pronation.

    The research is confusing and frustrating, I know.

    Prescribing a shoe type to a foot type hasn’t shown any consistent decrease in injury risk. That’s not to say that shoe type is irrelevant. It’s not to say that knowing your foot type isn’t important or that you shouldn’t put thought into your shoe selection. But it does beg the rationale that we are much more than our shoes.

    So while shoe prescription is typically based on what category you fall into, often times foot mechanics are much more complicated and unique to the individual. Body weight, hip and knee alignment, muscular control, foot strike pattern, they all play a role in how you run. We are complex beings. We have complex mechanics. We often times have issues, a shoe can’t fix, even if you did pay $120 for them.

    If a deficit exists, you cannot simply fix it by changing the shoe you put on it.

    Shoe Rules

    So now what? How do you pick a shoe in a world full of possibilities? Here’s my 5 Shoe Rules to live by:

    1. If it ain’t broke, don’t fix it. If the shoe you’re currently wearing hasn’t given you any issues, don’t change it. Why mess with a good thing?
    2. Buy a shoe from a store that cares. Most stores let you try their shoes on. Good stores let you run on a treadmill in them. Great stores let you take them home and run in them. Actually run in them. Find a store like this so you can adequately test a new pair of shoes.
    3. Go with your gut. While the research is mixed on shoe selection, one thing is fairly consistent in real life… if it’s comfortable, you’re less likely to get injured. Don’t let a trend, a salesperson, or a book tell you what to wear. They’re your shoes. Own them.
    4. Perform a shoe check (See Video Below)
    5. If you’re injured. Go see someone. And by someone, I don’t mean the teenager that works at Dick’s Sporting Goods after school. I mean a licensed healthcare professional. More specifically, I mean a licensed physical therapist, better yet a licensed physical therapist that’s a runner (obviously I’m a little biased).

     

     

    -Dr. Annie Neurohr, PT, DPT

    Rubin Institute of Advanced Orthopedics, Baltimore MD

    Annie

                                                                                          

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    Photo References

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    1 thought on “What Shoe Talkin’ Bout? A Guide to Picking and Prescribing Footwear.”

    1. Jon Furrs

      Any recommendations on toe box? I know some folks like the looser fit (me). But those GTS’s are anything burn loose up front.

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