Can running shoes really prevent you from getting injured and if so, how do you choose the right pair for you? Running rehab specialist Matt Phillips reports.
How did you choose your last pair of running shoes? If you visited a specialist running store, chances are you were observed on a treadmill to see if you ‘overpronate’, ‘underpronate’ or are ‘neutral’, or maybe asked to stand on a pressure plate to reveal your ‘foot type’. Those of you new to running and/or carrying a lot of weight were perhaps advised to try a more traditional, cushioned shoe, whilst the more experienced of you may have been steered towards a less structured, minimalist shoe. And yet, how much science is there behind these methods of shoe selection? How much can the ‘right’ shoe reduce injury?
The variety of running shoes has certainly increased over the last few years, much of it stimulated by the publication of Christopher McDougall’s best seller ‘Born To Run’ in 2009. Claims started to appear that barefoot running could strengthen the feet, reduce running injuries, encourage proper running form and improve performance. Whilst some runners proclaimed barefoot running (along with the typical shift to forefoot striking that barefoot running encourages) as a cure for injury, others were not so fortunate with widespread reports of a dramatic increase in calf and Achilles tendon issues. Studies confirmed that whilst barefoot running could reduce the risk of certain running related injuries for certain runners, it could increase the risk of injury for others.
The heightened profile of barefoot running brought a shift in the shoe market from the heavily structured & cushioned traditional running shoe to a new ‘minimalist’ trend. Vibram FiveFingers headed the revolution and though they ran into some problems for unsubstantiated claims regarding injury & performance, they did pave the way for a whole new selection of ‘minimalist’ shoes offering less ‘drop’ (incline angle between heel and toe), less cushioning, a wider toe box (more room for the toes) and more flexibility.
Like barefoot running, conclusive evidence for the benefits of minimalistic footwear is still a work in practice. A 2012 review in the Journal of Strength & Conditioning titled ‘Running Barefoot or in Minimalist Shoes: Evidence or Conjecture?’ concluded: “Running barefoot or in minimalist footwear has become a popular trend. Whether this trend is supported by the evidence or conjecture has yet to be determined.”
So, do we all stick with traditional shoes then? Not necessarily – prepare yourself for a shock: the traditional way of selecting running shoes has no evidence whatsoever. Basing your shoe choice on whether you ‘overpronate’, ‘underpronate’ or stay ‘neutral’ is an antiquated idea that in all honesty should have disappeared from the high street years ago. Diagrams linking ‘foot types’ (high, normal or flat) or degree of pronation (overpronation, neutral, oversupination) with recommended type of shoe are not based on any science and need to stop being used.
Despite still being used in stores and clinics all over the country, there is no quality evidence linking risk of injury with the degree to which the inner arch of the foot falls whilst running. As far as using pressure pads to determine foot type, it has been shown that what your arch does whilst you are standing on the spot can have very little to do with what happens when you are running. The dropping of the inner arch during gait, known as pronation, is a natural part of movement.
Variances in human anatomy mean some runners will pronate more, others less. There is no ‘normal’ level of pronation, so how can anyone define when there’s too much? There is no data or evidence to suggest that ‘neutral’ alignment is linked to running injury. Trying to force such an alignment via use of shoe or insert may even cause discomfort and pain.
So how do we choose running shoes?
Whilst there is no quality research linking shoe type with injury, we really don’t have an evidence-based model on which to base shoe selection. Until we do have such a model, there will always be an element of trial & error when it comes to choosing shoes. In its absence, runners should definitely focus efforts on more evidence-based ways of reducing risk of injury, e.g. avoiding sudden changes in training (frequency, intensity, duration) and doing strength work.
That said, using what we do know, we can make the following suggestions:
• Say goodbye to the traditional overpronation model of shoe selection; if you find it being used in a store, go to different store.
• Cushioning is not as linked to injury prevention as you may imagine; if you are new to running or carry a lot of body weight, don’t be afraid to test a lighter, less cushioned shoe.
• Minimalistic shoes are on a spectrum; find the lightest, least cushioned shoe that works for you (rather than jumping straight into Vibram FiveFingers). The Minimalist Index by the Running Clinic is a good place to start.
• Your running shoe should always feel comfortable; if you are ‘prescribed’ a shoe but it feels uncomfortable, don’t buy it.
Avoid sudden changes from traditional shoe to minimalist shoe; transition slowly to allow your body to adapt. We are all individuals; what works for one runner will not necessarily work for another.
When it comes to injury prevention, focus your efforts on monitoring your training habits and doing strength training rather than relying on shoe selection.
Matt Phillips is a Running Injury Specialist at StrideUK in Sussex. Listen to Matt’s podcast: www.runchatlive.com