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Fit To Run: The Truth about Running Shoes, Like it or Not (Part 2)

As promised, here are the 4 features that I consider in determining a running shoe that best allows your body to control running mechanics and minimize injury risk:

 1. Drop the Heel

Heel-to-toe drop refers to a difference in the height between the outsole/midsole of the heel vs. the outsole/midsole of the forefoot.

Traditional running shoes are a modified version of “high heels”, whereby the difference in height between the heel and toe is often 10-12 millimeters. This was originally developed as a means to establish a “heel rocker” and promote a smooth progression through the stance phase of running. However, the foot works best in a flat position in order to appropriately stabilize your stride. Scientifically speaking, a decreased heel-to-toe drop optimizes the feedback received by the foot when contacting the ground that allows for appropriate landing response and muscle firing patterns.

I often recommend shoes with a 4-6 mm (or less) heel-to-toe drop. Minimalist shoes are often “zero drop”, meaning that the stack height at heel and forefoot is the same. While most individuals can run in a “zero drop” shoe, it should be noted that the transition from traditional footwear to a zero drop model is a delicate process that should be completed over several weeks (up to 2 months, in my experience). This is due to the fact that low drop models require increased activation of calf musculature to dissipate the forces of landing.

Great consideration for runners with: Runner’s knee, IT Band friction syndrome, shin splints, stress reaction or fracture


2. Lose the excess cushioning!

 This recommendation might ruffle some feathers. More cushion sounds like it would be a good thing. Who wouldn’t want to feel like they are running on clouds? As a matter of fact, this is an analogy often used by shoe manufacturers to promote their “maximum cushion” models. Once again, despite cushioning being a major selling point for traditional footwear, there has been no evidence that more cushioning equals less running injuries or improved performance.

 I will frequently recommend running shoes with low-to-moderate cushioning. The foot plays an important role in proactively controlling muscle firing patterns and lower body stability through its responsiveness to input received when it contacts the ground. This sensory feedback is best interpreted through pressure receptors located throughout the foot. When the relayed feedback is “clouded” by excessive cushioning, the foot is unable to appropriately determine and proactively respond to the high forces associated with each landing cycle. There have even been studies to suggest that runners land harder in higher cushioning shoes as compared to those with low cushioning models. Although the cushioning may decrease the immediate stress to the foot and ankle, more forces are being transmitted up the lower extremity placing the runner at increased risk of stress-related injury.

Great consideration for runners with: Stress reactions or fractures (especially of the tibia, femur, pelvis), Runner’s Knee, Arthritis of the hips and knees


 3. Don’t cramp the toes!

Many traditional shoes have a narrow toe box. Here is a simple way to make sure you are fitted with an appropriate running shoe:

Take out the insole of the shoe and step onto it with your bare foot. If the outer borders of either your 1st or 5th toe extend past the edges of the insole, the shoe will not allow appropriate spreading of your toes during the push-off phase of your running cycle.

 The toes naturally spread while running which allows for improved leverage of the foot and, thus, stability of the lower leg.  Do yourself a favor and find shoes that accommodate the shape and mechanics of your foot!

Great consideration for runners with: Bunions, Metatarsalgia, midfoot/forefoot strikers


 4. Don’t stress the support!

As mentioned earlier in the article, traditional shoes are often prescribed with a certain amount of support based on foot type. “Support” most often refers to the amount of posting on the inner aspect of the shoe which is proportionate in size to the height of the arch. Traditionally, higher posting is recommended for feet with decreased arch height. The theory of this is that the built-in arch support will “control” the degree of pronation during running.

The problem with this theory is that the point in the cycle in which the greatest pronation occurs is when the heel has already raised from the ground. As such, the arch support is not even useful at the point in the running cycle where it is theoretically most necessary.

The most important feature of a pair of running shoes is comfort. I often recommend starting with a neutral model shoe, which has little-to-no posting.

Great consideration for runners with: Shin Splints, Stress Fractures, Runner’s Knee

In summary, don’t count on your shoes to do the work for you. Some shoe features matter (see above) while others simply have not been shown to affect injury rates or performance. To manage and treat running injuries, make sure to find a Physical Therapist who is well-versed in video running analysis and understands the unique biomechanical demands of running.



**Much of the information presented in this posting is based on research completed and/or analyzed by Jay Dicharry, Physical Therapist and Board Certified Sports Clinical Therapist. I highly recommend his book Anatomy for Runners to any clinician or runner looking to enhance their knowledge of running anatomy and biomechanics.

Anthony Moss, DPT

Physical Therapist

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