A Clinical Pearl

by Jay Dicharry, MPT, SCS

Running Shoe

 

Every day, patients ask, “What’s the best shoe for me?” There’s a big problem when a clinician’s knowledge base of shoe prescription has been largely, and in some cases entirely, shaped by the shoe industry itself. Shoes are the tools that our patients use to accomplish their running goals, and it’s critical that we understand how shoes impact gait and how gait impacts shoes. Here are 3 common myths that we hear often – even from clinicians. As musculoskeletal experts, let’s make sure that we understand the role of shoes, and that we’re prepared to deliver the truth on footwear to our patients.

Myth #1:

Running Shoes Prevent Injury Both minimalist shoe companies and the ultra-padded sneakers on the other end of the spectrum think they can prevent you from breaking down. Despite what you might hear in clever marketing, no studies have actually proven that one type of shoe can prevent injury compared to another. And while some runners may enjoy fewer injuries after switching shoes, not everyone will react the same to changes in footwear. What works better for you might be horrible for one of your friends. There are a number of good shoes out there, it just comes down to a question of matching the shoe to the person.

Myth #2:

You Need to Shop for Your Foot Type If your patient is an overpronator (meaning the foot rolls inward upon landing), has high arches, or is flat footed, they’ve most likely been searching for the perfect shoe for their foot type for years. As you probably know, the general shoe store dogma is: Overpronators need motion control People with high arches need more cushion Neutral runners should be in a more neutral shoe Turns out, there’s actually no proof backing these concepts. I think the person who coined these ideas was probably the same one who said to coat yourself in honey if you have the chickenpox. It’s not true, it hasn’t held up, and it’s just silly. The arch is dynamic. It moves. You don’t hold it up in one place. Plus, research shows that when running, different foot types move much more similarly than differently.1 In one review, when researchers tried to find evidence of elevated, cushioned heels and pronation control systems (think reinforced arches and dense midsole foam—benefitting runners in any way), they came up short.2 A 2013 study in the British Journal of Sports Medicine found that moderate foot pronation is not associated with an increased risk of injury amongst beginning runners using a neutral shoe.3 The bottom line? There’s zero proof that arch height or foot shape plays an effective role in footwear prescription.

Myth #3:

Energy Return Makes You Faster Perhaps one of the biggest myths out there is the concept of “energy return”. Companies have been playing around with different materials, claiming they’ll help absorb some of the shock from running and return it to your stride for added speed and endurance. If it sounds too good to be true, that’s likely because it is. No shoe, unless it has an engine in it, will ever return energy to the runner. Switching to a lighter shoe on race day is the only thing shoe-related that may make you slightly faster, but not if you don’t already have the proper strength training base. Gimmicks aside, you can help your patients run faster and prevent injury, there’s just not a magical cure-all shoe to help do it. I would recommend plyometrics drills like box jumps, which you can have your patients throw in mid-run if they pass by a picnic table, and spending more time in the weight room to become a more powerful and injury-free runner.

Originally published by Jay Dicharry, MPT, SCS for MedBridge Inc.

References:

  1. Dicharry JM1, Franz JR, Della Croce U, Wilder RP, Riley PO, Kerrigan DC. “Differences in static and dynamic measures in evaluation of talonavicular mobility in gait.” J Orthop Sports Phys Ther. 2009 Aug;39(8):628-34.
  2. Ryan, MB, et al. “The effect of Three Different Levels of Footwear Stability on Pain Outcomes In Women Runners: A Randomised Control Trial.” Br J Sports Med, 2009.
  3. Richards, CE., Magin, PJ., Callister, R. “Is your Prescription of Distance Running Shoes Evidence Based?” Br J Sports Med. (43): 159-62, 2009.
 

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