• Rob

The Truth about Running Shoe Prescription

I have a passion. This passion usually involves a group of people, dressed in shirts, shorts, and a variety of multi-coloured shoes. We have a meeting place and, at a certain time, we take off like we are chasing something. You guessed it, my passion is running. I have another passion, it is learning. Whenever these two passions meet, for some reason I get excited!

The last couple of weeks on my blog, we have talked about running research. Changing your cadence/ step rate to help decrease the chance of injury. In addition, barefoot vs. shod runners, finding out that plantar fasciitis and hip injuries were much higher in shod runners compared to barefoot runners. Shod runners seemed to have more injuries, unless you take into account the mileage run by each group of runners. This showed that there was no difference in injury rates.


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This week we are going to talk about running shoes. Yes, I definitely have opinions on running shoes. I am not going to chat about that this time around. What I am going to talk about is the injury rates associated with different types of running shoes.


Before the mid to late 1980’s, there was only one basic type of running shoe; Many different brands but one basic shoe. That all changed when Nike introduced the Nike Air Max. It revolutionized the running shoe market. From there, many other running shoe companies developed their brand of running shoes. All with different bells and whistles. The running shoe companies have developed three basic types of shoes: motion-control, stability, and cushioning shoes. Each was developed for a certain type of foot.


Motion-control running shoes were made to be stiff and have very little rear foot motion. These shoes were designed for people with low arches or flat feet. It is believed, by some, that this type of running shoe will control the motion, see where they got the name, of a flat foot. In general, a flat foot has more motion than a ‘normal’ arched foot.


Cushioning shoes were made to be flexible and absorb a lot of force. This type of shoe was designed for people with high arched feet. High arched feet are very rigid and do not absorb shock well. Putting this type of foot into a cushioning shoe that absorbs the impact of running, is thought to help people with this type of foot avoid running injuries.


The stability shoe is made for the person that does not need a motion control shoe or a cushioning shoe. These people have ‘normal’ arches in the feet, not too high nor too low.


I am going to go over a study this week that compares the injury rates of people that were given the ‘correct’ shoe type for their foot vs. people that were simply given a stability shoe regardless of their foot shape. The study is called: Injury-Reduction Effectiveness of Prescribing Running Shoes on the Basis of Foot Arch Height: Summary of Military Investigations. The abstract can be found if you click on the title.


This is really interesting because it is a meta-analysis of three randomized controlled trials where military recruits were either prescribed running shoes on their foot arch height or simply given a pair of stability shoes.


This study compares the trials done in the US army, Air Force and Marines. In all three trials the experimental and control groups worked, slept, ate, trained all side-by-side during each experiment. This is about as close as you can get to a perfect experiment, where the only thing that differs in the groups are the running shoes.


The recruits feet were measured and were either assigned a motion-control, stability or cushioning shoe based on their low, medium or high foot arches, respectively. Or they were simply given a stability shoe. The groups in all three experiments were assigned randomly, if I did not already mention that. One last piece of information, there were over 7200 military recruits used in this study, just under 5000 men and about 2200 women. That is a lot of people to gather injury data from. Image source


What did they find…


The results showed that “... there was little difference between the experimental and control groups…”. This trend continued for the men and for the women.


If the specific running shoes helped to decrease injuries with specific foot types, then the model of assigning shoes to foot types is a good way to go. For example, for military recruits with low arches should have less injuries wearing motion-control shoes, than military recruits with low arches wearing stability shoes. Likewise, military recruits with high arches should have less injuries wearing cushioning shoes, than military recruits with high arches wearing stability shoes.


The studies found that the rate of injuries “... were found to be similar, even for those comparisons looking at match vs. mismatch foot and shoe types”.


“Recruits with plantar shapes indicative of low arches who wore stability shoes had injury rates that were similar to those who wore motion-control shoes. Recruits with plantar shapes indicative of high arches who wore stability shoes had injury rates similar to those who wore cushioned shoes”.


There might be a difference associated with different arch heights when the person is experiencing symptoms or if they have been previously injured.


Interesting to know that the findings “... were similar in all 3 services [Army, Air Force and Marines], showing no difference between experimental and the control groups...”.


One issue with this study and it was mentioned in the study was that there were several different brands of shoes worn by the Army recruits, while the Air Force and Marine Corp only had one pair of shoes, in each category. For example, for stability shoes the Army had 9 different shoes, the recruits could pick from if they were in the experimental group (only one if they were in the control group) and the Air Force and Marine Corps only had one shoe (each had a different shoe). It did not matter if the recruit was in the experimental or control groups in Air Force or Marine Corps, only one shoe available.


Systems that fit the running shoe to the foot type, simply do not work to decrease running injuries. Period.


What does work? How are you supposed to get a shoe that helps you run better. Get the running shoe that feels the best on your foot.

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When you go shopping for running shoes and you try on a number of pairs of running shoes and nothing really feels great. Then you put on that one pair that feels like a pair of slippers. That is the pair of running shoes to buy. If the shoes feel great and do not have any hot spots (i.e. spot that rub and can cause a blister) you have found a good pair of shoes for you. Your foot shape is as individual as you are. Just because your buddy at work likes Brand X, does not mean that Brand X will fit your feet like they fit his/her feet. You have to go out and try different brands until you find the one that you feel is the most comfortable.


As you may remember from my previous blog posts, I believe that running in the least amount of shoe that your body will allow is best. It boosts the neural input from the bottom of the foot. This causes a chain reaction up the body activating different postural reflexes and changes the way people run. Shoe companies that I really like and try to buy their shoes whenever I can are; Inov-8 and Vivobarefoot. Just because these shoes work for me, does not mean they will work for you. You have to try them out and get used to them. These two brands of shoes are very flexible, this is will cause you to have a little transition period when starting to wear then if your regular shoes are stiff. The transition is generally starting with wearing the shoe an hour a day and every second day adding another hour.


If you have any comments on running shoes, which ones you like, which ones you don’t like or any other tips on picking a pair of running shoes for yourself. Please leave a comment and we can discuss!

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