Department of Family Medicine and Community Health (Drs. Sidhar and Hammer) and Department of Orthopedics and Rehabilitation (Dr. Hammer), University of Wisconsin School of Medicine and Public Health, Madison kartiksidhar@gmail.com
The authors reported no potential conflict of interest relevant to this article.
The running shoe industry offers a variety of running shoes, from minimalist shoes to cushioned stability shoes that vary based on the amount of cushioning, level of motion control, and amount of heel-to-toe drop. With so many options, new runners might wonder which shoes can reduce their risk of injury and how they should select a pair.
Stability.A characteristic of running shoes promoted by the industry is their stability: ie, their motion control. Stability shoes are marketed to runners who overpronate and therefore limit motion to prevent overpronation. The benefit of stability shoes, or stability insoles, is unclear.30 A randomized controlled trial showed that, in runners who overpronate, motion-control shoes reduced their risk of injury.31 However, another study assessed whether shoes that had been “prescribed” based on foot morphology and stride reduced the risk of injury (compared to neutral, cushioned shoes) and found no change in the incidence of soft-tissue injury.32 Given no strong evidence to suggest otherwise, runners can be advised to buy shoes based on comfort rather than on foot morphology or running stride.
Heel-to-toe drop.Another component of shoe variability is heel-to-toe drop (the height difference between heel and forefoot). A study suggests that moderate-to-high (8-12 mm) heel-to-toe drop is associated with a reduced risk of running injury.33 Barefoot running shoes, which, typically, have no heel-to-toe drop, are associated with increased risk of injury—specifically, foot stress fracture (especially in runners who are even moderately overweight).34,35
Shoe age and shoe wearcan be modified to reduce injury. There is evidence that running shoes lose approximately 50% of cushioning after 300 to 500 miles of use.36 Another study found that rotating running shoes—ideally, different types or brands—can lead to fewer running-related injuries.37
In general, patients can be counseled to use shoes that feel comfortable, as long as they replace them regularly (TABLE 2). Runners can also consider alternating pairs of different running shoes between runs. Overweight runners should avoid minimally cushioned and low heel-to-toe drop running shoes.
