Mend Physical Therapy Blog and Injury Information

Runners And Retailers Believe Its Gotta Be The Shoes, But Clinicians Not So Much

July 16, 2020


In a classic Nike commercial, Michael Jordan denies Mars’ (Spike Lee) repeated statements that it had to be the shoes. We often hear similar proclamations and claims in regards to running shoes and their ability to reduce running injury risk. Unfortunately, despite significant technological advancements in shoes the evidence has not shown an impact of shoe cushioning, heel drop, or even clinician recommendations on shoe wear based off clinical measurements. In my practice this evidence has reduced my shoe prescriptions for healthy runners, but differences can be found among shoes for injured runners.

Research has shown shoe features can impact loading at the foot and ankle, as well as, knee joints. Interestingly, shoes with greater cushioning have been associated with increased landing and knee forces, but decreased foot and ankle forces. Conversely, shoes with less cushioning have been shown to improve foot strike (heel to mid strike changes) and reduce knee forces, but increase ankle and foot forces. In my practice, these shoe choices can significantly help injured runners returning from foot and ankle or knee injuries, respectively.

Despite the available research many runners and retailers continue to prescribe shoes based off foot types (pronation vs. supination) and the belief injuries can be reduced with a specific vs. general quality running shoe. Dhillon and colleagues examined the differences between runners, retailers, and health care providers (Physical Therapists, Athletic Trainers, physicians, podiatrists) on the benefits of shoe selection on running injury risk (BMJ Open Sport Ex Med. 2020). Surveys were completed 1035 participants detailing their understanding on running shoe selection. Comparisons were then made between each groups beliefs and the available evidence guiding the answers to these questions.

Authors reported runners stated comfort, performance, and reduced injury risk were the three most common reasons behind their shoe choice. Understandably, runners also reported retailers and the internet were the most common influencers on their purchase (clinicians were a distant third). Runners also had significantly higher beliefs on shoe selection and future reduction in injury risk. Conversely, clinicians moderately disagreed that cushioned shoes decreased contact and knee forces. Both groups believed shoe changes during training could increase an athlete’s injury risk. Finally, clinicians agreed on prescribing different shoes for injury vs. healthy populations and high or low cushioning for patients with foot ankle or knee pain, respectively.

Injured runners are encouraged to work with a Physical Therapist to determine their readiness to run and shoe wear recommendations. Healthy runners should aim to select a comfortable, name brand shoe preferably from a local running store that allows them to try the shoe risk free for a limited amount of time.