Shoe selection has become a topic of interest lately particularly among runners. Many sports shops offer a gait analysis service to help with the process of shoe selection with a wide variety of shoe types available. A runner will select a shoe or be advised on their selection based on the theory of extra-cushioning as a protective measure against impact forces, and anti-pronation features to prevent over-pronation or ‘flat feet’. Both influencing factors can be very misleading.
It is not how hard you hit the ground at initial contact or how hard the surface is, that causes overuse injury. It is at mid-stance when the foot is flat under the centre of mass when peak impact forces are absorbed when the risk of injury is at its highest. How the body interacts with the ground as opposed to what’s on the athlete’s feet is most important.
In order to absorb forces effectively and efficiently, certain technique changes can be made so that the leg is stiffer while in contact with the ground. A soft spongy limb will result in greater forces absorbed locally and for longer.
|Everybody pronates to some degree. Pronation itself is not a problem. It’s the speed of pronation that is the problem for many athletes. This can be influenced by hip strength and running technique.
It is important to look at hip strength first. Weak hip muscles and poor joint stability can reduce the ability to control the speed of pronation. If you can’t control your hip first, how can you then control your foot?
An athlete who runs with a cross-over step can place greater stress on the inside their shin as it attempts to absorb forces with greater degrees of movement within the ankle. This will also make the process of controlling pronation very difficult. Increasing step width can sometimes help reduce the amount of deceleration and stress in the medial shin.
Minimalist shoes and barefoot running
This is another concept that gathered great attention among the running community in recent years as a means of achieving natural mid-foot or forefoot landing based on how our ancestors used to run. Attempting to replicate ancestral practices can be dangerous given that humans nowadays have evolved and adapted to a more sedentary lifestyle.
To completely change from normal running shoes to barefoot or minimalist while replicating the same workloads can be simply too much stress due to gait alterations. Of course, there is nothing wrong with doing some short runs or drills barefoot or minimalist to improve balance (or proprioception) and train foot strength.
There can be a tendency to over-prescribe orthotics. For many athletes, this can be seen as a quick-fix measure. Unless the athlete has properly addressed their strength and movement deficits, it is like bringing your car to a mechanic to fix the wheel tracking without pumping up the flat tyres first.
Of course, if an athlete has improved their strength and running gait and still has injury issues, then there may be a legitimate case for an intervention such as orthotics. It is best to seek advice from a sports medicine physician who can then refer the athlete to a suitable sports podiatrist.
So what type of shoe is best?
This is a question many of our patients at the UPMC Sports Surgery Clinic ask us. The best advice to give an athlete is to select a shoe that is comfortable to run in. We would usually focus on strength and improving running technique first before looking elsewhere.
When assessing a runner’s gait, it is important to look at the body moving as a whole unit. The foot does not work in isolation!