RUNNING SHOES ARE HURTING YOU!!!

I have no affiliation to any shoe company, and do not receive any rewards.  I write as a doctor, trying to help others live a better life, based on experience and scientific research. 

Running shoes have significantly evolved in recent years, yet running injuries like tibial stress syndrome, compartment syndrome, plantar fasciitis, and stress fractures continue to be on the rise.  65-80% of runners suffer an injury annually, and between 1994 and 2007, running-related injuries increased by 34%.  These injuries cost the medical field over 18 billion dollars a year, and many psychosocial issues for individuals.  So why does it seem that running shoe technology and running injuries have such an inverse relationship?

The average runner applies about 3-5x of body weight force at each step.  Chances are a runner’s common path involves a hard surface like concrete, asphalt, or even treadmill...and very little natural surface (grass, dirt, and sand).  These surfaces have very little absorption properties, and the stresses are transmitted throughout the lower limb joints and back.  Image the difference between playing football on grass vs concrete!  Despite the changes in shoes, their advancement has not led to preventing injuries, rather possibly increasing problems. 



The running gait cycle begins and ends when the foot makes contact with the ground, and is divided into four phases: stance phase, early float, mid swing, and late float.  Today’s running shoes are generally loaded with cushioning, elevating the heel 8-16mm.  It is hypothesized that additional arch support and cushioning could be detrimental to overall foot and joint health. Extra support may result in decreased tissue tolerance to mechanical stress and secondarily predispose individuals to developing more injuries.   Naturally, humans are designed to strike the ground in a toe-heel fashion (toes hit the ground first), but traditional shoes have turned us into heel-toe strikers, significantly changing the foot/ankle physiology, predisposing to injury.  Also, the body is naturally leaning forward when running, which is supported by toe-heel running, and opposed during heel-toe running.



The foot is widest near the toes and slimmest at the heal.  The increased total surface area at the toes reduces focal pressures on surrounding joints and ligaments.  Think of the difference when walking on ice with snow shoes vs high-heels. 



Shoe runners tend to display excessive eversion of the heel at foot strike and this may lead to an increased rate of patella-femoral pain syndrome compared with barefoot runners.  The plantar fascia passes over and underneath the heal, making heel-toe running more likely to develop plantar fasciitis.  The heel-toe seen in running shoes leads to more vertical forces on distal joints, leading to knee, hip, and back problems.  Running toe-heel allows greater force displacement and less stress on the joints.  Furthermore, the calve muscles are contracting when running, but a heel first gait forces the calve muscles to stretch, making the ankle less stable and more prone to injury.  So in many ways traditional shoes can be counterproductive.  The extra cushioning, raised heel, and arch supports lead to significant changes in ankle kinetics, leading to injuries in multiple joints.  Orthotic devices are often rigid, which provide maximum strength and less flexibility, but can increase pressure on the bony prominences and contribute to the development of lower-extremity injuries, including stress fractures.


As discussed, barefoot running changes the ankle back to natural movement and function, reduces loading stress, and decreases risk of injury.  But to actually run barefoot today is very dangerous from puncture injuries (glasses, metal, nails, rocks, etc), and may be inappropriate is some circumstances.  Even though some find the toe shoes funny looking, they are essential in supporting barefoot running techniques while providing great protection.  If you are switching to barefoot running, do so slowly, as the lower limb has become accustomed to the maladaptive pattern set by traditional running shoes.  Without a stepwise approach, rushing into fully using barefoot running shoes can lead to injuries.  To transition, use the 10% rule and increase every week.  So the first week, run in your barefoot shoes 10% the time/distance you would normally do, and increase by 10% the next week.  Once transition has been completed, many report decreased joint and back pain, along with better posture and faster/easier running.