Footwear, breaking the myths

Firstly many thanks for the huge response following the first blog, lets keep this momentum going.

I thought the picture above was very current, with the recent hype of using the ‘extra’ eyelet in the trainer. I will speak about other lacing techniques in a different blog.

Right let’s get started. The footwear industry is a multibillion dollar market. On twitter I am seeing questions asked about ‘what shoes should I buy?’, ‘I have a pronated foot type, what motion control shoes should I buy?’ or ‘When do I need to buy new shoes’

Before we get into footwear selection lets go through the anatomy of the sporting shoe.

People are focusing a lot more on the ‘drop’ or ‘pitch’ of the shoe especially with the barefoot, minimalist and maximalist trends, below is picture explaining how we work the ‘drop’ or ‘pitch’ out.

So to explain, stack height A is the heel height and stack height B is the forefoot height and the drop is difference between the two. Changing the drop of the shoe will affect lower limb function. For example a shoe with a lower drop will tend to aggravate an Achilles issue as it increases ankle stiffness and reduce knee stiffness (increases compliance) so may reduce knee pain. The opposite is true for a shoe with an increased drop. It is also important to remember that the gradient in which the drop reduces will be different in different sizes, for example if you look at a UK size 3 and a UK size 11 on the same trainer, the heel and forefoot height will be the same, however the size 3 has a shorter distance to reduce its height.

What are some of the current Myths?

• Foot type needs to match shoe type.
• Running shoes need to be next size up, compared to normal shoes.
• Trainers and barefoot running prevent injuries.
• I need to change my trainers every 300-500 miles.

Myth 1 – Foot type needs to match shoe type.

Currently we are still basing the running shoe we buy, on the shape of our arch / foot.

• Pronated (Flat foot) – Stability/Control shoe.
• Neutral (‘normal arch’) – Neutral shoes.
• Supinated (high arch) – Cushioned shoe.

It is often done via what is known as the ‘wet foot’ test, standing on a towel after getting out of the bath or on the sand at the beech to give the foot print. Why do people do this? People think it will prevent injuries, also it seems very simple and logical, it is simply not appropriate as misleading. 1,2 Foot typing is something we need to move away from as well, however that is a whole different blog.

Right, nice, thanks, but what do I do then?
Running shoe selection in the pain free runner, needs to be based on comfort, and not focusing on matching ‘shoe type’ and ‘foot type’ You will try on many different trainers before you find the ones that are comfortable.

There is no magic formula to picking the right shoe, it can be tricky to know where to start. A possible way if not had any professional advice is worth trying 3 different types of ‘Neutral’ and 3 different types of ‘Stability’ and 3 different types of ‘Cushioned’ trainers and find which is comfortable. I know we need to try and move away from the shoe types methods, however currently this is how they are sold.

If you are having issues finding the right shoe, always seek professional advice from your local Sports Podiatrist.

It is also important to fit the correct shoes for the correct job, you would not run a marathon in high heels (though the world record was broken for this in London this year.)

Look at the picture below, running shoes used for squash.

Look at the wear under the big toe.

This is what should have been used; notice the big toe area, which is reinforced.

It is important to remember, that it is not just a one shoe approach, when it comes to running shoes. Racing flats tend to have a smaller drop, lighter and reduced support and are used just for races to help achieve quicker times, compared to heavier training shoes. Shoes such as the Hoka’s are very popular in the Ultra marathon population, the ultra cushioning shoe helps to reduce leg stiffness, meaning people’s legs are not feeling as tied at the end of the race.

There is some thought that rotating your shoes and surface you run on will help prevent injury. With the thinking that the tissues (bone, ligaments and tendon) do not become over loaded by repetitive cyclic loading, for example it is common to see one sided injuries in track runners, who constantly train on the track running multiples of the 400m lap. It is common to see marathon runners train on road, whilst having some track and grass sessions as well.

Top Tips – Running shoe choice is very personal, not the same shoe will work for everyone, always try before you buy. I recommend not buying online, unless you are buying a 2nd pair. Once you find the shoe for you, buy multiple pairs, as when you come to replace the shoes, they will not be available and new model may not suit you. Shoe reviews are helpful, however what worked for the person reviewing the shoe, may not work for you.

Myth 2 – Running shoes need to be next size or half size up, compared to normal shoes.

Incorrect, this normally tells me, your day to day shoes are too small or running shoes too big.

This leads nicely onto the fitting of a running shoe. A colleague and mentor of mine Mr Trevor Prior, Consultant Podiatric Surgeon from Premier Podiatry, carried out a small study and found that 90% of people wear shoes that are too small. We fit children shoes well. Something happens between childhood and adulthood and we forget how to fit a shoe (may be teenage years).

Let’s have a reminder.

• There must be 1 index fingers width (1cm) between the big toe and the end of the shoe.
• Make sure feet are not bulging out the side, the widest part of the foot is from base of the big toe joint across to the base of the 5th (little toe) joint. Also assess this is standing, as the foot is wider compared to sitting.

Don’t get hung on up shoe size, different brands use different lasts, which all fit slightly differently. We treat shoe companies like bank accounts, once we found one that works, we stick with them, shoe companies know this. Also we have the UK, EU and US sizing systems in the UK and not always converted the same. For example my work shoes are a UK8, Brooks Transcends UK9, Salming Squash shoes UK8.5, Solomon Speed cross UK8.5 and they all fit me the same.

Top Tips – Ignore the shoe size, focus on the fit, Always fit your bigger foot and ask for 3 different sizes at once when in the shop trying the shoes on.

Myth 3 – Trainers and barefoot running prevent injuries.

I am yet to see any evidence that trainers or barefoot running prevents injuries. This does not mean, that in the painful running population I may recommend certain shoes. These must still pass the golden rule of comfort though. However if you are pain free, it is always wise to adapt the approach of ‘if it ain’t broke don’t fix it’

I do not want to get into the barefoot debate, for the record I am not against barefoot style of running; it is about right person at the right time, it can be very effective in off-loading certain structures. Though there is no evidence it prevents injuries. I have seen a few metatarsal stress fractures in people who have had a sudden change to barefoot running. Also just because you in run barefoot or minimalist footwear, it does not mean will always forefoot strike, I have seen runners in minimalist shoes, heel strike (again not always a bad thing)

There is some evidence to show that comfort helps reduce the risk of injuries.

Myth 4 – I need to change my trainers every 300-500 miles.

Ok, this myth is not as big as the others, as this is true for some people. There are many factors that contribute to when to change footwear.

• Weight
• Running surface
• Running style

So trying to give it a blanket approach is not ideal, however it can give you a rough idea.

A study has shown that footwear can still be functional past the 300-500 mile mark4. A common way to test the life left in a shoe is to try and compress the heel of the shoe. In new shoes this will not be easy; however in a worn shoe this will become easy. This is again has not been validated, however it is what I use in clinic, also if you pick up you shoe and push at the heel and toe end, if the trainer bends in the middle then it is time to replace.

There is no hard and fast rule on when to replace your shoes, if you are starting to pick up a few niggles and no other elements have changed, than that may be a sign the footwear needs replacing.

When you change your footwear, make a note of the mileage and that will give you a rough guide of when to change them next, providing there are no major changes in weight, running surface and style.

Orthoses and shoes

To help finish off, the last item is not a myth, however some advice regarding orthoses and shoes. Many runners use orthoses, it is important to make sure that trainers and orthoses work together. Think of them like a married couple, they have to work together to succeed. To give an example some shoes have a narrow heel, if you try and fit orthoses which are wider, the orthoses sit at an angle and not flat and can causes discomfort and changes the effect of the orthoses. This is why some people say you need to fit orthoses into ‘neutral’ and others ‘support’ shoes, it is all about the fit shoe and type of orthoses you are using.

Also the orthoses will only work as well as the shoes they are in. A common question I get asked is ‘do I have to go up a shoe size’ the answer is normally no, just remove the trainer lining and as long as the shoes fitted correct to begin with, than you should be ok.

It Is also important to remember that everyone reacts differently to orthoses and footwear, it is a very personal choice and you need to be sure they correct tool for the job.3 Think about glasses, there are different glasses for reading and different glasses for driving, orthoses are the same, work footwear and running trainers are different and the mechanics of the lower limb are different between running and walking, so some times two sets of orthoses are required.

Summary

• Footwear choice is very personal, what works for you will not necessary work for your fellow UKRunChat colleague.
• Try before you buy.
• Check the fit.
• Matching ‘foot type’ to shoe type, is dated, needs to stop and doesn’t prevent injuries
• If you use orthoses, always take them with you when buying new shoes, they have to work together.
• Comfort is key, when choosing your running shoe.
• If in doubt, seek professional advice.

UPDATE

Ok, this will throw a potential spanner in the works. Last week was the Footwear Biomechanics symposium in Liverpool, whilst I could not attend, due to the joys of social media, I was kept up to date.

There was an abstract, presented by Laurent Malisoux, from Sports Medicine Research Laboratory at the Luxembourg Institute of Health. It was a good study prospective, double blind randomised control trail (good level of evidence in research terms) looking ‘motion control’ against ‘neutral’ trainers. What they found was that injury rate was lower in people with a pronated foot posture when wearing ‘motion control’ shoes.

A word of warning this is only an abstract and not a full paper, hopefully what shoes where used will come out, however so far looks like a good paper, which may challenge our current thoughts. I will update once the full paper is released.

The advice is you still need to base you shoe selection on comfort, though if you have a pronated foot position you may benefit from a ‘motion control’ shoe, though if this is not comfortable, don’t buy it.

References

1) Ryan, M. B., Valiant, G. A., McDonald, K., & Taunton, J. E. (2010). The effect of three different levels of footwear stability on pain outcomes in women runners: a randomised control trial. British journal of sports medicine, bjsports69849.

2) Richards, C. E., Magin, P. J., & Callister, R. (2009). Is your prescription of distance running shoes evidence-based?. British journal of sports medicine, 43(3), 159-162.

3) Mills, K., Blanch, P., Chapman, A. R., McPoil, T. G., & Vicenzino, B. (2010). Foot orthoses and gait: a systematic review and meta-analysis of literature pertaining to potential mechanisms. British journal of sports medicine, 44(14), 1035-1046.

4) Bianco, R., Acquesta, F. M., Azevedo, A. P. D. S., Fraga, C. H. W., Barone, S., Mochizuki, L., … & Serrão, J. C. (2013). Kinetic responses of running shoes submitted to prolonged use: a case report. Revista Brasileira de Educação Física e Esporte, 27(4), 521-529.