What Shoe Prevents Running Overuse Injury?
- Greg Marshall
- 1 hour ago
- 5 min read
Science, technology, and clinicians are yet to give us the clear answer.
Running is an old sport. What's interesting though, is that year over year, it's gaining in the utilization of technology and innovation.
We've seen large movements in running footwear with regard to both culture and technology, even over the last decade. Shoe designs burst into the limelight, hailed as the ultimate solution, before slowly falling back into line with the other categories of running footwear on the market. There was an era of pronation control shoes through the 1990s, which were replaced by the minimalist movement in the early 2000s. We've since moved onto tackling "maximalist" and "super" shoes with the introduction of extra-tall stack height shoes, carbon plates, and novel midsole foams.
Nevertheless, running-related overuse injuries remain a plague on the sport, sidelining some 20% of runners for at least a few days each training block. Shoe manufacturers and running retailers have worked with clinicians (podiatrists, physical therapists, etc.) to help runners and walkers alike find a footwear solution that will keep them free from injury.
With the advances in shoe design and materials science over the last decade, what should we know about footwear's injury-reducing capabilities?
It's hard to quantify reduced injury risk in a data driven way
In a research setting, it is hard to answer the question "Did this shoe reduce the risk of injury?" because it's a multi-part question. Before we can answer that question, we first need to answer three others:
Does this runner's gait make us concerned about the possibility of them becoming injured?
Does this runner's gait change when we change the shoe on their foot?
If a change occurred, did the change improve or worsen the worrisome parts of the runner's gait?
Each of these questions represents an entire field of research.
We've abandoned theories of injury reduction before
Pronation Control
Scientists fixated on pronation-- that inward collapse of the arch as we weight our leg and take a step-- in the 1970s. The proposed solution brought to market by commercial manufacturers was something called the "medial post" in which a stiffer foam was used in the portions of the shoe under that arch area, to try and reduce that inward collapse.
Those shoes went to market and eventually made it into labs for rigorous testing, before it was determined that a) the medial post wasn't doing much in terms of altering the way the foot moved, and b) pronation of the foot isn't actually a bad thing for the majority of people.
Manufacturers have continued to produce shoes with a medial post, though there's much less emphasis on these features now. The pronation control model was abandoned, and we went back to the drawing board. How can we reduce injury incidence with the shoe we put on your foot?
Impact Force Reduction
In the early 2000s, scientists and shoe producers picked up on a couple of other features of the running stride: foot strike pattern and the resulting impact forces of the foot hitting the ground. It was around this time that companies like Vibram began marketing minimalist footwear that promoted a "natural" running stride. The popular book, Born to Run, hit bookstore shelves and regaled us with tales of the Rarámuri people, who were among the best distance runners in the world despite (or perhaps as a result of, the book suggests) doing all of their running virtually barefoot.
Looking back, it's clear that the minimalist movement was driven as much by culture trends as by scientific evidence, if not even more so. By the mid-2010s, we'd come to the realizations that:
1) minimalist shoes indeed change impact forces, but that hasn't translated to reduced injury prevalence,
2) shoe cushioning is not making injury risks worse, and
3) running barefoot is not superior to running with a traditional cushioned shoe in any significant way.
If anything, the chatter was that minimalist shoes were increasing injury prevalence as people transition from supportive running footwear to unsupportive running footwear too fast for the body to adjust. That's a worthwhile topic in itself, but for another day.
Current Framework for Injury Reduction: Habitual Motion Path and Comfort Filter
The end of the minimalist movement left us with our current paradigm for injury risk, proposed in 2016 by biomechanist Benno Nigg at the University of Calgary in 2016. It has since been named the "Habitual Motion Path" paradigm, and is meant to be held in concert with the "Comfort Filter" paradigm that was postulated at the same time.
The Habitual Motion Path and Comfort Filter paradigms essentially say that the shoe should be comfortable for the runner to run in, and then it will be the best option for the runner in terms of mitigating injury risk.
It's akin to throwing our hands up, saying "whatever you think is best" to every runner who walks through the door looking for a shoe that will keep them injury-free.
I find this wholly unsatisfying. The best ideas we've got for reducing injury risk, it seems, are to provide no individualized guidance, because historically that guidance has only ever made matters worse. After 40 years of work in trying to give better injury-reducing footwear recommendations, we've not improved the situation.
The newest shoe technology still hasn't solved the problem.
Today's shoe market is dominated by thick underfoot cushions, along with the novel innovations in shoe materials and construction that we must pay a premium for.
Maximalist, or ultra-cushioning shoes, look a lot like shoes of the past decades, just taller. The construction and materials isn't all that different from the shoes we made 10, 20, or 30 years ago, though shoes have all gotten a bit lighter.
The novel innovation of the last decade is something else entirely, and that is the "super shoes" of today that include super light and springy foams along with a carbon plate for energy return. Research on these shoes is reaching a fever pitch since it was demonstrated that these shoes substantially alter the performance of runners. But performance is a different problem than injury mitigation.
Going all the way back to our three questions that we started with, science has continued to close in on some features of the running gait that might lead us to trouble. That answers the first question. We've seen that the runner indeed moves differently when we put a super shoe on their foot. That answers the second question, but that third question of whether those changes increase or decrease injury risk remains murky.
References and Further Reading
Agresta C, Giacomazzi C, Harrast M, Zendler J. Running Injury Paradigms and Their Influence on Footwear Design Features and Runner Assessment Methods: A Focused Review to Advance Evidence-Based Practice for Running Medicine Clinicians. Front Sports Act Living. 2022 Mar 9;4:815675. doi: 10.3389/fspor.2022.815675. PMID: 35356094; PMCID: PMC8959543.
Nigg BM, Baltich J, Hoerzer S, Enders H. Running shoes and running injuries: mythbusting and a proposal for two new paradigms: 'preferred movement path' and 'comfort filter'. Br J Sports Med. 2015 Oct;49(20):1290-4. doi: 10.1136/bjsports-2015-095054. Epub 2015 Jul 28. PMID: 26221015.
Bonato M, Marmondi F, Faelli EL, Pedrinelli C, Ferraris L, Filipas L. Advanced Footwear Technology in Non-Elite Runners: A Survey of Training Practices and Reported Outcomes. Sports (Basel). 2024 Dec 20;12(12):356. doi: 10.3390/sports12120356. PMID: 39728896; PMCID: PMC11679133.
Gaudette LW, Bradach MM, de Souza Junior JR, Heiderscheit B, Johnson CD, Posilkin J, Rauh MJ, Sara LK, Wasserman L, Hollander K, Tenforde AS. Clinical Application of Gait Retraining in the Injured Runner. J Clin Med. 2022 Nov 1;11(21):6497. doi: 10.3390/jcm11216497. PMID: 36362725; PMCID: PMC9655004.
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