Active Voice: Running Shoes & Foot Type – Is There a Good Match?
By Rudy Dressendorfer, P.T., Ph.D., FACSM

Viewpoints presented in SMB commentaries reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM.

Rudy Dressendorfer, P.T., Ph.D., FACSM is an accomplished scientist, educator and clinician with a career focused on clinical exercise physiology. He is an ACSM Program Director and has served on ACSM’s certification and education committee. He retired as full professor of human performance and sport at New Mexico Highlands University and subsequently taught exercise physiology and did collaborative research with faculty at the University of Alberta in Canada. Currently, he practices sports medicine as a licensed physical therapist in California. Rudy has published extensively on physical conditions, injuries and related prevention strategies for endurance athletes. He also has direct experiences with these issues, as he is a highly successful amateur triathlete.

Running shoes are customized for foot arch posture and marketed with reference to poorly defined foot types. In running-specialty stores, a “shoe technician” will often visually assess foot type while the runner stands and walks in socks or barefooted. Also, the runner’s training shoes are usually inspected for signs of excessive wear on the medial or lateral side.

The foot type is categorized neutral if the medial longitudinal arch appears normal, overpronated if it is much lower than normal (shoes show more medial wear) or oversupinated if higher than normal (shoes show more lateral wear). A shoe type is then recommended to match the observed foot type: a neutral shoe for a normal foot, a motion-control shoe for an overpronated foot and a high-cushion stability shoe for an oversupinated foot.

Despite troubling evidence, this quasi-prescriptive method is supposed to help prevent or manage running-related injuries.

Risk of Running-Related Injury & Foot Type

In theory, certain postural deficits of the foot could contribute to lower extremity injuries in runners. The overpronated foot is hypermobile, and the associated greater rearfoot motion can increase internal rotation of the tibia. Consequently, the increased medial plantar pressure in runners who overpronate may predispose them to develop certain leg problems such as Achilles tendinitis, tibial stress syndrome, posterior tibialis tendonitis and patellofemoral pain. In contrast, the rigid supinated foot has reduced ability to absorb ground impact forces at foot plant. The oversupinator is likely to develop iliotibial band friction syndrome, peroneus tendonitis, trochanteric bursitis, plantar fasciitis and stress fractures.

However, a few prospective studies have shown that runners who wore the shoe type to match their foot type in training did not benefit from less leg pain or have a lower incidence of injury. Ironically, in one study, the runners reported more pain wearing the assigned shoes compared to when they wore shoes not typically recommended for their foot type.

Yet, biomechanical studies indicate that motion control shoes may effectively reduce excessive rearfoot mobility and tibial internal rotation in overpronators and that cushioned shoes may reduce tibial shock in runners with high, rigid arches. Regardless of foot type, the addition of cushioning materials to shoes does help attenuate foot shock. For example, marathon runners who wore midsole-cushioned shoes during over-distance training showed less running-related breakdown of red blood cells, which may occur in the feet, than runners whose shoes provided minimal cushioning.

Precautions
  • In overpronators, the static foot type (standing) usually appears more abnormal than the functional foot type (walking or running barefoot).
  • Stride mechanics may change according to the shoe type worn.
  • It’s a good idea to replace worn-out running shoes. However, if the new shoes are not the same type, they may alter the runner’s stride mechanics and thus not necessarily lower the risk of injury.
  • When switching shoe type, a short trial at home followed by self-evaluation for leg or foot pain may help prevent a running-related injury from developing or worsening.
  • Standard running shoes change the stride mechanics of experienced barefoot runners.