CHAPTER 10

Considerations in the Selection of a

Running Shoe
HEATHER K. VINCENT, PHD, FACSM •
KEVIN R. VINCENT, MD, PHD, FACSM, FAAPMR

INTRODUCTION awareness, and acts as an arch to distribute mechanical

The rapid growth in the participation of running for forces during load bearing. Shoes can modulate the foot
health and competition has contributed to the exponen- actions between the body and the environment.3 There
tial demand for running shoe production and develop- are several types of running shoes:
ment. Over the past 50 years, running shoes have 1) Trainersdthe vast majority of running shoes, which
evolved from a minimal design to highly cushioned and are meant to protect the runner from the ground
supportive to light, partial minimalist shoes.1 Numerous and resist wear to last for many miles
athletic footwear companies have emerged to respond to 2) Light trainersdlightweight versions of the trainer
the demand for the range of products that fit the needs of that may help speed, and thus, shave off potentially
the growing market. Purchasing a running shoe can be seconds from race times depending on the race
very overwhelming for the typical runner; store displays distance
are flooded with shoes of different weights, designs, fea- 3) Racing flatsdbuilt strictly for speed and have the
tures, and materials and prices. Information sources for capacity to take up to 30e40 s off a 10K time
shoe selection are not often based in evidence. The con- 4) Trail shoesdhighly durable, breathable running
sumer is left either to decide for themselves which shoe shoe meant for rugged terrain
they like or to be dependent on a salesperson or other in- We will more completely analyze “trainers,” which
dividual to select for them. The challenge for clinicians comprise the majority of shoes used by consumers.
who advise patients on running shoe use is staying Key characteristics that can modify the foot interaction
abreast of the continuous updates in footwear and the with the ground include sole stiffness, sole thickness
rapidly changing scientific landscape of shoe benefits (sole thickness at heel and toe and difference between
and risks to help runners make more informed choices. the two which is termed heel-to-toe drop), structural
This chapter works to provide evidence-based tips for stability/motion control or offloading components,
helping runners select running shoes. toe box width, and shoe weight.
Sole stiffness. The lower limbs can adjust springiness
and stiffness in response to contact with different
KEY SHOE CHARACTERISTICS ON GAIT running surfaces.4 For example, when running on
The foot is an engineering marvel, as it contains 26 hard surfaces, the muscles of the leg work harder to in-
bones, interconnected with a large network of muscles crease compliance, whereas running on softer surfaces
and ligaments, tendons, and fascia.2 Clinically, the triggers increased leg stiffness.5 But wearing shoes of
most important point to remember is that running different stiffness properties can change the interaction
shoes need to be thought of as protectors of the plantar between the leg and the ground and thus the mechani-
surface of the foot from injury against the environ- cal loading on the body. Vertical peak impacts increase
mental surface, and not as replacers of muscle efforts as the shoe midsole softens, indicating that more cush-
of the foot and lower limb. Shoes should also not inter- ioning is associated with harder landings.6 Softer foot-
fere with the normal load-bearing functioning of the wear slows the exchange of momentum and increases
musculoskeletal structures of the foot. The foot senses the time duration of the impact, subjecting the runner
contact surface characteristics, has kinesthetic to higher vertical forces for a longer time.7 Higher

Clinical Care of the Runner. [Link]

Copyright © 2020 Elsevier Inc. All rights reserved. 95
96 SECTION II Biomechanics and Rehabilitation

impact forces have been linked to injuries, including secondary unintended loading effects on other areas
patellofemoral pain syndrome, stress fractures, and such as the tibiotalar joint16 and the knee.19 Rearfoot
plantar fasciitis.8 Moreover, the softer the sole of the striking also becomes more prominent with motion con-
shoe, the greater the risk for abnormal mechanics such trol features in the arch.16 Use of shoes with medial post-
as exaggerated foot pronation.9 ing or support structures restrict the natural spring
Sole thickness. The thickness of the midsole can motion of the foot arch to dissipate loading forces during
change how and how long the runner contacts the running. Restriction of arch flattening during normal
ground. The distribution of that sole thickness from un- loading also interferes with impact dampening and
der the heel and toe also changes running motion. Evi- recoverable energy strain in the elastic tissues.20 Impor-
dence shows that runners who are habituated to run tantly, the motion control features of running shoes
with minimal shoes with thin soles land on the ground can reduce the engagement of intrinsic foot muscles
more softly than runners who run partially in minimal and perpetuate foot weakening over time. Shoes that
shoes. Vertical and resultant load rates are lowest among are described as “neutral” allow the natural pronation
runners committed to minimal shoewear, but these and supination to occur during the gait cycle.
loads are increased even if a runner is habituated to a Toe box width. During different phases of the gait cycle
small amount of cushioning.10 The overall thickness from initial contact, the foot naturally transforms from a
can also increase ground contact time.11 This effect is compliant structure to a rigid lever at push-off.2 Upon
most pronounced when shoes have relatively high thick- foot contact, the mediolateral arch drops in a controlled
ness at the heel (24 mm) and a 12-mm heel-to-toe manner and widens the plantar surface of the foot to
drop compared to less thick shoes with less change in help distribute the loading across the metatarsals. At
thickness from heel to toe (0e5 mm drop).12 With midstance, both the mediolateral and longitudinal foot
respect to initial foot impact position, the foot strikes arches depress, the metatarsals splay, and the weight of
with a more plantarflexed position in shoes with mini- the body is supported by the network of intrinsic foot
mal heel-to-toe drop compared with larger drop muscles and muscles about the ankle.2 Foot morphology
values.12 This plantarflexion effect is favorable, as signif- also changes after long runs, such that ball width, girth,
icant dorsiflexion (more heel strike) at initial impact can and foot volume all increase and arch height decreases.21
be related to higher impact forces and loading rates.13 Restriction of the natural foot deformation and midfore-
Moreover, less or minimal cushioning in running shoes foot widening can (1) change the loading distribution
may facilitate ankle and foot proprioception during and forces occurring in the foot during stance and (2)
running; minimal shoes improve kinesthetic sense14 create running-related repetitive loading issues such as
and ability to sense when the foot makes contact with interdigital neuromas, metatarsalgia, bunions, and pain-
the ground. Finally, shoes with less cushioning can effec- ful toenails. Shoes with narrow toe boxes or more
tively increase intrinsic foot muscle strength.15 pointed forefoot shape increase pressures on the medial
Structural stability or motion control components. aspect of toes and forefoot22 and increase pressure and
Some commercially available shoes contain structures shear stress under the second metatarsal head.23
that modify the foot motion to help improve foot Shoe weight. The main effect of shoe weight is on
posture, provide stability, and prevent pronation during running economy, defined as the amount of oxygen
loading.9 These structures include polyurethane compo- or energy used to run at a specific work rate. Heavy
nents in the arch,9 medial posts,16 or different layers of shoes require more energy to move than light shoes.
foams of varying stiffness. Runners with obvious over- Among the various shoe types on the market, the eleva-
pronation may derive transient injury risk reduction tion in oxygen cost while wearing rocker bottomed
benefit from motion control shoes but not runners shoes during running compared with standard running
with neutral or supinated feet.9 However, most evidence shoes and minimalist shoes ranges from 4.5% to
indicates that neutral shoes can be safe for runners even 5.6%.24 Adding mass to the shoes can increase meta-
with excessive pronation.17 Other designs include lateral bolic rate by 1.11% for every 100 g of shoe, and the en-
wedges that are crafted to change knee alignment and ergy cost increases proportionate to the weight.25 This is
lessen medial knee forces.18 Wedges or thick shoe inserts problematic for competitive runners since the extra
in theory do offload the knee. However, from the clinical weight degrades distance running performance during
perspective, there is a mechanical trade-off of changing a time trial event. Commercial shoes are not adjusted
natural foot motion with extra structures in the shoe. for a runner’s body weight; thus, heavier shoes exert a
One must consider that changing the pronation and greater relative metabolic effect in runners of smaller
foot eversion with motion control shoes may create body weight.25 Over the course of a long distance event,
 CHAPTER 10 Considerations in the Selection of a Running Shoe 97

lighter shoes may confer energy savings and protect runner may have different brand preferences, but if
against muscle damage compared with heavy shoes. they can find a couple models that have these character-
istics, this would be preferable. Rotating among a couple
different pairs may also provide sensorial challenges for
COUNSELING RUNNERS ON RUNNING the runner and prolong the life of each pair.
SHOE CHOICE There are clinical conditions that may require
For most runners, common goals are running longevity specialized running shoes. For example, rocker bottom
and injury prevention. Generally, light shoes that support shoes can be useful under certain conditions where
development of strong durable feet can help runners minimization of plantar pressures is clinically impor-
attain these goals. Table 10.1 provides features of running tant. The design of these shoes causes a simultaneous
shoes that are most likely to complement normal foot rolling phenomenon along the plantar surface while
motion and conserve energy. Many manufacturers will increasing ankle rotation.26 The net result is a reduction
sell a model of shoe that contains the following charac- in vertical impact energy and elevation of rotational en-
teristics: light weight, neutral, low or no heel-to-toe ergy, both of which reduce plantar force during loading.
drop, moderate to minimal cushioning, low heel height, Medial forefoot plantar pressure can be reduced by 11%
wide toe box, and flexible but resilient midsoles. Each e12% by rocker bottom shoes.27 Runners with reduced
range of motion at the first metatarsophalangeal joint,
TABLE 10.1
sesamoiditis, metatarsalgia, or early forefoot overload
General Features of Running Shoes That Support may benefit from a shoe with a rocker bottom design.
Healthy Foot Motion During Running Over the
Long Term. HOW AND WHEN TO PURCHASE A RUNNING
Characteristic How to Determine SHOE
Common practice in commercial sales is to ask the run-
Lower 24 mm height, Found on shoe
ner to walk on a treadmill or walk on a track in the store
sole true manufacturer
thickness minimal 6 mm specifications to help them find the right shoe. This is neither helpful
nor necessary to purchase a good running shoe. Com-
Low heel- 6 mm Found on shoe
parison of walking mechanics to running mechanics is
to-toe manufacturer
drop specifications
quite different and should not be the gauge by which
a shoe is purchased and likely results in recommenda-
Neutral No thick arch Look in product tions of stability or motion control shoes and orthotics
design cushioning description for
to “control excessive pronation.” When purchasing
necessary; no “neutral shoe.”
stability or motion Look at shoe sole
running shoes, the foot size of both feet should be
control for layers or blocks measured to account for interindividual variations in
components of color. Compress foot dimensions. If there is substantial foot size differ-
needed the shoe sole on the ence, the runner may need to have two different shoe
color block, and see sizes. Importantly, shoes that may have been fitted
if the medial side is well in the morning no longer feel comfortable later
stiff compared with in the day. Thus, the time to purchase shoes is during
rest of sole the later afternoon or early evening, a time by which
Wide toe The metatarsals of Wear shoe and any changes in foot volume have occurred.
box foot should be able stand in it. Be sure
to fully splay; toes that even with full
should be weight bearing that COUNSELING RUNNERS ON SAFELY
completely spaced the toes can fully TRANSITIONING TO MINIMAL SHOES
apart with ½ inch of wiggle and the toes Some runners will present to clinic desiring to transition
space from the big can curl up to a lighter shoe or minimal shoe to achieve a more
toe to the shoe “natural” running motion with less emphasis on heel
cover
strike.1 Minimal shoes are defined as footwear
Light shoe <10 oz men, < 9 oz Found on shoe providing minimal interference with the natural move-
weight women manufacturer ment of the foot due to its high flexibility, low heel to
specifications toe drop, weight and stack height, and the absence of
motion control and stability devices. Cautioning the
98 SECTION II Biomechanics and Rehabilitation

patient that simply donning minimal shoes will not be there are practical guidelines that can be surmised from
enough to induce the purported changes to become a biomechanical data on shoewear and foot strike patterns
mid to forefoot strike runner.12,28 Injuries can be miti- of runners. Thus, advising patients on selecting a running
gated if appropriate planning occurs to allow the foot shoe can be simplified by focusing on a few key character-
and ankle to adapt to the greater mechanical and ener- istics: light weight, neutral, low or no heel-to-toe drop,
getic demands1 in minimal shoes. Specifically, changing moderate to minimal cushioning, low heel height, wide
shoes alone from standard cushioned shoes to mini- toe box, and flexible but resilient midsoles. Rotate among
malist shoes in runners accustomed to rearfoot striking a couple different pairs, and avoid off-the-shelf orthotics
acutely increased peak vertical impact forces and rate of or trendy gimmicks. The bottom line is that the shoe
force loading despite more knee flexion.29 During needs to protect the foot, not do the work for the foot,
fatiguing long runs, plantar pressures increase at the and not change foot function or mechanics.
forefoot with acute use of minimal shoes in unaccus-
tomed runners.30 Thus, an abrupt switch to minimal
shoes is ill-advised. Some runners may fear the risk of
REFERENCES
injury with switching31 and need guidance on how to
1. Davis IS. The re-emergence of the minimal running shoe.
safely make the transition to a less cushioned shoe. J Orthop Sport Phys Ther. 2014;44(10):775e784. https://
While evidence is limited to indicate which type of tran- [Link]/10.2519/jospt.2014.5521.
sition is ideal, there are two general approaches that can be 2. Duerinck S, Hagman F, Jonkers I, Van Roy P, Vaes P. Fore-
used to counsel runners with safe shoe transition. First, foot deformation during stance: does the forefoot collapse
gradual exposure to minimal footwear into the running during loading? Gait Posture. 2014;39(1):40e47. https://
program over a period of weeks or using a “transition [Link]/10.1016/[Link].2013.05.021.
shoe” (heel-to-toe drop of 6e12 mm) prior to the use of 3. Kelly LA, Lichtwark GA, Farris DJ, Cresswell A. Shoes alter
a minimal model32 with no reduction in training mileage the spring-like function of the human foot during running.
J R Soc Interface. 2016;13(119). [Link]
can be used. Second, a significant reduction in running
rsif.2016.0174.
volume (similar to that of a return-to-run program for
4. Ferris DP, Louie M, Farley CT. Running in the real world:
stress fracture) using the new minimal shoe and gradual adjusting leg stiffness for different surfaces. Proc Biol Sci.
progression in mileage over time is another approach. 1998;265(1400):989e994. [Link]
Wearing the new minimalist shoe for a period of time rspb.1998.0388.
during the day can even increase foot and leg muscle vol- 5. Bishop M, Fiolkowski P, Conrad B, Brunt D, Horodyski M.
ume and help prepare individual for running in these Athletic footwear, leg stiffness, and running kinematics.
shoes.33 Both techniques can reduce the risk for injuries J Athl Train. 2006;41(4):387e392.
related to abrupt shoe changes and allow the musculo- 6. Baltich J, Maurer C, Nigg BM. Increased vertical impact
skeletal system time to remodel to the new mechanical forces and altered running mechanics with softer midsole
shoes. PLoS One. 2015;10(4):e0125196. [Link]
loading. Moreover, different approaches can meet the
10.1371/[Link].0125196.
needs of runners with different short- and long-term goals
7. Addison BJ, Lieberman DE. Tradeoffs between impact
and time frames to accomplish the transition. It is impor- loading rate, vertical impulse and effective mass for
tant to note that accompanying changes in technique walkers and heel strike runners wearing footwear of vary-
(“soft” landings, shorter lighter steps, quiet foot strikes) ing stiffness. J Biomech. 2015;48(7):1318e1324. https://
are important to promote healthy running motion in [Link]/10.1016/[Link].2015.01.029.
minimal shoes. Strength and endurance is required to 8. Willson JD, Bjorhus JS, Williams DSB, Butler RJ, Porcari JP,
maintain good running form and soft landings to avoid Kernozek TW. Short-term changes in running mechanics
the eventual increase in heel forces,34 longer ground con- and foot strike pattern after introduction to minimalistic
tact times,35 and reduction in leg stiffness36 that happen footwear. Pharm Manag PM R. 2014;6(1):34e43. https://
[Link]/10.1016/[Link].2013.08.602. quiz 43.
with long distance running.30 Even among highly trained
9. Malisoux L, Chambon N, Delattre N, Gueguen N,
elite runners, it is recommended to make gradual transi-
Urhausen A, Theisen D. Injury risk in runners using stan-
tions during different seasons to prevent injury from min- dard or motion control shoes: a randomised controlled
imal racing flats during competitive periods.37 trial with participant and assessor blinding. Br J Sports
Med. 2016;50(8):481e487. [Link]
bjsports-2015-095031.
SUMMARY 10. Rice HM, Jamison ST, Davis IS. Footwear matters: influ-
Although there are many factors that go into choosing the ence of footwear and foot strike on load rates during
best running shoe for an individual runner, and definitive running. Med Sci Sport Exerc. 2016;48(12):2462e2468.
data are lacking to steer every runner to one shoe type, [Link]
 CHAPTER 10 Considerations in the Selection of a Running Shoe 99

11. Chambon N, Delattre N, Guéguen N, Berton E, Rao G. Is running economy. J Sci Med Sport. 2014;17(3):312e316.
midsole thickness a key parameter for the running [Link]
pattern? Gait Posture. 2014;40(1):58e63. [Link] 25. Hoogkamer W, Kipp S, Spiering BA, Kram R. Altered running
10.1016/[Link].2014.02.005. economy directly translates to altered distance-running
12. TenBroek TM, Rodrigues PA, Frederick EC, Hamill J. performance. Med Sci Sport Exerc. 2016;48(11):2175e2180.
Midsole thickness affects running patterns in habitual rear- [Link]
foot strikers during a sustained run. J Appl Biomech. 2014; 26. Lin S-Y, Su P-F, Chung C-H, Hsia C-C, Chang C-H. Stiff-
30(4):521e528. [Link] ness effects in rocker-soled shoes: biomechanical
13. Esculier J-F, Dubois B, Bouyer LJ, McFadyen BJ, Roy J-S. implications. PLoS One. 2017;12(1):e0169151. https://
Footwear characteristics are related to running mechanics [Link]/10.1371/[Link].0169151.
in runners with patellofemoral pain. Gait Posture. 2017;54: 27. Sobhani S, van den Heuvel E, Bredeweg S, et al. Effect of
144e147. [Link] rocker shoes on plantar pressure pattern in healthy female
14. Squadrone R, Gallozzi C. Effect of a five-toed minimal pro- runners. Gait Posture. 2014;39(3):920e925. https://
tection shoe on static and dynamic ankle position sense. [Link]/10.1016/[Link].2013.12.003.
J Sports Med Phys Fitness. 2011;51(3):401e408. 28. Tam N, Darragh IAJ, Divekar NV, Lamberts RP. Habitual
15. Ridge ST, Olsen MT, Bruening DA, et al. Walking in mini- minimalist shod running biomechanics and the acute
malist shoes is effective for strengthening foot muscles. response to running barefoot. Int J Sports Med. 2017;
Med Sci Sport Exerc. August 2018. [Link] 38(10):770e775. [Link]
10.1249/MSS.0000000000001751. 114863.
16. Peltz CD, Haladik JA, Hoffman SE, et al. Effects of footwear 29. Willy RW, Davis IS. Kinematic and kinetic comparison of
on three-dimensional tibiotalar and subtalar joint motion running in standard and minimalist shoes. Med Sci Sport
during running. J Biomech. 2014;47(11):2647e2653. Exerc. 2014;46(2):318e323. [Link]
[Link] MSS.0b013e3182a595d2.
17. Nielsen RO, Buist I, Parner ET, et al. Foot pronation is not 30. Lussiana T, Hébert-Losier K, Millet GP, Mourot L. Biome-
associated with increased injury risk in novice runners chanical changes during a 50-minute run in different foot-
wearing a neutral shoe: a 1-year prospective cohort wear and on various slopes. J Appl Biomech. 2016;32(1):
study. Br J Sports Med. 2014;48(6):440e447. https:// 40e49. [Link]
[Link]/10.1136/bjsports-2013-092202. 31. Rothschild CE. Primitive running: a survey analysis of run-
18. Lewinson RT, Fukuchi CA, Worobets JT, Stefanyshyn DJ. ners’ interest, participation, and implementation.
The effects of wedged footwear on lower limb frontal J Strength Cond Res. 2012;26(8):2021e2026. https://
plane biomechanics during running. Clin J Sport Med Off [Link]/10.1519/JSC.0b013e31823a3c54.
J Can Acad Sport Med. 2013;23(3):208e215. https:// 32. da Silva Azevedo AP, Mezêncio B, Valvassori R,
[Link]/10.1097/JSM.0b013e31826b7c83. Mochizuki L, Amadio AC, Serrão JC. Does “transition
19. Lilley K, Stiles V, Dixon S. The influence of motion control shoe” promote an intermediate biomechanical condition
shoes on the running gait of mature and young females. compared to running in conventional shoe and in reduced
Gait Posture. 2013;37(3):331e335. [Link] protection condition? Gait Posture. 2016;46:142e146.
10.1016/[Link].2012.07.026. [Link]
20. McKeon PO, Hertel J, Bramble D, Davis I. The foot core 33. Chen TL-W, Sze LKY, Davis IS, Cheung RTH. Effects of
system: a new paradigm for understanding intrinsic foot training in minimalist shoes on the intrinsic and extrinsic
muscle function. Br J Sports Med. 2015;49(5):290. foot muscle volume. Clin Biomech Bristol Avon. 2016;36:
[Link] 8e13. [Link]
21. Mei Q, Gu Y, Sun D, Fernandez J. How foot morphology 34. Larson P, Higgins E, Kaminski J, et al. Foot strike patterns
changes influence shoe comfort and plantar pressure of recreational and sub-elite runners in a long-distance
before and after long distance running? Acta Bioeng Bio- road race. J Sport Sci. 2011;29(15):1665e1673. https://
mech. 2018;20(2):179e186. [Link]/10.1080/02640414.2011.610347.
22. Branthwaite H, Chockalingam N, Greenhalgh A. The effect 35. Willems TM, De Ridder R, Roosen P. The effect of a long-
of shoe toe box shape and volume on forefoot interdigital distance run on plantar pressure distribution during
and plantar pressures in healthy females. J Foot Ankle Res. running. Gait Posture. 2012;35(3):405e409. https://
2013;6:28. [Link] [Link]/10.1016/[Link].2011.10.362.
23. Kase R, Amemiya A, Okonogi R, et al. Examination of the 36. Dutto DJ, Smith GA. Changes in spring-mass characteris-
effect of suitable size of shoes under the second metatarsal tics during treadmill running to exhaustion. Med Sci Sport
head and width of shoes under the fifth metatarsal head Exerc. 2002;34(8):1324e1331.
for the prevention of callus formation in healthy young 37. Logan S, Hunter I, Hopkins JT JT, Feland JB, Parcell AC.
women. Sensors. 2018;18(10). [Link] Ground reaction force differences between running shoes,
s18103269. racing flats, and distance spikes in runners. J Sport Sci Med.
24. Sobhani S, Bredeweg S, Dekker R, et al. Rocker shoe, mini- 2010;9(1):147e153.
malist shoe, and standard running shoe: a comparison of