'What kind of shoes should I wear?'

"What kind of shoes should I wear so this doesn't happen again?"

I am consistently asked this question by patients who enjoy running. With buzzwords like shod (wearing shoes) versus barefoot running and options ranging from motion control to minimalist shoes, it is no small wonder that people feel confused and are asking this question.

In physical therapy school, we learned about the more "traditional" recommendations: motion control for the over-pronator and a flexible shoe with good shock absorption for the stiff, highly arched foot type.  We learned to watch a patient's running mechanics and examine the wear patterns of their shoes. We learned to remind them to replace running shoes every 300-500 miles. This is an oversimplification to say the least, but what we find when looking in the literature is that being placed in the correct shoe type does not necessarily correlate with lower injury rates in runners.

As a clinician, when I look at the literature, I feel like I'm a photographer looking through an out-of-focus camera lens. Rarely do studies provide black and white conclusions. More often than not, studies twist the camera lens so that something becomes slightly less fuzzy (usually at the expense of making a different part of the picture blurred). The literature regarding footwear and running mechanics is no exception. Many studies have found differences in the mechanics of the foot with barefoot versus shod running. The techniques used in these studies (eg. skin markers), however, have been suggested to lack accuracy. The end result? There is a lot to discuss and plenty of debate.

Possibly, the most helpful answer is to take a look at footwear trends. Sneakers were first mass-produced in the 1920s. The supportive sneaker gained popularity in the 1970s, claiming to decrease injury by absorbing the shock of running. The 1980s brought us the sneaker with an air bladder to further improve shock absorption. Now, here we are thirty-some years later, in the midst of the barefoot running craze. This trend was further intensified in 2009 with the publication of Born to Run: A Hidden Tribe, Superathletes, and the Greatest Race the World Has Never Seen by Christopher McDougall. Since that time, in an effort to protect the skin during barefoot running, minimalist shoes have taken off. Like many things, footwear seems to be cyclical.

Long story short, footwear is not the end-all-be-all when it comes to prevention of running injury. Here's my recommendation: be smart with your training and don't put too much stock in your shoes. It may be helpful to have someone evaluate your running mechanics, particularly if you are recovering from an injury. If you plan on increasing mileage or making a change in footwear, do it gradually. Also, remember that if you are running for two hours a day, you are spending 22 hours not running. So decrease your risk of injury by emphasizing good body mechanics and wearing appropriate footwear during the rest of your life to put your body in its optimal condition when it's time to run.

Jennifer Zellers, P.T., D.P.T., received her degree from Columbia University and is an advanced clinician at Thomas Jefferson University Hospital. 

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