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Evolution of the running shoe: evidence & opinion

Forty years ago there was only one running shoe designed for long distance running. Itwas a black canvas shoe shaped like a track spike shoe with a gum rubber outsole andConverse was the manufacturer. Now there is a veritable plethora of running shoes tochoose from.

Ten years ago I wrote an article highlighting the fact that despite the progression ofresearch and development and improvements of the modern running shoe, there was nochange in the frequency and type of running injuries between 1967 and 1997. In 2006,there continues to be a similar frequency and type of running injuries that there were in1967. This observation suggests that the modern running shoe has little effect onpreventing injury.

Many articles published by experts tout the belief that shoe selection is importantcomponent of preventing running injury. It should be noted the articles purporting thisbelief do not reference case studies or controlled clinical trials.

Retrospective case studies are available which demonstrate a running injury that wasalleviated by switching to a different running shoe.

B.R. Wilk (2000) published a case study demonstrating that a triathlete developed plantarfasciitis as a result of running in a defective running shoe. The shoe construction defectwas a heel counter that was glued into the shoe at an inward leaning angle resulting in agreater medial tilt of the heel counter compared to the other shoe.

A. Cunningham (2004) reported successfully treating two runners with lower leg pain bymodifying their running style from a heel strike to a mid-foot strike. This wasaccomplished by training on a treadmill while running barefoot and when runningoutside, switching footwear from standard running shoe to a running shoe with thinnerharder soles.

Michael Gross (2006) published a case study documenting that a running shoe designedwith a heel flare contributed to shin pain. Using motion and force plate analysis, he wasable to conclude that shoes with a heel flare lead to greater stress to the anterior shinmuscles. When the patient switched to a shoe without a heel flare, she was able toalleviate the shin pain.

Retrospective studies are important but prospective studies are more convincing, andthere are no prospective studies demonstrating that selecting a particular running shoedesign decreases the incidence of developing an injury.

Defective shoes:
When shopping, examine the shoes closely looking for differences between the right andleft shoe. The shoes should be symmetrical. Place the shoes on level surface and checkorientation and alignment. Lightly tap each shoe to create a rocking motion. The tapshould result in a similar rocking motion. If the rocking motion is asymmetrical, itsuggests that one shoe is deformed relative to the other. Push and poke the air bladdersand mid soles. Look for extra bits of glue or stitching. Tug on the seam between theupper and the sole to see if it separates. Once purchased, this type of examination shouldbe done periodically to determine if the shoes should be retired.

Recently I evaluated an injured runner’s shoes. Both the right and left shoe were markeda size 9, but when the soles were matched up it was obvious one was at least a 1/8”longer than the other. Fortunately, one of the things that has changed in the last 40 yearsis that the quality control of shoe manufacturing has improved. However, there continuesto be the infrequent “lemon” which passes through quality control and invariably this willcontribute to an injury.

In the sixties, shoe manufacturers did not distinguish between male and female. Shoescame in various lengths but there was only a D width was available, except for NewBalance which has consistently made various shoe widths available. After the firstWomen’s Olympic marathon in 1984, shoe manufactures starting providing female shoesin a B width. Only recently have some shoe manufactures started providing 3 differentwidths. If you have a wide or narrow foot it is important to recognize that shoes ofvarying widths are available, and depending on where you shop for shoes, you may haveto actually request shoes of an uncommon width.

Running shoes are rarely the sole cause of an injury and equally rarely are they apanacea. When selecting a running shoe, the factors a runner has the most control overare: choosing where to buy the shoe, choosing which sales person to ask for assistance,making sure to get the proper fit and size and avoiding defective shoes.


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