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Advice from Dr. Greenapple
On a daily basis, the two most common questions I get asked in the office are, "When can I run/workout again?", and "What is the best running shoe to avoid injuries?"  I will skip the first question and target this article to the second one.   So, which shoes are the best to run in?
 
Unfortunately, I do not have the answer for you.  The reason is simple and the key word is YOU. As with everything I see in the office, there are multifactorial issues and reasons for injuries, proper footwear, training, and "proper form" for running.  I will try and give you a little personal history and my theories on footwear and running.
 
When I first moved to Charlotte in 1996 after practicing in California for ten years, there was one running store.  They had a relationship with a podiatrist and I found out that a large percentage of the runners were getting running shoes and then being fit for orthotics.  I was a little surprised at the amount of "motion control" many runners had in their shoes.  Just about every injury from plantar fascia to ITB was "fixed" with an orthotic or a motion control shoe.  My opinion was quite different on what to do for these maladies.  Besides different approaches to treatments, I was putting people in Nike Frees or very neutral shoes with the idea of strengthening the foot, not casting it in a hard orthotic.  Of course, this did not go over well and the idea did not make sense to many.  I then received the name and title of "anti-orthotic."  I found this interesting because I was also casting people and making orthotics.  The difference is some need support and some need strengthening; the important thing is looking at everyone and every case as an individual.
 
Fast forward to 2009 and the book Born To Run by Christopher McDougall came out (a great read for those who have not read it yet). With the book and some "pseudo-science," the revolution of minimalist running shoes was just about born.  People were doing minimalist running and using things like barefoot running to strengthen their feet and improve their running stride, myself included though long before the book came out.  Unfortunately, like many "new concepts," people jumped on board as if this was the panacea for performance and injury prevention.  Even though the book was a fun read, Chris McDougall did a large disservice and made some large assumptions in my opinion.  He searched out a group of Mexican Indians from the Tarahumara tribe in Copper Canyon who were known for the "super human" ways of running long distance and searched for some of the reasons for their success.  They ran in homemade sandals for hundreds of miles and seemed to be injury free.  If that worked for them, it must be right for all of us.  So, drop the heel of your running shoe from a 12mm toe-to-heel difference and all should be good, correct?  Well, not so fast. Perhaps they had some genetic help.  Perhaps the fact that they and their ancestors have been doing this for hundreds of years played a role.  Perhaps, perhaps, perhaps. 
 
Let's look at the geometry of the running shoe.  Since we always were told and thought that heel strike was the way to walk and run, the shoe industry beefed up the heels of the shoe with lots of cushion, springs, gels, shocks, and so forth to reduce impact in hopes to prevent injury.  They used a 12mm difference between the forefoot of the shoe and the heel. Along came information that we should be landing more on the forefoot and toe area, and followed by McDougall's idea of running in sandals like the Tarahumara people, a whole host of running shoes were born.  These shoes range from having a zero drop to an 8mm drop to a 4mm drop, and from built-in lugs to help you run forefoot to shoes with roll bars to push you forward.  Where there is a fad and some hopeful science there is a way to sell a product, especially if it promises you to become faster and injury free.  Saucony has made a video promoting their "Geometry of Strong," which reduces 33% of the traditional heel drop to 8mm, so runners can "easily adjust their stride and land further forward, without reducing cushioning or stability." The change also claims to set runners up "so the ankles, calves, knees, quads, and hamstrings are in a better position to take the impact of striking the ground," and create "a more spring-like position, that lets the runner coil and rebound, allowing them to feel faster..."  Key word, feel!
 
Let's look at the science behind. There are studies out there that confirm stability shoes increase forces to joints at the ankle, hip, and knee. I have personally seen on force plates tested with runners that cushion shoes actually make you land harder looking for the solid ground beneath.  For many years we have looked at pronation and all the "bad" it does to foot strike and midstance.  However, correlating this to injury and prevention, well, the science is not so strong.  Personally my belief is still that strengthening the foot with methods such as minimalist running and pseudo barefoot drills can aid in "correcting" poor mechanics.  Video gait analysis has been a great tool in figuring this out, along with lots of research.
 
Now comes the caveat.  We still have to look at the runner as an individual and figure out what is best for them, instead of what looks good in the research of the shoe (mostly done by the company who made the shoe).  Here is a great example.  I had a new patient last week who is a very good triathlete.  He had what is called an accessory navicular bone in his foot.  The navicular bone is on the bottom of the foot where a muscle in the shin attaches and is known as the key stone of the arch.  Due to the fact that this athlete has an "extra" navicular bone, the angle and attachment of his muscle is different, causing his arch to fall and him to pronate.  Would a minimalist shoe help strengthen his foot? No!  He needs support with a shoe and possible orthotic.  In fact, surgery may also be indicated, although not necessary in this case.
 
Let's talk about another fad: the maximalist shoe.  A cushioned shoe, big, kind of bulky but light weight with a minimalist drop of 6 or 8mm.  We will see how this interesting concept takes hold in the industry.  In the meantime, if you want to run in a minimalist type of shoe, I have a few recommendations.  First of all, start with an 8mm-drop and work your way lower if you choose.  Most of us have run in 12mm all of our lives and it takes time to adapt.  Secondly, do some foot strengthening exercises.  Look at previous articles on foot strengthening or go to my web site to see a video on "big toe" flexor hallicus brevis strengthening exercise.  Go to a running store where they will watch you run and comment on your foot strike.  Go to a sports doctor who understands gait and biomechanics.  Try many different shoes and see how they feel.  This will take time and money.  But, you PERHAPS will be less injured and PERHAPS FEEL faster.  Below is a picture of what I am currently running in. The only one missing is the Hokka. I have run in them once, but they hurt my ankle and I have returned them.  Bad shoe? No, just not for me. Good luck and as always, enjoy that run!

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