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Recent research is challenging the idea that runners who overpronate or underpronate need specially fitted shoes.
For more than 30 years, runners who overpronate (roll their feet too far inward) or underpronate (don’t roll their feet far enough inward) have been told they need specially prescribed shoes for adequate support to avoid injury. However, the belief that running shoe prescription should be based on arch height has been challenged by a number of recent studies.
Mounting Research, Growing Confusion
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David Altieri, PT, DPT, OCS, CSCS, a doctor of physical therapy with Carolinas Rehabilitation, part of Carolinas HealthCare System, says most of this research has not focused on injury prevention, but rather on running kinematics (motion). For runners on the far ends of the arch spectrum, with either very high or very low arches, Altieri recommends purchasing either a cushioned or motion-control shoe. Those in the middle of the arch spectrum should have enough comfort and support from a neutral shoe.
Altieri suggests novice runners visit a specialty running store to be properly fitted.
A recent Danish study published in the British Journal of Sports Medicine included 987 healthy novice runners with varying degrees of foot pronation. The runners were all issued the same pair of neutral pronation shoes. At the one-year follow-up, researchers determined the number of injuries had no correlation to the degree of foot pronation and concluded that overpronation should not be considered a risk factor for running injury.
The researchers suggested factors like injury history, training volume and the weight of the runner were stronger indicators of injury risk.
Several other studies have shown similar findings.
A Note on the Minimalist Trend
Barefoot-style or minimalist footwear has been popular for a few years now. The concept is intriguing: that running barefoot or wearing minimalist shoes is a more “natural” way of running and can strengthen muscles that aren’t stimulated while wearing a traditional shoe. Minimalist or barefoot runners argue the type of running they do causes a shift from a heel to a mid-forefoot contact, the result of which is reduced force at contact and possibly a reduced risk of injury.
Altieri cautions against minimalist running, however, noting there is no evidence to support this supposedly reduced injury risk and says it may actually lead to an increased injury potential. Studies of runners who have switched from traditional to minimalist shoes have seen multiple foot injuries, including fractures of the heel and the long bones of the forefoot, as well as plantar fascia ruptures.
One study discovered that 35 percent of runners who made the switch to minimalist shoes continued contacting the ground with their heels (even after two years). Vertical impact forces were 40 percent higher compared to heel contact in traditional shoes.
If you do decide to opt for a minimalist shoe, don’t jump right into them. Altieri advises any runner considering a minimalist shoe to adopt a break-in period.