How to Choose the Right Athletic Shoes Q&A

What are some of the common foot injuries among athletes?

There is a common denominator for most common problems and that is shock absorption. You have X amount of shock that your foot sees when you’re involved in athletics, particularly the runners. It has to be absorbed somewhere, so it’s absorbed initially in the shoe wear, into the foot and up the foot, up the leg until that energy is absorbed. So most of the injuries that we see have to do with shock absorption, certainly in the runners population. Plantar fasciitis is real common, stress fractures are real common, shin splints are real common, Achilles tendonitis are real common and those all relate to repetitive stress over a period of time where the foot doesn’t handle it well and then starts to break down in some form or fashion.

What can an athlete do to ensure himself or herself against this?

One of the things that actually got me interested in runners injuries and shock absorption was initial work we did in the early 1980’s with running shoes. If we could maximize the amount of stress the shoe could absorb before the person’s foot ever felt that shock, then we could diminish the number or certainly the incidents of injuries that, that individual saw during a course, during their training. I think what we proved in the mid 1980’s and subsequently published and presented at some national meetings was that about sixty to seventy percent of the shock absorption characteristics of the shoe was gone at about between two hundred and fifty and five hundred miles. I think once that dawned on everybody, the shoe manufacturers went back and re-looked at the types of materials they were putting in the guts of the shoe, as it were, to absorb shock. Where actually they are pretty uniform now across the board and all manufacturers.

What should you look for then when you’re buying a shoe?

There are a lot of things to consider when you buy a pair of shoes, but the most important thing is to be comfortable with the way it fits. For a running shoe if it’s not comfortable when you first put your foot on it and stand on it and walk around on it in the shop, it’s certainly not going to be any better when you start logging miles on it. So that’s a certain thing. I realize there’s faddish, stylish concerns, but I think the mid sole or the part that’s actually absorbing all the shock that feels right particularly. I think these have become better and better since the 1980’s and now you have the little gel cushions that are built in some shoes. Some reworked the polyurethane to where it’s a better shock absorber. One particular shoe that has a little air bladder in it that maintains its resiliency with multiple usage of it. So I think that’s not really a concern now. I think a lot has been said about the different types of surfaces, it’s probably not that terribly important. I think the biggest mistake that I see people who go into a particular place to buy a shoe for a runner is that pronation, or flat footedness is bad. If I could put out a message then I would say to all runners in a short message that pronation is not bad, it’s functional. It’s the way your body absorbs a lot of the shock. Now if you pronate too much, if you’re too flat footed then it will break down. But for instance if you are high arched to begin with and you go get a shoe that constrains your foot further then that shock is going to go somewhere else, and it’s just going to go above the foot and ankle up into the knee and you end up with a knee cap tendonitis which is the most common scenario. So, the point of the message is pronation is not necessarily bad and you need to know whether you have a flat foot or a high arch. High arched individuals don’t handle shock very well. The reverse is true of someone who is very flat footed.

A high arched person needs a strong shock absorber in their shoe?

They do and they need a shoe that’s less restrictive, one that bends fairly easily that doesn’t have the big build up on the medial side with the big arch support in it and the flap that over. With a lot of the training shoes have the little Velcro pieces that come over the top that actually pull the medial side of the shoe over so that it jacks up, if you will, the medial arch.

How does a shoe need to bend?

You need a shoe that’s fairly flexible. If you can consider the high arched individual with a relatively rigid foot, then you don’t want to put it in a rigid shoe. You want it in a shoe that bends fairly easily, that’s fairly malleable. Or somebody who has got a real flexible foot that is flat footed, you want them in a more rigid shoe. That’s kind of a rule of thumb, if you will, for people in picking what kind of shoe. Typically most of the press has a big to do about over pronation and having the different types of engineering in their shoe that prevents pronation, so that the lay public unknowingly will go in and get a shoe they really don’t need and that’s not best for their foot.

The rule of thumb is if you’re flat footed, you have a flexible foot, you need a more rigid shoe. Where as if you’re high arched and you have a rigid foot you need a more flexible shoe. Much in the same if you are high arched and have a rigid foot then you need something that is more straight in line. If you look at the shoes from below and it’s more in a straight line, then that’s the kind of shoe you need to fit. If you’re flat footed, you need something that will make yourself simulate having an arch and that has a little bit more of a curve to it. So those are a few of just general tips about purchasing shoes that help you mechanically absorb shock better. That’s, in essence, what we do as physicians, whether it’s orthotics. Put the position where it works mechanically best to handle those types of shocks that they see when they run and hence minimize their energy.

What about wearing shoes that aren’t for your sport. Can you wear running shoes to walk in? Can you wear running shoes to play tennis in?

Again it depends on what type of foot. As a general rule there are as many different types of shoes as there are sports. Bicyclists use a totally different shoe than you would say if you were going to play tennis. As a general rule the running type activities, be it tennis, the raquet type sports, or be it out on the road and road running, there’s not that big of variation that mandates you buying two separate shoes for those two different types of activities.

How many tons do we put on our feet just walking and running?

There’s been some mechanical testing that measured the actual pressure in terms of foot pounds. It’s pretty well accepted now, just say a one mile walk for the average male that say is a hundred and fifty pounds. It is equivalent to about for that individual shoe and foot seeing about sixty tons of pressure per mile. If you run at a pretty leisurely pace it’s greater because you’re vaulting into the air and then coming back down on your heel, then it’s a little over a hundred tons. So you are talking about tremendous forces that an individual sees over a period of time with running. Most of my patients that are serious runners run between forty and fifty miles a week on the average.

Is there anything else that we need to mention?

We get caught up in the gimmicks and the better shoes are not necessarily the most expensive. If you get a shoe that fits well, feels comfortable, the mid sole construction, there’s not that much variation in it nowadays. I think you need to know whether you are a high arched or flat footed individual and most individuals know that just from past experience, or what people have told them, or just walking wet on the concrete you can tell, see what your footprint is. If that’s the case then I think that simple guideline that I mentioned, that if you are high arched you have a rigid foot you are not going to handle shock very well so you need everything working for you. If you’re flat footed, overly so then you need some support, then you need the shoe that prevents pronation.