Do Runners Get What They Pay For With Expensive Shoes?

By Brian McCurdy, Senior Editor

When choosing a pair of running shoes, consumers have a wide range of choices with a number of models available in different price ranges. Does buying a more expensive running shoe necessarily translate into getting a better quality shoe? A recent study suggests there may not be that much difference in cushioning between inexpensive and more expensive shoes.

The study, which was recently published in the British Journal of Sports Medicine, compared a total of nine pairs of men’s running shoes from three different manufacturers. Researchers compared low-priced shoes (£40-45), medium-priced shoes (£60-65) and high-priced shoes (£70-75) with all prices in pounds as per United Kingdom (U.K.) currency. Forty-three men participated in the study and wore size 8 or 10 shoes (U.K. sizes).

Researchers used the Pedar® in-shoe system (Novel Electronics) to measure plantar pressure from under the heel, across the forefoot and under the great toe. The study also assessed comfort with a visual analogue scale, according to the study. Researchers also recorded differences in plantar pressure among shoe models and among shoe brands or costs.

The study authors concluded that low and medium cost shoes in all three brands demonstrated the same or better cushioning than more expensive shoes. The performance of shoes was comparable in both walking and running trials on a treadmill, according to the study. Study authors noted that comfort is a subjective phenomenon and there was no difference in comfort among the shoes tested.

However, Nicholas Romansky, DPM, cites defects with the study. He contends researchers should have examined how shoes performed one to two months later and should have considered more parameters in the study. Doug Richie, Jr., DPM, adds that he is “not surprised” that researchers noted no significant difference between cheaper and more expensive shoes when comparing brand new pairs.

“The essential difference I have observed is the rapid deterioration of cushioning, which is seen in cheaper shoes in just several days of use,” says Dr. Richie, a Past President of the American Academy of Podiatric Sports Medicine (AAPSM).

How Important Is Cushioning?

In general, Richard Bouché, DPM, looks at three areas for running shoes: injury prevention (pronation/supination control and cushioning), performance (shoe weight, efficiency and energy dissipation) and comfort (fit, climate, cushioning). He notes cushioning may play a role in all three to some degree. However, Dr. Richie notes there is not enough evidence in the literature that confirms whether cushioning has an impact in injury prevention for runners.

“There is no consensus in the scientific community that cushioning plays a major role in the prevention of injury to the lower extremity,” says Dr. Richie, an Adjunct Associate Clinical Professor in the Department of Applied Biomechanics at the California School of Podiatric Medicine. “While intuitively, we would assume that cushioning is important, studies have failed to verify that this will prevent injury.”

Although Dr. Bouché thinks cushioning does play a role in athletic shoes, he concedes that having more cushioning is not necessarily better. He says numerous durometers are available and though machine testing may conclude that softer may be better, physiologic testing with patients indicates that paradoxically, the softer the midsole, the more impact there is on the lower extremity.

Drs. Bouché and Romansky say there are multiple factors to consider when it comes to recommending running shoes. Although runners can get good shoes that are inexpensive, Dr. Romansky maintains that one should consider the patient’s height, weight, running surface and whether the patient is a forefoot or a heel-toe runner when it comes to making shoe recommendations.

“There probably is an ideal amount of cushioning for individual athletes based on shoe type, surface, activity, weight, foot type, lower extremity mechanics, injury history, etc. We look at all of these factors when determining the best type of shoe for an individual athlete,” says Dr. Bouché, a Staff Podiatrist at The Sports Medicine Clinic in Seattle and a Past President of AAPSM.

Dr. Bouché cites the “muscle tuning model” of Benno Nigg, PhD, which may explain the role of cushioning and comfort. As he explains, the body tries to minimize uncomfortable soft tissue vibrations from impact forces based on the shoe, the individual athlete and the surface.

Dr. Bouché suggests that some athletes may perform better in stiffer shoes and some may perform better on softer surfaces. Dr. Bouché says this could depend on the muscle tuning capacity of the athlete and the relative strength and flexibility of the soft tissues. Dr. Romansky also advises taking into account how the weather affects the hardness of the running surface. He says runners need firmer shoes in warmer weather and softer shoes in colder weather in order to counter the road surface.



Understanding Runner Expectations And Perceptions

What expectations do runners have when they purchase expensive shoes? Dr. Richie says they are looking for durability and reliable performance over a period of six to 12 months of use. He adds that runners often choose shoes that give a feel of support and stability. This may not be a perception of comfort but is still a desirable feature of footwear for many athletes. Dr. Richie points out that the study did not measure this attribute.

As Dr. Richie notes, athletes depend on shoes to prevent straining of vital soft tissue structures including tendons and ligaments. He says studies have demonstrated that footwear can reduce the moment or strain on these structures. For athletes with a history of injury, he always looks for a shoe’s motion controlling features and not its cushioning features.

It is also important for DPMs to ask patients what they want in a running shoe, according to Dr. Romansky, a team physician for the United States Olympic and World Cup Men’s and Women’s soccer teams. He says one should ascertain whether patients are looking for comfort, stability, all-terrain or mileage use, and tailor shoe recommendations to their requirements.

Good shoes cost about $75 to $100, asserts Dr. Romansky, a Fellow of the American College of Foot and Ankle Surgeons. When choosing a shoe, if the patient likes a certain shoe company, he advises sticking with that company and that shoe. He also suggests returning to the same shoe store and speaking to an experienced salesperson. When a new running shoe comes out, Dr. Romansky advises against jumping on the bandwagon and waiting until the next generation of the shoe is available so all the kinks are worked out.

“Unfortunately, marketing plays a big role in the ‘selling’ of these shoes, which makes it difficult for the consumer to differentiate value in shoewear,” says Dr. Bouché.

Dr. Bouché says cheaper athletic shoes could offer comparable quality midsoles in regard to cushioning. He says the difference in cost in comparison to a more expensive shoe may be attributed to marketing and proprietary features.

“The ‘bells and whistles’ will cost you more,” he says. “Since there are no studies to prove otherwise, there is a perception that a more expensive shoe is better but this is probably not true.”



Study Reveals Increased Prevalence Of MRSA

By Brian McCurdy, Senior Editor As the rate of methicillin resistant Staphylococcus aureus (MRSA) infection continues to increase, a recent study in the Journal of the American Medical Association (JAMA) notes that the infection is no longer confined to acute hospital care, with many infections originating in the community.

The study surveyed MRSA in nine United States communities in 2004 and 2005. Researchers observed 8,987 cases of invasive MRSA. Of those, 58.4 percent were community-onset infections, 26.6 percent were hospital-onset infections, 13.7 percent were community-associated infections and 1.3 percent could not be classified, according to the study. Study authors note that in 2005, the rate of incidence of invasive MRSA was 31.8 people per 100,000.

Furthermore, the study notes that MRSA infection was highest among people age 65 and older, and also highest among males and African-Americans, concluding that MRSA affects some populations “disproportionately.” 

During the surveillance period, authors found there were 1,598 deaths in the hospital of MRSA-infected patients with a 2005 standardized mortality rate of 6.3 people per 100,000.

What methods can be taken in the community setting to prevent MRSA infection? The Centers for Disease Control and Prevention (CDC) recommends keeping one’s hands clean and keeping open wounds covered and clean, according to Nicholas Bevilacqua, DPM, an attending physician at the Foot and Ankle Clinics at Broadlawns Medical Center in Des Moines, Iowa. He also notes CDC recommendations that people should avoid being in contact with other people’s wounds or bandages, and avoid sharing personal items like razors or towels.

Citing prevention as the key to reducing the incidence of MRSA, Dr. Bevilacqua emphasizes the importance of identifying patients at risk for MRSA infection. He says the single most important risk factor is a patient’s previous history of MRSA infection or colonization. Other risk factors include recent hospitalization, nursing home residence, prior use of antibiotics, recent incarceration and using intravenous drugs, according to Dr. Bevilacqua.

As the JAMA study notes, those with healthcare risk factors and community-onset MRSA likely acquired the pathogen from healthcare contacts such as those originating from recent hospitalization or nursing home residence. Study researchers note that if patients became infected during transitions of care from acute care settings, “it follows that strategies to prevent and control MRSA among inpatients, if properly applied, may have an impact on these infections as well as on the traditional hospital-onset infections.”

For a patient with risk factors and an infected wound, Dr. Bevilacqua suggests considering initial empiric therapy consisting of an anti-MRSA agent. After reviewing the culture and sensitivity results, Dr. Bevilacqua says one should subsequently emphasize appropriate therapy that targets the specific organism. Dr. Bevilacqua says physicians should avoid “the reckless use of broad-spectrum antibiotics as bacterial resistance will continue to rise.”

For patients hospitalized with confirmed MRSA infections, he says one must isolate such patients and implement contact precautions.

Can Micronutrients Help Relieve Neuropathic Pain?

By Brian McCurdy, Senior Editor How much of an impact can nutritional supplements have for patients with diabetic neuropathic pain? Within a recent article in Practical Pain Management, researchers discussed findings from a six-month study of nutritional supplements for patients with diabetic neuropathy.

The study involved 28 patients with neuropathy, most of whom had comorbid conditions such as hypertension, obesity and hyperlipidemia. Researchers provided five nutritional supplements, which included N-acetyl-cysteine, alpha-lipoic-acid, L-carnitine, vitamin C and selenium. According to the study, researchers asked patients to rate eight parameters: burning pain; numbness; overall pain; and perceived level of impairment of function, concentration, thought clarity, alertness and energy.

Patients experienced significantly reduced burning pain, overall pain and numbness, according to the study. Authors also noted that several patients chose to remain on the medication after the study due to marked pain reduction.

Researchers initiated the study on the premise that while over-consuming fats and carbohydrates is a factor in diabetes, under-consuming micronutrients may be a factor in complications.

In his clinical experience, John Hahn, DPM, ND, says nutritional supplements can be beneficial for patients with diabetic neuropathic pain. He uses a new injectable homeopathic complex medicine, Guna-Neural (Guna Laboratories), an FDA-registered medicine designed for outpatient treatment of acute and chronic pain affecting peripheral nerves. According to Dr. Hahn, Guna-Neural contains beta endorphins, neurotrophin and other synergistic homeopathic medicines. Guna-Neural sensitizes the cell receptors through up-regulation mechanisms, causing an enhanced analgesic action of the endogenous beta endorphins, according to Dr. Hahn, a member of the American Association of Naturopathic Physicians.

Utilizing a mesotherapy injection technique, he says one would provide 1 to 2 ampoules per treatment at two treatments for the first two weeks. Dr. Hahn recommends one treatment a week until the patient has pain relief, saying the average treatment is eight to 10 sessions. He notes has not seen any adverse reactions or drug interactions with this medication.



In Brief

Barrier Therapeutics has announced promising results from its ongoing Phase 2 study with pramiconazole, a broad-spectrum oral antifungal, in patients with onychomycosis of the toenails. Eighteen patients took 200 mg pramiconazole once a week for 12 weeks and showed clinical improvement of signs and symptoms, according to the company.



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