Recommending Athletic Footwear For Runners

By Douglas Richie Jr., DPM

What is a good running shoe? How often are you asked this question? It seems that whenever a stranger learns that you are a podiatric physician, the first question he or she asks is about a shoe. Rather than asking how we can prevent foot amputations in patients with diabetes, the average American is more interested in what shoe a podiatrist is recommending.
Yet when it comes to footwear recommendations, most podiatric physicians have very little objective information on which to base their opinions. Having 25 years of clinical experience in podiatric sports medicine practice, I would like to offer some guidelines for making shoe recommendations to the running athlete.
Before looking at the foot type (the obvious primary criteria for recommending a specific shoe), look at the patient. Body mass will supercede any foot type classification in terms of footwear requirements for exercise.A 200-pound individual will require an extremely firm, stable shoe whether he or she has a stable foot or not. A 110-pound female elite runner may not require motion control features in a shoe even if she is a “pronator.”
The training regimen of the patient will dictate whether multiple shoes are necessary for long road runs and speed work on a track.Many people prefer running on trails or grass, which would alter the normal cushioning requirements that would be needed on asphalt.
Finally, the age, fitness and competitive level of the patient can significantly alter the shoe recommendation. An older runner who “plods” at a 12- minute per mile pace will have different requirements than a 20-year-old elite “toe runner” who blazes along at a sixminute per mile pace.

Emphasizing The Importance Of The Patient’s Injury History
Granted, there are other factors to weigh with the patient evaluation. The patient will probably have an injury history that one should consider. In general, podiatrists should correlate running injuries to impact shock or excessive motion. Unfortunately, there is no clear understanding of which injuries are primarily due to impact and which are due to excessive pronation or supination. Still, the experienced clinician has a sense of what footwear characteristics are desirable to prevent injury.
If the patient has had previous stress fractures, cushioning characteristics are preferable in shoe selection. Previous Achilles tendinopathy should dictate footwear with firm midsoles and ample heel elevation. There may be a current injury that will dictate a specific shoe requirement. Hallux rigidus will require a shoe with a stiff sole. Plantar heel pain syndrome will require a shoe with torsion stability. Patellofemoral pain syndrome is usually associated with excessive pronation although multiple other factors are also involved. Pronation control features in a running shoe include firm heel counters and medial posting of the midsole.

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