Facing The Challenges That Shoe Gear Creates

Nicholas A Campitelli DPM FACFAS

For many who read my blog posts and know my philosophies and principles, you already are aware of my feelings about shoes. Trust me, even though I am a proponent of the whole “barefoot” movement, I probably wear more running shoes than most of my critics could even imagine. Over the past four years, I have been fortunate to have tested and run in many different running shoes as a result of the work I have done with studying minimalist running shoes.

I could talk for days about what I have learned but I want to point out one aspect with this post. Shoes can change many variables when it comes to treating an injury and it is not always for the best.

Zhang and colleagues compared differences in ground reaction force (GRF), center of pressure (COP) and lower extremity joint kinematic and kinetic variables during level walking in flip-flops, sandals and barefoot in comparison to running shoes.1 The results demonstrated that "... barefoot, flip-flops and sandals produced different peak GRF variables and ankle moment compared to shoes while all footwear yield different COP and ankle and knee kinematics compared to barefoot."

Keenan and coworkers pointed out that the effects of current athletic footwear on lower extremity biomechanics are unknown.2 Their study, along with other studies and reviews, note increased stride length when people walk in shoe gear.2-5 In a review of articles published on barefoot running between 1980 to 2011, Lorezno and Pontillo says data does support using a forefoot strike pattern instead of a heel strike pattern to reduce GRF, ground contact time and step length.4 Additionally, Hall and colleagues cite limited evidence that barefoot running is associated with decreased impact GRF, lower peak knee flexion and varus joint moments, and increased stride frequency in comparison to a neutral shoe.4,5

There are other factors that shoe gear affects. These factors include peak knee varus moment, hip flexion and extension, forefoot versus rearfoot strike pattern, ground reactive forces, Achilles tendon loading, and knee and hip joint torques.2,3,6

The point of the discussion is that factors we all once learned to look at when examining runners such as shoe wear patterns, mileage on shoes, increased pronation, shoe type, and foot type seem to be discussed less in the current literature in regard to treating runners. It seems that the more current topics of debate are foot strike patterns, stride length and how shoes themselves can change the aforementioned parameters.

In my practice, I have had tremendous success looking at runners’ weekly mileage, intensity, heart rate, form and type of shoe gear as opposed to discrete biomechanical factors. We have seen that foot type is not always a predictor of injury among runners or walkers in the literature. Therefore, I would advise those who zone in on foot type in regard to running injuries (and even non-running related injuries) to begin considering the other parameters discussed here.7,8


1. Zhang X, Paquette MR, Zhang S. A comparison of gait biomechanics of flip-flops, sandals, barefoot and shoes. J Foot Ankle Res. 2013 Nov 6;6(1):45.

2. Keenan GS, Franz JR, Dicharry J, Della Croce U, Kerrigan DC. Lower limb joint kinetics in walking. Gait Posture. 2011 Mar;33(3):350-5.

3. Wearing SC, Reed L, Hooper SL, Bartold S, Smeathers JE, Brauner T. Running shoes increase Achilles tendon load in walking: an acoustic propagation study. Med Sci Sports Exerc. 2014; epub Feb 4.

4. Lorenz DS, Pontillo M. Is there evidence to support a forefoot strike pattern in barefoot runners? A review. Sports Health. 2012 Nov;4(6):480-484.

5. Hall JP, Barton C, Jones PR, Morrissey D. The biomechanical differences between barefoot and shod distance running: a systematic review and preliminary meta-analysis. Sports Med. 2013 Dec;43(12):1335-53.

6. Kerrigan DC, Franz JR, Keenan GS, Dicharry J, Della Croce U, Wilder RP. The effect of running shoes on lower extremity joint torques. PM R. 2009 Dec;1(12):1058-63.

7. Buldt AK, Murley GS, Butterworth P, Levinger P, Menz HB, Landorf KB. The relationship between foot posture and lower limb kinematics during walking: A systematic review. Gait Posture. 2013 Jul;38(3):363-72.

8. Morley JB, Decker LM, Dierks T, Blanke D, French JA, Stergiou N. Effects of varying amounts of pronation on the mediolateral ground reaction forces during barefoot versus shod running. J Appl Biomech. 2010 May;26(2):205-14.

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