Point-Counterpoint: Minimalist Running Shoes: A Significant Advance Or Injuries Waiting To Happen?

Nicholas A. Campitelli, DPM, FACFAS, and Kevin A. Kirby, DPM

Significant advance.

Noting a lack of evidence support for traditional running shoes with elevated cushioned heels, this author says the wider toe box of minimalist shoes and a gradual transition of running form can be beneficial for runners.

By Nicholas A. Campitelli, DPM, FACFAS

To think a shoe could solve every runner’s problems with injuries is hard to believe yet that is what it has come to in our society. It is not just runners who have this perception. This belief seems to be pretty common in the general population as well. Most would not argue that when it comes to foot pain, the shoe is the first thing patients will look at to solve their problem.2

   The question that has arisen in the past several years is, “Do we really need a supportive shoe to run?” My answer is absolutely not. Having been on both sides of this argument, I feel I can offer an unbiased opinion. For 10 years, I suffered from sesamoiditis that did not respond to any shoe or orthotic that I wore. Only after I abandoned traditional running shoes and changed my running form was I able to resolve the issue.

   My problems with traditional running shoes are numerous. First, the shoes tend to have a large cushioned heel, which really serves no biomechanical purpose other than absorbing shock. In fact, a 2009 literature review of several electronic databases found that the prescription of running shoes with elevated cushioned heels and pronation control systems was not evidence-based.1 Consider that even when fitting a patient for an orthotic device, of all the angles and positions in which one places the foot and measures it, many physicians never consider the height of the shoe’s heel.

   Ankle equinus is a condition that often requires surgery to resolve the biomechanical issues it is creating. Yet what happens when one slips a foot into a traditional running shoe? The foot assumes a plantarflexed position in which it is expected to function when one is running. To give you an example, a heel height of 14 mm will place the foot of an individual with a size 9 shoe in 4 degrees of plantarflexion.

Rethinking Our Perceptions On Excessive Pronation

Traditional running shoes as a whole typically fall into three categories that are universal among the running shoe manufacturers. The shoes are supposedly created for individuals with arch types that are high, normal or flat. The rigidity and support will increase or decrease depending on the foot type and the theory that one will need to control or encourage excessive pronation.

   This running shoe paradigm does not take into account the runner’s form or foot strike pattern but only presumes he or she is heel striking. When you look at how a podiatrist interprets Root’s theories of biomechanics and how excessive pronation can lead to injury, it is only in regard to heel striking. If you convert that same foot type to a forefoot or midfoot strike, will the runner still experience excessive pronation or will the pronation that is occurring absorb the impact up until the point when the heel then strikes the ground?

   This is the controversial point. Does the definition of excessive pronation as has been discussed in regard to injury even exist if one lands with a forefoot or midfoot strike pattern?

Understanding The Premise Behind A Wider Toe Box

I think we can all agree that proprioception is a key component to all individuals’ gait. If we cannot feel the ground beneath our feet, then it becomes very difficult to recruit the lower extremity musculature adequately to respond to the terrain we are running on. This is where the toes play an important role.

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