Wednesday, July 28, 2010

The Ongoing Running Shoe Controversy and What I Do

Over the past week there has been a flurry of provocative news regarding running form and shoe selection that has caused quite a stir on the running community. First was the talk, as covered by Amby Burfoot from Runner's World, during a conference call in which Dathan Ritzenhein announced his entry into the 2010 NYC Marathon that Ritzeinhein has been experimenting with a new running form. Under the tutelage of Coach Alberto Salazar, Ritzenhein has been using shoe inserts and custom orthotics to adjust his running stance to be more forefoot, in an effort to prevent injuries, which has plagued him for the past couple of years. This news was intriguing as this was really the first instance that an elite American distance runner has openly declared an intention to switch to the techniques of forefoot running. Then, came the report of a study conducted by the military (summarized here by Gretchen Reynolds, in the New York Times Well blog), that found no correlation at all between wearing proper shoes (based on foot/arch type) and injury prevention. According to the report, "Injury rates were high among all the runners, but they were highest among the soldiers who had received shoes designed specifically for their foot types. If anything, wearing the “right” shoes for their particular foot shape increased trainees’ chances of being hurt." This study was frightening as it provided the first evidence that our current method of selecting shoes based on foot type may be erroneous. Then later that same day, my fellow blogger and evolutionary biologist friend Peter Larson posted a great review (Thanks Peter) on a recent study in the British Journal of Sports Medicine that involved a randomized control trial assigning women runners training for a half marathon to categories of shoes based on their observed degree of pronation. The authors found that 100% of runners in the highly pronated group assigned to motion control shoe (as would be normally done by convention) got injured! Not only so, but pronated runners suffered more pain from wearing stability shoes (that were assigned to them based on their foot type) than from wearing neutral shoes. There were other gross inconsistencies in the fitting of the right shoe to the right foot type, forcing the authors to conclude that "...our current approach of prescribing in-shoe pronation control systems on the basis of foot type is overly simplistic and potentially injurious." And if that weren't shocking enough, as Peter as astutely points out, one of the co-authors of this paper is Gordon Valiant, a biomechanist who works for Nike Sports Research Laboratory, and is the same guy who helped Dathan Ritzenhein, under the direction of Alberto Salazar to change his footstrike from heel to forefoot!

So what are we, the recreational athletes, the everyday warriors, who have been wearing shoes for years prescribed by a salesperson based on our foot types into this categorization of shoes that has now been proven not only ineffective but potentially injurious, supposed to take away from all of this? Are we supposed to take off our shoes immediately and run barefoot? Do we have to try every model of shoe out there, regardless of our foot type and decide based on "feel"?

Many runners and friends have asked for my opinion on this subject and I hesitate to give one because I do not believe there is yet enough conclusive evidence to know what is the "right" thing to do. Most of the science is empirical, theoretical and/or anecdotal which isn't the same as facts. So in the absence of facts, any discussion about the advantages/disadvantages of a particular style of running or a particular shoe disintegrates into a philosophical debate which doesn't really interest me.

Having said all that though, I do have some guiding principles about running and shoes that has served me well that I can share. (I'm doing this only because many people have asked.) Again, this my personal philosophy based on my knowledge of medical science. Don't take it as a general recommendation or authoritative dogma.

1. It's always better to run in less shoe than more shoe. As one sports medicine colleague advised me - Running in more shoe than you need is like running with a cast on your feet.
2. I believe strongly that the foot a dynamic structure. What that means is that the hundreds of muscles that make up the feet is always constantly changing and adapting to the environment and forces applied to it. Your foot will change from month to month, year to year. What works perfectly this training cycle will not be appropriate for your next training cycle. By extension, there's no sense in hoarding shoes for longer than six months to a year.
3. Rotate your shoes. Being in different models stressing different bones and muscles of the feet is beneficial to overall health of the lower extremity. It will also highlight and pinpoint areas of weakness and pain that you might not be aware of just running in one set of shoes all the time.
4. Don't be afraid to experiment and try new techniques and new shoes no matter what your preferences and biases are. Just be careful and listen and hear what your feet are telling you. (As a rule, runners are not good listeners...especially to their own bodies. Trust me on this.)
5. I train in Saucony Rides, do tempo runs and long races in Saucony Kinvaras and race short distances and intervals in Saucony Fasttwitches. Just sayin...


Michelle said...

Good post Lam.

I have been switching off my running shoes for a while now. I have also been running 1x a week in Vibrams. I feel they are slowly strengthening my feet and calves. I also agree, less is more. I despise heavy running shoes. I cannot run well in them. Give me the Kinvara's or Launch and I am a happy girl.

Thanks for your insight.

Running and living said...

I buy any type of shoe I find on sale (except motion con trol - few people should wear those, I think) and just rotate among them. I have about 6 pairs now, and so I rarely use 2 pairs during the same week.

Personally, I think overpronators are going to get more injured no matter the shoes they wear. But, the more mileage, the less overpronation. I speak from experience, I used to land on my heels and overpronate when I started running (this pattern was clear from just looking at my worn out shoes) and have become a midfoot/forefoot striker and no longer overpronate except during the last few miles of a marathon, when my form collapses.

Lady Southpaw said...

Good advice Dr Lam! I think listening what you're body is telling you is always the best course of action and I like your suggestion about wearing different types of shoes to constantly stress your feet in different ways.

I actually just got a pair of Kinvaras this week! I really wanted to try them, but I was thinking of using them more for middle distance type runs like 3-8 miles as opposed to long distance. I may have to see how it goes and re-evaluate...

Anne said...

Because of a mild injury on my right knee (after buying new shoes), my PT had me run barefoot and then taught me the 1-2-3 cadence and now, even with my shoes on, I tend to land on the forefoot very very comfortably. I just bought my first racers and I love the feel and comfort of this new, straigher running form :)

Lisa said...

this is a great post, thanks for sharing it. Somehow I had missed out on all the controversy, so I appreciate that you brought it up.

I just wish running shoes weren't quite so expensive so it would be easier to have several pairs of shoes going at one time. My next pair of shoes definitely won't be as built up as the ones I'm wearing now.

Pete Larson said...

Thanks for the mention Lam! I think your advice is very sound, and I am also a shoe rotator and believe strongly that less is more. The more variation in force application that we can throw at our feet and legs, the stronger they will be all around. If the shoe companies were smart, they'd also start advocating this and suggest that everyone buy at least 5 pairs of shoes to rotate!

Doug said...

I have bought all my running shoes lately at Sports Authority and for one reason. They are a large store and I try on almost all of the shoes and run up and down the long aisles of the store. This assures me that I have found the most comfortable shoes for how I am running. This takes me a couple hours to pick each pair of running shoes, but I have been completely satisfied each time I use this method. I happen to be a forefoot runner as well.

Morgan said...

In light of my current experiment with the VFF's this post was very enlightening! Thanks for all the great info Lam!

Linna said...

Lam, this was a great, insightful post! I will have to say since I am relatively new (started running last May) that I still am figuring out what is best for me in terms of footwear. I agree with a previous comment that running shoes are expensive, and I don't know that I can buy a running shoe that may not end up working out for me! I think maybe I should definitely try out new sneakers though, but I recently bought another pair of Mizunos Wave Inspires since I really liked them and figured, why change something that I know works? Thanks for your thoughts!!!

Jamie said...

Great post Lam! I recently started rotating my shoes and have found it to be extremely beneficial.

Anonymous said...

It's amazing how much of an impact different shoes can have on our running.

Paul B said...

Good post, thanks for sharing your thoughts!

I agree with what you're saying - more facts need to be determined before solid advice can be given on the matter.

I've only recently, after suffering with ITBFS and little niggly injuries over the last few years, decided to experiment with my gait and barefoot.

I don't think barefoot/minimal is for everyone. You need to be in the right mindset for it. And I definitely don't think you can jump straight in. Most peoples feet muscles will be weak and need to be conditioned in order to run barefooot/minimal shoe without injury to start with. A process that can take a long time!

That said, since starting my experiment 2 months ago, I haven't had any hint of ITBFS, I'm running quicker and with less effort.

I think there's definitely something in this barefoot/natural running lark.

Again, good post sir.

Vava said...

Interesting post, and definitely supported by my experience. When I was going through my ankle injury woes I was prescribed orthotics and never felt comfortable with the explanation I was given for their purpose, namely to "support the arch". The arch is weakened when supported, and so doing so will only lead to more trouble.

As far as the wisdom on foot-type based shoe selection I think this is also very intriguing. My foot is high arch and neutral, yet wearing a neutral shoe led to problems. For the past two years I've been wearing stability shoes and my foot injury (plantar fasciitis) has gone away.

Anyway, thanks for the links and tips!

The Laminator said...

Thanks everyone for your perspectives and testimonials...

@Michelle - Good job with the VFFs. I think once a week is probably adequate for what you are using them for - mainly for strengthening feet and calves.

@R&L - I think you're right. It makes sense. Whatever deficit you have, the more you run, the more your foot will naturally adapt and remodel to a way that "corrects" that deficit.

@Lady Southpaw - Thanks! Rotating shoes is very important because it allows your feet to adapt to new stresses and pressures. I hope you like the Kinvaras...they have served me pretty well!

@Anne - I think everyone should have a "racer" shoe in their rotation no matter what they normally run in. It helps with speedwork and improves form and efficiency as well.

@Lisa - Yes, I agree that shoes can be expensive. However, I think if you do not wait for the end of the life cycle of your particular shoe, you will naturally have different shoes to rotate through. I always buy the next shoe when I'm halfway through with the old pair.

@Peter - Thanks for your article and insight. That would be a good marketing scheme I think. Buy several pair of shoes and rotate through them to get maximum benefit of each shoe.

@Doug - In theory, your selection process sounds good, but aren't you then limiting yourself to the particular style of shoes they happen to came at the time you're shopping. Maybe there can be others that can "fit" you better that you haven't tried because that particular store didn't have them? Just a thought.

@Morgan - Thanks. BTW, how's your VFF experiment going?

@Linna - It's okay to stick with something you're comfortable with when you're first starting out but as you run more and gain more experience, you will learn that some shoes are better for some workouts and others for other workouts, so naturally, your shoe arsenal will expand...just like your regular shoes. You don't wear the same dress shoes everywhere, do you? Same idea with shoes.

@Jamie - Thanks. Yes, shoe rotation is key.

@Rio - Shoes can have as much impact as you want it to. It is about the only essential equipment we have in our sport and it is the only protection we have against the elements so it's important.

@Paul - Thanks and congrats on your newfound speed and recovery from ITB. Running minimal or barefoot will be awkward for some which is why I advocate for each individual runner to listen to their bodies as to how much they can handle. No one says your first run in minimalist shoes has to be 6,8, or 10 miles. Build up slowly. But again, most runners don't like to hear that so they jump right in and run entirely in their new shoes which is why a lot of them will unfortunately get injured.

I found your article on this controversy very insightful too, I might add.

@Vava - I'm mixed on the idea of orthotics. I think it is at most a temporary solution for a chronic problem. Moreover, I think orthotics need to be reevaluated yearly because the foot changes from year to year. Maybe after 6-12 months of weating orthotics, I wouldn't need them anymore. It also makes the shoe heavier and slows you down. Why wear it if you don't need it after a few months or so.

J said...

very thought provoking! Since you run in Saucony I hope mine work out! I am interested to see where the running shoe industry goes from here!

joyRuN said...

I have to start all over again with my shoe search. I'd been running primarily in my Nike Frees with some short runs in my Vibrams. With this fracture though, I'm inclined to find the cushiest shoes out there that won't let my feet budge even a millimeter.


Ms. V. said...

I'm a Mizunos girl, and I buy two pair for each training cycle. VFFs and barefoot running freak me out...although when Mizunos go...they go, and it's sorta like barefoot running! LOL

Jesse said...

I always enjoy reading your perspective on things like this, since you're not only an accomplished runner but you also obviously have FAR more medical knowledge than me.

I don't own two pairs of shoes that are the same model, and so I end up wearing three or four different models each week. I wasn't sure if that was good or bad, but it's nice to know I'm not the only one who does that, and that there might be some benefit to it also.

The Laminator said...

@J - Me too! I think there will be more and more minimal shoes coming out until the powers that be decide on a new paradigm and a new marketing scheme. I hope your new Sauconys work out for you.

@JoyRun - Hey Joy! I think you have to be careful. Just because you were injured does not necessarily mean a bulkier shoe will be better for you. I'd be slow with it, but I wouldn't toss out the VFFs just yet.

@MrsV - I know what you mean. You don't have to be freaked out though. You should try a short quarter mile on a treadmill or jogging track just to see how it feels. If nothing else, it will help improve your form.

@Jesse - Thanks for the positive feedback. I think you are right to rotate shoes. It's the only way to go until the smarter people decide on a good way to prove that one type of shoe is better than another. Otherwise, going with moderation and variety is probably the best idea!

vibram said...

i prefer lighter shoes, so i usually use my vibram five fingers pair..much flexible and feels nice on feet..though i have a running shoes collection such as saucony shoes and brooks beast

Men’s sport sandals  said...

I want to switch my older shoes as they make my foot pain. I like to wear shoes that are durable and comfortable too also they should be light in weight.

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