More on Shoe Selection – ACSM position

“But Dr. Maggs, I have to wear “X” shoes because I ____________ (fill in the blank with “overpronate”, supinate, have high arches, have flat feet)”

If you’ve been reading these newsletters, or our blog, you are well aware that we have great disdaine for these comments.  Shoe prescriptions have been built on very little other than prevailing theories.  There is very good research evidence disproving these theories.

Shoe prescription should be based on so much more. This newsletter will not get into the science of WHY these beliefs about shoe prescriptions are wrong.  If you are interested in the science, I have written about it previously here, here and here.  The British Journal of Sports Medicine published on the topic back in 2008.

The purpose of this post is that, finally, the mainstream healthcare organizations are starting to see the light.  The American College of Sports Medicine (ASCM) is the largest sports medicine and exercise science organization in the world with more than 50,000 members.  They weighed in on the topic of shoe prescription last month.  Here is a link to their new position statement on shoe prescription, but to save you time, I have listed some of their findings below…

Here are some of their general guidelines (in their words) for what to look for in a shoe:

  • Neutral (does not contain motion control or stability components).  These extra components interfere with normal foot motion
  • Minimal heel to toe drop
  • Lightweight
  • Foot shape or arch height are not good indicators of what kind of running shoe to buy
  • Pronation is a normal foot motion during walking and running. “Pronation alone should not be a reason to select a running shoe. Runners may be told while shopping that because pronation is occurring, issue with arch support is best. In fact the opposite may be true. Pronation should occur and is a natural shock absorber.”  

  They go on to list “Shoe Qualities to Avoid”:

  • High, thick cushioning
  • “Extra arch support inserts or store based orthotics. These items are often not necessary. Orthotics should be considered temporary fixes (less than 6 to 8 weeks) until foot strength is increased”

With all that being said, I think there are some potential pitfalls in their recommendations…

  • I am not of the opinion that “everyone” should be an a neutral shoe with minimal heel drop.  There are many exceptions.
  • There are specific injuries that can be a result of too much pronation, so I don’t think we should totally discount pronation. The problem is we have no definition of what “too much” actually is. More importantly, there are many causes of “too much” pronation including ankle mobility, proper motor control and stability of the muscles in the hip and calf, velocity of the swing of the contralateral hip, stability and motor control of pelvic rotation, fatigue, anatomic variations etc.  If those issues aren’t addressed, you may create more problems by trying to “fix the overpronation.”
  • My point is, if you simply look at the foot to see what kind of shoe someone should be in, you are missing the boat.  Runners with good running form and proper training plans can run in just about any shoe. 
  • Shoe and orthotic prescription for runners is a delicate business with many factors to consider. If you don’t have a very high level of anatomy education and biomechanics education, you are really rolling the dice. Even with these qualifications, it is a very difficult proposition.  In, our experience, the more you read and learn, the more you realize how complicated the issue is. In this aspect, confidence has sort of a bell curve relationship with knowledge.

   Unfortunately, there are people who will be resistant to the idea that shoe prescription should be based on more than observing the feet or the idea that a shoe choice that is based on the amount of pronation is incorrect or irresponsible.  Unfortunately, there are people in positions of perceived authority who are still advising outdated and incorrect advice.  Runners World and Web MD are examples.  They still have their websites stating that shoe choice should be based on foot type and pronation.

  If this post has you thinking about what type of shoe you should be in, I wrote a brief piece about selecting a running shoe here.