Shoe Choices

Many people’s shoe choices may be creating more of a problem than they solve.   Big, bulky shoes and orthotics not doing what people think they are and they are most likely creating problems you wouldn’t otherwise have.

I hope the information below doesn’t come off as me trying to shocking or trying to be a maverick just for the sake of being different.  The information below is very evidence based, but unfortunately, many in health care and almost all in retail and the general public is unaware of the disparity between popular opinion vs. actual research.

**A word of caution: if you are planning on switching to a more minimalist shoe, please talk with me before you make that transition.  If you’ve been in supportive shoes for a long time, the feet may have a difficult time adapting.  Being judicious is advised!**

As the theme of this email goes, I will keep it very brief.  If you have any questions about any part of this, please let me know!

Myth #1)  I should wear rigid, bulky shoes with arch supports because I have flat feet and I need to “support” my foot.

  • These rigid, bulky shoes with “support” clearly weaken the tissues of the feet. Imagine hurting your neck and being told you need to support your neck with a cervical collar for the rest of your life.  What would happen to your neck muscles?  Instead of using an external device to support your arch, it would make more sense to use your intrinsic foot muscles to support the arch:
    • Zhang 2018: This study showed wearing more minimalist shoes is associated with a stiffer arch and bulkier foot muscles
    • Chen 2016: During a 6 month transition to a more minimal shoe, runners had a significant increase in size (measured by MRI) in the muscles of the foot from baseline to the 6 month checkup vs. those runners who stayed in more supportive shoes.
    • Johnson 2015: Another paper showing increased foot muscle size in those who transitioned to more minimalist shoes over a 10 week period
    • Miller 2014: Yet another study looking at the increase in foot muscle size (via MRI) in those who transition to a more minimalist shoe, this time over a 12 week period

Myth #2: I should have a shoe with more/less support because I have high/low arches.

  • This is a convenient way to prescribe shoes, but unfortunately, it doesn’t hold up under the scrutiny of research
    • Knapik 2015: 7,203 military personnel studies in 3 different studies, looking at injury rates in those prescribes a shoe based on their arch type, or…just given a standard shoe. The results: No difference in injury rates
    • Ryan 2011: 81 female runners training for a ½ marathon prescribed a shoe based on neutral, pronated or “highly” pronated feet. The results, “The findings of this study suggest that our current approach of prescribing in-shoe pronation control systems on the basis of foot type is overly simplistic and potentially injurious.”  e. slightly more injuries in those given a shoe based on their arch type.

Myth #3: I need orthotics to help prevent/treat my plantar fasciitis.

  • A systematic review is a study that takes all the available research, ignores the poorly designed studies and comes to a conclusion based off of gathering evidence from all the other better designed studies…
    • Rasenberg 2018: Looked at a total of 20 papers on the effects of orthotics on plantar fasciitis (believe it or not, it’s technically called “plantar heel pain” these days). They found no difference between expensive, custom orthotics vs off the shelf orthotics, but then again, no difference between those and a sham orthoses (a flat piece of plastic).  They conclude, “Foot orthoses are not superior for improving pain and function compared with sham or other conservative treatment in patients with plantar heel pain.”
    • Whittaker 2018: Looked at 19 different papers and found orthoses are not effective for plantar heel pain in the short term (0-6 weeks), or the long term (13-52 weeks), and there is some evidence that they may be effective for the medium term (7-12 weeks), however, “however it is uncertain whether this is a clinically important change.”

Does that mean that orthoses are never needed?  No, I’m not saying that.  There are specific cases where they are helpful, such as sesmoiditis, metatarsalgia, hallux rigidus etc., but for the most part, I feel orthoses for the general population are overprescribed with too many false promises.

Other thoughts:

Shoes may be responsible for certain foot deformities (Hallux valgus, bunions, Morton’s neuroma’s etc).  This is because the foot will gradually change it’s morphology, akin to Chinese foot binding.

You may think that’s a bit ridiculous, but look at these picks from Dr. Mark Cucuzzella, a West Virginia primary care doctor who took x-rays of his feet while barefoot and then while wearing a standard pair of dress shoes.

Lastly (not really lastly, but I’m trying to keep this brief), if you’re a runner, switching to a lighter shoe will most likely improve your performance:

  • Hoogkamer 2016: Subjects did not know which shoes they were getting, but some shoes had small metal BB’s injected into the midsole, adding weigh to the shoe. They switched who got the heavier shoes in subsequent weeks and retested.  Adding 100g to shoes added an avg of 4 sec to a 3K race and 300g adds 15 seconds to a 3K.  That was only a 3K race!
  • Fuller 2015: another review paper looking at 33 different papers. Conclusion: Better running economy in a lighter shoe compared to a heavier shoe.  Better running economy in a minimalist shoe vs a standard shoe.

**Again, a word of caution: if you are planning on switching to a more minimalist shoe, please talk with me before you make that transition.  Some people will not do well with that transition**