By Vinay Matai, DPM
With so many brands and styles of running shoes, recommending the correct one can be challenging and overwhelming. We can choose to refer the patient to a local running store or as podiatrists use our knowledge to educate him/her on choosing the proper footwear.
First, the patient needs to understand how complex the foot structure really is: 26 bones (28 with sesamoids), 33 joints and over 100 ligaments. As Leonardo DaVinci stated, “the human foot is a biomechanical masterpiece.” Understanding the patient’s biomechanics are crucial in choosing the right shoe. A complete exam including a biomechanical exam and asking the patient specific questions will help determine the best type of shoe. Here are a few examples of questions you may ask to better understand your patient’s needs.
What type of activities do you plan on using the shoe for? Walking, running, high intensity interval training (HIIT), trail/mountain walking, or simply for standing up at work.
What is the most important feature of the shoe? The patient’s response is usually one of style, comfort, or support.
How old are your current shoes? Look at the treads of the shoe. Remember, the life of a shoe is approximately 300-500-mile range, but factors such as body weight and type of activity may affect the livelihood. Examining shoe wear and tear can tell if it’s expired.
What is your budget? This question can be sensitive and difficult to ask. To circumvent this, notice the patient’s shoes during the encounter. The brand and style can tell us price points without necessitating the question. Their shoes tell a story- the type of work they do or their buying pattern.
What shoe brands do you usually purchase? Brand loyalty is very important with millennials and even Generation X. This is important because if they are loyal to checks or stripes (Nike or Adidas), then you are going to want to suggest something that’s in-line with their psyche, or be prepared to spend a little more time convincing them that the brand they’ve been wearing for years will no longer meet their biomechanical needs.
Are you a runner? What are your speed goals? Will the shoe be used for distance running or sprinting? Is the patient training for a 5k or a half marathon? The weight of a shoe can affect race times- the heavier the shoe the slower the time.
Now that we’ve gained additional information, we must educate our patients on the types of running shoes and parts of a shoe. There are 3 main categories when it comes to athletic shoes: neutral, stability and motion control. There are however a few more specialized categories such as minimalist, zero-gravity shoes, rocker bottom, track or trail shoes.
Neutral: Neutral shoes are great for a person with a normal or medium arch height. They can also work for mild pronators. Neutral shoes do not guide the foot, rather they allow the foot to move naturally within the shoe. The design is usually absent of a stabilizing frame or medial post. One thing that varies among neutral shoes is the amount of cushioning and the weight of the shoe. Some people prefer a high cushion shoe while some may prefer a lower profile shoe with minimal cushioning. Notable examples of neutral shoes are the Nike Pegasus, Brooks Ghost, Asics Cumulus and a high cushion option is the Hoka Bondi.
Stability: Stability shoes are made with stability features such as a medial post or a stiffer material through the midsole. They often include guide rails which control side-to-side motion. This type of shoe is great for those with mild to moderate pronation or someone with normal to low arch height. These shoes are more rigid than neutral shoes but not as rigid as a motion control shoe. Notable examples of stability shoes are New Balance 860v9, On Cloudflyer, Saucony Guide ISO 2, Nike Zoom Structure 22, Asics GT2000, Brooks Adrenaline GTS 19, and Hoka One One Arahi
Motion Control: Motion control shoes provide the most stability. If you have a patient with a symptomatic flat foot with a flexible deformity, this style should be recommended. Warning! These shoes can only be found in your specialty running store. Motion control shoes are for your mild to severe pronators and usually have a firm post that reinforces the arch, stiffer heels and a designed to counter overpronation. Often times shoe companies have a proprietary component that enhances their arch, for example Hoka One One’s J-FRAME™ adds support by using a firmer density foam on the medial side all the way to the front of the shoe and extending back on the heel’s lateral side. Notable examples of motion control shoes are. Hoka One One Gaviota, ASICS GEL-Kayano, Brooks Addiction, and Saucony Omni
With these helpful tips, you can now speak with confidence in recommending brands or styles of shoes. I do recommend visiting local running stores and building relationships with their staff. Often you can pass discounts from running stores to your patients with your referral. Your local running store is also a great place to give small presentations and get to know local runners. It is a great opportunity to build your brand and market yourself for free.