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Austin Running Expert: Why flatter/more neutral (less heel to toe offset) running shoes cause less knee and foot strain

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When you decide to go on a nice long run or walk, have you ever felt an irritating, mild pain, which radiates around your knee joint? Having pain in the ball of your foot during or after walking? If so, than you may be injuring or aggravating your joints. Conditions such as Patellofemoral Pain Syndrome, otherwise known as “Runner’s Knee”, ball of foot pain or big toe joint pain can be attributed to a popular sneaker design. Whenever you are experiencing pain at a joint, it means your body is telling you that something is wrong. If you are feeling pain, than you need to begin assessing what is causing the pain before the condition worsens. You may be surprised that one of the largest contributors to knee strain and running injuries results from wearing the wrong shoe type for your feet. We want to make a couple suggestions as to why you may want to reconsider the type of running shoe that you are using.

Did you know that the height difference between the heel and front of your shoe (heel to toe offset) may affect the biomechanics of your stride or landing?

Over the years, this has been a modification made to running shoes due to the benefits for alleviating stress on your knees.

For those with forefoot issues, such as arthritis and ball of foot pain, these kinds of shoes/sneakers may force more pressure into a problem area. Often I educate patients about the shoes they thought would be helpful are actually hurting their condition.

The ultimate goals during running are to Reduce Impact Shock and have Proper Body Alignment When Landing after each stride.

Reduce The Impact Shock – You can reduce the shock of impact by landing properly and evenly on your foot rather than striking heel or toe first. When you land heel or toe first, you increase the loading rate at specific areas on your foot, which ultimately places increased stress at certain joints, such as your knees.

Proper Body Alignment When Landing – In order to reduce the impact of shock when landing, it is important to keep your pelvis level and your thigh in a neutral position. You also want your foot to be aligned underneath your hip and landing flat, around the area of your mid-foot. If you see that your heel is landing first and out in front of the rest of your body, than you may also want to try taking shorter strides to help correct your bodies’ alignment in order to stick a proper landing.           

The problem with running shoes that have a higher Heel-to-Toe drop (10-12mm), is that they encourage you to strike the ground at your heel prematurely since it is closer to the ground. This causes a disproportional, abrupt force and large load (weight) on the small area of your heel. These impact forces are not able to be absorbed by the rest of the foot as well therefore; these forces are directed towards the knee joint. At first, this may not be a problem, but over time, the shock absorbing cartilage around the knee becomes damaged and your muscles begin to work in an unnatural fashion, which makes you prone to injury. Studies have shown that higher heel-to-toe offset shoes increase Hip Internal Rotation Torque and Knee Flexion Torque. These are clear indicators that these running shoes force your bodies’ mechanics in an unnatural position, thus making you prone to injury.

Choosing a more neutral running shoe may decrease the strain on your knees and prevent injury, however, EVERY PERSON IS DIFFERENT! The best way to find out what type of running shoe is best for you, is to see your podiatrist, so they can evaluate your foot-type and assess your running form.

Dr. Shine John, DPM, FACFAS
Podiatric Physician, Surgeon, Specialist at Austin Foot and Ankle Specialists
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