One Size Doesn’t Fit All…

One Size Doesn’t Fit All…

Running has been the most common form of exercise since the dawn of time. One of the reasons for its popularity is that it only requires footwear and even that has been debated. This blog will briefly discuss the evolution of running footwear in the past 50 years and provide recommendations for the avid runner.

Flashback to the running boom of the 70s that introduced the infamous Nike “Waffle Trainer” created by Bill Bowerman with inspiration from a waffle-iron. Then the early 80s brought the first “PECH” shoes (pronation control, elevated cushion heel running shoes). Fast forward to 2009, and Christopher McDougall’s “Born to Run” book ignites the barefoot running craze.

Selecting the proper running shoe can be difficult given the vast number of options available. However, one thing is certain, one size doesn’t fit all…


Traditional Shoes

The application of sports science to running shoes began in the late 1970s after the popularity of running led to an increased occurrence of running related injuries. At that time, different types of running gaits were presented based on arch type and foot alignment and shoes were designed to match each type.

  • High arch and normal (mild) pronation -> neutral shoe
  • Normal arch and normal (mild) pronation -> stability shoe
  • High arch and supination -> cushioned shoe
  • Flat arch and moderate-severe pronation -> motion control

Figure 1.

Although research has shown that the classic model of shoe prescription is not effective in decreasing injury or improving performance, it continues to be used today.



At the other end of the spectrum, came the idea of completely eliminating shoes to allow for more “natural” running. Research comparing barefoot to traditional shoes demonstrates that shoes significantly alter gait styles. Traditional shoes with high heels and soft cushioning, alter our foot’s ability to sense the ground and allow us to land hard on our heel, often times leading to overstriding. This repetitive overstriding leads to increased mechanical stress and poor running efficiency. Barefoot running allows the foot to feel the ground and tends to bias the gait style to an improved form. However, there is no research showing that barefoot running decreases injury or improves performance. Additionally, barefoot running can lead to a multitude of other problems including skin breakdown stress fractures of the foot.



Minimalist shoes are defined as footwear that provides minimal interference with the natural movement of the foot and meets the following criteria:

  • High flexibility
  • Low heel to toe drop
  • Low weight
  • Low stack height
  • Absence of stability and motion control technologies

Figure 2.


Transitioning to Minimal Shoes   

If transitioning from traditional shoes to minimal shoes, it’s important to do so gradually to decrease risk of injury. Transitioning too quickly can lead to symptoms in your foot, Achilles tendon or calf muscle. A 1 month transition time is recommended for every 10% change in Minimalist Index Score. For example, if transitioning from shoes rated 50% to 80%, allow a 3 month transition period. It’s also important to incorporate injury prevention exercises focusing on foot intrinsic muscles and calf strengthening.

Visit and search for your specific shoe to determine its minimalist index.

Figure 3.

What About Orthotics?

The foot is responsible for two main functions 1) facilitate the body’s shock absorption mechanism and 2) propel the body across the ground. However, when deformities exist the foot compensates in various way in an attempt to perform its role. In doing so, it places a greater demand on other surrounding tissues, often times leading to injury.

Foot deformities are classified based on whether correction is possible with active (muscular contraction) or passive (manual correction by physician) manipulation:

  • Rigid foot deformities—indicates a structural abnormality with restricted joint motion.
    • Treatment of extreme cases of structural abnormalities may require surgical correction. However, manual physical therapy can be effective in improving joint mobility and should be considered as a first option.
  • Flexible foot deformities—indicates a muscular imbalance or an adaptive lengthening or shortening of the soft tissue structures.
    • Treatment in these cases can involve foot orthotics and physical therapy

If a runner has good structural alignment, instead of resorting to a pair of custom-molded orthotics that can cost hundreds of dollars, they should seek a physical therapist to help them strengthen and stabilize the foot for long term results. Research suggests that an off the shelf insert costing under $50 can be as effective as a custom orthotic in some cases.


Bridging the Gap

Different foot types have different injury patterns. Because running involves a sequence of movements that start with the foot hitting the ground, the degree of supination and pronation will have an impact on the forces moving through the knee, hip, pelvis and spine. If you tend to supinate when you land, you lose the natural shock absorption provided by the arch. Instead, you maintain a stiff arch which may lead to increased stress up to the shin where increased rates of stress fractures are observed. Over pronation has been linked to injuries such as, shin splits, Achilles tendinopathy, stress fractures in the metatarsals, and patellofemoral pain syndrome. Conversely, weakness of the hip and thigh musculature can have a negative impact on foot mechanics during running.


Decision Time

A lot of information has been presented, but here is what we know:

  1. Research has shown that traditional shoes aren’t decreasing injury rates or improving performance. Running barefoot may result in improved proprioception and foot strengthening, but may not improve performance and can lead to a host of other problems. New research demonstrates that lightweight shoes (minimal shoes) may improve running economy when compared to barefoot and traditional shoes.


  1. None of the current evidence provides a clear answer on the ideal footwear for runners. If you currently wear traditional running shoes and they haven’t caused you any trouble, then maybe there’s no need to change. However, if you are looking for improved running efficiency and a shoe that allows more natural foot function then consider transitioning to a minimal shoe, but make sure the transition is done in moderation.


  1. If you are having problems with running, shoe ware is only one factor to consider. Assessment of lower extremity flexibility, strength of the foot, thigh, hips and pelvis are also an important part of the equation. If you are interested in a running assessment, contact us and we will connect you with the right clinician to keep you  moving towards another PR!


Written by Daniela Espino, BS, SPT; Georgia State University Department of Physical Therapy; 2018




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Foot Deformities

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History of Running Shoes

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Nigg, BG., Baltich, J., Hoerzer, S., & Enders, H. (2015) Running shoes and running injuries: mythbusting and a proposal for two new paradigms: ‘preferred movement path’ and ‘comfort filter.’ Br J Sports Med, 49 (20):1290-1294.


Richards, C., Magin, P., & Callister, R. (2008) Is your prescription of distance running shoes evidence based? British Journal of Sports Medicine. 43(3) 159-162.  


Warne, JP & Gruber, AH. (2017) Transitioning to Minimal Footwear: a Systematic Review of Methods and Future Clinical Recommendations. Sports Med Open. 3(1).