Since the 1970s, running shoes have been categorized by prescription: If you have X issue, wear Y shoe. At first, these prescriptions came in the form of “neutral” versus “stability,” referring to the level of cushioning and specialized arch support. Shoe manufacturers claimed that such features could alleviate stresses placed on the body that result in running injuries. In recent years, those prescriptions have gotten even more specific, thanks to a wave of minimalist, maximalist, and zero-drop soles, all of which claim to be the ticket to injury-free running.
Shoe prescriptions are widely accepted as the cure for all running ills. A 2014 study found that most runners believe wearing the wrong shoe type is a major cause of running-related injuries. But according to a paper published in the British Journal of Sports Medicine, there’s no evidence that’s actually the case.
“Much of what has become part of our common belief is based on marketing by shoe companies or by common sense logic,” says lead author Dr. Chris Napier, Clinical Assistant Professor at the University of British Columbia and director of the UBC Run Clinic. “I think most people accept that running shoe companies are going to push the limits of what they can say about a shoe to get you to buy it, and we take this into account when deciding which shoe to purchase, but they need to be careful in their claims.”
He cites the infamous Vibram FiveFingers as a perfect example. Over the course of five years, the company sold 70 million pairs of those shoes on the claim the footwear could reduce running injuries. However, there was no scientific evidence to back up such claims. A class-action suit was filed against Vibram, who settled in 2014 for 3.75 million dollars.
Cases like Vibram show how people expect—and buy into—marketing buzz because they want to believe Y shoe will fix X issue. But what happens when the buzz comes from the experts? Many trusted sources, including health care practitioners and running shoe retailers, tout the (unfounded) capabilities of specific shoe designs. “Runners expect more objectivity from these sources and trust when a practitioner recommends a shoe based on its characteristics and potential for injury prevention,” says Napier. “Our main goal [of this paper] was to expose that, at present, evidence is lacking that any shoe-type, be it minimalist, maximalist, traditional, or zero-drop, can prevent injury.”
Napier and his partner, Dr. Richard Willy of the University of Montana, reviewed several high-quality studies, including randomized control trials and observational cohort studies on running shoes and found a lack of conclusive evidence to support traditional shoe prescription to prevent running-related injuries.
“Based on current evidence, we can’t recommend any specific shoe design to prevent injury in healthy runners,” says Napier. Gait retraining, he says, is more effective for injury prevention than shoe selection. One study cited in his paper showed a 62 percent reduction in running-related injuries for runners who adjusted their stride or footstrike patterns; this is in stark contrast to studies that found no change in gait or injury rates after switching to minimalist footwear, even after six months of use.
This revelation might leave some runners feeling flustered—if they don’t truly need a shoe prescription, how should they pick what shoe to wear? Napier’s advice: Whatever feels good.
“In a healthy runner, since I can’t recommend a particular shoe type to prevent injury, I would recommend the shoe that is the most comfortable and will get them out running the most,” says Napier. “If it differs significantly from what they are already wearing, then I counsel them on the need for a prolonged transition between shoes. I also underscore the importance of training load (volume and intensity) in the prevention of injury. In the end, shoe choice probably has far less impact on future injury than other factors such as training load.”