Health·SECOND OPINION

Can the design of a running shoe help prevent injury? A B.C. researcher says he has the answer

For years, runners have received conflicting advice about what style of running shoe is best for preventing injuries. So a physiotherapist from UBC decided to review the strongest research on the topic. His blunt assessment has reignited one of the fitness world's fiercest debates.

Barefoot? Big sole? For years, runners have been getting conflicting advice about the ideal shoe

UBC physiotherapist Chris Napier reviewed the science around running shoe design and concluded there is no 'high-level' evidence to support the theory that particular shoes are better for preventing running injuries. (Keith Dunn)

This is an excerpt from Second Opinion, a weekly roundup of eclectic and under-the-radar health and medical science news emailed to subscribers every Saturday morning. If you haven't subscribed yet, you can do that by clicking here.

Challenging the scientific evidence behind running shoes is not for the faint of heart.

"People have very religious beliefs about this. It's crazy," said Chris Napier, a physiotherapist at the University of British Columbia.

Still, Napier dared to kick that hornet's nest by writing a recent commentary in the British Journal of Sports Medicine suggesting that running shoe design makes no difference when it comes to preventing injuries.

His conclusion was blunt.

"Runners should be instructed to choose a certain type of running shoe over another shoe no more so than a blue shoe over a red shoe," he wrote.

Some experts say comfort is the most important consideration when shopping for a new pair of running shoes. (Shutterstock/PEPPERSMINT)

Sports science writer Alex Hutchinson added fuel to the running shoe debate this week with a column in the Globe and Mail with the headline: "The myth of the running shoe."

Hutchinson ranks the running shoe controversy high on the list of fitness flashpoints, right up there with the debates about the benefits of stretching and the low-carb, high-fat diet.

"It's something people feel strongly about," he said.

Controversy began with barefoot running theory

Hutchinson traces the shoe controversy back to what he calls "the great minimalism debates of 2009."

That's when a book called Born to Run shook the running world with the theory that running barefoot is better. Suddenly, the running world was divided into polarized camps.

"Barefoot running is the idea that we're born to run without shoes and that's the way our feet move best," Hutchinson said.

Until then, the running shoe market had been dominated by the highly structured shoes that were developed in the 1970s after an Oregon trainer named Bill Bowerman famously pressed rubber with a waffle iron to create the original waffle-soled running shoe.

What we see is that there's really no high-level evidence that any running shoe design can prevent injuries.- Chris Napier, UBC physiotherapist

The idea behind those early high-tech shoes was to control the way the foot rolls inward as it takes a step, called "pronation." The shoes were also intended to reduce the force of impact and therefore reduce injury.

But then the barefoot craze took off, with a series of shoes — some of them looking like a glove for the foot  — designed to mimic barefoot running but still protect the foot from a harsh urban terrain and northern climate.

"A lot of people got caught up in that," Napier said. 

As the minimalist shoe craze settled down, a new trend quickly emerged — the maximalist shoe designed with extreme cushioning. 

Lack of evidence

And through it all, runners are getting conflicting advice.

"We were growing concerned [about] some of the claims that were being made on social media and in research circles, being made by health professionals especially, and researchers, that certain running shoes could prevent injuries," Napier said.

So Napier and co-author Richard Willy from the University of Montana reviewed the highest-quality research featuring randomized controlled trials and systematic reviews.

"What we see is that there's really no high-level evidence that any running shoe design can prevent injuries," Napier said.

Sports science writer Alex Hutchinson traces the running shoe controversy to the barefoot running craze that began in 2009. (Stefan Wermuth/Reuters)

None of this comes as a surprise to University of Calgary kinesiology professor Benno Nigg, a prominent biomechanics researcher.

"What you have at the moment is a lot of religion and dogma and beliefs and very little facts," he said.

"The development of running shoe technologies aimed at reducing impact forces and pronation has not led to a decline of running-related injuries," he wrote in a paper published last year.

He says there are a variety of biomechanical factors associated with those injuries that are not well understood. And the type of shoe is not a significant variable.

He suspects the high number of running injuries has more to do with the exercise habits of runners than the quality or design of their shoes. 

"The reasons are ... too much mileage, or not enough recovery or those types of things," he said.

One study reported that in a single year about 50 per cent of all runners will suffer knee injuries, or other running-related problems including plantar fasciitis, Achilles tendinopathy and stress fractures of the foot and the tibia.

Experts choose comfort over design

So what do the experts recommend for runners facing a dizzying variety of highly engineered footwear? Choose comfort. 

Nigg's research suggests comfort might even play a role in preventing injury.

One of his studies compared a group of soldiers who used an insole versus soldiers who wore regular military-issue boots with no added insole. The results showed fewer injuries in the group that wore the comfort-enhancing insole.

"It's not running, it's military activity, but it's a good indicator," he said.

Napier agrees that comfort is a good guide.

"My advice is fairly simple. I tell people that comfort is probably the most important thing. A comfortable shoe is something you will get out and run in."

Hutchinson, who in addition to being a sports science writer is a former member of Canada's national running team, says he has two simple questions when shopping for running shoes: 

"Is it comfortable and is it on sale? That's how I choose my shoes."

About the Author

Kelly Crowe

Medical science

Kelly Crowe is a medical sciences correspondent for CBC News, specializing in health and biomedical research. She joined CBC in 1991, and has spent 25 years reporting on a wide range of national news and current affairs, with a particular interest in science and medicine.