Does your pronation matter when choosing a running shoe? ~ Rasmus Østergaard Nielsen

According to runners’ magazines, shoe stores, and practitioners, an understanding of your personal pronation type is crucial to choosing the proper running shoe. Indeed, this assumption has affected the runner´s choice of running shoes: in 2009, seventy-three percent of all cross-country runners identified foot posture compatibility with shoe design as the most important factor in choosing a running shoe.

But do runners really need to pay particular attention to their foot type when choosing a running shoe to reduce the risk of injury? The following is intended to provide readers with an evidence-based update on the most recent research in this field.

Nielsen-pronation-smallGoing from no evidence to little evidence…

In 2009, Richards et al published a review to determine whether the practice of prescribing distance running shoes featuring elevated cushioned heels and pronation control systems tailored to the individual’s foot type was evidence-based. They concluded it was not.

In 2011, Ryan et al concluded that our current approach of prescribing in-shoe pronation control systems on the basis of foot type is overly simplistic and potentially injurious. They based their findings on a randomized controlled trial, in which females running in motion control shoes sustained both a greater number of injuries and had a higher risk of missed training days than persons running in stability or neutral shoes.

Recently, colleagues and I published a paper in the British Journal of Sports Medicine. Almost 1,000 healthy novice runners were followed prospectively for a year while they ran in a neutral running shoe regardless of their foot type. No differences in injury survival existed between individuals with pronating feet or neutral feet. Based on the findings from our study and the study by Ryan et al, it seems clear that a neutral running shoe is a feasible choice regardless of the foot posture.

What about injured runners?

Many runners are injured and many seek advice on choice of running shoes in shoe stores and among clinicians. Unfortunately, very little is known about the choice of running shoe and injury risk among those having had an injury. It is highly important to stress that motion control shoes, neutral shoes, and minimalist shoes may be a feasible choice for injured runners with specific injuries. Personally, I think some injuries are well-treated in motion-control shoes, other injuries in neutral shoes, and others in minimalist shoes, or even no shoes at all.

What is pronation?

In the International Foot and Ankle Biomechanics community, up to forty different definitions of pronation have been presented. Therefore, pronation is a term which may cover various aspects of the foot such as rear-foot angle, navicular drop / height, bulge at the talo-navicular joint, or even several aspects of the foot merged into an index (i.e. foot posture index).

It is important to stress, that pronation may cover different aspects and it is, indeed, important to specify what is meant by pronation before using the term. In the most recent scientific articles, pronation is measured by the foot posture index (FPI). If pronation had been measured using a different approach, other results than those reported may have been presented.

For more information on foot pain, turn to Chapter 40 in Clinical Sports Medicine.

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Rasmus Østergaard Nielsen received degrees in physiotherapy (2006) and Master of Health Science (2012) and has worked as as clinician from 2006. He is currently a Phd student at Aarhus University, Denmark. Nielsen also sold running shoes in a runner´s store from 2005 to 2009. Click here for full resume / CV.

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