Physical Therapists Using Clinical Analysis To Discuss The Art And Science Behind Running and The Stuff We Put On Our Feet

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The Monday Shakeout: A Simple Guide to Foot Health and Footwear
By Matthew Klein

Welcome to our third edition of the Monday Shakeout! This week we discuss the often overly complicated topic of foot heath in footwear. This post could easily be an entire book but we are trying to simplify this down in a digestible way for the majority of people. 

The minimalist shoe and barefoot wave was one of the many times significant questions were raised about the impact of shoes on the general public's feet. There have always been extremists that claim all footwear is bad and puts EVERYONE's body out of alignment (this is absolutely not true and is often fear mongering to sell something). There are also other extremists who claim that no one should be barefoot and everyone needs extreme motion control/high cushioning for adequate alignment (also not true and also probably trying to sell something). A small percentage of people may certainly be sensitive to abnormal positions, but most people can adapt to almost anything. There are an even greater number than benefit from shoes, allowing them to go farther, faster and possibly safer than without. This includes those with significant pathology, including balance deficits, joint pathologies, neuromuscular problems and more. That said, many people would benefit from spending some time in less shoe or barefoot. The key is not to make extreme generalizations for every person. Each individual will need something different, but there are some overarching concepts that may be helpful to follow when it comes to health feet and footwear choices.

Having Adequate Fit/Room

A common issue for individuals with footwear is either having too much or too little room in their shoes. Too much room can cause sliding, blisters and insecurity. Too little room can also cause blisters, compression and possible injury to nerves, muscles and areas requiring blood supply and a reduction in the foot's natural ability to shock absorb (Agresta et al., 2022). While some would assume that everyone needs a wide toe box, people have differently shaped feet that need shoe shapes that match them. Someone with extremely narrow feet may not do well in a super wide natural/minimalist shoe, while those with wide feet may not do well in an extremely narrow track spike. The key is to find a shoe that has enough room for your feet. Regardless if you have a narrow, normal or wide width or volume feet, the shoe you choose should have enough room that your feet do NOT go numb, feel excessive pressure or feel loose. You should also be able to wiggle your toes in the shoe and they should not feel compressed to the point you cannot spread or move them. These are extremely important movements that are required for adequate shock absorption and function of the foot. You should have a shoe that fits as closely as possible to the shape of your foot and avoid extremely tapered toe boxes (front). More or less room is not necessarily a good thing. It will depend on your feet and your preferences.

Author's Note: We will have a future discussion on bunions and 1st Toe position in the future. This post is too short to dive into that. That said, footwear should not push your big toe EXCESSIVELY inward. 

Feels Comfortable/Matches Your Body's Mechanics

Each person moves differently. Our joint axises, muscle length, ligament stability and neuromuscular control all vary. This can make choosing a shoe challenging but I would suggest following the guide from the RUN-CAT footwear comfort scale to help (Bishop et al., 2020). This great study found that when it comes to footwear comfort, some of the key components are cushioning at the heel and forefoot, shoe stability and forefoot flexibility. More or less is again not better. Finding an optimal amount is.

The amount of cushioning underfoot at the front and the back should be comfortable. It should not feel like it is uncomfortably hard and should also not feel like you are running through soft quicksand. It should feel just right. What feels right may vary and if your body can tolerate it, a few different levels of cushioning may be a good thing as variety in footwear has been found to decrease injury risk (Malisoux et al., 2015). Extremely cushioned shoes can be a little less stable, while super minimal shoes do not provide much shock absorption. Extremely cushioned shoes tend to be more protective, while super minimal shoes tend to be light and work more of your foot and ankle muscles. One is not necessarily better than the other. Finding the optimal amount for each person or having a variety of options is.

Shoe stability means the platform you are standing on does not feel so wobbly you are going to fall off and not so rigid that your feet hurt. As we have discussed extensively, stability can come in a variety of ways. Some people also react poorly to stabilizing methods in shoes while others need high amounts. Thus, finding something that makes you feel centered on the shoe without being excessively forced is another important factor. An extremely unstable shoe may cause compensations and abnormal loading, which can either be uncomfortable or difficult to run in. A shoe that is too stable/rigid can also cause compensations due to limiting motion too much, either increasing forces into certain areas or making it difficult to move through a shoe. More or less is again not better. Finding an optimal amount is.

Forefoot flexibility is highly individual. Some people like a ton of flexibility if their toe joints move a large amount and they have control over it. Others do not want any flexibility due to sensitivity, limited mobility at their toes (Hallux Rigidus for example), plantarfascial issues (sometimes) and more. The later may choose a stiff soled shoe with a significantly rockered sole. Those who have pathology that limits the strength or mobility of their toe joints or ankle should consider a rockered sole as it replaces movement facilitatory factors that may have been lost due to the pathology. Those who do not have pathology and want to make their feet move/work more may want to consider something more flexible. Speed is a different factors. David and I have frequently discussed how flexibility can feel good for some workout efforts, while an extremely stiff sole can be more comfortable for extremely fast and long efforts. This will depend on how your foot moves, individual mechanics and other factors within the shoe (like how soft it is). More or less is not necessarily better for everyone, but finding the optimal amount is (Mcleod et al., 2020).

Beyond Footwear: Feet Exercise Considerations

Foot health extends far beyond shoes. Feet contain one of the highest densities of muscles in the body. These should all be utilized and can certainly be trained. Various popular exercises, including Toe Yoga, Short Foot, Toe Spreading, Toe Extension, Towel Crunches and more can be helpful. Barefoot activities, like walking, grass strides at the end of runs, lifting (carefully in the right environment) and balancing can also improve foot strength as much as some of these exercises (Ridge et al., 2018). Spending time working your foot muscles can occur in a variety of ways. It would be optimal to try to get a little bit of all of them, but a few ones you know you will do consistently works even better. The most important part is consistently working on this as muscular strength, mobility and coordination will decrease if you do not continue to use them. That is why sustainable habits are the best, making simple actions an optimal choice. If that means spending some time walking barefoot inside or spending some time balancing while barefoot at least five times per week while you brush your teeth or cook, go for it.


Agresta, C., Giacomazzi, C., Harrast, M., & Zendler, J. (2022). Running injury paradigms and their influence on footwear design features and runner assessment methods: a focused review to advance evidence-based practice for running medicine clinicians. Frontiers in Sports and Active Living, 4, 74.

Bishop, C., Buckley, J. D., Esterman, A. E., & Arnold, J. B. (2020). The running shoe comfort assessment tool (RUN-CAT): Development and evaluation of a new multi-item assessment tool for evaluating the comfort of running footwear. Journal of Sports Sciences, 38(18), 2100-2107.

Malisoux, L., Ramesh, J., Mann, R., Seil, R., Urhausen, A., & Theisen, D. (2015). Can parallel use of different running shoes decrease running‐related injury risk?. Scandinavian Journal of Medicine & Science in Sports, 25(1), 110-115.

McLeod, A. R., Bruening, D., Johnson, A. W., Ward, J., & Hunter, I. (2020). Improving running economy through altered shoe bending stiffness across speeds. Footwear Science, 12(2), 79-89.

Ridge, Sarah T.; Olsen, Mark T.; Bruening, Dustin A.; Jurgensmeier, Kevin; Griffin, David; Davis, Irene S.; and Johnson, A. Wayne. (2018). Walking in Minimalist Shoes Is Effective for Strengthening Foot Muscles. Faculty Publications. 3159.

Van Alsenoy, K., van der Linden, M. L., Girard, O., & Santos, D. (2023). Increased footwear comfort is associated with improved running economy–a systematic review and meta-analysis. European Journal of Sport Science, 23(1), 121-133.


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Ultraspire Fitted Race Belt: The best way to carry your phone and goods on the run. No bounce and various sizes for waist. (Also recommend the Naked belt)
Saysky Running Gear: We were really taken aback by this Scandinavian company's ultra-thin, durable performance clothing
Skratch Recovery, Coffee Flavor: Mental and physical boost post run. Coffee flavor is excellent and goes great straight into a fresh brewed cup
goodr Sunglases: Run in style with goodr's super fun sunglasses.
Feetures Socks: Massively grippy socks that will make you feel more one with the shoe
Amphipod Hydraform Handheld Water Bottle: Perfect for long runs when you need hydration in the summer
Trigger Point Foam Roller: Help get those knots out post-run and feel better for tomorrow
Theragun Massager: This small version is great on the go for working tired legs
Ciele Hat: Our team's favorite running hat of choice!
Fractel Hats: Our team's wider fitting running hat of choice!


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