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: On the Impacts of Different Stack Heights
By Matthew Klein

In this week's Monday Shakeout, Chief Editor Matt Klein shares some thoughts on what we know about the impacts of different stack heights and wonders how to balance it all.

The Hoka Stinson 7 sits at 43 mm in the heel

We recently had a great podcast (link) about defining what a maximalist shoe is. A majority of shoes on the market today have moved into the maximalist realm. Even a majority of traditional shoes like the ASICS Nimbus series, the Saucony Triumph series, the Mizuno Wave Rider series... everything. Almost all racing flats, save a few that would still be considered maximalist 10 years ago, have incredibly tall stack heights. Even the natural shoe companies like Topo and Altra have gone the maximal route, although they still have a few holdouts like the ST-5 and maybe the Superior. A few companies like Xero Shoes and Vivobarefoot have remained minimal with their entire lines staying extremely low, desperately holding on to the low stack life as everyone else towers above them (stack height-wise).

Is There Something Wrong With This?

There is not anything wrong with this. As I discussed in a recent post, there is no evidence that maximal shoes make your feet weak. However, we do know that maximal shoes tend to shift where your body works up toward the knee and hips (Sobhani et al., 2017). Like prior discussions I have had on footstrike, shoes do not necessarily reduce forces, but certainly shift where they go. We do know that minimal shoes do cause muscle size increases (hypertrophy) of the intrinsic foot muscles above normal (Ridge et al., 2015). This is clearly a result of the work shifting to the foot and ankle and away potentially away from the hip and knee (Sinclair et al., 2016).

Running Injuries Still Come from Age-Old Issues

My hope with this is not to push people into one type of shoe or another. Shoes are tools that will work differently for different people. I am going to encourage everyone reading this to not think of any footwear type as "best," but rather think what may be optimal for each unique individual. We know from the evidence that in regards to shoes, the only way to modify injury risk is to consider training in a variety of them (Malisoux & Theisen, 2020). Year after year with new footwear types, we have yet to see a change in injury rates. Runners continue to get injured due to a variety of factors. Overtraining, poor nutrition, old poorly or non-rehabilitated injuries (a history of an injury is the greatest risk factor for the same injury) and a variety of other factors will continue to also influence this.

Footwear will, for the most part, simply shift where people will get injured.
There will always be exceptions to this, but I continue to stand by the fact that footwear cannot prevent injuries but they can cause them if used inappropriately.

How to Balance Running in Maximal Shoes?

What really has my brain going right now is how to balance out the different stack heights. Knowing that each type tends to shift the muscular load to different areas, in my mind it would make sense to try to find some kind of balance in training to spread those forces out. For me personally, this means most of my training is in maximal shoes but all other time is spent barefoot or in minimal shoes, especially during strength training. I have continued to do brief runs (1-2 miles) in minimal shoes as a foot and lower leg strengthening at least once a week. Not surprisingly, many of the issues I tend to have while training full-time in maximal shoes (deep hip rotator irritations especially) have been minimized.

This advice will obviously depend on the individual but for those who can, I highly suggest if you are training in one stack height extreme, consider going the other direction once in a while for a break. Those who have certain pathologies may not be able to do this and will need to think about focused strengthening, mobility work and smart training for optimal performance. Shoes do not prevent injuries, they simply shift where forces go. We know that spreading things out tends to be best (think cross-training) so if you can do so, I would encourage you to not isolate yourself or others into one extreme. Instead, ask yourself which tool or tools may be best at what time for each individual.


Grier, T., Canham-Chervak, M., Bushman, T., Anderson, M., North, W., & Jones, B. H. (2016). Minimalist running shoes and injury risk among United States army soldiers. The American Journal of Sports Medicine44(6), 1439-1446.

Malisoux, L., & Theisen, D. (2020). Can the “appropriate” footwear prevent injury in leisure-time running? Evidence versus beliefs. 
Journal of Athletic Training55(12), 1215-1223.

Ridge, S. T., Olsen, M. T., Bruening, D. A., Jurgensmeier, K., Griffin, D., Davis, I. S., & Johnson, A. W. (2018). Walking in minimalist shoes is effective for strengthening foot muscles. 
Faculty Publications. 3159.

Sinclair, J., Richards, J., Selfe, J., Fau-Goodwin, J., & Shore, H. (2016). The influence of minimalist and maximalist footwear on patellofemoral kinetics during running. 
Journal of Applied Biomechanics, 32(4), 359-364.

Sobhani, S., van den Heuvel, E. R., Dekker, R., Postema, K., Kluitenberg, B., Bredeweg, S. W., & Hijmans, J. M. (2017). Biomechanics of running with rocker shoes. 
Journal of Science and Medicine in Sport20(1), 38-44.


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The Importance of Heel Bevels

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