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: Research on Finding Optimal Shoes and the RUN-CAT
By Matthew Klein

We've talked about RUN-CAT a few times at Doctors of Running. Matt provides a full overview in this week's Shakeout to discuss why it is such a powerful tool for selecting shoes.

The current evidence on finding the optimal shoes for each person has evolved a great deal over the years. When I started working in running stores over a decade ago, the prevailing way to match shoes to people was to put them on a treadmill, watch how much pronate (or at least, what we were told was pronation), decide how much or little stability they needed, then bring out 2-3 shoes for them to try. I learned quickly to take a look at their feet and try to figure out how much width and length they might need, but then let them figure out what was best. When a customer asked me "what should I be looking for when I try these on?" I would just say "whatever feels best." I assumed (with no biomechanical training) that I knew that if I followed that biomechanical model of attempting to "correct" someone's pronation, everything else would fall into place in regards to fit. It didn't take long for me to find out, through observation and error, that actually did not work most of the time. A small percentage of the population worked in this way, but most people did not.

As I entered physical therapy school shortly after (still working in running stores), I realized that "pronation," which describes a natural combined motion at the foot and ankle that is necessary for shock absorption, was not a primary pathology. Rather it was one piece of the puzzle. Attempting to "stop" it with pronation control and other mechanisms didn't always work and frequently caused more issues for those who pronated and had good movement control. I began to focus on other ways to fit shoes, including asking more about the person, their history of training/shoe use and their goals. I also began to focus on teaching new (and experienced) runners how to figure out what worked for them based on what I was doing daily in the back room.

Through experimentation, I was also trying to figure out the best shoe for me. That actually led to the creation of Doctors of Running as I had such a hard time finding the perfect shoe that I started writing about it hoping to educate and help others on their own footwear journeys. As I continued my own journey, it began challenging to manage all the different variables that went into footwear and distill them down into something manageable for the general public.

Evolving Research on Optimizing

The research also evolved on this as well. The biomechanical/pronation model was called into question as it did not work all the time for the majority of the population. We now know that stability shoes tend to work best for those with a history of pronation related injuries and less consistently for those who pronate without issue (Willems et al., 2021). Dr. Benno Nigg, a godfather of running footwear research, began writing about alternate ideas, including the comfort filter and the preferred movement pathway (Nigg et al., 2015). These ideas came about as we realized that comfort was highly predictive of success with footwear and each person had a unique movement path during gait. This movement pathway needed to be facilitated rather than controlled in many cases, hence why some people did not respond well to typical stability systems.

Developing the RUN-CAT

Dr. Chris Bishop and a brilliant team from Australia, decided to figure out which factors related to comfort were most important to focus on. After extensive research, four primary features were identified as the most important variables to look for in immediate comfort: forefoot cushioning, heel cushioning, forefoot flexibility and stability. Forefoot width was originally included as a fifth, but due to some statistical issues it was removed (although I would still consider it personally). These four items were graded on sliding scales, with individuals looking for what was best for them, rather than being on the extreme ends of stability/unstable, soft/firm and highly flexible/stiff. This fit with the comfort paradigm and preferred movement pathway, finding something that worked with your mechanics rather than against them. This work became the RUN-CAT or the Running Comfort Assessment Tool. Later evidence suggested that despite the name, it is not a valid measure for assessing footwear comfort in cats.

Editor's Note: -_-

For experienced and advanced runners, there may be additional things you are looking for. Certain parts of the upper or sole that you know work/do not work for you may help your decision when looking for shoes. For new runners especially, the RUN-CAT can be a great way to help guide an otherwise overwhelming and confusing process. The purpose is to find what feels best for the individual (you) rather than what is the most of each of the variables. Despite not being included, I would still suggest adding width as a 5th variable here. Finding an optimal fit/hold of the foot is important, making sure a shoe is neither too narrow or too wide. Outside of that, this is an excellent guide to consider what may work best for you, along with continued refinement as you learn what shoes and footwear types your body responds best to. 


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 Sciences38(18), 2100-2107.

Nigg, B. M., Baltich, J., Hoerzer, S., & Enders, H. (2015). Running shoes and running injuries: mythbusting and a proposal for two new paradigms:‘preferred movement path’and ‘comfort filter’. British journal of sports medicine49(20), 1290-1294.

Willems, T. M., Ley, C., Goetghebeur, E., Theisen, D., & Malisoux, L. (2021). Motion-control shoes reduce the risk of pronation-related pathologies in recreational runners: a secondary analysis of a randomized controlled trial. journal of orthopaedic & sports physical therapy51(3), 135-143.


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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
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About the 1st MTP and its Role in Running

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