ShoeGuy: Running Rx

New shoes can be tools for healthy running

By J. D. Denton
As featured in the JulyAugust 2008 issue of Running Times Magazine

If only running shoes were drugs. Powerful drugs, more powerful than 10 cortisone shots, able to knock out any injury without a single side effect, and do it faster than a downhill finish. Maybe then everyone on the planet could run 100 miles a week without pain, but Shoe Guys would have to accept Blue Cross and running shoes would cost $1,200 a pair.

OK, not going to happen, not even in the weirdest of dreams (or nightmares, if you're a Shoe Guy), but runners still look at shoes as medicine. To cure plantar fasciitis, Achilles tendinitis, or whatever happens to be the "itis" of the month, it's easier, and a heck of a lot more fun, to shop for running shoes than it is to see a real doctor.

But shoes aren't drugs. They're simply tools designed to do a job. As long as you run, however, the risk of injury is there no matter how good the tools. Shoes are rarely the sole cause or cure, but if poorly chosen they can certainly increase the risk.

Take the high school kid with an angry iliotibial band that threatened his track season. The lanky young gazelle was enjoying an injury-free running career until one day near the end of a long tempo run, his knee locked up with pain after pausing at a busy intersection. He struggled with it for days before his coach suggested different shoes might help. Not wanting to hear "Stop running!" from mom, dad, or the family doc, he dutifully went to see Shoe Guy.

Conventional wisdom says a fit 17-year-old kid with strong legs and efficient mechanics should be able to run in the lightweight, high-performance trainers he purchased a month before the incident at the intersection. Or so he thought. They replaced his previous super-light trainers, but just like beefier standard trainers, so-called "performance" running shoes are not all created equal in the support department. Just because you're a fast, lightweight kid doesn't mean you can run hard and long in just any old fast, lightweight shoe.

And though physically more gifted than most, this youngster was no exception. The modest medial post in the shoe midsole was no big deal when the shoes were new, but it became a big deal as the shoes broke down. The soft lateral side of the midsole went south while the firm medial side stayed tough, all this as his training ramped in intensity and distance. The classic perfect storm for injury. After 100 miles or so, the increased ratio of stability differential in the midsole threw off the kid's stride just enough to annoy the IT band, and then that fateful tempo run pushed it into full-blown carnage. For legs that had never known pain, it was the storm of the century.

After noting the uneven outsole wear pattern and deformed midsole on the under-performing performance trainers, I put the kid into a pair of flexible neutral trainers with no medial post. The sidewalk test confirmed the old shoes had too much of a good thing, that is, too much stability. These feet had all the natural stability they needed.

As he returned from his brief out-and-back on the sidewalk, I was satisfied with the level of support and asked the same question I've asked thousands of times from this very spot: "How do they feel." Meaning the shoes.

"My knee still hurts," replied the gazelle, obviously expecting instant gratification.

Of course it still hurts. Shoes are tools, not a magical pain-killing drug. If you watch basketball or football on TV, at some point you may see an injured player limp into the dressing room with a trainer, only to return a few minutes later and lope back into the game. Trust me, he's not wearing new shoes.

The solution to this kid's grumbling IT band was also not just new (meaning biomechanically more appropriate) shoes, but also a dose of R.I.C.E., which stands for rest-ice-compression-elevation, not "buy new shoes." With patience, smart training, and good shoes (that cost way less than 1,200 bucks), the kid will be back at it soon enough. No drugs needed. Not now, and if he's smart, not ever.
J.D. Denton owns and manages a Fleet Feet store in Davis, Calif. He is a widely recognized writer and expert on running shoes and can be reached at shoeguy@fleetfeetdavis.com.