Injury Considerations When Choosing Running Shoes

The following is a list of features to look for or a type of shoe to consider based on a number of foot-related pathologies. Often, if chosen correctly, simply getting somebody in the proper shoe can go a long way in alleviating their symptoms. These are things to pay close attention to depending on the injury:

• Hallux Rigidus (1st MPJ arthritis): shoe with more of a rigid forefoot and rearfoot rocker. Increased stiffness will limit unnecessary flexion through the big toe joint and a rearfoot rocker will promote heel-to-toe propulsion with less effort (examples: most Hoka models, Altra Experience Flow)

• Bunions: Wide toe box to prevent pain that is usually caused by rubbing irritation on the upper. A soft mesh upper should also help alleviate this. Some can also develop a Tailor’s bunion on the opposite side of their foot or corns on their 5th toe. They will equally benefit from a wider toe box shoe for the same reasons. (Examples: any Topo Athletic or Altra running shoe models)

• Neuroma pain (nerve pain between the toes/metatarsals): people will usually get neuromas from a history of wearing shoes or cleats with a narrow toebox, in addition to often having less foot strength/stability (worsened by narrow shoes). These patient’s will also need a shoe with a wider toebox, though they’ll also need further ancillary treatments due to how long it takes for the irritated nerve to calm down.

• Haglund’s Deformity (posterior heel spur): Adults will get irritation from the posterior bony prominence (Haglund’s deformity), so will need a less firm heel counter and something more flexible/forgiving. Those that experience a lot of irritation with this will also probably want and benefit from a supportive recovery sandal to wear around the house, which is better than the alternative that they will turn to (walking barefoot). Being barefoot will put increased stretch on their Achilles, which will probably make it feel worse.

• Achilles tendonitis (midsubstance) and Calcaneal Apophysitis (Sever’s Disease): Kids will experience pain in their heels while their growth plate is still open at the location where the Achilles tendon is inserting, usually between the ages of 8-14. The following is usually overuse related and improves with R.I.C.E. therapy and offloading of the heel. The treatment for Achilles tendonitis is very similar, though the condition is of course affecting the tendon itself. Staying away from zero drop shoes is the number one priority for both of these injuries, and they’re one of the only cases I encourage a shoe with a larger heel-toe drop. If somebody elects to stay with a lower heel-toe drop shoe, they can augment it with a heel lift placed under their heel in the shoe.

• Posterior Tibial (PT) Tendonitis: This in my opinion is the primary and one of the few indications for a motion-control shoe (examples would be Brooks Addiction or Beast). The guiderail technology that many motion control shoes now have, straight last on the outsole of the shoe, and firm heel counter will combine to attempt to isolate excessive pronation of the foot, which will usually exacerbate symptoms in those with PT tendonitis.

• Peroneal Tendonitis: Peroneal tendonitis is in some ways the opposite of PT tendonitis and is an injury that you do NOT want motion-control or other rigid supportive shoes. With peroneal tendonitis, we want more pronation, since the injury is likely to be exacerbated by increased supination (inward rolling) forces. If possible to find to a shoe with more of a curved last, this will suit them best (i.e. Hoka Clifton, Brooks Glycerin Flex). Otherwise, people with peroneal tendonitis will do just fine with a cushioned, neutral shoe with a firm heel counter if they have a high arch or a history of rolling their ankle.

• Gastrosoleus Equinus: Equinus is a fancy medical term referring to having tight calf muscles. This can be caused by a number of reasons including inactivity, lack of stretching, prolonged history of wearing shoes with a high heel to toe drop, diabetes, and more. If when stretching your calves from a seated position you are unable to create at least a 90-degree angle (ideally less) between your foot and leg when bringing your toes toward you, then you have to be mindful of the heel to toe drop when purchasing a new pair of shoes. If you are historically used to always wearing shoes with a 10mm drop, and suddenly decide to wear minimalist shoes with a zero drop (no drop from the heel to the toes of the shoe), you’ll be placing excessive tension and stretch on the calf-muscle complex which will increase the risk of it being strained and torn. Some people can slowly convert to a lower heel-toe drop overtime provided that the conversion is gradual and accompanied by frequent daily stretching. Some people such as those with progressive diabetes will have tendons that are less forgiving. If you fall in this camp and are unsure if a pair of shoes is right for you, consult with me or another medical provider before making the switch.

• Metatarsalgia (pain under the “balls of the feet”): Metatarsalgia or pressure points in the forefoot on the bottom of your feet occur for a number of reasons, but the two most common camps I see people struggling with it are older folk with fat pad atrophy, which is exactly as it sounds, and occurs naturally with age in the forefoot and the heel of the foot. The second case is biomechanical in nature, occurring in all ages, and due to poor walking/running mechanics or strength and stability deficits. Assuming the biomechanics are perfectly normal, then a shoe with a lower heel-toe drop in somebody with good calf flexibility, one that is neutral, well cushioned in the forefoot, and having a rearfoot rocker should all help take pressure off the bottom forefoot of their feet.

• Plantar Fasciitis: I left the most controversial one for last. You will see headlines for “The Best Shoe for Plantar Fasciitis” splattered all over the internet. Most of the features that all of the running shoes that are advertised have in common are increased cushion within the midsole and specifically within the arch. Aside from this, you can see a wide variety of shoes including those with and without rearfoot rocker designs, dress shoes, and shoes with anywhere from zero to 16mm in drop from heel to toe. So, how do I know which shoe is actually “THE ONE”?? The internet rage and advertising campaigns that have benefited from this injury are not surprising considering how painful and difficult it can be to get rid of for some that are inflicted by it. In reality, the shoes are only one factor at play that will help alleviate this condition. Here are the things to consider if you’re currently plagued by it

1. How much heel drop? As noted above, there is little to no consistency when it comes to websites recommending shoes for plantar fasciitis if the shoe should have a larger or smaller heel to toe drop. This has always puzzled me since calf stretching has always been one of the primary treatment options that providers recommend for plantar fascitiis. I emphasize the stretching less than most, but if you do believe that it is important, and the patient is stretching 15 minutes per day while wearing a shoe with a 10mm drop for 8 hours of the day, how effective is that stretching going to be? The shoe they are wearing is automatically putting them back into a “less stretched” position. Referring back to my section on gastrosoleus equinus, counterarguments to this point would be that shoes with minimal heel drop in a person with very tight calf muscles can put them at risk of a strain or tear of their calf or Achilles, which I agree with. Because I think tight calves do have some effect on causing plantar fasciitis, I will try to steer younger people with better calf flexibility towards smaller heel drop shoes. With those for whom this would be too risky, I would prefer to focus on intrinsic support and function.

2. What can be addressed with shoes alone? The most commonly documented causes of plantar fasciitis include overuse of the plantar fascia, increased strain, tight calf muscles, obesity, foot structure, and biomechanics. Features in a good running shoe that would be most likely to address a number of these causes would be increased cushioning, arch support (+/- a custom vs. OTC orthotic), and a lower heel-to-toe drop in a younger, more flexible patient. Older patients with less calf flexibility would benefit more so from a rocker bottom rearfoot to help them propulse off. Research supports the idea that patients tend to get improvement in their plantar fasciitis symptoms with a thicker, more cushioned midsole in their shoe¹. In this patient base that is symptomatic, they are more likely to benefit from more cushioned and supportive shoes than a young adult with feet on the flatter side that are otherwise asymptomatic.

3. What are other providers missing? My belief is that one of the primary reasons that patient’s get plantar fasciitis as a result of overuse or increased strain of the ligamentous structure is due to improper functioning of the plantar fascia as a result of biomechanics. I will see many patients in clinic with plantar fasciitis with perfectly normal arch heights and more calf flexibility than you and I combined. For these people, is the treatment option simply MORE arch support and calf stretching? There has to be more involved. The functions of the plantar fascia include aiding in shock absorption, supporting the medial arch on the bottom of your foot, and aiding in propulsion off of the big toe via what is known as the Windlass Mechanism². If the involved limb is more externally rotated at the hip as it should be, the individual is wearing orthotics or too stiff of shoes that prevent adequate flexion of the big toe joint, or any other biomechanical factors are at play that prevent the plantar fascia from functioning and pulling in the orientation that it is intended to, then the patient will experience increased strain and overuse of the ligament overtime no matter the flexibility of their calves or how comfortable their shoes are. This reinforces the importance of individualized evaluations of strength, mobility and gait patterns up and down the kinetic chain when trying to treat the root cause of any injury, let alone plantar fasciitis.

Addendum (05/15/2026): In all the shoes that Jonathan Beverly (Outside Magazine) tested for best supportive shoes of 2026, for the first time there was not a single shoe with a traditional medial post. With this being the case, it is becoming more difficult to differentiate “stability” shoes from traditional neutral shoes. The differentiating factors are becoming more arbitrary and less distinct, but generally people will feel more supported by shoes with a straighter last, wider base of support in the forefoot, and denser foam.

References:

• ¹Umar H, Idrees W, Umar W, Khalil A, Rizvi ZA. Impact of routine footwear on foot health: A study on plantar fasciitis. J Family Med Prim Care. 2022 Jul;11(7):3851-3855. doi: 10.4103/jfmpc.jfmpc_637_21. Epub 2022 Jul 22. PMID: 36387720; PMCID: PMC9648311.
• ²Bolgla LA, Malone TR. Plantar fasciitis and the windlass mechanism: a biomechanical link to clinical practice. J Athl Train. 2004 Jan;39(1):77-82. PMID: 16558682; PMCID: PMC385265.