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There have been quite a few threads recently about the selection of running shoes, manufacturer's claims and the evidence base of their design.

One thing I hear time and again from advocates of barefoot and minimalist running shoes is that a typical shoe is 'too cushioned and has a too high heel'. Certainly manufacturers have historically pushed the value of cushioning in their marketing otherwise there would be no Gel/Air/Hydroflow/Zigtech etc etc etc...

However do Podiatrists look at cushioning as an important component of a running shoe design??
I know that I do not personally consider this apart from not wanting a shoe which too soft... of course which is subjective.

The American APSM footwear testing recommendation does not mention cushioning as something to consider- see here- http://www.lowerextremityreview.com/article/a-three-point-approach-to-testing-running-shoes

I think their tests are pretty close to what I would personally suggest to patients to look for in a shoe with the addition of it feeling comfortable!
So...

Does anyone have any other general recommendations?
Does anyone actually recommend a shoe because of cushioning above any other shoe (granted I do not suggest running in leather soles dress shoes)?
Does anyone actually recommend cushioning as a feature?
Any experiences where you think a running shoe has lead to an injury because of a lack of cushion?

 

Not considered it important since I realized how few injuries are linked to impact loads!... that was at least 15-20 yrs ago!

 

a couple of points

Be interested to know if FF cushioning reduces Bending moments of the metatarsals then if so would be a good reason to recommend Cushioning for some - although the increased likely hood of rearfoot striking from a thinker shoe would have a similar effect without cushioning I guess.

Recommending shoes should really be broken into new and experienced runners.

Experienced runners without major problems - go with what you know

New runners - many variables - but comfort is key.

 

I generally look at cushioning in elderly patients with fat pad atrophy.

 

If the activation of the triceps surae is the same, then the bending moments on the forefoot are going to be the same. (Exception if bony end of range of motion contributes to internal ankle plantar flexion moment.) However, if there is a long metatarsal, the cushioning could compress more under a single metatarsal with a higher load and this could allow other metatarsals to bear more load. Especially if the material set (stays compressed) under the metatarsal with higher load. In that scenario the bending moment would be reduced on an individual metatarsal.

Eric

 

The anti pronation feature of a harder medial midsole and a softer lateral midsole (many different designs achieve this) will shift the center of pressure more medially when the heel is on the ground. So, folks with a medially deviated STJ axis get that anti pronation feature and folks with a laterally positioned STJ axis don't.

Eric

 

Interesting in the repies so far that they refer to forefoot cushioning as I have the same initial thought.

My suspicion would be that cushioning with respect to marketing of runners would tend to be more focused around cushioning at the heel ie "reduced impact"

Personally, cushioning at the heel is not something i care too much about unless I feel it is too soft or a race walker has tibialis anterior overusage

 

QUOTE (Be interested to know if FF cushioning reduces Bending moments of the metatarsals)

I'm confused by this statement mike. Does a rigid material not reduce the bending moments of a structure?

Cushioning material would likely lessen compressive force but would it really reduce bending?

For example,treatment for met stress fracture= stiff soled shoes or rigid sole plate.

Scott

 

It depends on by which the stiff shoe reduces bending moments. I recall a paper that found that there was a decrease in forefoot peak pressures with a rigid shoe when compared to a flexible shoe. Peak pressure under the metatarsal head will correlate with bending moment on that metatarsal.

There may be a behavioral change caused by the rigid shoe. There may be less planar flexion moment in the achilles tendon because it's harder to plantar flex the ankle in the rigid shoe. I've got some quite stiff mountain bike shoes, and when I walk in them I notice I choose to plantar flex my ankle less in them when compared to a running shoe. I believe that is the mechanism by which a stiff soled shoe can help a metatarsal stress fracture. However, if you have a foot structure with a long 2nd met, a rigid shoe with a cushioning insole that put more force on the other mets and less on the second would be better than the rigid shoe alone.

Eric

 

I pretty much do the same, however with some caution. There are quite a few shoes with these design features where the lateral material is, in my opinion, too soft and the medial material too relatively firm- In some patients this can cause problems particularly if the have a very lateral foot strike.
Eg: Adidas have strong market presence in the Middle East and I found that 2 of their higher end stability type shoes- Supernova Sequence and Adistar Salvation- performed very differently though they would have the same general classification. The Adistar had a very soft lateral heel unit. Interestingly this feature seems to be less obvious in the newest version of the shoe...