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Monday, August 28, 2023

Monday Shakeout: Differences Between Low vs. High Heel Drop Shoes



The Monday Shakeout: Breaking Down Low vs. High Heel Drops
By Matt Klein

A question we often get is about heel-to-toe drops. What does a low drop shoe do? What does a high heel drop shoe do? What's the best drop for me? It can be further confused when including things like rockers to the shoe. In this edition of the Monday Shakeout, we rounded up our editorials on drops to help you better understand the effects that each have on runners.


Differences in Lower Extremity Load with Drop Variation

As the maximalist era of the footwear industry stabilizes and we are seeing less minimal footwear, heel-toe drop in shoes seems to be stabilizing. 20 years ago almost every running shoe had a 10-12 mm drop whereas now those are less common. 6-10mm seems to be the norm now with a larger number of shoes with lower heel drop and an extremely small number above. This is not necessarily a good or bad thing as individual needs vary greatly. It does mean things are different in regards to what tissues are loaded during running gait.

Lower drop shoes tend to load the Achilles tendon, calf and ankle. We have repeatedly said that transitioning to a lower drop, minimal shoe requires adequate calf strength and ankle mobility. However, while a rocker can unload these areas somewhat in a higher stack, low drop shoe, some of those same requirements still apply. If you land first at your heel in a zero drop maximal shoe, you compress the rearfoot more than the forefoot, creating a negative drop shoe. This requires a large amount of appropriate ankle mobility and calf strength to control and progress forward. There are a few true negative drop shoes on the market now, so those requirements are even higher. Regardless of where you land in a lower drop shoe, more motion is required at the ankle (especially at the talocrural joint). This requires a great deal more dorsiflexion, which initially stretches the calf muscles and Achilles tendon. These muscles must tolerate a larger range of motion during running gait, which requires more eccentric and concentric control at this muscle group. Thus, having adequate range of motion and strength are extremely important at the ankle with this shoe type. This can be beneficial to move some stress away from the knee and hip given the shock absorption that occurs early at the ankle. It is imperative to remember this doesn't always happen and when it does, forces/loads are not decreased, they are simply moved.

Higher drop shoes tend to load the knee and hip more. They require less range of motion at the calf and Achilles tendon to progress forward. These can be beneficial for those who have extremely limited dorsiflexion range of motion either from the ankle joint (talocrural) or the muscles around it (calf, posterior tib, etc). However, they do require more range of motion and shock absoprtion/load at the knee and hip. The position of the foot in a high drop shoe naturally puts the knee in a more forward position. This naturally creates more stress at the anterior knee, which requires higher levels of quad strength to control. The additional forward motion at the knee naturally requires the hip to also flex more, requiring higher levels of glute strength to help with shock absorption during landing. A higher drop shoe can also allow for more hip extension during the terminal stance at terminal stance due to the calves not being a limiting factor, which can also require more range of motion from the hip flexors.

These are not good or bad things, instead depending on the individual mechanics, strength and tissue tolerances of each individual. If you have stiff ankles and are interested in a higher drop shoe, then you should be working on the strength/range of motion of your knee and hip. If you want to try a lower drop shoe because it may reduce stress at your knee/hip, know that you will need to spend extra time maintaining/working on your ankle motion/strength. Heel drop is single aspect of footwear that is dynamic (it does change depending on where you land and midsole compliance) but is one of the many parts of a shoe that will impact different runners differently.

Drop in Max Cushion Shoes

The majority of max cushion shoes on the market, particularly trail shoes, tend to have a lower heel drop. This is often done from a stability standpoint, as a higher heel drop combined with a higher stack creates the possibility for more frontal plane torque at the ankle. Lower heel drop typically have more inherent stability, however this is only if you have adequate calf/ankle range of motion. For those with limited motion, there bodies may compensate with the joints directly below the talocrural (ankle) joint, including the subtalar and midfoot joints. As these have joint axis in the frontal plane, those with limited ankle mobility may compensate with excessive movement in the frontal plane, making low drop shoes inherently more unstable for this population. This makes sense that even the research demonstrates that lower drop shoes put more torque through the ankle regardless of the stack height (Richert et al., 2019). That may be good for some people with great ankle mobility or strength, but not for others that lack it.

This does not take into account the effect from rockered soles, which also shift the work away from the ankle (Sobhani et al., 2013). This has been a common suggestion from us for those with Achilles tendon issues, to consider a rockered shoe as those have been shown to unload the calf and Achilles tendon (Sobhani et al., 2013). The ultimate combination may be a shoe like the Craft CTM Ultra 2 that has a higher heel drop (10mm) combined with a significant rocker. The higher heel drop and rocker will both shift work away from the ankle and up higher, unloading the calves and Achilles tendon in the process. The increased flexibility up at the forefoot does not unload them completely, but does reduce the risk of the shoe being too stiff, which can actually increase loads into the ankle to get over it (Mcleod et al., 2020).

What about 12mm Drop Shoes?

With the onset of both the recent minimalist and maximalist footwear trends, the running shoe industry has shifted to more moderate heel-toe drops. 8-10mm is the most common, with far more in the 0-7mm range than the 11-12mm range. Higher drop shoes are now rare, whereas at one point they were the norm. With higher midsole stack heights, lower drops do make sense for inherent stability. A tall rearfoot without a stable base is inherently unstable, as opposed to the lower heel drop, higher stack height but wide lasted maximal shoes we know today. These shoes often feature rockered soles, which can reduce stress on the Achilles/calf. However, the lower drop still requires some degree of ROM, which can be problematic for those with limited motion or acute injuries to posterior structures like the calf muscles or the Achilles tendon.

Higher drops can unload irritated calves/Achilles in certain situations in a way that a rockered sole cannot. A higher heel drop reduces the required range of motion the calf muscles and Achilles tendon need to go through to progress forward. This may be beneficial also to those who have extremely limited dorsiflexion range of motion either at the talocrural (ankle) joint or of the calf muscles.

Those who benefit from high drop and support may include those with posterior tib strains given that the post tib both plantarflexes and inverts the foot. So taking it into dorsiflexion and eversion (pronation) may stress it. A similar situation arises for those with peroneus longus strains as that muscle plantarflexes and everts the foot. Those who need to unload a posterior tibialis may do better in a shoe like the Wave Inspire 18 with its medial support. Those who need to unload a peroneus longus may do better in a shoe with medial and lateral guide rails like the Adrenaline given the more central and guided nature.

Those asking whether there is still a place for high drop shoes, the answer is yes. It is not necessary to have a huge number, but having a least a few in the industry will benefit a small population of people. The rest will likely do better in more moderate ranges like we are seeing today.

References

McLeod, A. R., Bruening, D., Johnson, A. W., Ward, J., & Hunter, I. (2020). Improving running economy through altered shoe bending stiffness across speeds. 
Footwear Science12(2), 79-89.

Richert, F. C., Stein, T., Ringhof, S., & Stetter, B. J. (2019). The effect of the heel-to-toe drop of standard running shoes on lower limb biomechanics. 
Footwear Science11(3), 161-170

Sobhani, S., Hijmans, J., Heuvel, E., Zwerver, J., Dekker, R., Postemia, K. (2013).  Biomechanics of slow running and walking with a rocker shoe.  
Gait & Posture: 38(4): 998-1004.

Sobhani, S., Zwerver, J., Heuvel, E., Postema, K., Dekker, R., Hijmans, J.  (2013).  Rocker shoes reduce achilles tendon load in running and walking in patients with chronic achilles tendinopathy.  
Journal of Science and Medicine in Sport.  http://dx.doi.org/10/1016/j.jsams.2014.02.008

Find more resources in our research archive.



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