The Monday Shakeout: How Do I Know If I Need A Stability Shoe?
By Matthew Klein
This week, Matt provides more clarity on a commonly asked question: How do I know if I need a Stability Shoe? He summarizes the current research on this subject, addresses some myths and outlines a simple process for figuring this out.
Although we have many types of shoe categories, several years ago the primary classifications of running shoes were either neutral or stability shoes. This system was based on a belief that pronation, a normal tri-planar motion that is required for adequate shock absorption, was inherently bad and should be controlled with various types of motion control systems (this is not true). Shoes that feature components help to stabilize or help people control pronation are called stability shoes. Those of us working in running stores or working as clinicians were taught to prescribe shoes after watching someone walk or run on the treadmill and visually measuring how much ankle pronation occurred. It did not take me long to figure out that this did not work all the time while working in running stores and occurred to me even faster when I was in DPT school. Some people took this to the extreme and believed that we didn't need any stability shoes at all, which led to a drastic decrease in the number of stability shoes in the market.
Recently, a small resurgence has occurred, with new models being added to the market. There is a greater variety in this category than ever before, with some shoes having traditional medial stability methods (medial posts) to guidance based shoes that keep you in the middle. Regardless of the type, there are still people who do benefit from running in a stability shoe. The goal of this is to help you understand if you might be one of those people.
As referenced above, pronation describes the inward motion of the foot during the shock absorption phase of running gait (loading response). It is made up of three motions at the foot and ankle including eversion, dorsiflexion and abduction. These movements occur at the heel, midfoot and forefoot as the medial arch extends the length of the inner side of the foot. This is an important motion as it is one of the primary ways the foot/ankle absorbs shock when landing with each step. Those who do not pronate or don't pronate enough may have an increased risk for bone stress injuries (Barnes et al., 2008). Once pronation occurs, the opposite motion needs to occur, called supination (made of inversion, plantarflexion and adduction of the foot/ankle). The transition between pronation and supination is important, as pronation brings the foot/ankle into a position where it is more flexible and able to absorb impact, while supination brings the foot/ankle into a position where it is stiffer for push-off. Although there are important and normal parts of gait, some issues can arise if people are not adequately conditioned to tolerate the forces associated with this or they do not have the strength or movement control to properly execute them.
Biomechanically, we know that just because we can see a movement does not mean it is a problem. Just watching someone run is not good enough to determine whether they need a stability shoe or not. Instead, there are two major concepts that can help determine if someone needs a stability shoe. The first relates to both comfort in the shoe and comfort on the road. The second involves looking at injury history. One of the most predictive factors of success in running shoes right now is the "Comfort Filter." Shoes that tend to be more comfortable (not too soft/firm, not too bouncy/dead, not too wide/narrow, etc) may work better for people (Nigg et al., 2015). So if you try on a stability shoe, it feels more comfortable than others or you find that you can run more comfortably in it (fatigue less, less discomfort, etc), you may benefit from using a stability shoe. Like all shoes, your body sometimes needs to break into them but if most things feel better in them, you might do best in a stability shoe.
The other component is looking at your injury history. We know that runners with a history of pronation-related injuries have a reduced future risk of injury if they use a stability shoe (Malisoux et al., 2016; Willems et al., 2021). Pronation-related injuries refer to injuries that may come from poor control of this movement, including Posterior Tibialis Tendinitis/Tendinopathy or Strains, Anterior Tibialis Tendinitis/Tendinopathy or Strains, Plantar Fasciitis/Fasciopathy, Calf muscle (Gastroc or Soleus) Strains, Achilles Tendinitis/Tendinopathy and some Patellar Tendinitis/Tendinopathies (some people, not everyone) (Some of these may collectively be referred to as "shin splints" if they occur in the tibia/fibula area). This is not an exhaustive list but a good place to start. A history of an injury is one of the greatest predictors of a recurrence, so if you find stability shoes comfortable and/or have a history of one of these injuries, you may want to consider a stability shoe.
So if you find stability shoes comfortable (or neutral shoes uncomfortable) and have a history of pronation-related injuries, you may want to consider doing most of your training in a stable or stability shoe. You can still run in neutral shoes, like super racing shoes, and there is good evidence that running in a variety of shoe types can reduce your injury risk (Malisoux et al., 2016). However, your primary daily training shoe and the majority of your miles may be best in a stability shoe. There is also a new category that has emerged called the stable neutral shoe. This is a neutral shoe that features components that make it stable without being fully classified as a stability shoe. So for those looking for stable shoes, there are options out there. For a full guide to stability shoes and an extensive list, check out our Guide to Stability Running Shoes. For those who want a rare stable or faster racing shoes, check out our list of Best Stable Racing Shoes.
References
Barnes, A., Wheat, J., & Milner, C. (2008). Association between foot type and tibial stress injuries: a systematic review. British Journal of Sports Medicine, 42(2), 93-98.
Malisoux, L., Chambon, N., Delattre, N., Gueguen, N., Urhausen, A., & Theisen, D. (2016). Injury risk in runners using standard or motion control shoes: a randomised controlled trial with participant and assessor blinding. British Journal of Sports Medicine, 50(8), 481-487.
Malisoux, L., Ramesh, J., Mann, R., Seil, R., Urhausen, A., & Theisen, D. (2015). Can parallel use of different running shoes decrease running‐related injury risk?. Scandinavian Journal of Medicine & Science in Sports, 25(1), 110-115.
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 Medicine, 49(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 Therapy, 51(3), 135-143.
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NEXT: Super Shoes and Running Economy?
