Do you get value for money when you buy an expensive pair of running shoes?
An investigation of the Institute of Motion Analysis and Research, Ninewells Hospital, Dundee (Clinghan RT, Arnold GP, Drew TS, Cochrane L, Abboud RJ, Br J Sports Med. Published Online First: 11 October 2007. doi:10.1136/bjsm.2007.038844) aimed to determine if more expensive running shoes provide better cushioning of plantar pressure and are more comfortable than low-cost alternatives from the same brand.
Design: Three pairs of running shoes were purchased from three different manufacturers at three different price ranges: low (£40-45), medium (£60-65) and high (£70-75). Plantar pressure was recorded with the Pedar® in-shoe pressure measurement system. Comfort was assessed with a 100 mm visual analogue scale. A follow-on study was conducted to ascertain if shoe cushioning and comfort were comparable to walking while running on a treadmill.
Participants: Forty-three female and twelve male subjects participated in the main and follow-on studies respectively.
Main Outcome Measure: Evaluation of plantar pressure and comfort.
Results: Plantar pressure measurements were recorded from under the heel, across the forefoot and under the great toe. Differences in plantar pressure were recorded between models and between brands in relation to cost. Shoe performance was comparable between walking and running trials on a treadmill. No significant difference was observed between shoes and test occasions in terms of comfort.
Conclusions: Low and medium cost running shoes in each of the three brands tested provided the same (if not better) cushioning of plantar pressure as high-cost running shoes. Cushioning was comparable when walking and running on a treadmill. Comfort is a subjective sensation based on individual preferences and was not related to either the distribution of plantar pressure or cost.
Mike O’Neill, podiatric surgeon and spokesman for the Society of Chiropodists and Podiatrists said “it is not the cost of the trainers that is important but the suitability of the trainers. Cross trainers should not be worn for running and running trainers should not be worn for playing squash or tennis. It is important to purchase trainers from a sports outlet that specifically has the knowledge as to which trainer is best for the individual in relation to their foot type and sport undertaken. Trainers purchased from multiple high street retailers often do not possess the same qualities that are desirable to prevent injuries when sports are being undertaken on a regular competitive level.”
The report says that advertising of advanced safety features for more expensive running shoes is often deceptive. Mike O’Neill said, “the research and development that goes into deciding the type of trainers is undertaken to a very high level.”
Trainers are also produced in two types:
High arch type foot – these trainers require specific shock absorbers,
Low arch type foot – these require the foot to be stabilised within the trainer and these trainers have additional stability qualities.
Mike O’Neill says, “Also the weight of the individual is important when choosing the type of trainer as some trainers are designed to absorb greater shock and control more motion which would be exerted by someone of more weight.”
Trevor D Prior, Consultant Podiatric Surgeon and spokesman for the Society of Chiropodists and Podiatrists said, ” At first, it may seem strange that surgeons would be interested in the outcome of studies on running shoes. However, given that we often recommend this as the first type of shoe worn following foot surgery, the relevance becomes more obvious. In many instances of forefoot surgery (i.e. bunion surgery), patients are able to return to trainers as soon as two weeks post surgery although it can take as long as 6-8 weeks. Of course, there are many types of running shoe and having the appropriate shoe of correct size is important; with the vast array of such shoes now available, the choice can be difficult.
The online publication of this article has, understandably, raised a lot of interest in the media as it questions the benefit of expensive running shoes. However, as with much research, the devil is in the detail which does not always serve the best interest of headlines.
As indicated in the abstract, the main aim of this well constructed paper was to compare the plantar pressure between shoes, with the researchers also dividing the foot into discreet regions to allow further analysis.
No significant difference was found between each type of shoe and each brand. Whilst differences did exist between different areas of each shoe/brand, this was not a consistent picture in that the site of the differences varied between shoes; perhaps not surprising as the different brands may have different aims when determining where to position the cushioning. The authors do report that, whilst there was no statistical difference between the shoes, there was a trend to the low cost shoe demonstrating more cushioning. To the delight of the media, this non statistical finding has been termed ‘if not better’. Whilst the authors postulate that this subtle difference may be more significant over time with repetitive impact loading, the reverse may also be true. More research is required, a point acknowledged in the paper.
It is perhaps not surprising that the authors decided to analyse the pressure values alone, rather than any level of functional control as the former variable is more discreet and easier to quantify for research purposes. In the introduction/review of the literature, they report:
1. That better cushioning materials in more expensive shoes attenuate impact force to a greater extent than less expensive alternatives,
2. That it has been suggested that the protective devices advertised are deceptive and runners subconsciously subject themselves to greater impact forces, increasing the risk of injuries,
3. That this is supported by a 123% greater injury frequency observed in runners training with expensive running shoes compared to less expensive models/brands.
Given that the authors go on to postulate that the subtle improvement in cushioning may be more significant over time, it is not clear from the paper whether this would be a good or bad feature.
Of course, other factors should also be considered when determining the benefit of any shoe and these include:
– The density (termed durometer) of the material will have a profound effect. A low durometer may provide greater cushioning but may not be sufficient for a heavier runner. Similarly, the durability of the low durometer material may be much less, requiring renewal of the shoe more rapidly.
– There is no data relating to the weight of the subjects or the durometer of the material between the varying shoes. It is quite possible that this varies arbitrarily between models and brands.
– The positioning of the cushioning may be important in injury protection and, based on this paper, this seems to be more brand than expense related.
– Many running shoes have features designed to help control foot function depending upon the individual foot type. These features may not relate directly to cushioning, indeed the opposite may be true if the aim is to resist excessive motion. Many stability/motion control shoes have a higher durometer material on the inside of the shoe which is claimed to resist pronation. Thus, the nature of the individuals foot function is an important factor. In this study, there had been no history of lower limb pathology and no gait abnormality although the criteria for the latter were not detailed.
Whilst we all aim to practice evidenced based medicine, the evidence base is not always available and one has to rely on experience and patient feedback. It is true that there are those that can run in less than the perceived optimum shoe without injury, much as there are those that can smoke all their life with no obvious ill health. However, for the cast majority, the correct shoe for their body weight, foot type/function and activity levels is important; a fact only too well appreciated by those regularly treating running injuries.
As previously mentioned, this is a well constructed study and the authors acknowledge the need to study a greater number of shoes. They have presented the data well although some of the terminology they have used has been seized upon by the media. What they have highlighted is that the price of the shoe alone is not necessarily the important factor. In my experience, when considering shoes for function:
– Shoes under £60 generally have less support/durability.
– Shoes between £60 and £100 are generally more supportive/durable and worth the additional investment 3. Shoes significantly greater than £100 rarely have the additional technology to justify the increased price tag.
So what should someone look for in a running shoe?
1. Fit is crucial as all too often, shoes are purchased too short. There should be a 1cm gap between the end of the longest toe and the shoe. This will then require the lace to be used to hold the foot in position.
2. Generally, the better quality shoes have a removable insole. This can be helpful for patients having had foot surgery as this can be removed to allow more room for swelling in the earlier stages of recovery.
3. The shoe should be of adequate width (or volume) – generally around two fingers width between the lace holes is ideal. Too close is too narrow and vice versa.
4. The shoe should be stable in the arch area (i.e. not bend) but flex (bend) at the front to co-incide with the ball of the foot.
5. Several shoes have some extra support on the inside to provide more stability (hence the term a stability shoe) which can be of particular benefit if there is a lower arch/flatter foot. A podiatrist or specialist running shoe shop will be able to advise the best type of shoe.
6. Some shock absorption beneath the heel and the ball of the foot helps with protection.
7. It is worth investing in a good running shoe even if you are having foot surgery but not going to run when you have recovered. A good fitting supportive shoe which is designed for marathon distances will be extremely good for walking/shopping etc. and help to minimise the recurrence or development of further problems. The same is true for anyone with foot or lower leg pain.
Whilst these are generally accepted principles, what is clear is that much more research is required to evaluate the effect of the various factors involved in the construction of running shoes and this should include more than just cushioning. In the future, the emphasis will be on the running shoe companies to produce the evidence they have available to support the claims made for individual features/footwear.