9 Comments

1. thanks James!
   Much appreciated.

2. Hey James,

   What’s your thoughts on throwing everyone in neutral platform shoes? If a tissue beed offloading you turn to orthotics and address the contributors to load concurrently?

   What’s your thoughts on most athletic shoes not accounting for foot structure. Ie tapering from balls of your feet when infact the toes are often the widest part?

   1. terrible idea to put everyone in neutral shoes. stability shoes, neutral shoes, lightweight shoes, minimalist shoes all have a place.

      the “right” shoe for a given person can change over time and many shoes can often work for one person.

      perscribing shoes should be based upon many factors. i personally believe current injury/pain should be the primary consideration. other factors can play a part, such as structure, function, and biomechanics although they are far less important. the final choice should take comfort primarily into account.

      good luck

      1. Yeah I’m not sure on that consensus – but that’s just my personal thought process at this time. That may change as time goes on.

         In my personal experience I have found most comfort issues relate to fit and whether a dual density midsole exists or not. Additionally the general way in which a “support” or “motion control” shoe is prescibed may it be pressure plate or gait appraisal is in many cases contradictory.

         I certainly exploit stack height, HHD, outersole configurations, sole surface area, and general density of the FULL midsole if I am concerned with a particular tissue. As for the inclusion of a very generically placed piece of high density eva to the inside of a shoe…..why bother?

         Not to say if a patient is running comfortably in a well fitted, “support” shoe I don’t think there’d be the need to have them change. I just think the typical approach is unjustified both scientifcally and from my experience.

         1. did you see the new study that showed runners with pronated feet had fewer injuries with stability shoes?

            kind of throws a monkey wrench into the “comfort is king” paradigm. i’m not going back to the old “match up a pronated foot to a stability shoe” process necessarily, but i definitely have to rethink how this impacts my process.

            http://m.bjsm.bmj.com/content/early/2016/01/08/bjsports-2015-095031.short?rss=1&utm_source=twitterfeed&utm_medium=twitter

            1. I wasn’t aware of it to be totally honest. It is a difficult topic as acknolwedging the sample size of the below article, the results of the article you quote is in stark contrast. http://www.ncbi.nlm.nih.gov/pubmed/25155917

               Do we base it on foot posture index, visual dynamic foot assessment(difficult despite what some will suggest), arch height or foot print?

               For myself if a patient is injured and I have prescribed orthotics I have no idea how the foot will respond in a dual density shoe. Despite spending several years on the store front.

               Atleast with a neutral platform I have a clearer image of how the shoe will perform.
               As for the uninjured ……may they traditionally be a candidate for support shoes then sure trial a well fitted option in comparison to well fitted neutral. But again if the walk in the store and I look at their foot statically and dynamically I have absolutely no confidence they will be better off in a support shoe.

               I strongly agree with you on the comfort point. Sold purely on comfort everyone would be getting around in nike frees. I think it is very imprortant the shoe is perceived to be comfortable by the customer. But it must also be fitted correctly and dynamically not controbuting to unwanted stress in the foot.

            2. I can’t think of anything you just said that I don’t agree with. All good points.

               I just read a blog post about that study you referenced. You might find it interesting as well. https://www.painscience.com/microblog/boot-blooper.html

            3. That’s really interesting. As much as you’d have to take that article with a grain of salt, it’d be dissappointing if it was true.

               I think your take on the prescription of athletic footwear is correct. Obviously there may be some difference between us but the main thing is that you make an “experienced” decision with the acknowledgement of available research. Personally I find those taking the acdemic high ground always come off as arrogant and in a practcial setting less effective. Simply basing practice of research is self limiting as it rarely paints the full picture…..as you have pointed out

               Cheers for the chat and the article. Much appreciated

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