Title Page Title: A Literature Review on Running Shoes and Biomechanics Author: David Ramocki DPT, CSCS Address:

7 !emlock Ave" #arwick, R$ %&''( )*mail: DaveRamo+hotmail"com Phone ,: -% *./ *%0&. $nstitution: 1one 2$nde3endent4 #ord Count: &,('

So5tware 6sed: 7icroso5t #ord &%%. Acknowledgements: I would like to acknowledge Professor Ken Holt of Boston University for his guidance in writing this paper. I would also like to acknowledge Marathon Sports Boston! for providing the shoes which appear in the figures of this paper.

$ Contents %. $. (. *. "#stract Introduction &esearch li'itations )o'ponents of a shoe &unning shoe research *.% Midsole hardness *.%.% &earfoot 'otion *.%.$ -orce peaks and loading rates *.%.( Muscle /M0 and 'eta#olic cost *.$ Midsole 'aterial *.( 3arus4valgus 'idsole *.* 6orsional rigidity and longitudinal 'idsole stiffness *.+ Insoles *., Heel counter *.. Heel flare *.1 Sole height *.2 )urved last *.%5 )o'#ined varia#les *.%% Shoe properties and foot structure 7iscussion +.% Philosophies of running shoe prescription +.$ -uture research )onclusion $ $ ( * + + , . 1 2 %5 %% %$ %$ %( %* %* %+ %, %. %1 $5 $%

+. ,.

A8stract
6here e8ist 'any different theories regarding how different running shoe properties will affect one9s #io'echanics and how running shoes should #e prescri#ed for runners to eli'inate in:ury and enhance perfor'ance. "lthough there have #een nu'erous a'ounts of research which have e8a'ined running shoes and their effect on a runner9s #io'echanics; the evidence is still lacking on what running shoe characteristics should #e prescri#ed for a given runner. In order to esta#lish what has #een e8a'ined in running shoe research; a full literature review will #e presented which includes running shoe varia#les such as: 'idsole duro'etry; 'idsole angulations; heel flare; heel counter; 'idsole 'aterial; 'idsole torsional rigidity; insoles; sole height; co'#ined varia#les; and the interaction of shoe properties with foot structure. )o''on theories and ideas for how to prescri#e a running shoe as well as li'itations to these approaches will #e discussed. )urrent research li'itations and ideas for the direction of future research will also #e discussed; and an overview of the construction of running shoes will #e descri#ed.

" $ntroduction
<ver the last * decades; running has #eco'e increasingly popular. "s the nu'#er of runners continues to increase; so too does the nu'#er of running in:uries. "s of %22$; it was esti'ated that nearly +5= of over (5 'illion "'ericans develop running in:uries each year; and $5>.5= seek 'edical care?%@. It has also #een reported that A > B of all runners sustain an in:ury which reCuires a change in practice and4or perfor'ance?$@. "lthough there 'ay #e 'any risk

( factors that can lead to the develop'ent of overuse running in:uries; running shoes have received a fair a'ount of attention with regards to research studies. 6here have #een 'any studies which have e8a'ined the effects of 'anipulating such shoe varia#les as 'idsole hardness; lateral heel flare; 'idsole wedging; etc. Such studies have shown that changing certain shoe properties can influence a runner9s gait para'eters. Because running in:uries are #elieved to result fro' a#nor'al gait kine'atics4kinetics; understanding how to successfully 'anipulate shoe properties to i'prove a runner9s gait #eco'es invalua#le. 7iscovering how such shoe properties can #e 'anipulated to 'atch a runner9s #io'echanical structure would significantly di'inish the prevalence of overuse running in:uries. &esearchers have used 'any 'ethods in an atte'pt to Cuantify gait para'eters when running in different running shoes. Many researchers have used force platfor's to 'easure the force distri#ution of the plantar surface of the foot to e8a'ine how the 'anipulation of shoe properties can affect the redistri#ution of such forces. -orce platfor' 'easure'ents provide infor'ation on the loading rates of the #ody as well as location of the forces under the foot. If hyperpronation is #elieved to #e a risk factor for running in:uries; then Cuantitatively showing that the hallu8 is #earing the 'a:ority of the ground reaction forces in late stance :ust as one e8a'ple! 'ay #e a relia#le indicator of such hyperpronation. <ther investigators have used high speed ca'eras to capture the 'otion of the foot and lower e8tre'ity when running in differing running shoes. 6he 'ost co''on lower e8tre'ity 'otion of interest is a'ount and ti'ing of rearfoot 'otion. &earfoot 'otion is deter'ined #y the a'ount of calcaneal eversion; as this is a significant co'ponent of su#talar pronation. )alcaneal eversion has #een used to represent su#talar pronation 'ainly #ecause it is the easiest to o#serve. <#serving e8cessive or poorly ti'ed rearfoot 'ove'ent when running in different shoes can help us to understand which shoe characteristics 'ay #e #eneficial to a runner; as hyperpronation and4or poorly ti'ed pronation has #een correlated with running in:uries. 6he goal of this review ai's to esta#lish what the research on running shoes has shown us and how this infor'ation 'ay #e used to prescri#e running shoes. 6his review will additionally address li'itations to the research and provide infor'ation on the construction of running shoes. Dastly; current philosophies for how running shoes are prescri#ed along with any potential shortco'ings will #e presented along with ideas for the direction of future research.

&" Research limitations

6he 'ain li'itation to all research is that we do not have conclusive evidence on what causes running in:uries. If we don9t have a full understanding of what is causing these in:uries; then how do we know what to 'easure when conducting our researchE <ver>pronation is the 'ost popular idea; and this has #een cited to #e correlated with running in:uries?(@. Several authors have touched upon the idea of late pronation poor ti'ing of pronation! as a cause of running in:uries?*>.@; although this has unfortunately received 'uch less attention than the idea of over>pronation. 6here are also schools of thought which #elieve that runners 'ay also over> supinate underpronate!; and that this 'ay #e responsi#le for running in:uries. It is also #elieved that there are certain foot structures which do not have the availa#le 'otion to pronate; and this lack of pronation leads to loss of shock a#sorption. 6he underlying the'e #ehind 'ost of these philosophies is that the :oints of the lower e8tre'ity are 'eant to go through a certain range of 'otion which is dee'ed to #e Fnor'alG; and deviations outside of this #andwidth of what is dee'ed nor'al is #elieved to stress the liga'ents and 'uscles of the #ody which atte'pt to restrict e8cessive 'otion. If such an a#nor'al 'otion as hyperpronation is leading to running in:uries; then we 'ust also esta#lish the cause of the hyperpronation in order to prescri#e the appropriate running shoe; #ut this will #e discussed later in this paper. " 'a:or li'itation throughout the 'a:ority of the research is that the 'ain dependent varia#le has #een su#talar :oint 'otion; and this has #een relied upon as an indicator of how the

* entire lower e8tre'ity is 'oving. Solely relying on the su#talar :oint 'ay #e 'isleading. -or e8a'ple; if a runner has a certain foot structure such as a rearfoot varus!; he4she 'ay try to co'pensate for the pronatory forces upon i'pact #y keeping the hip internally rotated and su#talar :oint supinated throughout the stance phase of gait. Internal hip rotation is considered a nor'al coupling with su#talar pronation; yet in this case the internal hip rotation is coupled with su#talar supination. Solely relying on su#talar :oint 'otion; especially for short periods of ti'e; 'ay not #e a relia#le indicator of how the hip; knee; and 'idtarsal :oints are 'oving. <ther li'itations to the research on running shoes have to do with relia#ility of the gait patterns which are o#served. Many studies have used force plates to assess a runner9s gait pattern. Hhen a runner is 'ade to run for a short distance and contact the force plate; he4she 'ay very well alter his4her gait pattern upon knowing that that particular step was to #e 'easured. 6he other criticis' which can #e 'ade against having a runner run for such a short distance; is that he4she 'ay #e a#le to carry on a co'pensatory gait pattern for so'e ti'e; and 'ay not reveal his4her true gait pattern until he4she has #eco'e so'ewhat fatigued. So'e studies have used reflective 'arkers on the skin and shoes to 'easure the 'otion of the underlying :oints; and this 'ay not #e an accurate representation of how 'uch the actual :oints are 'oving?1;2@. 6he overwhel'ing 'a:ority of these studies used only 'ale su#:ects for e8peri'entation; and so'e studies had as few as + su#:ects. 6he shoe varia#le in Cuestion was not always isolated for the tests; as 'any e8peri'ents co'pared shoes which had several different construction features. Many of these studies only used a few trials when collecting data; and so'e investigators chose to only analyIe the data fro' the trials which showed the greatest values in ter's of the outco'e 'easures. It has #een suggested #y several investigators that runners have a F'e'oryG for a running shoe; and the runner 'ay need a significant adaptive period for each new shoe in order for the FtrueG gait kinetics4kine'atics to #e unfolded?%5; %%@. " 'a:or li'itation with regards to generaliIing the results of each of these studies is that the overwhel'ing 'a:ority of studies used su#:ects who were avid runners with no running> related sy'pto's. Most authors reported that the su#:ects were only accepted into the study if they had Fnor'alG lower e8tre'ity architecture; were free of pain at the ti'e of the study; had never had running>related in:uries; etc. In reality; the 'a:ority of people running are not free of pain; do not have Fnor'alG lower e8tre'ity architecture; and have had 'any running>related pro#le's in the past. 6herefore; caution should #e used when atte'pting to generaliIe the results of these studies to the average runner.

." Com3onents o5 a Shoe

In order to #etter understand the research which has #een conducted on running shoes; it is necessary to #eco'e acCuainted with the anato'y of a running shoe. 6his is also i'portant if we are to 'anipulate certain shoe varia#les in an atte'pt to co'ple'ent a runner9s anato'ical lower e8tre'ity structure. Please refer to -igure % while reading the description of each co'ponent of the shoe. Dast 6he construction of a shoe #egins with the last. 6he last is the #asic fra'e of the shoe upon which all other co'ponents are placed. 6he last 'ay #e #oard; slip; or co'#ination>lasted. If the 'aterial of the upper part of the shoe is sewn directly onto the top of the 'idsole with nothing covering it; then the shoe is said to #e slip>lasted. If there is a #oard overlying this stitching; then the shoe is said to #e #oard>lasted?%$@. If the shoe has a #oard overlying the stitching on the posterior portion of the 'idsole; then it is said to #e co'#ination lasted. 6his can #e visualiIed #y re'oving the insole and e8a'ining the inside portion of the shoe. " #oard> lasted shoe 'akes a shoe 'ore rigid; which is #elieved to reduce the a'ounts of pronation; yet

+ this has not #een confir'ed with scientific research. " running shoe9s last 'ay also #e straight; curved; or se'i>curved. 6his curvature designates the adduction of the forefoot portion of the shoe. " shoe with a curved last will have the forefoot portion adducted relative to the rearfoot portion; whereas a straight last will have little4no forefoot adduction?%(@. )urved lasts tend to #e slip>lasted; and if a shoe is #oard>lasted; it usually has a straight last?%*@. Upper 6he upper portion of the shoe refers to the covering of the superior portion of the shoe?%+@. It is usually 'ade of nylon; although other 'aterials such as leather 'ay #e attached to it?,@. 6he va'p is the portion of the upper covering of the shoe which e8tends fro' the toes to the 'id> arch area. 6he re'ainder of the upper fro' the 'id>arch to the posterior aspect of the shoe is called the Cuarter. 6he toe #o8 is the area in the front of the shoe which contains the toes?%(@. 6he area where the upper portion of the shoe 'eets the 'idsole is called the featherline?,@. 6he tongue covers the dorsu' of the foot and provides protection fro' the laces?%+@. 6he posterior surface of the upper has a heel counter with the "chilles pad fle8 notch! located directly superior to this. 6he heel counter is a 'olded piece of plastic or polyurethane which is 'olded and placed in the heel area to supposedly contain the calcaneus and prevent unwanted 'ove'ent. 6he heel counter 'ay e8tend #eyond the heel area to the postero>'edial aspect of the shoe?%,@. 6he covering of the heel counter is referred to as fo8ing. <ccasionally; the 'edial arch will have reinforced stitching which is known as the saddle?%+@. Botto's 6he #otto' of a shoe is co'prised of the 'idsole; outersole; and insole?%*@. 6he outersole is the 'ost inferior portion of the shoe. 6his is usually co'posed of car#on ru##er; to provide traction and protection. 6he 'idsole is Cuite possi#ly the 'ost i'portant part of the shoe. 6he 'a:ority of the research on running shoes involves the 'anipulation of the 'idsole. Midsoles are al'ost always 'ade fro' ethylene vinyl acetate /3"! and polyurethane. 6he /3" is a re'arka#le su#stance which replaced ru##er 'idsoles in the %2.5s. It has 'uch greater shock a#sor#ing capacity with 'uch less weight?%$@. 6he /3" is heated and 'olded to the shape of the foot. Upon cooling at high pressures; tiny gas #u##les #eco'e trapped within the /3" this is considered closed>cell foa'!. 6his is what 'akes for the light>weight; high shock>a#sor#ing Cualities of the /3". 6he disadvantage is that with repetitive use; the gas #u##les slowly #eco'e e8pelled and the /3" e8hi#its decreased shock>a#sor#ing a#ility?%$@. 6he 'idsole can #e co'pressed into 'any different densities which can create soft or hard shoes. Many shoe 'anufacturing co'panies have incorporated other 'aterials into the 'idsole in the atte'pts to #etter a#sor# shock; such as the airsoles found in Jike shoe; gel in "sics shoes; etc. 6he insole sockliner! of a shoe is the re'ova#le lining of cushioned 'aterial which is pri'arily for co'fort and friction>reduction. 6he insole is usually 'ade fro' neoprene foa'; polyethylene foa'; or viscoelastic 'aterials?%*@.

-" Running Shoe Research

-" 7idsole !ardness

Much of the research that has #een perfor'ed on running shoes has e8a'ined the effects of varying the 'idsole hardness duro'etry!. 6he duro'eter of a shoe is deter'ined through the use of an i'pactor device which involves dropping an o#:ect of known 'ass fro' a predeter'ined height to calculate the resistance of the 'aterial against penetration. -ro' this test; the 'idsole is given a Shore value fro' % to %55; with the harder 'idsole receiving a higher score. 6he 'a:ority of running shoes have 'idsole densities which have a Shore value which ranges #etween *5 K .5.

, Many shoe co'panies have incorporated a dual density 'idsole a 'idsole of $ different densities!; which usually has a higher Shore value on the 'edial aspect of the posterior 'idsole See -igure $!. <ccasionally; a shoe will have the harder portion of the 'idsole e8tend #eyond the 'idfoot; #ut the harder 'aterial will never #e solely in the forefoot. 6he harder portion of the 'idsole will usually have a gray color; whereas the softer portion of the 'idsole will usually #e white. 6he idea #ehind this construction is that the harder 'idsole 'aterial on the 'edial aspect of the shoe 'ay help to decrease rearfoot eversion; although research on this topic is lacking "lthough the dual density shoes provide differing colors to show the location of the harder portion of the 'idsole; one 'ay still want to know e8actly how hard the 'idsole 'aterial is. Si'ilarly; in the case of a shoe with a single density 'idsole; there are no visual clues which will allow one to know its hardness. "fter all; shoe 'anufacturers do not provide infor'ation regarding the Shore values of their shoes. In order to deter'ine the 'idsole hardness of a shoe; one can 'anually perfor' a pinch test?%$@ to get an idea of that shoe9s duro'etry See -igure (!. "lthough this test will not provide an actual Shore value; it will allow for a co'parison #etween the different 'idsole duro'eters of different shoes. *.%.% &earfoot Motion "'ong the studies perfor'ed for 'idsole hardness; rearfoot 'otion has #een e8a'ined with regards to 'a8i'al a'ount of su#talar pronation; 'a8i'al pronation velocity; and the ti'e it takes for #oth of these varia#les to occur. 6hese para'eters have #een e8a'ined #ecause e8cessive and4or rapid calcaneal eversion assu'ed to #e a relia#le 'easure of su#talar pronation! has #een hypothesiIed to #e positively correlated with running in:uries. Ha'ill et al.?*@ looked at the effects of tread'ill running with shoes of ( different duro'eter 'easures. It was found that the softer shoe led to increased 'a8i'al pronation and decreased ti'e until 'a8i'al pronation; yet this was found to #e statistically significant only when co'paring the hard and 'ediu' duro'eter shoes to the soft shoes; and not when co'paring the hard and 'ediu' duro'eter shoes. In a si'ilar study?%.@; it was found that harder shoes had reduced the 'a8i'al pronation of runners who perfor'ed ground running over a force platfor'. However; no infor'ation was provided regarding the specific shoe properties or of any statistical tests used. Kaelin et al.?%1@ e8a'ined the effects of 'idsole thickness and duro'etry through ground running over a force platfor' and found that the harder shoes resulted in increased 'a8i'al pronation velocities; although control of 'idsole thickness was not discussed. 7e Hit et al.?%2@ found that tread'ill running with harder shoes led to an increased inversion angle at touchdown; and a larger and faster rearfoot eversion value. )onversely; the softer shoes led to a larger 'a8i'al rearfoot eversion. However; Jigg et al.?$5@; found that the a#solute vertical and horiIontal velocity of the heel as well as the rearfoot and shoe angle prior to ground contact did not differ significantly #etween 'idsole conditions. Ha'ill et al.?$%@ co'pared racing flats of softer 'idsole! with training shoes harder 'idsole! and found that the 'a8i'u' rearfoot angle eversion! was *$= higher; and total rearfoot 'otion fro' inversion to eversion! %(.2= higher when tread'ill running in the softer racing flats; although there were differences other than 'idsole hardness #etween each shoe type. Stacoff et al.?$$@ looked at the differences in pronation #etween shoes of differing duro'etry; and concluded that the harder shoes defor'ed less at touchdown which led to an increased lever ar' #etween the action line of the ground reaction force and the su#talar :oint. However; the authors used a 'odel to calculate that the su#talar :oint velocities were increased with harder shoes larger lever ar'!; and this was not actually 'easured independently of this 'odel. 6he results of these studies suggest that soft shoes lead to higher a'ounts of pronation; whereas harder shoes lead to higher rates and decreased total a'ounts of pronation. 6his

. research lends credi#ility to the idea that hyperpronators should #e prescri#ed a F'otion controlG shoe which has a hard 'idsole. However; a 'ain pro#le' with this research is that there see's to #e an interaction effect #etween an individual9s structure and the running shoe. Because a runner9s structure likely dictates how his4her gait will adapt to a shoe; it is i'portant that future research e8a'ine which aspects of a runner9s structure are responsi#le for such gait changes. "nother pro#le' with such findings is that it is not known which varia#les of pronation are 'ost strongly correlated to running in:uries. If pronation velocity is 'ore of a risk factor for in:ury than 'a8i'al a'ount or ti'ing of pronation; then this 'ay indicate that harder running shoes are not advantageous. If total a'ount of pronation is 'ore i'portant in ter's of running in:uries; then softer shoes would #e disadvantageous. If ti'ing of pronation is a significant risk factor; then 'ore research is needed which e8a'ines the pronation angle at ter'inal stance4preswing; as none of the afore'entioned studies have investigated this varia#le. *.%.$ -orce Peaks and Doading &ates -orce peaks during the contact phase of running have #een studied using force platfor's which provide such infor'ation as contact force also referred to as initial force peak or passive force peak! and propulsive force also referred to as second force peak!; as well as rate of loading?$5@. 6his infor'ation reveals how 'uch force each aspect of the foot is #earing. Such infor'ation can provide insight into a#nor'al loading patterns which are #elieved to #e related to running in:uries. "dditionally; knee fle8ion velocity and a'ount have also #een studied usually in co'#ination with force plate studies! with the assu'ption that an increased a'ount4rate of ti#ial advance'ent over the foot is correlated with an increased contact force4rate. "n interesting finding across several of these studies was that the 'a8i'al vertical contact peak force was not statistically different #etween soft and hard 'idsole shoes and even less for the hard shoes!. In one study?$5@; it was found that when su#:ects engaged in running across a force platfor' in harder shoes; there was a trend for decreased i'pact force peaks; although this was not statistically significant. It was also found that while the ti'e of occurrence for #oth the i'pact force peak and 'a8i'al loading rate decreased when switching fro' the shoes of a (+ to *+ Shore duro'etry value; they re'ained the sa'e for the Shore $+ to (+ duro'etry values. Milani and Hennig?%.@ si'ilarly used a force platfor' to show that su#:ects wearing harder shoes e8hi#ited a decreased i'pact force peak yet a shorter ti'e to reach this value; although this study did not provide specific infor'ation regarding the shoes or the statistical tests. " si'ilar study?%2@ found decreased initial vertical i'pact peaks with a higher loading rate when su#:ects ran in harder shoes; although the relia#ility and validity of this study are Cuestiona#le. )larke et al.?$(@ also found a longer ti'e to peak vertical i'pact peak in the softer shoes; #ut no differences in a#solute force 'agnitudes #etween the soft and hard shoes; although the vertical propulsive force was significantly higher in the softer shoes. In a study #y Hright et al.?$*@; a 'odel of a hu'an leg was created using kine'atic infor'ation fro' a sa'ple of 2 'ales in the atte'pts to esta#lish whether or not the kine'atic adaptations to loading forces could #e perfor'ed passively. It was found that their results coincided with other authors; in that there was no difference #etween peak i'pact forces #etween hard and soft shoe groups; and that the rate of loading was higher for the harder shoes. Hennig et al.?$+@ investigated the i'pact force varia#les as well as the perception of hardness for differing 'idsole hardnesses while ground running using sensory transducers and a force platfor'; and again it was found that the first vertical force peak was lower for the hard shoes. However; the peak pressures in the heel were higher and the forefoot #ore 'ore weight with the hard shoes. 6he results of these studies suggest that the i'pact force peaks are si'ilar #etween shoes with hard and soft 'idsoles. However; the loading rates appear to #e less for softer running shoes. 6hese studies suggest that either the hardness of the 'idsole does not influence i'pact

1 force peaks; or that the foot 'ust #e 'aking kine'atic adaptations to decrease the i'pact force when running in shoes with a hard 'idsole. 6he results of these studies suggest that if initial i'pact is a factor for running in:uries; then there will not #e a significant difference #etween shoes of differing 'idsoles. However; if loading rates are a factor for in:ury; then a softer 'idsole which is co''only prescri#ed! would #e #eneficial. It is very possi#le that since shoes of increasing 'idsole hardness see' to e8hi#it less i'pact force; there 'ust #e kine'atic changes during gait to help decrease the kinetic forces at i'pact. Initial pronation 'ay #e a solution to decreasing the initial i'pact forces; as several studies have shown that running in harder shoes leads to a faster initial pronation?%1; %2@. "nother proposed 'echanis' is that the knee fle8ion will #e greater or occur faster with the harder running shoes. However; results of testing knee fle8ion velocity and a'ount have not revealed this to #e the case. <ne study?$,@ found that there were no statistically significant results for knee fle8ion a'ount or velocity when running in shoes of a different duro'etry value; yet there was a trend towards increasing knee fle8ion velocity with the harder shoes. Ha'ill et al.?*@ si'ilarly found no statistical difference for knee fle8ion para'eters when running in shoes of different duro'eters. Kaelin et al.?%1@ found that when running with harder shoes; the knee angle #efore i'pact was increased. <nce again; no statistical infor'ation was given for this study. "nother study?$5@ found that there was no difference for knee angle at touchdown #etween the hard and soft shoe groups. Hardin and Ha'ill?$.@ e8a'ined kine'atic differences #etween su#:ects wearing shoes of different duro'etry values while running on a downhill tread'ill grade. It was found that there were no differences #etween 'idsole groups with regards to peak ti#ial acceleration. 6he results of these studies do not show any kine'atic changes in knee fle8ion that occur #etween running in hard and soft shoes. Perhaps the increased rates of pronation are leading to internal ti#ial rotation without 'uch additional knee fle8ion. 6his 'ay #e a potential cause of knee in:uries. More research is needed which elucidates why the i'pact force peak is less when running in harder shoes; and why pronation rates increase without a corresponding increase in ti#ial acceleration rates. 6he results of these studies 'ay lead us to reconsider the popular notion that runner9s who have rigid arches which lack the a#ility to pronate should #e prescri#ed soft FcushionG shoes. *.%.( Muscle /M0 and Meta#olic )ost 6here has #een 'uch interest a'ongst runners and coaches with regards to the effect that a 'idsole hardness 'ay have on perfor'ance. "dditionally; 'uscle /M0 has #een used to esta#lish whether or not running shoes of differing 'idsole duro'etry 'ay lead to increased need for 'uscle force; which is a postulated cause of posterior ti#ial stress syndro'e. Meta#olic cost has often #een studied #y 'easuring 3<$ while tread'ill running. 6he eCuip'ent used to do so 'easures the a'ount of inspired and e8pired <$ to calculate the total <$ consu'ed which is a direct 'easure of 'eta#olic cost!. Blood values such as he'atocrit and he'oglo#in a'ounts have also #een used to 'easure the he'atological effects of running. Muscle /M0 has #een used to calculate the a'ount of 'uscle force generated #y attaching electrodes to the tested 'uscles to 'easure the electrical signal that is #eing sent to the 'uscle for contraction. It appears that altering only the 'idsole duro'etry of a shoe does not see' to have an effect on 'eta#olic cost. In one study?$,@; su#:ects ran on a tread'ill for (5 'inutes wearing hard and soft shoes. It was found that there were no significant differences in 'eta#olic cost across shoe groups. "nother study?$.@ e8a'ined the he'atological response of running in shoes of differing duro'etry when perfor'ing a downhill tread'ill run. 6here were no statistically significant differences found #etween creatinine kinase; he'atocrit; or he'oglo#in levels for any of the conditions; suggesting that there was no difference in 'eta#olic cost. Hakeling et al.?$1@ e8a'ined su#:ect9s /M0 changes that occur at touchdown with running in shoes of different

2 duro'etry values. It was found that #etween shoes; 'uscles; and su#:ects; the /M0 intensities changed #efore heel contact with the ground. 6he authors reported that this change in /M0 intensity through different lower e8tre'ity 'uscles supports the idea that 'uscles are tuned to contract differently when the 'idsole hardness is varied. 6hus #y 'anipulating the 'idsole density; one 'ay alter the need for certain 'uscle use #efore contact with the ground. However; this study relied on a sa'ple of , su#:ects; and there was no consistent pattern of 'uscle use #etween shoe conditions suggesting that 'uscle use for differing 'idsoles is su#:ect specific!. 6he results of these studies suggest that 'anipulating 'idsole duro'etry alone does not result in differences in 'eta#olic cost. However; if increasing the duro'etry of a shoe leads to increased shoe weight; than this can certainly lead to an increased 'eta#olic cost. It is interesting that 'uscle use did change when the 'idsole hardness was 'anipulated. If a consistent pattern can #e shown regarding which 'uscles #eco'e overworked with differing 'idsole duro'eters; then this could help to decrease 'any running in:uries. However; the 'uscle responses to differing shoes are likely to #e su#:ect specific. -"& 7idsole 7aterial 6here have #een several studies conducted which have e8a'ined the effects of changing the 'idsole 'aterial on a runner9s gait. 6he 'a:ority of the investigators integrated an air> pocket into the 'idsole; and used o8ygen consu'ption as an outco'e 'easure. "s stated earlier; the 'idsole is usually co'posed of ethylene vinyl acetate /3"!. In a study #y -alsetti et al.?$2@; #lood 'easure'ents were taken fro' su#:ects #efore and after a %+ 'ile run to e8a'ine the effects of running in a fir'>soled versus an air>soled running shoe. 6he post>run #lood values for the air>soled group showed increases in he'atocrit; 'ean cellular volu'e; and 'ean cellular he'oglo#in. 6his suggests that the air>soles resulted in less red #lood cell da'age. "dditionally; the white #lood cell count was twice as high in the fir'> soled shoes as co'pared to the air>sole group; suggesting that the fir'>sole condition had 'ore stress placed upon the' during the run. However; the weight of each shoe was not provided #y the authors; and the shoes pro#a#ly had other design differences other than the 'idsole 'aterial. In a si'ilar study?(5@; the o8ygen cost of running was e8a'ined in conventional shoes versus running in shoes with an encapsulated air>cushioned 'idsole. It was found that the o8ygen consu'ption was $.,= less on average for the air>soled group; and no su#:ects had lower o8ygen consu'ption levels for the conventional shoe. It was interesting to note that the shoes with the air>soles actually weighed 'ore than the fir'>soled shoes. He#ster et al.?(%@ found contrasting results in that there were no differences in 3<$; stride length; or heart rate #etween /3" and air>filled 'idsole shoes during tread'ill running. 6hese studies support the idea that running in shoes which have an air 'idsole 'ay lead to a decreased 'eta#olic cost. However the li'ited research on this topic 'akes it difficult to co'e a#out with a definitive conclusion; and 'ore studies 'easuring this varia#le need to #e perfor'ed. "nother aspect that has #een e8a'ined is the ti#ial a8ial tensile strain when running in an air>soled shoe. Milgro' et al.?($@ used a percutaneous e8tenso'eter to 'easure ti#ial strain values #etween su#:ects perfor'ing overground running in an air>soled shoe Jike "ir Ma8! or a Lohar shoe varus heel; deep heel cup; #road arch support; valgus 'idsole at level of 'etatarsals!. 6he investigators found that there were no differences #etween shoes with regards to peak>to>peak ti#ial co'pression>tension strain values or rates. In another study?((@ shock attenuation characteristics were assessed using ti#ial acceleration para'eters #etween su#:ects perfor'ing fil'ed>tread'ill running in different shoes. 6he * shoe conditions were: a! 7ou#le density /3" with cantilever outsole #! 7ou#le density /3" c! "ir>filled cha'#ers within a dou#le density /3" d! /ncapsulated dou#le density /3". 6he investigators found no

%5 differences for peak ti#ial acceleration or ti'e to peak ti#ial acceleration across shoe conditions; and the knee fle8ion4e8tension differences were not found to #e significantly different. 6he results fro' these studies suggest that air>filled 'idsoles are not effective in reducing lower e8tre'ity shock when running. Unfortunately; no other kine'atic data was recorded; so no results on a'ount and rate of pronation when running in air>soled shoes can #e revealed. "side fro' research which has e8a'ined air>filled 'idsoles; there were several studies which e8a'ined altering the 'idsole 'aterial of a running shoe. Morgan et al.?(*@ designed a shoe which had a car#on fi#er 'aterial which was 'olded to for' a leaf spring within the 'idfoot of the 'idsole and an elastic strap was configured which attached fro' the calcaneal> area of the shoe and wrapped around the distal leg near the 'alleoli. 6his shoe was co'pared with a conventional shoe with FstandardG 'idsole and outsole 'aterials. <verall; there was a lower 'ean o8ygen consu'ption during a %5 'inute tread'ill run for the leaf spring group; although this was not consistent for all su#:ects. <nce again; the shoe of which the leaf spring was co'pared 'ay have differed in 'any aspects; and no real conclusions can #e 'ade e8cept that 'ore research is needed in this area. "nother study?(+@ e8a'ined the effects of running in shoes which had cushioned colu'n syste's in the rearfoot of the shoe. <f the three shoe conditions; the first had a * colu'n 'ulticellular urethane elasto'er Jike Sho8!; the second a * colu'n ther'oplastic polyester elasto'er Iso>dyna'ic shoe!; and the third a single unit /3" foa'. /ach runner perfor'ed 'ultiple trials of running across a force platfor' while wearing reflective skin 'arkers. "lthough there were su#tle differences in loading rate and 'agnitude; there did not appear to #e a significant difference when co'paring the control shoe single unit /3" foa'! to either of the *>colu'ned 'idsole shoes; and little can #e generaliIed fro' this study. Jigg et al.?(,@ e8a'ined the effects of changing the heel 'aterial within a shoe. 6he two shoes which were used differed only in the heel9s 'idsole 'aterial which was either hard and visco>elastic; or softer and less visco>elastic. Both lower e8tre'ity 'uscle /M0 and o8ygen consu'ption were used for outco'e 'easures for su#:ects perfor'ing tread'ill running. 6here were no group differences #etween the two shoes for either of the two outco'e 'easures; yet there were 'any individualiIed differences #etween the two shoes. -". 9arus:9algus 7idsole "nother varia#le that has #een studied with running shoes has to do with the angulation of the 'idsole. Several studies have e8a'ined the effects of varying the valgus and varus angle of the 'idsole configuration. It should #e noted that only studies that e8a'ined actual shoe 'odifications were included in this review; as there are other studies which have reviewed the effects of differing orthoses9 angulations on gait. In a study #y Holden and )avanagh?(.@; the free 'o'ent of ground reaction MI9! was 'easured #y having su#:ects run over a force platfor' when wearing a shoe with either a neutral; varus; or valgus 'idsole varus 'idsole was raised 'edially; the valgus 'idsole was raised laterally!. It was found that the 'a8i'u' free 'o'ent of ground reaction MI9! and net angular i'pulse increased when switching fro' varus to neutral to valgus 'idsoles. However; while MI9 was consistent #etween each su#:ect and shoe condition; there were differences in MI9 #etween su#:ects of the sa'e shoe condition. 6his suggests that su#:ects of differing lower e8tre'ity structure will respond differently to differing shoe properties. In a study #y Milani et al.?(1@; su#:ects with internal shoe>pressure 'onitors were fil'ed while running across a force platfor' wearing shoes with either a neutral; 1 degree varus; or 1 degree valgus 'idsole. It was found that the 'a8i'al pronation and pronation velocity was less for the varus shoes and higher for the valgus shoes. -or the valgus 'idsole condition; increased lateral rearfoot loads and first ray contri#ution was found; and the takeoff angle was found to #e

%% (.1 degrees of pronation on average. )onversely; the varus 'idsole condition e8hi#ited increased 'edial 'idfoot loads and fifth 'etatarsal contri#ution #ut no statistically significant differences in takeoff supination angles when co'pared to the neutral 'idsole condition!. 6his suggests that the valgus 'idsole created increased pronation values which led to an increased 'edial forefoot loading response. In another study?(2@; su#:ects perfor'ed tread'ill running while wearing a shoe with a neutral; %5 degree varus; or %5 degree valgus 'idsole. 6he results showed that the a'ount of pronation increased when 'oving fro' the varus to neutral to valgus shoes; which is consistent with the afore'entioned studies. Brauner et al.?*5@ confir'ed these results in showing that running shoes with progressive increases in varus angulation led to decreases in total pronation a'ount and 'a8i'al pronation velocity. 6he results of these studies provide evidence that shoes with a varus 'idsole create less total pronation values; whereas valgus 'idsoles create higher pronation values. <nce again; if total pronation is a factor in running in:uries; then running in shoes with a varus 'idsole would see' appropriate. However; no running shoes since Brooks9 'odels in the %2.59s have such a feature; and this 'ay #e understanda#le given the fact that an individual runner should have a custo' varus 'idsole angle to prevent in:ury and opti'iIe his4her running 'echanics. -"- Torsional Rigidit; and Longitudinal 7idsole Sti55ness 7uring the gait cycle; a runner9s foot 'ust adapt to the terrain during su#talar :oint pronation4supination #y undergoing a torsional rotation a#out the 'idtarsal )hopart9s! :oints and tarso'etatarsal Disfranc9s! :oints. It has #een postulated that running shoes 'ay interfere with this natural 'ove'ent and 'ay lead to running in:uries?*%@. "s is the case with 'idsole duro'etry; the shoe 'anufacturers do not provide a consu'er with an o#:ective torsional rigidity value. However; one can 'anually perfor' a torsional test?%$@ #y grasping the shoe anteriorly and posteriorly with #oth hands and generating a twisting force to get an idea of a shoe9s torsional rigidity. "gain; this for' of su#:ective 'anual testing reCuires a co'parison #etween shoes to get an idea of how rigid a shoe is. Unfortunately; there has not #een 'any studies conducted which have e8a'ined kine'atic varia#les when varying the torsional rigidity of the shoe. In a study #y Stacoff et al.?*$@; 2 su#:ects fro' the Swiss Jational tea' of 'iddle distance runners who were all forefoot strikers! were fil'ed while running with their own running shoes and racing spikes. /ach runner had skin 'arkers to 'easure the foot kine'atics. 6he running shoes were torsionally rigid; whereas the racing flats were torsionally fle8i#le. Midfoot and rearfoot torsional angles and velocities were recorded; and it was found that the only significant difference #etween the two shoe types was that the running shoes showed a greater initial change in the 'idfoot torsional angle after touchdown. 6he authors of this study only included one trial which incorporated the 'a8i'al values for statistical analysis; which decreases the validity of the study. "dditionally; the fact that the torsional rigidity of a shoe e8hi#its a strong correlation with the duro'etry of the 'idsole 'akes it difficult to differentiate which varia#le is responsi#le for any o#served gait para'eters. 7ue to the fact that the participants were an elite group of athletes who used a 'ore rare running style forefoot contact!; this study lacks the e8ternal validity to 'ake any real conclusions a#out the effects of a shoe9s torsional rigidity on a runner9s gait. More research is clearly needed to deter'ine how the rigidity of a running shoe can affect one9s gait para'eters. &oy and Stefanyshyn?*(@ e8a'ined the effects of 'anipulating the longitudinal 'idsole stiffness on running econo'y; kine'atic gait varia#les; and 'uscle /M0. 6he longitudinal #ending stiffness of a shoe 'ay #e esti'ated #y holding the shoe at #oth ends and atte'pting to fold the shoe in half. In this study; the authors 'easured running econo'y through 3<$ consu'ption; kine'atic data through use of high>speed ca'eras and force plate data; and 'uscle activity through use of /M0 electrodes. &unning shoes with three different longitudinal

%$ stiffness 'easures control shoe: %1 JM''; stiff shoe: (1 JM''; stiffest shoe: *+ JM''! were used for this e8peri'ent. It was found that there were no significant differences in /M0 or kine'atic varia#les. 6he <$ consu'ption for the stiff shoe e8hi#ited a decrease in 'ean <$ consu'ption of %=; yet there were several su#:ects who had less 3o$ consu'ption 'easures when running in the control shoe as co'pared with the stiff shoe. 6he results of this study suggest that since there were no linear effects on running econo'y when longitudinal #ending stiffness was altered; individual characteristics will likely dictate the 'ost opti'al stiffness 'easure for a runner. -"0 $nsoles Shock a#sor#ing shoe insoles have #een around for 'any years. 6here has #een a fair a'ount of research regarding the effects of shock a#sor#ing insoles on the reduction of stress fractures. However; al'ost all of this research has used walking4'arching as a 'eans to 'easure the outco'e 'easures; and research e8a'ining insoles with respect to running para'eters is li'ited. In one study?**@; su#:ects with skin 'arkers attached to their lower e8tre'ity perfor'ed running trials across a fil'ed force platfor' while wearing shoes with differing insoles. 6wo shoes of the sa'e construction were used for the trials; e8cept one shoe did not have a heel counter. 6he original insole Shore $* for #oth shoe 'odels!; $ viscoelastic insoles Shore $, and $1!; and $ elasto'er>#ased insoles Shore $2 and (*! were used with each su#:ect and in #oth shoe>types!. It was found that there was no difference across conditions for the vertical i'pact force and ti'e of i'pact force peak. 6here were a few s'all effects #etween insole conditions regarding rearfoot para'eters. -or the non>heel countered shoe; the original insole led to a lower initial change in rearfoot angle as opposed to the Shore $, viscoelastic insole. In the heel>counter shoe; the Shore $1 viscoelastic insole had a lower initial change in rearfoot angle than did the Shore (* insole. In a si'ilar study?*+@; force plate data was used to co'pare running with and without a Sor#othane cushioned insole. In this study; the runner9s vertical ground reaction force peak i'pact and force loading rate values were lower when using the cushioned insole. It would appear fro' these studies that there is conflicting evidence for the insoles effect on i'pact forces or rearfoot para'eters; and 'ore research is warranted. -"( !eel Counter 6here have #een several studies which have e8a'ined the 'ove'ent of the foot within a shoe?*.; 2@; #ut e8a'ination of the influence of heel counter rigidity upon 'ove'ent of the rearfoot has #een scant. Heel counter rigidity can #e 'easured using a cla'p which co'presses the heel. 6he force needed to co'press the heel a given a'ount will dictate its rigidity. "s was the case with 'idsole duro'etry and torsional rigidity; the heel counter stiffness of a shoe is not provided #y the 'anufacturer; yet 'anually sCueeIing the posterior portion of the shoe where the heel counter is located?%$@ can give an idea of the heel counter stiffness. In one study?1@; three different shoes were used which all had differing heel counter rigidities "via $5+5 MB; Jike Haffle Street; and Jike "ir %15 with eternal plastic reinforce'ent of heel counter re'oved!. 6he su#:ects perfor'ed tread'ill running with 'arkers attached to #oth the rearfoot and shoe for each of the heel counter conditions. It was found that only the shoe with the rigid heel counter showed a difference #etween shoe and calcaneal 'otion; with the calcaneus everting 'oreso than the shoe. 6he heel counter of the shoe e8hi#ited significantly less velocity when co'pared with the calcaneus. Hhen running in the $

%( shoes with 'ore fle8i#le heel counters; the 'ove'ent #etween the heel counter and calcaneus was not significantly different. 6hese results suggest that heel counter rigidity is not effective in controlling rearfoot 'otion; as a rigid heel counter would #e necessary to prevent calcaneal 'ove'ent; yet the rigid heel counter in this study was not shown to contain the calcaneus. It should #e noted that the three shoes used for this study had differing properties and that heel counter rigidity was not controlled. -"7 !eel <lare 6he flare of the shoe 'ay #e: a positive nu'#er given in degrees! indicating that the inferior portion of the posterior outsole is 'ore lateral than the superior portion; it 'ay #e neutral indicating that the superior and inferior portions of the posterior portion of the outsole are eCually lateral!; or it 'ay #e rounded which indicates that the inferior portion of the posterior outsole is 'ore 'edial than that of the superior portion. Many shoes availa#le today have a positive heel flare which is rounded. 6he lateral heel flare of a shoe9s outsole can #e 'easured fro' the posterior aspect of the shoe using the angle for'ed #etween the 'ost supero>lateral portion of the outsole and the 'ost infero>lateral portion of the outsole See -igure 2!. 6he lateral heel flare of a shoe has #een studied #ecause it is #elieved that with an increased lateral heel flare; there e8ists a greater lever ar' #etween where the shoe contacts the ground and the su#talar :oint?*.@. Because of this; it is #elieved that a larger lateral heel flare will result in higher pronation values due to the larger 'o'ent ar' of the pronatory torCue. "lthough there have not #een any studies perfor'ed with regards to 'edial heel flare; there are shoes availa#le which provide this See -igure *!. -ro' a 'echanical standpoint; it would 'ake sense that a s'all lateral heel flare and a larger 'edial heel flare would help to co'#at e8cessive pronation. 6he studies which have varied the lateral heel flare of a shoe see' to show differing results with regards to its effects on pronation and other kine'atic para'eters. In one study?*1@; su#:ects ran across a force platfor' with ( differing lateral heel flares $+ degrees; neutral; and rounded!. /ach su#:ect had #one pin 'arkers as well as shoe 'arkers. It was found that there were no effects #etween conditions on ti#io>calcaneal rotation or shoe eversion; and inversion #etween the flare conditions was not statistically different for each su#:ect. However; there were significantly different touchdown inversion values for each flare condition #etween differing su#:ects. 6he #one pins showed there to #e different eversion velocities for differing flare conditions with no consistent pattern #oth a'ongst and #etween su#:ects. 6he authors concluded that the eversion para'eter 'easures appeared to #e highly su#:ect specific. <nce again; it appears as though an individual9s structure highly dictates how he4she will interact with different shoe types. <ne significant finding for this study was that the total shoe eversion and 'a8i'al shoe eversion velocity was twice as high as the values recorded fro' the #one pin 'arkers; which 'ay indicate that the foot is 'oving within the shoe. In a si'ilar study; Jigg and Morlock?*.@ e8a'ined the effects of varying the lateral heel flare of a shoe %, degrees; neutral; and rounded! on specific rearfoot para'eters and loading rates. It was found that with increasing lateral heel flare; the initial pronation and initial pronation velocity increased. 6otal :oint and shoe pronation was not affected across differing heel flare conditions. 6he initial inversion angle at touchdown decreased as the lateral flare decreased; #ut the initial knee angle at touchdown was the sa'e across the different flare conditions. -or the force plate para'eters; it was shown that there were no differences across conditions for the 'ean vertical i'pact force peak and 'a8i'al loading rate. 6hese studies are so'ewhat inconclusive. It see's as though lateral heel flare can influence the touchdown supination of the foot; yet there was only a consistent pattern for this in the study #y Jigg and Morlock?*.@; which showed that the increased lateral flare led to an increased touchdown supination angle. "lso; initial pronation and pronation velocity see's to

%* increase with increasing heel flare. "s is the case with 'any other shoe varia#les; 'ore research is needed. "lso; there 'ay very well #e a significant interaction effect #etween heel flare and foot type; as was seen with the study #y Stacoff et al.?*1@. Also see results of the effects of lateral heel flare in the Combined Variables section. -"' Sole !eight Nerosch et al.?*2@ e8a'ined the effects of su#:ects perfor'ing tread'ill running in a shoe with a negative sole versus a conventional shoe. " negative sole i'plies that the construction of the 'idsole is done in such a way that the toes are placed higher than the heel within the shoe. 6he negative>soled shoe had a sole height of $+ '' at the toes and %5 '' at the heel; as opposed to the control shoe which had a sole height of %5 '' at the toes and $5 '' at the heel. Su#:ects were assessed with regards to fil' kine'atics; and also anterior ti#ial intraco'part'ent pressures. 6he ti#ial co'part'ent pressure was 'onitored using a co'part'ental pressure 'onitor with a slit catheter and lancet needle. It was found that su#:ects wearing the negative> soled shoe had an average of 1 degrees less dorsifle8ion at heel strike. 6he su#:ects with the control shoe had a 'ean plantar fle8ion of %, degrees 5.%. seconds! following heel strike as opposed to the negative>soled group which had a 'ean of , degrees 5.%5 seconds!. 6he control shoe group had significantly higher peak co'part'ental pressures as co'pared with the negative>soled shoe. 6his study suggests that the use of a negative>soled shoe 'ay help to decrease the intraco'part'ental pressures in the anterior ti#ial co'part'ent while running; and hence decease anterior Fshin splintsG for certain runners. 6he authors of this study #elieve that this is due to the decreased a'ount of eccentric dorsifle8ion which is reCuired #y the ti#ialis anterior 'uscle upon initial contact. However; 'ore studies will need to #e perfor'ed to provide 'ore support for this concept; as this was the only study which e8a'ined this aspect of a running shoe. &einsch'idt and Jigg?+5@ e8a'ined the effects of varying the heel height of a running shoe to esta#lish if shoes with a higher heel would decrease the plantar>fle8ion 'o'ent throughout the stance phase of gait; and hence decrease the a'ount of tension on the "chilles tendon for runners who are prone to "chilles tendonitis. -or each of the five different shoe conditions which were used; the forefoot sole had a height of 5.1 c'; whereas the heel had a height of $.%; $.*; $..; (.5; and (.( c' for each of the respective shoe conditions. It was found that heel height did not have a significant effect on 'agnitude or ti'e of occurrence for 'a8i'u' plantar> fle8ion 'o'ents. 6he results of this study suggest that altering heel height does not affect the a'ount of stress which is placed through the "chilles tendon when running; yet 'ore studies will need to #e conducted to confir' these results. -"/ Curved Last 6here has yet to #e any pu#lished research to date that has co'pared the effects of running in a straight versus a curved last. 6he curvature of a last can #e seen #y viewing the inferior aspect of the shoe See -igure +!. It is a co''on #elief that shoes with a curved last should #e prescri#ed for high>arched runners with little pronation range of 'otion; and straight lasts should #e prescri#ed for hyperpronators. Several authors have speculated that a curved last will create 'ore pronation due to the lack of 'edial arch support?+%; %(; %$; +$@. -rederick?+%@ reports that he has conducted unpu#lished research which shows that straighter lasts have 'ore 'edial support and a wider heel #ase; and reduce 'a8i'u' pronation. )learly; research needs to #e pu#lished which e8a'ines the differences #etween last configuration #efore anything can #e concluded.

%+

-" % Com8ined 9aria8les 6here are several studies in which the authors chose to investigate the effects of 'anipulating several varia#les of a shoe to see how the gait para'eters would change. However; do to the co'ple8ity of researching several varia#les at once; interpretation and a generaliIation of an overall 'essage regarding the effects of 'anipulating shoe varia#les #eco'es difficult. In a study #y Jigg and Bahlsen?+(@; 'idsole hardness and lateral heel flare were varied to 'easure the pronation4supination and i'pact forces of su#:ects running across a force plate. 6hree shoes of differing 'idsole constructions %! single density 'idsole of Shore (+ duro'etry; $! .5 duro'etry 'idsole 'ounted atop a Shore *5 duro'etry; (! Shore (+ 'aterial on the 'edial 'idsole and Shore $+ on the lateral 'idsole! were used; and three different heel flares %, degrees; neutral; and rounded! were added to each of these three conditions. It was found that for the %, degree flare; the $nd shoe showed high initial shoe and :oint pronation whereas the third shoe showed low initial :oint pronation. 6he neutral and rounded heel flared conditions did not show significant differences for each of the three shoe conditions. It was also found that for all shoe conditions; having a rounded flare led to a decreased inversion angle at touchdown; whereas for the %, degree flare condition; shoes % and $ showed the highest initial inversion angles at touchdown. )onsistent with past research; shoe ( softest 'idsole! had the highest vertical i'pact peak and rate across all flare conditions. 6his study suggests that when a shoe has a large heel flare; a soft lateral 'idsole helps to decrease the pronation; and that shoes with a neutral or rounded heel flare 'ay not #e affected #y varying 'idsole hardness with regards to the a'ount of initial pronation. 6his study also showed there to #e 'uch individual difference #etween shoe>type. In a study #y )larke et al.?+*@; (, pairs of shoes were constructed with the co'#inations of three different varia#les: Heel flare neutral; %+ degrees; and (5 degrees!; 'idsole duro'etry $+; (+; *+ Shore values!; and heel height %5 '' 'idsole; %5 '' 'idsole with %5 '' heel lift; %5 '' sole with $5 '' heel lift; and $5 '' sole with %5 '' heel lift!. 6he 'a8i'al pronation; total rearfoot; and ti'e until the 'a8i'u' velocity of pronation 'otion increased with the softer shoe conditions; although there were no significant differences #etween the 'ediu' and hard duro'eter shoes for the 'a8i'al pronation and total rearfoot 'otion. It was also found that shoes with the neutral heel flare had significantly greater 'a8i'al pronation and total rearfoot 'otion as co'pared with the other two flare groups; which differs fro' the results #y Jigg et al. ?+(@ . 6he neutral flare condition was also found to have a later ti'e until 'a8i'al velocity of pronation as co'pared to the (5 degree flare condition. It was shown that as heel height increased; the ti'e until 'a8i'al velocity of pronation increased as well. 6he authors also stated that shoes with a soft 'idsole and neutral heel flare showed the greatest a'ount of 'a8i'u' pronation as opposed to the shoes with hard 'idsole and (5 degree heel flare showed the least. 6hese two studies see' to have varying results. 6he study #y Jigg and Bahlsen?+(@ see's to support the idea that shoes with a large heel flare and soft 'idsole lead to less pronation; yet no infor'ation is provided across flare conditions. 6he study #y )larke et al.?+*@ supports the idea that the large flare and hard 'idsole lead to less pronation. Jigg and Bahlsen?+(@ also showed that neutral4rounded heel flares are unaffected #y 'idsole hardness with regards to rearfoot para'eters; whereas )larke et al.?+*@ show that the shoe with the neutral heel flare led to higher 'a8i'al pronation when co'#ined with a softer 'idsole. 6hese inconsistent results could very well #e due to each individual9s structural differences. 6herefore; nothing can #e concluded at this ti'e fro' these studies; and 'ore

%, research will need to #e perfor'ed #efore any conclusions can #e 'ade. However; fro' a #io'echanical standpoint; it would 'ake sense that a large lateral heel flare with a hard 'idsole would increase the resistance ar' of the torCue and create higher pronatory forces. 6his 'ay not have #een revealed in these studies due to the potentially high variation in each su#:ect9s foot structure. -" Shoe Pro3erties and <oot Structure

6here have #een few studies which have e8a'ined the interaction #etween individual structure and running shoe properties; although this has #eco'e the research trend within the last several years. 6he few studies which have #een conducted on this 'atter only took into account arch height as an indicator of lower e8tre'ity structure; and4or relied on gait o#servation to la#el su#:ects9 pronation values. 6he li'itations of only taking into account one9s arch height and relying on o#servation of gait will #e discussed later in this report. Kinoshita et al.?++@ e8a'ined the differences #etween hard and soft 'idsole duro'eters #y having su#:ects perfor' ground running over a force platfor'. 6he researchers perfor'ed a static lower e8tre'ity #io'echanical analysis and a dyna'ic gait assess'ent and categoriIed the su#:ects into ( groups: high pronator; nor'al; and low pronator. -or all duro'eter 'easures; the peak pronation angle was highest for the high pronator group; and lowest for the low pronator group. -or the within group 'easure'ents; it was found that the high pronator group had significantly lower pronation angles when running in the harder shoe while the nor'al and low pronator groups did not differ significantly in regards to pronation angles when alternating #etween hard and soft shoes. 6hese results are consistent with the co''on prescription idea that runners who pronate e8cessively should #e prescri#ed a shoe with a harder 'idsole. In a study #y Butler et al.?+,@; runners of low and high arch height were separated into two groups of $5 runners using the "rch Height Inde8 as an o#:ective 'easure'ent instru'ent. /ach runner perfor'ed 'ultiple trials of running across a force plate in the Jew Balance %%$$ 'otion control classification: straight last and hard 'idsole 'aterial fro' rearfoot to 'idfoot! and the Jew Balance %5$$ cushion classification: se'i>curved last; soft 'idsole!. It was found that the high>arched runners had a lower instantaneous loading rate when running in the cushion shoe as co'pared to the 'otion control shoe; yet the low>arched runners e8hi#ited a higher instantaneous loading rate when running in the cushion shoes. It was also found that the 'otion control shoes led to lower rearfoot eversion peak and eversion e8cursion across #oth groups; yet these values were only %.% and 5.. respectively and this 'ay not #e clinically significant!. However; the decrease in loading rate for the high>arched group when running in the cushion shoes lends so'e credi#ility to the popular notion that cushion shoes should #e prescri#ed for the high>arched runners who do not have the su#talar 'o#ility which allows pronation. In a si'ilar study; Butler et al.?+.@ again used the Jew Balance %%$$ and %5$$ to e8a'ine the interaction of high and low arch types of runners when perfor'ing a prolonged4fatiguing tread'ill run. -or the low arch group; it was found that the peak ti#ial internal rotation decreased with the 'otion control shoe and increased with the cushion trainer throughout the course of the run; #ut this was not the case for other values of pronation such as peak rearfoot eversion. It was also found that peak ti#ial acceleration was less throughout the course of the run for the low arch group when running in the cushion trainer; and the peak ti#ial acceleration was less for the high arch runners for the entire run when running in the cushion trainer. )heung and Jg?+1@ also e8a'ined the effects of fatigue on hyperpronators when tread'ill running in #oth neutral "didas Supernova )ushion! and 'otion control "didas Supernova )ontrol! shoes. /ach su#:ect was allowed into the study #y Cualifying as a hyperpronator via a static su#>talar neutral e8a'ination and a dyna'ic e8a'ination of tread'ill running. "ll kine'atic data was collected at the #eginning of the tread'ill run and at the end of a fatiguing run. It was found that the 'otion control shoes reduced rearfoot 'otion co'pared to the neutral

%. shoes #oth pre and post>fatigued states. It was also found that when running in the 'otion control shoes; the rearfoot 'otion did not significantly change fro' pre to post>fatigue. Hhen running in the neutral shoe; the rearfoot 'otion increased #y ,.+= fro' pre to post>fatigued states. 6his study differs fro' that of Butler et al.?+.@ in that this study showed an increase in rearfoot 'otion when running in softer shoes whereas the previous study did not show a significant difference in rearfoot 'otion when running in the cushion trainer shoe. )heung and Jg?+2@ perfor'ed a si'ilar study where a group of $+ runners with OP , degrees of dyna'ic pronation where tested with a 'otion control shoe "didas Supernova )ontrol! and a neutral shoe "didas Supernova )ushion! to esta#lish how well these shoes controlled pronation during a %.+ k' tread'ill run. It was found that the runners wearing the neutral shoe had significantly higher a'ounts of pronation throughout the tread'ill run; whereas the runners wearing the 'otion control shoe did not show significant differences in their total pronation angles. "dditionally; there were higher peak force values over the 'edial 'idfoot and first 'etatarsal heads throughout the run when running in the neutral shoes. In a study #y Hegener et al?,5@; runners with a cavus foot>type where used to e8a'ine the effectiveness of cushioned running shoes "sics 0el Ji'#us , and Brooks 0lycerine ( were co'pared to the 7unlop 3olley control shoe! on plantar pressures at the whole foot; rearfoot; 'idfoot; and forefoot while perfor'ing over>ground running. 6he in>shoe Jovel Pedar>Q was used to record plantar pressures. 6he -oot Posture Inde8 was used to deter'ine which participants had a cavus foot>type. -or peak pressure 'easure'ents; the cushioned shoes led to significantly decreased peak pressure for the whole foot as well as for the rear4'id4fore foot when co'pared with the control shoe. 6here was also a significant decrease in pressure ti'e integrals when co'paring the cushioned shoes to the control; indicating a 'ore gradual loading when running in the cushioned shoes. Interestingly; the force values for the cushioned running shoes were higher at the 'idfoot and lower at the forefoot as co'pared to the control shoe. 6his likely indicates that the cushioned shoes acted to spread the forces out over the entire foot; whereas the control shoe kept the contact forces consistent with the foot structure i.e. over the rearfoot and forefoot!. 6he authors of this study also found decreased plantar pressure values in the rearfoot when running in the "sics 0el Ji'#us ,; and decreased plantar pressure values in the forefoot when running in the Brooks 0lycerine (. 6his 'ay #e significant when prescri#ing running shoes for runners with different foot>strike patterns i.e. rearfoot; 'idfoot; or forefoot> strike pattern!; or for runners who develop pain and4or stress fractures in different areas of the foot. 6he results of these studies are generally in agree'ent with the co''on prescription ideas which involve prescri#ing hard 'idsole F'otion controlG shoes to those who pronate e8cessively; and prescri#ing soft 'idsole FcushionG shoes to those who have a cavus foot and hypopronate.

0"% Discussion
"lthough there has clearly #een 'uch research conducted in the real' of running shoes; there have not #een 'any studies which have looked at 'atching a runner9s 'echanics to a specific running shoe. However; the trend has 'oved towards the categoriIation of runners #y either their arch type and4or dyna'ic gait presentation; and deter'ining how the different groups of runners react to differing shoe properties. 6he research has given us so'e insight into 'atching a runner with a pair of running shoes. 6he 'ain varia#les which appear to have an effect on a runner9s gait appear to involve 'idsole duro'etry and varus4valgus 'idsole angulations. Specifically; shoes with a harder 'idsole; varus 'idsole; and of the 'otion control category appear to li'it total pronation values; whereas shoes with a softer 'idsole; valgus 'idsole; and of the cushioned category appear to increase total pronation values. In order to now understand how a running shoe prescription can

%1 #e 'ade; an overview of co''on philosophies will #e e8a'ined. 6he philosophies regarding running shoe prescription which will #e e8a'ined are those of running shoe store e'ployees which will #e ter'ed the 0eneralist viewpoint!; the #io'echanical view which will #e #roken down into su#talar>neutral #io'echanists Kine'atic viewpoint! and non su#talar> neutral #io'echanists Kinetic viewpoint!. 0" Philoso3hies o5 running shoe 3rescri3tion

0eneralist 3iewpoint 6he foundation of this philosophy is that a runner is categoriIed as a hyperpronator overpronator!; neutral runner; or hypopronator supinator or under>pronator! and prescri#ed a running shoe depending into which category a runner falls. 6here are several factors which leads to this classification. " generalist will look at your arch height in non weight>#earing and then in weight#earing to esta#lish how 'uch arch collapse is present i.e. are you standing with a pronated stance; a neutral stance; or a high>arched stance!. 6he generalist will also have the runner run for a short distance to esta#lish whether or not that runner hyperpronates; is neutral; or supinates. If a runner is found to have a low arch in weight#earing and hyperpronates; he4she is prescri#ed a 'otion control shoe which has a straight last and hard 'idsole. If the runner has a nor'al arch in weight#earing and pronates #ut not e8cessively; he4she is prescri#ed a sta#ility shoe which will have a se'i>curved last and 'ediu' duro'etry 'idsole. Dastly; if the runner has a high arch in weight#earing and supinates throughout the gait cycle; he4she is prescri#ed a cushion shoe which has a curved last and soft 'idsole configuration. Knapik et al.?,%@ e8a'ined this philosophy with 'ilitary recruits; #ut there were 'any confounding varia#les which disallows any conclusions fro' #eing 'ade. 6here are several key li'itations4criticis's of this philosophy. 6he #iggest li'itation is that pronation is the varia#le which is treated instead of what is causing the pronation. It is #elieved #y 'ost #io'echanists that certain foot structures are what lead to different gait patterns see Kinetic viewpoint for ela#oration on this topic!; and there can #e different foot structures which can lead to such gait patterns as hyperpronation or late pronation. 6reating all hyperpronators with the sa'e running shoe 'ay not #e appropriate. -or e8a'ple; a runner 'ay e8hi#it a significantly pronated foot due to the intrinsic factor of a co'pensated forefoot varus; or fro' an e8trinsic source such as fro' co8a valga which has led to a co'pensated genu varu'; which will then lead to a varus attitude of the lower leg and foot towards the ground forcing the foot into a pronated position. )onsistent with the li'itation to this philosophy is the reliance on standing arch height. 6here 'ay #e runners who stand in a neutral position giving the appearance of a 'id>high arch! who have a co'pensated rearfoot varus defor'ity. 6his foot structure will likely lead to hyperpronation and4or late pronation which is difficult to o#serve dyna'ically; as a runner with this foot>type is already significantly pronated when the calcaneus is perpendicular with the distal %4( of the leg in stance. 6he second li'itation is that the generalist is forced to rely on watching a runner run for a very short distance; and 'uch like the li'itation to the running shoe research; this 'ay not #e the runner9s true gait pattern. 6his #rings us to the third 'ain criticis' of this philosophy; which is that ti'ing of the pronation is not e8a'ined only a'ount of pronation!. It is very co''on for a runner to have a rearfoot or forefoot varus defor'ity See -igure ,! which 'ay lead to s'all a'ounts of pronation very late into the gait cycle. 6his late pronation has the potential of stressing the passive plantar fascia; spring liga'ent; I6 #and; etc! and dyna'ic ti#ialis anterior; ti#ialis posterior; fle8or hallucis longus! 'echanis's of resupination. "dditionally; this late pronation is difficult to o#serve and 'ay appear as supination to an untrained eye. Kine'atic 3iewpoint

%2 6he key co'ponent to this philosophy is that a runner9s varus4valgus angulation of the rearfoot and forefoot are what deter'ine how a runner9s gait pattern will e'erge. 6he angulations of the rearfoot and forefoot are found #y placing the runner in a prone position on a plinth with his4her feet hanging off of the plinth. 6he e8a'iner9s hands palpate the talus over the antero>'edial and anterolateral aspect of the talo>navicular :oint; and the foot is inverted and everted until the talus is dee'ed to #e neither adducted nor a#ducted See -igure .!. 6his is known as the su#talar>neutral position of the foot. Hhile #eing held in the su#talar>neutral position; the runner9s varus4valgus angulations of the rearfoot and forefoot are deter'ined #y the e8a'iner; and the runner is then placed in the weight#earing position of resting stance to esta#lish any co'pensations of the lower e8tre'ity. 6his position is #elieved to #e i'portant as this #io'echanical theory ascertains that the foot will function 'ost efficiently when this position of the foot is achieved during ter'inal stance. <nce the angulations are deter'ined; the runner is prescri#ed a running shoe which co'ple'ents the runner9s foot>type. If the runner has a large rearfoot varus for e8a'ple; then a running shoe with a varus 'idsole and4or hard 'idsole would #e prescri#ed to offset the pronatory forces which are created #y these angulations. However; #ecause varus 'idsoles are not currently availa#le; the runner would have to settle for a 'otion control shoe which has a hard 'idsole 'aterial. If the runner had a significant forefoot valgus; then he4she 'ay #e prescri#ed a softer cushion shoe to decrease the a'ount of supination upon ter'inal stance. Because running shoes do not currently have varus4valgus 'idsoles; #io'echanists who adhere to this philosophy often prescri#e orthoses4orthotics to #e used inside a running shoe. 6he 'ain criticis' of this philosophy is that e8a'ining the foot in a su#talar>neutral position does not take into account how the foot is striking the ground; and hence is not taking into account the kinetic forces which are likely to dictate how the lower e8tre'ity will undergo it9s loading response pattern. Kinetic 3iewpoint 6he critical co'ponent of this philosophy is that the gait pattern which will e'erge for a given runner co'es a#out #ecause of the kinetic forces which are created #y the angulations of the foot when it first strikes the running surface?,$@. Because #io'echanists who adhere to this theory are concerned with the kinetic forces of the foot upon i'pact; they are not concerned with e8a'ining the foot in it9s su#talar>neutral position. 6he e8a'iners who follow this philosophy will place the runner in the prone position with his4her feet over the edge of the plinth; and have the runner hold his4her feet in 5 to %5 degrees of dorsifle8ion as this is the position the foot will #e in when it strikes the ground!. <nce in this position; the e8a'iner notes any rearfoot or forefoot varus angulations &efer again to -igure ,!. Such rearfoot and forefoot varus angulations are of i'portance due to the pronatory torCue which is created upon the foot9s i'pact with the ground. Hith a varus foot structure; the foot has a pronatory force spread over a s'aller surface area of the lateral foot which creates high pronatory forces and a larger lever for pronatory torCue; and the foot generates 'ore 'o'entu' into pronation as the foot pronates to 'eet with the ground See -igure 1a!. Hith a forefoot varus defor'ity; this sa'e pronatory torCue is created; yet this happens later into the gait cycle See -igure 1#!. It should #e noted that there are 'any other lower e8tre'ity varia#les which are recorded during the #io'echanical e8a'ination which atte'pt to predict how the foot is striking the ground; yet the intrinsic foot structure is the 'ost i'portant factor. If the runner has a rearfoot varus angulation; then he4she would #e prescri#ed a running shoe with a varus 'idsole and4or hard 'idsole. <nce again; #ecause varus 'idsoles are not currently availa#le; this runner would #e prescri#ed a 'otion control shoe with a hard 'idsole or an orthosis. If the runner were to have a forefoot varus defor'ity; then he4she would #e prescri#ed a running shoe with a forefoot varus wedge or a running shoe with a harder 'idsole 'aterial in the antero>'edial aspect of the shoe. Because neither of these running shoe

$5 characteristics is currently availa#le; then this runner would have to settle for a 'otion control shoe with a hard 'idsole or #e prescri#ed an orthosis. 6he 'ain li'itation to this philosophy is that atte'pting to esta#lish e8actly how the foot will contact the ground and understanding how 'uch each :oint of the lower e8tre'ity is contri#uting to the way the foot strikes the ground is difficult. 6rying to o#:ectively esta#lish the a'ount of hip anteversion4retroversion; ti#ial varu'; rearfoot4forfoot varus; 'idtarsal 'o#ility; first ray position; etc. and trying to predict how these varia#les will relate to the position of the lower e8tre'ity when it 'akes contact with the ground is a difficult task. "dditionally; slower runners will tend to #e rearfoot strikers and will likely achieve full foot co'pensation when the foot is closer to %5 degrees of plantarfle8ion. Prescription 7ecision Hith several different philosophies and little supportive evidence to each one; how does one decide how to prescri#e the proper running shoeE Ironically; #ecause the only true differences in running shoes which are on the 'arket today involve choosing #etween soft cushion!; 'ediu' sta#ility!; or hard 'otion control! 'idsoles; the decision for prescription #eco'es very si'ilar regardless of which philosophy is used when 'aking a prescription. "fter all; the 'a:ority of differences #etween 'ost running shoes today have 'ore to do with aesthetic appeal than they do 'echanical properties. However; there will #e so'e differences in prescription #etween these different philosophies. 6he key feature of the kinetic philosophy is that principles of physics are used to e8plain why a runner is undergoing a#nor'al pronation too 'uch or too late!. "dhering to the generalist9s philosophy will lead one to try to treat pronation; instead of trying to understand the cause of the pronation?,$@. If one does not understand which intrinsic4e8trinsic aspects of the foot are creating the a#nor'al pronation; then how can one know which aspects of the shoe should #e custo'iIed to an individual9s feetE "dhering to the kine'atic philosophy 'ay also #e inco'plete #ecause physics is again not taken into account. -or e8a'ple; there 'ay #e two different runners who #oth have a neutral rearfoot and %5 degree forefoot varus 'easured in su#talar>neutral. &unner R% however; has %5 degrees of forefoot varus when 'easured in the resting position which is 5 to %5 degrees of dorsifle8ion!; and runner R$ has $5 degrees of forefoot varus and %5 degrees of rearfoot varus when 'easured in the resting position. &unner R$ will clearly have different values of pronatory torCue as co'pared with runner R%; and thus need different running shoe properties. Until 'ore research #eco'es availa#le; it 'ay #e useful to try to i'ple'ent aspects of #oth the kinetic and kine'atic philosophies at this ti'e. 0"& <uture Research 6here are two 'ain ideas which would likely i'prove the nature of running shoe prescription if i'ple'ented in future research. 6he first idea regards #etter atte'pts at 'atching an individual runner9s lower e8tre'ity structure and 'echanics to certain running shoe properties. -or e8a'ple; creating a shoe with a hard duro'eter 'idsole in the antero>'edial aspect of the 'idsole or creating a forefoot varus 'idsole for runners who have a forefoot varus defor'ity would #e a good Fne8t>stepG for research. Si'ply e8a'ining arch structure when standing or trying to treat the pronation itself is not sufficient as this techniCue does not fully take into account the kinetic forces that a runner will create #ecause of his4her foot structure. It is for this reason that we should #etter atte'pt to 'atch a runner9s lower e8tre'ity structure and dyna'ic 'echanics with different running shoe properties to reduce or eli'inate the a#nor'al forces upon i'pact. Many of the current studies have found there are certain interaction effects for runners of differing 'echanics; and atte'pting to generaliIe that a certain running shoe property will do the sa'e thing for all runners 'ay not #e correct.

$% Secondly; we should #e designing our studies so that runner9s are actually given a chance to run in a given shoe for a 'atter of weeks to 'onths; and our outco'e 'easures should involve such varia#les as a'ount of lower e8tre'ity pain; a'ount of distance which can #e ran #efore onset of pain; etc. 0iven the fact that 'any runners are not a#le to run for the distances that they would like #ecause of such overuse in:uries as posterior ti#ial stress syndro'e; patello>fe'oral pain syndro'e; anterior co'part'ent syndro'e; and plantar fasciitis :ust to na'e a few!; then why aren9t we 'easuring the running shoe9s a#ility to co'#at these pro#le's in a 'ore practical and applied 'annerE

("% Conclusion
6he current research on running shoes has given us so'e insight into how ad:usting certain running shoe properties 'ay influence a runner9s gait. He still need 'ore evidence which shows us why running in:uries co'e a#out so that we 'ay #etter configure running shoes to co'#at these pro#le's. "lthough there is no solid evidence on this 'atter; the principles of #io'echanics will likely lead us in the proper direction when prescri#ing a running shoe. -ro' a #io'echanical standpoint; e8a'ining the kinetic forces which are created #y the interaction of a runner9s rearfoot4forefoot varus angulations upon i'pact with the ground is #eneficial to esta#lish why a#nor'al pronation is co'ing a#out; instead of trying to treat the pronation as a cause of in:ury. He si'ply cannot treat hyperpronation or late pronation #y prescri#ing a running shoe unless we e8a'ine why this a#nor'al pronation is co'ing a#out. It is this author9s hope that future research will take into account a runner9s individual foot structure and try to decipher which running shoe properties will #est co'ple'ent each foot structure.

$$

Re5erences %. 3an Mechelen; H. &unning in:uries: a review of the epide'iological literature. Sports Medicine %22$S %* +!: ($5>((+; $. Hoe#erigs; NH. -actors related to the incidence of running in:uries. " &eview. Sports Medicine %22$S %(: *51>*$$ (. )le'ent; 7B; 6aunton; N/; S'art; 0H; et al. " survey of overuse running in:uries. 6he Physician and Sports'edicine %21%S 2 +!: *.>++ *. Ha'ill; N; Bates; B6; Holt; K0. 6i'ing of lower e8tre'ity :oint actions during tread'ill running. Medicine and Science in Sports and /8ercise %22$S $* .!: 15.>1%( +. 3iitasalo; N6; Kvist; M. So'e #io'echanical aspects of the foot and ankle in athletes with and without shin splints. 6he "'erican Nournal of Sports Medicine %21(S %% (!: %$+>%(5 ,. )avanagh; P&. 6he Bio'echanics of &unning. In: 6he &unning Shoe Book. "nderson Horld; Moutain 3iew; )"S %215: .1>2+ .. &oot; MD; <rien; HP; Heed; NH. Jor'al and "#nor'al -unction of the -oot. )linical Bio'echanics )o.; Dos "ngeles; %2.. 1. 3an 0heluwe; B; 6iele'ans; &; &oosen; P. 6he influence of heel counter rigidity on rearfoot 'otion during running. Nournal of "pplied Bio'echanics %22+S %%: *.>,. 2. Stacoff; "; &einsch'idt; ); Stussi; /. 6he 'ove'ent of the heel within a running shoe. Medicine and Science in Sports and /8ercise %22$S $* ,!: ,2+>.5% %5. Dees; ". 6he role of athlete response tests in the #io'echanical evaluation of running shoes. /rgono'icsS%211: (% %%!: %,.(>%,1% %%. Barnes; &"; S'ith; P7. 6he role of footwear in 'ini'iIing lower li'# in:ury. Nournal of Sports Sciences %22*S %$: (*%>(+( %$. Joakes; 67. Staying In:ury -ree. In: Dore of &unning. Hu'an Kinetics Pu#lishersS (rd edition; %22%: .,5>..$ %(. Pink; MM.; No#e; -H. 6he foot4shoe interface. In: 0uten; 0J ed!; &unning In:uries. Philadelphia; P": H.B. Saunders )o'pany; %22.: $5>$2 %*. Nohnson; N". 6he running shoe. In: 6e8t#ook of &unning Medicine. Mc0raw>Hill; Medical Pu#. 7ivision; JT; $55%: +12>+2$ %+. McKenIie; 7); )le'ent; 7B; 6aunton; N/. &unning shoes; orthotics; and in:uries. Sports Medicine %21+S $: ((*>(*. %,. "nthony; &N. 6he functional anato'y of the running training shoe. )hiropodist %21.S *+%>*+2 %.. Milani; 6D; Hennig; /.M. 6he influence of footwear construction on foot 'echanics during running. Proceedings; Jinth Biennial )onference; )anadian Society for Bio'echanics; 3ancouver; %22, "ugust: $%>$*; %1. Kaelin; Q; 7enoth; N; Stacoff; "; et al. )ushioning during running K Material tests contra su#:ect tests. Proceedings of the -ourth Meeting of the /uropean Society of Bio'echanics %21+: ,+%>,+,; %2. 7e Hit; B; 7e )lercC; 7; Denoir; M. 6he effect of varying hardness on i'pact forces and foot 'otion during foot contact in running. Nournal of "pplied Bio'echanics %22+S %%: (2+>*5,; $5. Jigg; BM; Bahlsen; SM; Duethi; SM; et al. 6he influence of running velocity and 'idsole hardness on e8ternal i'pact forces in heel>toe running. Nournal of #io'echanics %21.S $5 %5!: 2+%>2+2

$( $%. Ha'ill; N; -reedson; PS; Boda; H; et al. /ffects of shoe type on cardiorespiratory response and rearfoot 'otion during tread'ill running. Medicine and Science in Sports and /8ercise %211S $5: +%+>+$% $$. Stacoff; "; 7enoth; N; Kaelin; Q; et al. &unning in:uries and shoe construction: So'e possi#le relationships. International Nournal of Sport Bio'echanics %211S *: (*$>(+. $(. )larke; 6/; -rederick; /); )ooper; DB. /ffects of shoe cushioning upon ground reaction forces in running. International Nournal of Sports Medicine %21(S *: $*.>$+% $*. Hright; I); Jeptune; &&; 3an 7en Bogert; et al. Passive regulation of i'pact forces in heel>toe running. )linical Bio'echanics %221S %(: +$%>+(% $+. Hennig; /M; 3aliant; 0"; Diu; U. Bio'echanical varia#les and the perception of cushioning for running in various types of footwear. Nournal of "pplied Bio'echanics %22,S %$: %*(>%+5 $,. Hardin; /); 3an 7en Bogert; "N; Ha'ill; N. Kine'atic adaptations during running: /ffects of footwear; surface; and duration. Medicine and Science in Sports and /8ercise $55*S (, +! :1(1>1** $.. Hardin; /); Ha'ill; N. 6he influence of 'idsole cushioning on 'echanical and he'atological responses during a prolonged downhill run. &esearch Uuarterly for /8ercise and Sport $55$S .( $!: %$+>%(( $1. Hakeling; NM; Pascual; S"; Jigg; BM. "ltering 'uscle activity in the lower e8tre'ities #y running with different shoes. Medicine and Science in Sports and /8ercise $55$S (* 2!: %+$2>%+($ $2. -alsetti; HD; Burke; /&; -eld; &7; et al. He'atological variations after endurance running with hard>soled and soft soled running shoes. 6he Physician and Sports'edicine %21(S %% 1!: %%1>%$. (5. -rederick; /); Howley; /6; Powers; SK. Dower o8ygen de'ands of running in soft> soled shoes. &esearch Uuarterly for /8ercise and Sport %21,S +. $!: %.*>%.. (%. He#ster; MN; Hel#ig; NN; /rd'ann; D7; et al. 6he effect of racing shoe 'idsole co'position on uphill; downhill; and level running econo'y. Medicine and Science in Sports and /8ercise %22, MayS $1 + Suppl!: *, ($. Milgro'; ); Burr; 7; -yhrie; 7; et al. " co'parison of the effect of shoes on ti#ial a8ial strains recorded during dyna'ic loading. -oot and "nkle International %221S %2 $!: 1+> 25 ((. McJair; PN; Marshall; &J. Kine'atic and kinetic para'eters associated with running in different shoes. British Nournal of Sports Medicine %22*S $1 *!: $+,>$,5 (*. Morgan; 7H; Miller; 6"; Mitchell; 3"; et al. "ero#ic de'and of running shoes designed to e8ploit energy storage and return. &esearch Uuarterly for /8ercise and Sport %22,S ,. %!: %5$>%5+ (+. "guinaldo; "; Mahar; ". I'pact loading in running shoes with cushioning colu'n syste's. Nournal of "pplied Bio'echanics $55(: %2 (,. Jigg; BM; Stefanyshyn; 7; )ole; 0; et al. 6he effect of 'aterial characteristics of shoe soles on 'uscle activation and energy aspects during running. Nournal of Bio'echanics $55(S (,: +,2>+.+ (.. Holden; NP; )avanagh; P&. 6he free 'o'ent of ground reaction in distance running and its changes with pronation. Nournal of Bio'echanics %22%S $* %5!: 11.>12. (1. Milani; 6D; Schna#el; 0; Hennig; /M. &earfoot 'otion and pressure distri#ution patterns during running in shoes with varus and valgus wedges. Nournal of "pplied Bio'echanics %22+S %%: %..>%1. (2. 3an Hoensel; H; )avanagh; P&. " pertur#ation study of lower e8tre'ity 'otion during running. International Nournal of Sport Bio'echanics %22$S 1: (5>*.

$* *5. Brauner; 6; SterIing; 6; 0ras; J; Milani; 6. 0radual increase of varus angle of running shoes gradually reduces pronation while 'aintaining cushioning properties. Nournal of -oot and "nkle &esearch $551S % Suppl %!:<*2 *%. Stacoff; "; Kaelin; Q; Stuessi; /; et al. 6he torsion of the foot in running. International Nournal of Sport Bio'echanics %212S +: (.+>(12 *$. Stacoff; "; Kalin; Q; Stussi; /. 6he effects of shoes on the torsion and rearfoot 'otion in running. Medicine and Science in Sports and /8ercise %22%S $( *!: *1$>*25 *(. &oy; N&; Stefanyshyn; 7N. Shoe 'idsole longitudinal #ending stiffness and running econo'y; :oint energy; and /M0. Medicine and Science in Sports and /8ercise $55,S (1 (!: +,$>+,2 **. Jigg; BM; HerIog; H; &ead; DN. /ffect of viscoelastic shoe insoles on vertical i'pact forces in heel>toe running. 6he "'erican Nournal of Sports Medicine %211S %, %!: .5>., *+. <9leary; K; 3orpahl; K"; Heiderscheit; B. /ffect of cushioned insoles on i'pact forces during running. Nournal of the "'erican Podiatric Medical "ssociation $551S 21 %!: (,> *% *,. )larke; 6/; -rederick; /); Ha'ill; )D. 6he study of rearfoot 'ove'ent in running. In: -rederick; /.). /d!; Sport Shoes and Playing Surfaces; )ha'paign; ID: Hu'an Kinetics %21*: %(+>%,* *.. Jigg; BM; Morlock; M. 6he influence of lateral heel flare of running shoes on pronation and i'pact forces. Medicine and Science in Sports and /8ercise %21.S %2 (!: $2*>(5$ *1. Stacoff; "; &einsch'idt; ); Jigg; BM; et al. /ffects of shoe sole construction on skeletal 'otion during running. Medicine and Science in Sports and /8ercise $55%S (( $!: (%%> %2 *2. Nerosch; N; )astro; HM.; Hal'; H; et al. Influence of the running shoe sole on the pressure in the anterior ti#ial co'part'ent. "cta <rthopaedica Belgica: ,% (!%25>%21; %22+ +5. &einsch'idt; ); Jigg; BM. Influence of heel height on ankle :oint 'o'ents in running. Medicine and Science in Sports and e8ercise %22+: *%5>*%, +%. -rederick; /). 6he running shoe: 7ile''as and dichoto'ies in 7esign. In: Segesser; B. and H. PfVrringer /ds.!; 6he Shoe In Sport, Tear#ook Medical Pu#lishers; )hicago %212: $,>(+ +$. Na'es; SD; Bates; B6; <sternig; D&. In:uries to runners. 6he "'erican Nournal of Sports Medicine %2.1S , $!: *5>+5 +(. Jigg; BM.; Bahlsen; H". Influence of heel flare and 'idsole construction on pronation; supination; and i'pact forces for heel>toe running. International Nournal of Sport Bio'echanics %211S *: $5+>$%2 +*. )larke; 6/.; -rederick; /).; Ha'ill; )D. 6he effects of shoe design para'eters on rearfoot control in running. Medicine and Science in Sports and /8ercise %21(S %+ +!: (.,>(1% ++. Kinoshita; H; Ikuta; K; <kada; S. 6he effects of #ody weight and foot>types of runners upon the function of running shoes. Nournal of Hu'an Move'ent Studies %225S %2: %+%> %.5 +,. Butler; &N; 7avis; IS; Ha'ill; N. Interaction of arch type and footwear on running 'echanics. "'erican Nournal of Sports Medicine $55,S (* %$!: %221>$55+ +.. Butler; &N; Ha'ill; N; 7avis; I. /ffect of footwear on high and low arched runners9 'echanics during a prolonged run. 0ait and Posture $55.S $,: $%2>$$+ +1. )heung; &6; Jg; 0T. /fficacy of 'otion control shoes for reducing e8cessive rearfoot 'otion in fatigued runners. Physical 6herapy in Sport $55.S 1: .+>1% +2. )heung; &6; Jg; 0T. Influence of different footwear on force of landing during running. Physical 6herapy $551S 11 +!: ,$5>,$1

$+ ,5. Hegener; ); Burns; N; Penkala; S. /ffect of neutral>cushioned running shoes on plantar pressure loading and co'fort in athletes with cavus feet. "'erican Nournal of Sports Medicine $551S (, %%!: $%(2>$%*, ,%. Knapik; NN; -eltwell; 7; )anha'>)hervak; M; et al. /valuation of in:ury rates during i'ple'entation of the -ort 7ru' running shoe in:ury prevention progra'. U.S. "r'y )enter for Health Pro'otion and Preventive Medicine; "#erdeen Proving 0round; M7 $%5%5. <cto#er $55% ,$. Holt; K0.; Ha'ill; N. &unning in:uries and treat'ent: " dyna'ic approach. In: 0.N. San'arco /d.! &eha#ilitation of the -oot and "nkle

$,

#acing

Tongue Achilles Pad Fo"ing Heel Counter $uarter

Toe !o"

Vam

Featherline

Midsole

Outsole

Figure 1a: The anatomy of a running shoe

Figure 1b: Shoe insole

$.

+ual +ensity Shoe

Single +ensity Shoe

+enser,Harder Midsole

Softer Midsole

Figure %: The shoe on the left is com osed of t&o different midsole densities' &ith the rearfoot ha(ing the harder midsole as sho&n by the dar) gray color* The forefoot is com osed of a softer midsole as sho&n by the &hite color* The shoe on the right is com osed of a single density midsole*

$1

Figure -: The density of the midsole may be determined manually by gras ing the to and bottom of the midsole bet&een the thumb and inde" finger to im lement the . inch test*/ Although this &ill not gi(e an ob0ecti(e durometry number' a com arison may be made bet&een different shoes to decide &hich midsoles ha(e a high or lo& density*

$2

Figure 1: The shoe on the left e"em lifies a rounded heel flare &hich is characteristic of most running shoes on the mar)et today* The shoe on the right sho&s a rearfoot medial heel flare*

(5

Figure 2: The cur(ature of the last may be found by turning the shoe o(er and imagining lines &hich bisect the anterior and osterior as ect of the shoe* The t&o shoes on the left ha(e more of a cur(ed last configuration' &hereas the shoes on the right ha(e a semi3cur(ed and straight last configuration*

(%

a5 6eutral Foot

b5 7earfoot and Forefoot Varus 8More forefoot (arus5

c5 Forefoot Varus

d5 7earfoot Varus

Figure 4: Common foot structures &hich are determined in the rone' non3 &eightbearing osition* The neutral foot &ill ha(e both the calcaneus and metatarsal head erfectly bisecting the distal tibia* The forefoot (arus deformity &ill ha(e the calcaneus bisecting the distal tibia' but the metatarsal heads &ill be in(erted in relation to the tibia* The rearfoot (arus deformity &ill ha(e both the calcaneus and metatarsal head in(erted as com ared to the distal tibia* The to ' right icture sho&s ho& there may be (arying degrees of rearfoot and forefoot (arus structures*

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Figure 9: The subtalar neutral osition is found by lacing the runner in the rone osition &ith his,her distal leg hanging off of the table* The e(aluator:s thumb and inde" finger al ate the antero3medial and antero3lateral as ects of the talona(icular 0oint &hile the foot is in(erted and e(erted* The oint &here the talus feels to be neither e(erted nor in(erted is said to be the neutral osition of the talus* From this osition' the degrees of rearfoot and forefoot (arus angulations may be determined* ;t should be noted that many biomechanists feel that e"amining the foot in <31< degrees of dorsifle"ion 8instead of subtalar neutral5 gi(es a better re resentation of the forces acting u on the foot &hen it ma)es initial contact &ith the ground*

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Figure =a: Ha(ing a rearfoot (arus deformity &ill lead to larger amounts of ronatory tor>ue &hen the foot ma)es initial contact &ith the ground* ?hen the foot first ma)es contact &ith the ground' the le(er arm for the ronatory rotation is greater' and the foot &ill generate high amounts of momentum as it ronates to meet &ith the ground* This &ill li)ely lead to e"cessi(e or late ronation during the runner:s gait cycle*

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Figure =b: Ha(ing a forefoot (arus deformity &ill li)ely lead to higher amounts of ronatory tor>ue late into the gait cycle* This laces the runner at ris) for late ronation*