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In 2019, male marathon runners recorded the five fastest times ever. Eliud Kipchogebroke broke the two-hour mark running the Vienna marathon in 1 hour 59 minutes 40 seconds. In the same weekend, Brigid Kosgei ran a 2:14 in the Chicago marathon. Two extraordinary feats, (pun intended), with one common denominator—the shoe. Shoe companies have been inserting (another pun… I know, the lowest form of humor) their technology into shoe construction for years. However, many health professionals and consumers do not understand the importance of these modifications. Chiropractors must be up-to-date on how shoe technology may affect athleticism, performance, and injury prevention.

Watch Dr. Steele explain shoe technology and how to choose the most appropriate style.

Today, let’s take a crash course in shoe construction. Then, explain how ChiroUp harnesses the collective knowledge of research, clinical experience, and emerging technology to efficiently transfer this information to patients, thereby improve clinical outcomes.

There are four main types of shoes, each manufactured by most major companies. Examination of shoe wear often yields a predictable pattern amenable to a change in shoe wear. Here are the four most common patterns of wear.



Motion Control / Stability

Cushioning / Neutral





 Runners with low or no arch often suffer from foot or ankle instability. Diminished foot intrinsic strength results in faster foot/ankle pronation, thereby stressing the foot, knee, and hip. These runners alter their gait and foot strike to accommodate instability. They will often land on the outside of their foot to take advance of the bony architecture of the lateral column. Unfortunately, they pronate through a greater range of motion at a higher rate of speed, perpetuating dysfunction.


Motion-control shoes utilize a more resilient durometer foam in the midsole to slow this rate and of pronation.

Tip: These shoes often have a different color foam in the instep of the shoe.


Runners with low arches have long-term foot or ankle instability (pes planus). These runners are unable to dissipate reactive ground forces appropriately. Repetitive stress is transferred up the kinetic chain to the knees and hips. 

Shoe Solution: STABILITY

These shoes contain robust cushioning to absorb shock and attempt to prevent injury through sole rigidity. Stability shoes may also include other materials like plastics to assist in sole stiffness.


Many seasoned runners have normal mechanics and arch height. These runners can adequately dissipate force, and their soles wear evenly. 

Shoe Solution: Neutral

Neutral shoes provide no external shoe support. If there is normal wear and tear on the sole, then don’t rock the boat. Also, consider using a neutral shoe if the patient already utilizes a prefabricated or custom orthotic. Adding aftermarket orthotics to the shoe with prefabricated orthotics may alter mechanics and the desired result.


Many people have high arched feet (pes cavus). Their footprint will typically leave a thin band along the foot’s lateral edge and the metatarsal heads. The outer edge of the foot and metatarsal heads represent a small surface area and therefore absorb the increased load.

Shoe Solution: Cushioned Shoes

These shoes are flexible and absorb more shock via increased foam. These shoes may prevent or reduce symptoms associated with tailor’s bunions and metatarsalgia.

Not all runners and walkers need the Nike Vaporfly. Still, all runners need to understand that most shoes contain technology that may affect their gait. The selection of the wrong footwear may contribute to lower extremity injury. Consider checking the bottom of your next patient’s shoes to assist in their recovery. The sole of worn shoes highlights the runner’s biomechanical fault. Increased wear indicates sites of compression and shear.

Consider adding the RUNNING SHOES ADL for your next patient with a running injury. The more informed your patients become, the more clinical success you will encounter.

And don’t forget: your clinical success can be tracked within your ChiroUp account! How often are you reviewing your Clinic Dashboard? Reviewing your average outcomes & satisfaction ratings is one way to stay on top of your care. Log in now to view your Dashboard stats and to see if there is a component that needs more attention.

  1. Hoogkamer W, Kipp S, Frank JH, Farina EM, Luo G, Kram R. A comparison of the energetic cost of running in marathon racing shoes. Sports Medicine. 2018 Apr 1;48(4):1009-19. Link

About the Author

Dr. Brandon Steele

Dr. Brandon Steele


Dr. Steele began his career at The Central Institute for Human Performance. Dr. Steele has trained with experts including Pavel Kolar, Stuart McGill, Brett Winchester, and Clayton Skaggs. He has been certified in Motion Palpation, DNS, ART, and McKenzie Therapy. Dr. Steele lectures extensively on clinical excellence and evidence-based musculoskeletal management. He currently practices in Swansea, IL and serves on the executive board of the ICS.

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