I work with a lot of runners with lower extremity pain and dysfunction. I insist they bring in their running shoes on the first visit so I can review what type of shoe they use and how they fit their feet/body.
All shoes are not created equal. I often find differences in fit and alignment in the same pair. To assess the shoes I place them on my desk and see if they tilt in/out. I also rock the shoe side/side and front/back. Many shoes will have a rock or twist to the sole which forces the foot/ankle into a particular position (pronation is most common). Another test is to place a ruler across the forefoot section of the shoe, often I find a transverse curve which creates the rocking motion. The rocking motion contributes to poor ankle control/balance.
The final test is to check the athlete’s single leg balance with shoes on/off. If their balance is better barefoot then the shoe is a problem. If their balance improves with the shoe on then they’re OK. This test is often shocking to the client, they had no idea the shoes they spent so much money on were contributing to their condition/injury.
Ideally a shoe should support the natural, neutral alignment of the ankle, the sole should neither have a twist or rocker to it – it should be stable. Many people use orthotics for corrective measures. Adding orthotics to poorly constructed/aligned shoe adds to the dysfunction instead of correcting it. In this scenario you have the shoe conflicting with the orthotic and the persons body. The knee is particularly susceptible to the poor alignment stress in this scenario.
The shoes in the picture above are brand new. My client with severe knee arthritis brought them in for me to check out, she was going on a trip and wanted to make sure these shoes were going to work for her body. As you can see the shoes tilt in, the left one tilts a lot, they also rocked side/side. In the picture below with the shoes on you may notice how the left shoe/ankle tilts in more than the right. The final test was to have her walk slowly in my office. I asked her to pay attention to how her ankles, knees and hips felt. She immediately noticed tension in her knees since the shoe forced her knees to rotate inward – not a good alignment for someone with arthritis. Needless to say she never wore these shoes again.
