BraceLab Clinical Clues

June 2022 No. 27

It is Not Rocket Science: Choosing the Right Running Shoe

by Jerry Ditz, DPT, Dip. Osteopractic, Cert. SMT, Cert. DN

The running shoe marketplace is oversaturated and confusing because of the multitude of brands and styles offered. Added to this confusion is the constant change in the running shoe industry and the tantalizing marketing campaigns influencing consumer choice. The excess of choices can be overwhelming and lead to poor choices.

How do you respond when your patient asks you for a running shoe recommendation? Is there a simple answer to this complex question?

T.J., a 27-year-old competitive runner, was referred to physical therapy (PT) because of foot pain while running, which started after he changed his running shoes. T.J. had changed his running shoes hoping to reduce his marathon time to under 3 hours so he could qualify for the Boston Marathon.

Typical Running Shoe Buying Process

T.J. had gone to a running shoe specialist at his local running store, stating he wanted to improve his marathon time. The specialist pressure mapped his foot to determine his arch type and analyzed his bare foot running video to determine foot and ankle movement, recommending a preferred shoe based on this information. During his test run in the store T.J. found the recommended shoes uncomfortable but was told by the specialist there is a break-in period and early discomfort is normal. Many competitive runners use their local running store for advice about the best shoe to purchase.


Research suggests pressure mapping (Figure 1) and treadmill video analysis (Figure 2) has mixed results in clinical trials. (1-2) These evaluation techniques appear effective in changing weight distribution of the foot and altering running form, but do not necessarily improve performance or reduce pain. Of greater benefit is evaluation of shoe comfort and shoe weight, citing evidence that a comfortable shoe helps decrease pain in runners, and a lighter shoe helps improve running performance.

Figure 1: Example of weight bearing pressure mapping

Figure 2: Example of treadmill analysis of running

T. J. Follow-Up

At his next PT visit T.J. brought several pairs of running shoes he was considering purchasing. With the knowledge that shoe comfort is the most important factor when choosing a running shoe to alleviate foot pain, T.J. ran in each pair of shoes and ranked them according to comfort. After the comfort ranking, each shoe was weighed. Coincidentally, his top two comfort choices weighed the same. T.J. began running in his top choice and reported his foot pain dissipated after two weeks.

It is Not Rocket Science

Recommending the best running shoe for patients can feel overwhelming because of the myriad of choices and the technology available to supposedly guide decision making. It seems the choice is simple: go with the pair that is the most comfortable and the lightest weight.


1. Agresta C, Giacomazzi C, Harrast M, Zendler J. Running injury paradigms and their influence on footwear design features and runner assessment methods: a focused review to advance evidence-based practice for running medicine clinicians. Front Sports Act Living. 2022;4(815675)

2. Nigg BM, Baltich J, Hoerzer S, Enders H. Running shoes and running injuries: mythbusting and a proposal for two new paradigms: ‘preferred movement path’ and ‘comfort filter’. BJSM 2015;49(20):1290-4.


Download Clinical Clues No.27, It is Not Rocket Science: Choosing the Right Running Shoe; June 2022

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Disclaimer: BraceLab Clinical Clues are intended to be an informal sharing of practical clinical ideas; not formal evidence-based conclusions of fact.

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