Does running barefoot put me at risk of toenail fungus?

Hi My Running Doc!

I have heard that going barefoot in locker rooms can put me at risk of a fungal infection and toenail fungus. Does running barefoot also put me more at risk of a toenail fungus infection? 

Thanks!

Jimmy, San Francisco, CA

Hi Jimmy, 

Great question!  The short answer is no... running barefoot does not actually put you more at risk of getting a toenail fungus infection than running in running shoes.

But before we explain that, let's explain why there is such a high risk of getting a fungal infection from a gym locker room.  People work out at the gym all day long. Most of them shower once they are done. 

So the floors in the locker rooms are continually coated with water dripping off of freshly showered athletes. This leaves the floors in the gym locker rooms perpetually moist. This moisture creates the perfect environment for fungal growth. If you walk around in there barefoot the chances are good you might pick up a fungal infection in the form of athlete's foot.

The same organism that causes athlete's foot is also the same organism that causes fungal toenail infections.

In order to get a toe nail fungus infection you must have a couple of conditions present at the same time.

1. Active fungus and/or fungal spores.

2. Trauma to the toenails.

Much like a gymnasium locker room, running shoes are actually the perfect incubators for toenail fungus. Your feet are like little heaters warming up the inside of the shoes to the perfect temperature for fungal growth.  When you exercise, your feet sweat. The inside of the running shoes are also dark and devoid of sunlight. All of this creates the perfect environment for toenail fungus to grow.  

When you run, the ends of your toes and hence the toenails can bump up against the inside of the shoes. Many marathon runners have witnessed this first hand in the form of black and blue toenails after a long run. It's not a large amount of trauma, just a small amount of repetitive trauma that can cause bruising under the toenail.

If you have this sort of trauma to the toenails when you have foot fungus growing inside your running shoes, the fungal spores and live fungus can get underneath the toenail and start to grow. The result is a  fungal toenail infection.

You know you have thick yellowing discolored toenails indicative a  toenail fungus infection.

When you run barefoot you're unlikely to have trauma to the toenails in the presence of a large amount of toenail fungus or fungal spores that are often coating the inside of running shoes. And in this respect, you're actually a lower risk of getting a toenail fungus infection when running barefoot as compared to when running in heavily used running shoes.

Dr. Christopher Segler, DPM is a marathon runner and 11-time Ironman triathlon finisher.  His podiatry sports medicine practice focuses on convenient rapid treatment of running injuries. He is often invited to speak at medical conferences on the topic of barefoot running biomechanics. You can learn more about running related toenail infections and laser treatment of toenail fungus at www.LaserToenailSanFrancisco.com   If you have a question about a toenail fungus infection or barefoot running injury you can call him directly at 415-308-0833. 

What to Consider in a Minimalist Running Shoe

Hi “My Running Doc!”

I recently read the book “Born to Run.”  after reading it, I became intrigued and have decided to try some minimalist running shoes. However a lot of stuff that I read online says that might get injured if I run barefoot or in minimalist shoes. 

As a little background, I am experienced marathon runner and have been running for decades. I have a neutral foot type and never had any serious running injuries. 

Do you have any recommendations on how to safely choose minimalist running shoes so I can run with a more natural running form to convert to more of a minimalist style?

Thanks!

Peter

San Francisco, CA

Hello Peter,

Great question!  There are a number of different types of minimal running shoes that  you can choose from.  But before you can make a reasonable choice on which you would be right for you you have to understand the basics of “minimalist shoes.”

I define a minimalist running shoe as one that has lightweight construction, minimal support and a decreased forefoot to rearfoot drop. 

In case you’re not familiar with minimalist running shoe construction is important to point out that the “ forefoot to rearfoot drop” is the difference in height of the heel as compared to the forefoot. Standing barefoot is a 0° drop.  A running shoe with a zero-degree drop is flat. Any shoe that has no more supporting material under the heel than under the forefoot will have a 0° drop. 

A standard running shoe has a 12 mm drop. This means that there is 12 mm of material under the heel, lifting the heel up relative to the forefoot.  Proponents of minimalist running argue that all this extra material under your heel is what forces you to land as a heel striker when you run in these type of running shoes.

Vibram FiveFingers® are the shoes that many people think of when they hear about barefoot running.  The argument for this type of shoe is that you get the most sensitive ground feel, and hence a running experience that is the most consistent with true barefoot running. However you are protected by a pliable rubber outsole. These shoes certainly fit the criteria of a minimalist shoe in that they have very little support, they’re very light weight and they have a zero-degree drop (meaning the heel is no higher than the toes.) 

Given that most people are accustomed to walking and running in shoes that have a slightly elevated heel, they can at risk of injuries like Achilles tendinitis and even potentially stress fractures if they switch to rapidly to a barefoot running style.

There are other shoes however which will help you learn how to run without the drastic change in forefoot to rearfoot drop.  Another extremely  popular minimalist running shoe is the Saucony Kinvara. The Kinvara has a 4mm drop, is very light (7.7 oz.) and is very supple.  it allows a good ground feel and lends itself the natural running form however it still maintains a modest amount of support. It allows a bit of insurance in the sense that if reform starts to fall apart and you begin to convert into a heel striker you at least have some cushion to protect you.

Another good option is Newton Running shoes. Newton’s are unique in that they have elastomeric lugs under the forefoot that help encourage you to land as more as a forefoot or midfoot striker.  For a neutral runner like yourself, the Newton Gravity Trainer would be a good choice. It weighs 9.1 ounces and has a 3mm forefoot to rearfoot drop. Newton running shoes are designed specifically with the intent to help runners learn how to convert to more of a natural running style. In fact Danny Abshire, the founder of the company is also authored a book which helps teach runners to convert their running style away from heel striking to potentially more efficient stride. 

I think Danny has the right approach. I myself run in Newton running shoes for speed workouts and for tempo runs.

However I also incorporate a couple of different kinds of running shoes based on the workouts that I am doing. I run in Kinvaras for some moderate runs.  I also run a more of a typical cushioning type of running shoe when I do long runs, or any run where I expect that I might walk. Reason for this is simple. Most people it is spent their lives in elevated heel shoes can develop a tight Achilles tendon. Walking in shoes with a 0° drop can lead to Achilles tendinitis quite rapidly. As someone who trains continually and almost always has an Ironman on the schedule I can afford to develop any issues. I consider using multiple types of running shoes as cross training for my feet. I believe it decreases the risk of injury.

If barefoot running form is a new adventure I hope you will find it to be helpful in developing a more efficient stride and ultimately a more enjoyable running experience. 

Dr. Christopher Segler, DPM is a marathon runner, 11-time Ironman triathlon finisher and is Board Certified,  American Board of Podiatric Medicine.  He lectures at medical conferences to help teach other podiatrists and sports medicine doctors about barefoot running biomechanics and the treatment of competent running injuries. His practice is limited to runners and triathletes. He performs remote consultations for runners all over the world via telephone and Skype. He also sees patients in person in both San Francisco, CA and Houston, TX.  If you have a question about a running injury that doesn't seem to be getting better, you can reach him directly at 415-308-0833. 

Marathon Blisters Related to Pronation?

QUESTION:

Hi Doc,

I have just finished a marathon qualifier for an ultra coming up here in South Africa. I have always been pretty neutral footed, but with the tendency to pronate slightly. I have always had the odd blister after a very long run, but lately they seem to be worse and I am wondering if I am beginning to pronate more (can this happen over time?). I have taken a photo of some blisters that occur after a marathon. I don't like to get rid of them, I sorta let them callous for the season so its not so sore :-). Should I try pronation shoes? What are your thoughts? I use Nike Pegasus +28's. Really hope you can shed some light on this for me :-) 

Many thanks

ANSWER:

Blisters that pop up anywhere on the foot during/after a marathon are always the result of excessive pressure and friction. With excess friction the underlying layers of the skin begin to separate. Fluid accumulates and collects between the dermis and epidermis creating the fluid filled bubble that runners know as a blister. In the pictures here we can see that one blister has clear fluid and the other is dark. The dark blister implies that this is a collection of blood. This kind of blister is of course often referred to as a "blood blister." 

A blood blister insinuates more pressure or increased trauma, not just friction.

The location of the blister is important and helps a podiatrist figure out the cause. These blisters and calluses forming at the inside of the big toe joint. The medical term for this location is the "medial and plantar-medial aspect of the first metatarsophalangeal joint." 

All runners know the basic causes of blisters.  To be clear we will review:

1. Running shoes that are loose. The feet slide around with every foot strike and push off while running. The result of 26.2 miles of this is excessive friction producing blisters. 

2. Running shoes that are too tight. The feet are compressed against the inside of the shoes, increasing the risk of excess friction (with increased pressure) at parts of the shoe that move (such as the tips of the toes or ball of the foot where the break in the shoe occurs).  

3. Wet feet. Think twice about running through those garden hoses on the marathon course. Moisture in the skin can weaken the structure between the layers of skin, making blisters form with less friction that usually required. 

4. Starting and Stopping too much. If you are running with a walk/run approach, all of the starting and stopping actually takes more force (and produces more friction) than running at an even pace. This can increase your risk of blisters.  

There are other certain circumstances that can contribute to blister formation at the medial big toe joint. 

1. Pronation. As the foot pronates, the foot rolls inward, unlocking the joints in the mid-foot. The first metatarsal bone gets pushed up by the ground and the running shoe effectively twists right around the inside of the big toe joint. This of course creates excess friction and stimulated the formation of blisters during longs runs such as marathons. 

2. Bunions. Same forces at work as in excess pronation, with the added pressure at the bunion stick out and presses against the inside of the shoe. 

Solutions:

1. Blister-prevention socks that have 2 layers that can glide past each other. In effect, you beat up the socks instead of the skin.

2. Custom orthotics or over-the-counter inserts that support the foot, stabilize the subtalar joint and decrease pronation. If properly fitted and constructed, inserts can slow the pronation that contributes to the problem. 

3. Motions control running shoes. Stability running shoes decrease pronation with aggressive medial posting on a stable platform.  They are heavier, and stiffer. Beware-if you have high arches they can increase your risk of shin splints and stress fractures. 

4. Build mileage gradually. This gives the skin a chance to toughen up and form protective calluses without blistering.  

When in doubt. See a local podiatrist for a complete evaluation, running shoe analysis and gait exam to assess your running biomechanics. 

Dr. Christopher Segler, DPM a marathon runner, podiatrist and 10-time Ironman Triathlon finisher who is is Board Certified, American Board of Podiatric Medicine.  He believes the best podiatry practice combines cutting edge technology with the old-school convenience of house calls. He makes podiatry house calls for runners in San Francisco, Palo Alto, Sausalito, Pacifica, and Corte Madera. He also does remote consults for runners who live outside of the United States. If you have a question, you can reach him directly at 415-308-0833. You can learn more about running injuries at www.DocOnTheRun.com 

Newton Gravity Trainer Running Shoe Review

Why I Decided to Write This Review
There are really two reasons I decided to write this review of Newton Gravity Trainer Running shoes. The first has to do with the fact that I am an award-winning foot surgeon and podiatrist who has chosen to limit my practice to elite, competitive and recreational athletes. For this reason, I get questions about running shoes from a lot of runners. I am frequently asked about “new trends in barefoot running” as well as about shoes like Newtons that reportedly create more of a barefoot-type running experience. I always prefer to answer such questions on the basis of scientific theory as well as personal experience.

The second reason is that I am an age-group Ironman triathlete who has aspirations of qualifying for Kona one day. So I have a very personal interest in discovering any and every way to increase my own biomechanical efficiency, decrease my risk of injury, and run faster. Newtons (in theory) should to do all three, so I thought I should give them a try.

First Impressions
As I opened the box and lifted my brand new Newtons from their tissue paper nest, the scent of new running shoes filled the air. And these shoes felt light as air themselves. I was extremely surprised to sense that these “trainers” actually felt quite a bit lighter than any other pair of running shoes I have ever owned. I also noticed the generous use of mesh in the uppers. While this certainly helps keep them light, I was also pleased because my feet are always hot. And in my shoes, there can never be too much cooling aeration.

In looking at the soles, the four forefoot lugs caught my eye. They protruded slightly more that the rest of the forefoot and heel. This, of course, is the business end of the Newton Running concept; where science meets the road, so to speak. It was obvious looking at the profile of the shoe, that the lugs should make it easier to land on the forefoot instead of the heel. I figured if these don’t get me to land on the forefoot, nothing else will.

Science or Gimmic?
Naming your product after the Father of Physics creates a pretty big pair of shoes to fill. After all, the laws of physics set some pretty strict rules to follow. There is a section on the Newton Running website called “Newtonian Science.” Within that section is a distillation of the laws of physics that affect all runners. Basically, it describes the science without all of the cumbersome math usually associated with physics.

In a nutshell, running is all about energy. And there is only so much to get you from start to finish. You must use your energy to cover ground. If you land on your heel and slow down, you use up valuable energy in braking. If you then have to re-accelerate to get going again, you use up more energy. This leaves you with less energy to get you to the finish in good form.

The Newton Running “Active Membrane Technology” is part of the patented components of Newton Running shoes and is one of Newton’s proposed keys to stop wasting energy and thereby start running more efficiently and faster. By writing this review, I hope to determine whether or not this is true and if the shoes can actually live up to Sir Isaac’s name.

Expectations vs. Experience
I will have to admit that when I first read about Newton shoes I was skeptical. I understand that all energy lost in a running stride, in theory, could be harnessed and returned. But when I first heard this notion applied to the elastomeric lugs on Newton running shoes, I envisioned Wile E. Coyote with coiled bedsprings attached to his feet bounding down a desert highway in pursuit of the Roadrunner. But I put my imagination aside and decided to trust the voice of reason and experience.

When I first laced them up, I noted a perfect fit. As a men’s size 12.5, I seem to (more often than not) have trouble finding shoes that run true to size. For that reason alone, I am always sheepish about ordering shoes online. The Newton Running website claims that shoes should be ordered “true to size” and they were precisely that. Great fit!

Standing in my Newtons, the most perceptible difference (as compared to my old running shoes) was a slightly lower heel height. This, of course, is also by design. Its really partly a lower heel, but more a relative drop from the thicker lugs on the forefoot. But I realized that in order to run faster, more efficiently, and get to Kona, I would need to learn to more consistently avoid landing on my heels anyway.

The Right Shoe for My Foot Type
With the first few steps, the shoes felt soft and cushy. Given my high-arched “rectus” foot type (most often referred to as “neutral” or incorrectly termed “supinated”), I knew I would appreciate the give in these shoes.

For anyone with a rectus foot type, cushioning is key. The reason is because a person with a lack of pronation (the opposite of a “pronated foot” or flatfoot) simply cannot absorb impact effectively when the foot hits the ground.

One way to describe pronation is to say that it is the motion in the joints of the foot that absorbs energy as the arch collapses. But in my case, in a sense, the joints are locked. There is an absence of pronation during walking and running. This means higher impact and higher risk of injuries such as stress fractures, shin splints and some types of tendonitis.

How Newtons Might Help Me Run
The Newton Gravity Trainers have the potential to help lower my risk of injury in two ways. First, the lugs are soft and provide ample impact reduction to compensate for my biomechanical deficiencies in terms of using my joints to absorb energy through pronation (this is important). Second, they should be able to convert my running style to one that reduces the impact the road will deliver to my chasis (this is more important).

The highest impact that a runner can sustain is by landing on the heels. The higher the arches, the higher the impact. Every time the foot lands heel-first out in front of the runner, a braking force is applied by the foot and lower leg. This slows the runner. The energy loss is essentially converted to friction, heat and that pounding sensation hammering through your legs.

By contrast, when you land on your forefoot, the 26 bones, 33 joints and more than 100 muscles, tendons and ligaments work together to absorb that impact. By landing on the part of the foot that is by nature more flexible, the force is spread out and dissipated more naturally.

This is where the barefoot running concept comes in. It is well known that barefoot runners land on the forefoot and never on the heels. Landing on the heels is a learned behavior resulting from a lifetime of reliance upon shoes. Barefoot runners simply run more efficiently and should be at lower risk of injury.

But you cannot just go run barefoot and expect to become someone who has the running style of a life-time barefoot runner. First, the risk of injuries such as stress fracture and tendonitis is very high when running barefoot. Second, you still have to train the brain to restructure your stride to run “like” a barefoot runner.

The First Ride on My Newtons
With the first few strides I immediately noted something unusual. I was landing on my forefoot.

After reading the instruction card that says the goal should be to “land, lever and lift,” I assumed that I would have to put a lot of effort into landing on the forefoot, levering off of the lugs (without pushing off with my toes) and finally lifting my knees and feet. But in fact it was all very simple and natural.

I tried to focus on keeping a high cadence and short stride, leaning forward slightly at the ankles. And just like that, I was landing more consistently on my forefoot. The few times I landing on the heels, it felt rather unnatural. This is likely due to the excess stretch of the Achilles tendon. As promised, the shoes were gently keeping me off of my heels.

Break-in Time
Having gotten my new Newtons only a couple of weeks before Ironman Louisville, I knew I wouldn’t have time to adequately break them in before the race. These shoes require a slightly more conservative break-in period.

I wore my Newton’s for five runs of 2 miles before I tried anything longer. Then three miles, then four and so on. Before long I was out on the road for a 10 mile run. I am pleased to say that my first 10 mile run in the Newtons went very smoothly. I was relaxed and felt like I was moving well. And in fact I was. I can honestly report that it was the easiest 10 mile run I have had this year. Maybe it only felt that way because I had recently recovered from an Ironman, or maybe I am becoming a more efficient runner.

Overall Impression
I can say that for me personally, I believe Newton Gravity Trainers are proving to be a valuable training tool and are changing the way I run for the better. As an award-winning podiatrist and foot surgeon caring for athletes, I would recommended Newtons to any of my patients who have had a history of injury, or simply hope to run more efficiently. It seems the greatest benefit is, of course, for those demanding efficiency such as marathoners and Ironman triathletes.

At the time of this writing, I am doing all of my long runs, bricks and speed workouts with Newtons. No pain, no injuries and no complaints. I love my Newtons. In about six weeks I will apply the true test: Ironman Florida. I plan to run the race in them and will post a follow-up review to update you on my progress. With the changes I have seen thus far, I am fully expecting to set a substantial new run split personal record. Who ever said physics can’t be fun!


Dr. Christopher Segler
Award Winning Podiatric Surgeon
Stay Fit, Go Long, Run Fast, Be Strong!
www.MyRunningDoc.com

Disclaimer and Disclosure: This product review is meant to serve strictly as opinion and personal experience regarding the product described above. None of the content herein is meant to serve as medical advice, but is for informational purposes only. The opinions are exclusively those of the author and are not meant to necessarily represent those of Newton Running. The author of this product review is not affiliated with Newton Running, is not a shareholder in the company and has no relation to any stakeholder in the company.

Can Runners Heal Heel Pain?

What could be worse than a runner with heel pain? Answer: a runner who has heel pain and can't run. In this excerpt from a video interview with Ironman finisher and award winning podiatrist, Dr Christopher Segler discusses heel pain.





Dr. Christopher Segler is an Ironman Triathlon Finisher and award winning foot doctor specializing in elite athletes. His podiatry sports medicine house calls practice is located in San Francisco, Marin, Oakland and Berkeley. You can register for a FREE membership and will receive the monthly newsletter “Finisher’s Circle,” which provides expert advice on increasing your running efficiency and preventing injuries and foot pain by visiting http://www.AnkleCenter.com .

Ring in The New Year with a 3 Day Run!

While most settled for watching Dick Clark and waiting for the ball to drop, a Scotsman named William Sichel was taking the ultra-marathon scene by storm. He ran in the new year by winning one of the toughest races on earth, the Across the Years 72-hour event held in Phoenix.

For three days he ran, sleeping little and logging more miles than most Americans would in a year, and more than most well trained marathoners would in a month. During the 72-hour event he saw temperatures ranging from near freezing at night to over 100 degrees during the day. All told he ran 269.36 miles through the Arizona desert. He ran almost continually and finished 34 miles more than the second finisher.

Hard to imagine beating someone by more than a full marathon distance.

Although tis sort of event might be enough any mortal, for him it is a warmup. He will follow-up with a 6-day race aiming to cover 567 miles during the Athens International Ultra Marathon Festival starting on 3 April. The 55 year-old runner will be running on an outdoor cinder circuit used during the 2004 Olympic Games.

With all that pounding, he’ll need more than a soft track and a truck load of Gu. We wish him luck!


Dr. Christopher Segler is Marathon Runner, Ironman, as well as an award-winning podiatrist, and sports medicine foot surgeon practicing at the Doc On The Run: San Francisco Podiatry Sports Medicine House Calls. For more information about heel pain, bunions, ingrown toenails and ankle pain, and other common causes of foot pain, you can order a FREE copy of his book, My Fit Feet, by visiting http://www.MyRunningDoc.com or http://www.AnkleCenter.com.

Marthon Champion Dies at Age 41

On Monday it was announced that Australia's double Commonwealth Games marathon gold medallist Kerryn McCann has died from cancer at age 41. She has long been regarded as one of Australia's best female long-distance runners. She was first diagnosed with breast cancer in 2007. Apparently the cancer spread to her liver four months ago.

It is reported that she died in peace at her home south of Sydney with her husband and three children by her side. "On behalf of the entire athletics community, I would like to pass on my sincere condolences to the McCann family," Athletics Australia President Rob Fildes said in a statement. "Kerryn will fondly be remembered for being an extremely popular team member who represented her country on 14 occasions, across an athletics career that spanned 22 years."

In 1996 at Atlanta and 2000 at the Sydney Olympics McCann competed in the marathon but saved her best performances for the Commonwealth Games.

She won the gold medal in Manchester in 2002 and later defended her title in Melbourne Australia four years later with an incredible last-lap effort against Kenyan Hellen Cherono. At that time she was 38.

She will be missed by the running community throughout the world.


Dr. Christopher Segler is an award winning foot surgeon and Ironman Finisher who treats elite athletes. His podiatry sports medicine practice is Doc On The Run: San Francisco Podiatry Sports Medicine House Calls. To learn more about increasing your speed and avoiding running injuries like tendonitis, shin splints and stress fractures, you can register for a FREE membership and copy of his monthly newsletter “Finisher’s Circle” by visiting http://www.AnkleCenter.com .

Dean Karnazes in Second at Sahara

Last month Dean Karnazes finished in 2nd place at the Sarah Race in Egypt. The Saharah Race is a 250K race across the largest non-polar desert on Earth. His time was 30 hours 13 minutes and 9 seconds. He was only about 3 hours behind Ryan Sandes; a South African who is 20 years younger. 

Paul Liebenberg (another South African) and Karnazes are competing to be the first to finish all 4 legs of the series in one year.  The series a part of a 4 race desert series including events in Chile, China, Egypt and Antarctica.

The final leg called  "The Last Desert" will be a 250K race across the Antarctic peninsula. It starts on November 24, 2008, just about a month after the event in Egypt.

I am guessing that it will seem cold compared to the Sahara.  

Go Dean, Go... And don't forget your mittens!

Pick the Perfect Running Shoes

Running Shoes...Your Injury Prevention Gear

Proper running shoes prevent injury. I am a foot and ankle surgeon. I am also an Ironman triathlete. I wear the very best running shoes. The very best for me, that is. Which of course implies that there is also a very best running shoe, just for you, as well. The shoes that are best for me are specific to my activity level, running style and foot type. For you to find the shoes that will help you to run most efficiently, and also help to prevent injury, you will need to know your running style and foot type as well.

At this point, I will let you in on a secret.  You don't need to see a foot doctor, or even read the rest of this article, if you might be in a hurry (because you are afraid you will miss one last run today). If you go to one of the few local specialty running shoe stores in your town, you will get free advice about which shoes are best for you. I can say, they know what they are talking about. Now, if you want to learn anyway, read on.

When considering new running shoes, take past experience with shoes into account, but don't bank on it.  The shoes you love now, may look similar and even have the same name next season, yet the fit and characteristics may be completely different.  If you have logged a lot of miles with a given model, you may want to buy more than one pair now. The reason is that manufacturers will frequently make unannounced design changes. These changes can vary from width, to cushioning, to major structural midsole alterations. I used to run in a shoe I loved, and then they suddenly changed the last (the form on which the shoe is constructed) and made the toe box smaller.  The result was a shoe with the exact same name, that I couldn't wear anymore.

If you have a pair of shoes that always causes blisters, heel pain, or shin splints, obviously, you should try something else. Having said that, if you have any pain from your shoes when you run now, you should drop those shoes in one of the "Keeping Chattanoogans On Their Feet" shoe donation bins around town. We have the locations listed on the Community Partners section of our AnkleCenter.com. If you do donate your old running shoes, I will personally see to it that they stop slowing you down, and go to help one of the 4,000 homeless people in Chattanooga. Treat yourself to a new pair!

Most runners have a rough idea about their foot type and this will determine what category of shoes will provide the right combination of cushion and support for your feet while you run.  The three main types are "Motion Control," "Stability Cushioning," and "Cushioning." Motion Control shoes are best for “over-pronators” who’s feet roll inward when they walk and run. Often associated with flat feet, theses athletes have arches that flatten out completely when running. These folks need the added support of Motion Control running shoes to prevent injury. Stability Cushioning shoes are best for “Neutral Runners or Natural Pronators” with a medium arch. These feet disperse shock effectively when they walk and run. They need a shoe that maintains this natural pronation, protecting against over-pronation and preventing injury. Cushioning shoes are best for “Under-pronators or Supinators” who’s feet don’t roll inward when they run. These feet are often associated with high arches and are prone to shin splints and pain in the big toe joint. This foot type is often rigid and does not effectively absorb shock. They need flexible shoes with maximum cushioning against impact when running.   

The wrong shoes can, and will, lead to injury. If you see an expert (found in a good running shoe store that maintains an excellent reputation among your local running community) you will get the right shoes. Then you just have to make sure you replace them before they are worn out and can no longer provide the shock absorption and/or support your body needs. Even if you use custom orthotics to correct some of the biomechanical limitations your foot type creates, worn out shoes will still lead to injury.

One of the most common questions I get from patients is "how many miles can I run before replacing my running shoes?" I typically recommend safely replacing running shoes every 200-300 miles.  Your mileage may vary. For example, I am 6'2" tall and weight nearly 200 pounds. I over-stride on downhills, which is high impact. I also usually either run on asphalt hills or concrete flats. Both are poison to running shoes. Now, if you weigh less, don't over-stride, and avoid hills and concrete, you may be able to go 500 miles. Go more than that and you are flirting with disaster. 

If you don't count miles or calories, there are several ways to evaluate the structural integrity and wear on your running shoes. If you are a heel striker (you land on your heels first when you run) look at the back of your shoe. If you see wrinkles in the material on the back outside half of the sole, you have worn out the midsole material.  The shoes can no longer provide sufficient shock absorption and should be replaced. If you are a forefoot striker (you land and run on your toes), look at the front outside edge of the sole at the ball of the foot. If you see wrinkles in the material here, you have worn out the midsole material and you need a new pair. If you look at the back of the shoe and the sole is compressed and tilting inward, you might need more pronation control. Start with the running shoe store fro a new pair of shoes. If that doesn't work, see a podiatrist. Always bring you old shoes to be evaluated at your visit. The wear patterns provide a great deal of information about you running style and possible injuries.

Once you get your bright, shiny new pair of running shoes, you have to break them in to avoid blisters and tendonitis. Do not show up for a Saturday morning long run and expect to show off your new shoes. I usually take my new ones on my long runs, but only wear them for the first 3 miles or so, then I switch back into my old shoes. Make sure you log at least 30 miles of short "break-in runs" before you go long. Your new shoes will still be bright and shiny for that long group run. That is, if the group can keep up with your new, more efficient stride long enough to notice!

Dr. Christopher Segler, DPM is a runner, triathlete and podiatrist in San Francisco. He has a podiatry practice that caters to busy young professionals and athletes in the Bay Area. To accomodate them, he makes house calls so they don't have to miss work (or a workout) when they start to have foot pain. You can reach him by calling 415-308-0833.

MyRunningDoc.com

Ankle & Foot Center