Which Running Shoes Will Help Me Prevent Injury?

Man running through park
Your physical therapist can help evaluate your running style. Westend61/Getty Images

Question: Which Running Shoes Will Help Me Prevent Injury?

I am a runner who developed knee pain while running. A physical therapist looked at my feet and noticed that I over-pronate. Should I use a special type of shoe to help me prevent future injuries while running?


Running is a great sport, but it can also be harsh on the joints of the legs. Problems involving the hips, knees, and ankles are common sites for running injuries.

Patellofemoral stress syndrome and ilitotibial band friction syndrome are injuries that may take weeks, or months, to heal and can sideline your running schedule. If you are a runner, you are likely to suffer some sort of running related injury during your career, and there are many treatments and tricks available to help you decrease the chance of injury.

Changing your running shoes and wearing shoes that are designed specifically for your feet is one common thought to prevent running injuries. But does wearing the right shoes while running (or walking) prevent injury?

The Case for Over-Pronation as Cause of Injury

Over-pronation is a condition where your foot or feet turn in excessively when you are standing and walking or running. If you excessively pronate your foot when it hits the ground, you may notice your foot and ankle rotate in and your arch falls. When this happens, your shin and thigh also rotate internally.

Excessive internal rotation of your leg while you are walking or running may cause increased strain on the structures around your foot, knee, and hip. The muscles in your leg, namely the hamstrings, the quadriceps, and the gluteus medius, must then work harder to maintain your leg in the best position possible for running.

Failure for these muscles to do this may be a cause of injury.

So if over-pronation causes excessive internal rotation of your leg, and excessive internal rotation of your leg may lead to injury, then correcting the over-pronation problem with supportive shoes and orthotics, right?

Maybe not.

For years, runners and other athletes have chosen the proper shoes based on the position of their feet. Over-pronators required shoes to support the foot, people with neutral feet required neutral shoes, and under-pronators (supinators) needed shoes that allow for some extra motion.

Let's Look at the Evidence

A study published in 2013 in the British Journal of Sports Medicine examined the effect of wearing a neutral shoe for running, regardless of foot type or position.

The researchers examined 927 novice runners and noted foot position. Over-pronators, neutral foot, or under-pronators were all given the same neutral running shoe and were followed for a year. Participants were monitored for injury, which included any musculoskeletal complaint of the legs or back as a result of running.

Of the 927 runners who participated in the study, 252 participants suffered an injury as a result of running. When foot posture type was factored into the data, it showed that it didn't matter which type of foot you had; injury rates were statistically the same regardless of foot type. In fact, over-pronators were injured less than participants with a neutral foot type.

Another study published in the Journal of the American Medical Association examined the effects of using a specific type of insert in your shoe to help treat osteoarthritis of the knee. The examiners analyzed the results of many different studies on the use of lateral wedge inserts for medial knee pain. These inserts help to change the position of your knee and take pressure off of arthritic structures inside the joint, and thus may help relieve pain.

The results of the analysis indicated that the use of lateral heel wedges for knee pain helped some people decrease knee pain. When compared to the use of a neutral insert in the shoe, there was not a statistically significant difference in knee pain relief. It appears that changing foot position with inserts or special shoe types does not affect knee pain.

Does that mean that everyone should just wear whatever shoe they want? Maybe not. A 2014 position paper by the American Academy of Pediatrics listed overpronation of the foot as an intrinsic risk factor for anterior cruciate ligament injury in young people. Maybe keeping the foot in the best position possible for young athletes may have some benefit. 

Bottom Line

Based on the results of studies, the choice of your footwear does not seem to be a strong variable to help prevent injuries while running. You should do just fine choosing a running shoe that is sized correctly and feels comfortable while walking and running.

When starting a running program, it may be a good idea to visit with a physical therapist to assess factors that may lead to injury. He or she can evaluate your flexibility and strength and prescribe an exercise program that may help keep your joints health and keep you running pain free.

Sources: Nielsen R, et al. "Foot pronation is not associated with increased injury risk in novice runners wearing a neutral shoe: a 1-year prospective cohort study." Br J Sports Med. 13 June 2013.
Parkes MJ, Maricar N, Lunt M, et al. Lateral Wedge Insoles as a Conservative Treatment for Pain in Patients With Medial Knee Osteoarthritis: A Meta-analysis. JAMA. 2013;310(7):722-730

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