Running Shoe Advice – A Podiatrist’s Perspective

Sep 29, 2020

Running is an extremely popular and “easy” way to exercise both from a cardiovascular and muscular fitness point of view. As runners always tell me, “You can just pick up your shoes and get out there” or “You just throw your shoes in the boot of your car and drive where you want to run from”

This sounds so easy but often the biggest obstacle, mainly for the novice runner, is running shoe choice. One just has to walk into a sports store footwear section, to be faced with a literal “wall” of choices.

In my years of experience as a Podiatrist, many of the runners I see are merely seeking advice in this endeavour. As with virtually everything in life, what may work for one individual, may not work for another. With that in mind, what follows is the advice I dispense daily in my capacity as a Podiatrist and is therefore based on my opinion and experience from over 20 years in practice.

Buying running shoes

The terms pronation and supination are well known to most runners, as are flat feet and high arched feet. A foot that is considered flat by its owner may not be seen this way by a Podiatrist and the same for a high arched foot. Also, the term pronation is often used to describe a pathology, when in fact it is a description of foot position at a certain point in the gait cycle. Pronation and supination are movements that are both required in a normal sequence of events in gait. Determining what is “normal” and what is “excessive” is almost impossible because there is no baseline to compare it with. In more recent developments in the field of foot biomechanics, the term overpronation is not acceptable in scientific and academic circles for exactly this reason and is also not always the cause of injuries.

Now to the shoes.

As Podiatrists, we often refer to three broad categories, which cover most running shoe brands, namely, Minimalist, Maximalist and Traditional shoes. Briefly these can be explained in the following way. The term heel to toe drop, which is often heard but not understood, is the angle from the highest section of the heel down to the forefoot. The stack height is the overall thickness between the foot and the ground, in other words the thickness of the entire shoe base. Minimalist shoes have a heel to toe drop of 0mm up to 6mm, generally speaking.

Traditional shoes have a heel to toe drop of approximately 8-13mm. Traditional shoes, as the name implies have been around the longest. In my opinion, minimalist and maximalist shoes are specialist shoes and are not for everyone. For this reason, when I refer to shoes in this article, they are mostly Traditional shoes. There is also another type of traditional running shoe, which is designed for off-road use or Trail running. Trail running shoes, by the nature of their purpose are firmer and less flexible in the midsole and more protective in the toe box. For this reason, they are normally not divided into neutral or stability and fall under the same category, namely Trail running shoes.

Within the Traditional category of shoes, there are a further three sub-categories, namely Neutral, Stability (mild anti-pronation/stability) and Motion Control (strong anti-pronation) shoes. These are the shoes that most people know, and these are the shoe categories that I most often prescribe in my practice.

Maximalist shoes are the newer generation of shoes that have a very thick midsole and in some cases a slight rocker sole, meaning that the middle section of the sole is angled to be slightly higher than the rear and the front part of the sole. The pioneer brand in this category is Hoka One One.

All the major brands have shoes which fall into some or all these categories. The more well-known brands are Asics, New Balance, Saucony, Brooks, Nike, and Adidas. There are obviously many others, too numerous to be covered in this article. Examples of some of the current more popular models of these shoes are:


  • ASICS: Cumulus or Nimbus
  • New Balance: 880 or 1080
  • Saucony: Triumph or Ride
  • Brooks: Glycerin or Ghost
  • Nike: Air Zoom Pegasus
  • Adidas: Ultraboost or Solar Boost


  • ASICS: 1000 or 2000 or Kayano
  • New Balance: 860
  • Saucony: Guide
  • Brooks: Adrenaline
  • Adidas: Ultra Boost ST

Motion Control

  • ASICS: 4000
  • New Balance Rubix
  • New Balance 1260

A major difference between the brands is the width and fitting, As a general example, New Balance is the widest shoe brand available and often is available in B and D widths for ladies and D, 2E, 4E widths for men. Other wider brands are Asics (up to 2E in some men’s shoes), Brooks and Saucony. Nike and Adidas shoes generally have a narrower last and therefore are much more snug fitting. These categories can be used as guides as to the type of shoe you may need, but ultimately the fit and the feel of the shoe are the deciding factors. For this reason, I refer my patients to a specialist footwear store. The staff in these stores are well versed in running shoes and their function. One may not get the same service in a general sports store.

The rule of thumb for the fitting of running shoes, is exactly that, a thumb width from the tip of the longest toe to the end of the shoe. In most cases, this equates to approximately a size (in number) bigger than your daily use or dress footwear. This allows for the flattening, lengthening, movement and swelling of the feet during exercise. Running in too small a shoe can cause blistering, and bleeding under the toenails, ultimately resulting in their loss. Fortunately, the nails are resilient structures, that mostly grow back. If you have a pre-existing problem with corns, bunions or ingrown nails, the fitting will also be important.

Socks are also an important consideration and the material that modern running socks are constructed from is hard wearing and the fibres are aligned according to their location when worn to reinforce the support and padding. They are also made from moisture wicking materials for the absorption of perspiration.

Even the laces and lacing technique have a role to play. If you have a very high arch or instep, the standard lacing technique may be a cause of pressure and pain at the highest point on top of your foot, and this can easily be managed by skipping the cross-over in the middle and reinforcing the top and bottom sections. There are many different lacing techniques that are used by runners and athletes in every sporting discipline.

These are only the more salient points that I reinforce daily with patients but remember there may be much more in each specific case. My advice would be to get some professional advice before going out to purchase expensive shoes. Shop at a specialist running shoe store and start by having them fitted correctly. If you are unsure consult with your sports podiatrist.

Mark Karam 

Mark Karam is a Podiatrist based in Bryanston with over 20 years of experience. Mark works in all areas of podiatry but has always a special interest in running and sport related issues. Find out more about Mark Karam here.

More articles