Blaise Dubois: Currently, the evidence is not clear enough to make very general recommendations for the general public. But with all the data, we are able to make valid recommendations: the more cushioning and larger the shoe, the more stress it places on the knee, hip and back. The more cushioning and larger it is, the less stress it puts on the foot in general. There is a general notion – widely disseminated among shoe sellers – that it takes more cushioning to reduce stress on the knee. It doesn’t work, both from a theoretical point of view and from a clinical point of view.
Gabriel Moisan: It’s hard to make very general recommendations, because there are a lot of nuances to be made. I agree with what Blaise said, but I would add one thing. I think the most important thing is that if you are not injured and you have no problems running, the best shoe is the one you already wear. If you find it comfortable, if you like it, buy another pair before the model is no longer sold.
BD: I agree, but there is a problem with all this: people are led to assume that cushioning, anti-pronators and drop [the difference between the heel and the forefoot] – the three technologies that have been promoted over the years – have a preventive role in injuries, which is not the case. But we managed to make everyone believe it, and the market succeeded in imposing these shoes on the public, who bought them at a high price. Currently, if we are not among an educated public, 97% of people wear them. We have made people totally dependent on a shoe profile.
BD: It especially scares all those who promote the big shoe. All the salespeople will promote technological shoes with cushioning, because that has been the statistical norm for 40 years. […] We have made thousands of successful transitions to minimalism, because the patients have been properly guided. But if you buy a FiveFingers [very minimalist shoes] and you run for 30 minutes afterward, you are sure to hurt your foot. It is not the fault of minimalism: it is the fault of maximalism which has weakened your feet for years.
GM: Minimalist footwear, by definition, is less controlling. Apart from changing the material and shape a little, there are not really any innovations possible. It is therefore more profitable for a company to create new technologies which, most of the time, are not scientifically validated. Companies are really pushing tech shoes, when that might not be what the patient needs. As a healthcare professional, we are fighting against a big machine that has an unlimited marketing budget.
GM: It’s not really that one causes more pain than the other; it’s the boss who is different. Depending on the shoe you wear, you can change the distribution of loads on the structures of the foot and leg. Minimalist shoes increase loads on the foot and calf, but they will take load off everything above the ankle. Conversely, maximalist shoes will remove load from the foot and ankle, but increase loads from the knee and hip. We can use these differences to our advantage depending on the location of injured runners’ pain.
BD: He’s already in trouble, since he’ll only be offered big shoes. 5, 10 years ago, we had at least a small selection of minimalist shoes displayed in stores, which is no longer the case today. The best you can do is choose a nice color and try the shoe on to see if it’s comfortable.
BD: Online, yes, there is. But if you go to a specialized store, the salesman will try to discourage you by saying that minimalist is an outdated fashion and that people have gotten hurt, then he will make recommendations based on bad practices. I’m going to be even more cynical: I think you’ll walk out of Walmart with better shoes than a specialty store.
GM: I understand Blaise’s cynicism, and I share it a little. It’s true that it’s demoralizing when you’re trying to have the entire continuum of shoes. On the other hand, the nuance I would bring is this: we are used to wearing shoes in everyday life, and a large proportion of them are more controlling than not enough. Personally, I’d be more likely to aim for the middle to start – a minimalist index of 50%.
GM: The main factor is training habits. How you run, how far, how often. The person who starts the race by doing 7, 8 kilometers, they’re going to get injured no matter what shoe they’re wearing.
BD: I totally agree: 80% of running injuries are due to poor quantification of mechanical stress, meaning the person did too much, too quickly. In the 20%, there’s a little bit of footwear and a little bit of biomechanics. The two instructions that could be given to a runner are to take smaller steps and make less noise while running.
