Why The Heels On Modern Running Shoes Are Hurting Us

Most running shoes on the market today have raised heels. Many people may not be aware of this, as running shoe manufacturers rarely advertise the heel height of their shoes. The extra material under the heel is usually referred to as cushioning instead. A lot of time is spent educating women about the consequences of wearing high-heel shoes, but little attention is given to the angled position the foot is placed in every time we lace up a pair of traditional athletic shoes.

Elevated Cushioned Heel Running Shoe

In running shoes today, the heel is raised on average about half an inch higher than the front of the shoe. There is no evidence that shows running in shoes with elevated, cushioned heels reduces injuries or improves performance. Several studies in recent years have indicated that cushioned heels may in fact be a major cause of common running injuries. Do running shoes really need raised heels?

History of Heels

Centuries ago the high heel was worn as a form of horse riding footwear. The “rider’s heel” was approximately 1.5 inches high and helped keep riders from slipping from the stirrups. Aside from assisting riders, the high heel had no functional value.

It was the impractical nature of heels that led the nobility and upper classes to adopt them as a fashion in the 16th and 17th centuries. Wearing impractical, uncomfortable footwear signified a person’s status above the working class. The popularity of high heels has risen and fallen several times over the last few centuries, but a raised heel design persists as a fashion in everything from men’s dress shoes to designer women’s footwear.

LouisXIVhighheels

Athletic Shoes Get Raised Heels

Up until 40 years ago athletic shoes were mostly flat, simple affairs. The first athletic shoes had flat rubber soles and leather or canvas uppers, like the Converse All-Star basketball shoe that debuted in 1917. The first man to run the mile in under four minutes, Roger Bannister, did so wearing thin leather slippers.

Onitsuka Tiger

Onitsuka Tiger, a popular running shoe in the 1960′s

New materials, new theories on the function of the foot, and an increased public interest in jogging during the 1970′s led to rapid changes in shoe design. Around this time podiatrists became increasingly involved in the design of running footwear. Running shoes began to grow bigger and heavier as they incorporated orthotic devices such as flared heels, arch supports, and the familiar extra cushioning under the heel.

The notion that extra cushioning would reduce strain on runners or help them run faster was purely conjecture. There was no research to support placing extra padding under the heel. Raising the heel height destabilized the foot which ending up creating a new set of problems. Shoe companies then devised new “technologies” in an attempt to correct the problems they created.

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The heel height in running shoes continued to rise decade after decade without any evidence that the extra cushioning reduced injuries or made runners faster. It was a bad mix of corporate marketing, consumer demand for innovation, and questionable science.

Today, the average heel height in running shoes is 12mm, or just shy of 1/2 inch. This is sometimes referred to as the heel-to-toe offset or drop. This heel-to-toe differential creates a ramp that places the front of the foot lower than the heel.

Heel Cushioning: Questionable Science?

A $20 billion running shoe industry wants you to believe the technology they pack into expensive shoes is helping, but there are no studies showing that any of the added features improve performance or reduce injuries.

Several studies in recent years have suggested that a raised heel is one of the main culprits for common running injuries, partly because they encourage heavier heel striking, higher loading rates, and greater rotational forces.

Raised Heel Problems

The biggest problem with an elevated and cushioned heel is that it changes the way people run. Barefoot runners and runners wearing shoes without cushioning tend to land toward the front of the foot. Landing on the forefoot or midfoot allows the body’s own shock absorption mechanisms to effectively cushion the impact of landing. This is the same running style children have before being exposed to raised heel footwear.

People switch from a midfoot strike to landing on their heels when given cushioned heeled trainers to run in. The cushioning in modern running shoes encourages runners to land forcefully on their heels. A vast majority of novice runners today are found to use a heel striking gait.

Slamming down on the heel, or running with an exaggerated heel strike known as an overstride, is only possible because of the added cushioning. Running this way is inefficient and places stress on the ankle, knee, and hips.

Even when a runner manages to keep efficient form in a cushioned shoe, the altered joint alignment caused by the elevated heel still changes the mechanics of running and alters the way forces are transmitted through the leg.

Running with an elevated heel:

  • increases joint torque on the hips, knees, and ankles when running in shoes with an average sized heel compared to running barefoot
  • limits motion of the ankle
  • increases stress on the patellofemoral joint in the front of the knee
  • interferes with the normal functioning and shock absorption capacity of the foot
  • changes running mechanics and encourages heel striking

The effects of a cushioned heel are not limited to running. Standing in a traditional running shoe is the same as standing on a ramp facing downhill.

Standing on a raised heel:

  • alters the way weight is distributed on the foot
  • changes the alignment of the ankles, knees, hips, and back
  • leads to a loss of flexibility in the muscles in the back of the leg and Achilles tendon

Taking into account these effects of wearing raised and cushioned heels, the list of injuries and conditions that may be related to modern running shoes could include:

  • Plantar Fasciitis
  • Shin Splints
  • Knee Osteoarthritis
  • Achilles Tendinitis
  • Lateral Ankle Sprains
  • Posterior Tibialis Tendinitis
  • Anterior Knee Pain (Runner’s Knee)
  • Decreased Balance
  • Hallux Valgus (Bunions)

The Reluctance To Change

Because raised heel shoes have represented the majority of shoes on the market over the past 40 years, it’s not surprising that this is the type of footwear most people are familiar with wearing. Minimalist shoes, or shoes without added cushioning and motion control devices, make up only a small part of the running shoe market.

Minimalist and “barefoot” style running shoes are viewed by many as a radical departure from traditional footwear. Cushioned heels have essentially become accepted as our new “normal”. Going back half a century however, there was no such thing as a minimalist shoe because all running shoes were minimalist!

Presently there is a lot of fear-mongering that minimalist shoes are dangerous and supportive and heavily cushioned shoes are necessary to prevent injuries. Besides not being supported by evidence, this notion is a bit backward. Shouldn’t the farther away from emulating barefoot activity a shoe is, the more thought we should give to the problems it can cause?

Defenders of modern running shoe design often point out that transitioning to minimalist shoes can be a long process. While there is some truth to this, what needs to be remembered is that there would be no need to make this transition if heels were never added to running shoes in the first place!

Some might argue that shoes need cushioning because humans didn’t evolve to run on hard surfaces like concrete and asphalt. Even if we assume that the body is not capable of adapting to hard surfaces on its own, this still does not justify adding more cushioning to the heel instead of having it evenly distributed across the entire shoe.

Recommendations

Currently, the absence of any clear benefit combined with the potential for injury are enough reason to suggest that people should move away from raised heel athletic footwear.

1. Pay attention to the heel-to-toe drop when buying new running shoes. Several brands like Merrell and Inov-8 list this measurement on their websites. Some online retailers like Running Warehouse provide heel-to-toe differential of their shoes and also allow you to search for shoes based on heel height.

2. When wearing athletic shoes, spend the majority of your time and do the majority of your running in zero-drop (flat) shoes. There is nothing wrong with occasionally running in a heavily structured or cushioned heel shoe, but don’t let a raised heel become your “normal” or default shoe.

3. If you’re used to wearing heavily cushioned footwear, transition slowly to a lower heel height to give your body a chance to adjust. If you’ve been using raised heel running shoes it can take several months or longer to adjust to the new stresses of a lower heel height. Moving to shoe with a drop in the 4-8 mm range before going to a completely flat shoe can help make the transition easier.

4. Most importantly, work on your running form to undo the changes caused by elevated heels. This typically involves paying attention to your posture, correcting overstriding, increasing cadence, and landing with the foot underneath your body. Incorporating barefoot running in your training can help. The Good Form Running website has resources to help runners learn how to make these adjustments.

Shoes play an important role in protecting our feet from the environment and the elements. But contrary to what athletic shoe companies have been marketing over the last several decades, people are very capable of running injury-free without any of the technology found in modern running shoes. Heels should never have been added to running shoes 40 years ago, so why do we still have them today?

Comments

  1. Inapickle says

    I am curious about your article. I have experienced two stress fracture to my distal tibia and fibula in the right leg in less than six months. They are not as a result of over training and the tibia one occurred after running in small increments whilst following a walk-jog-walk style return to running after the fibula fracture. I have had a lot of time off running to heal the tibia one now but any running results in inflammation/pitting and bone. I just seem to end up with a stress response in both legs around the distal third post tibia after limited amounts of impact exercise. V frustrating. My Physio thinks the stress fractures have occurred as a result of very limited dorsiflexion range due to anterior ankle impingement and tight calves. I cannot stretch the calve muscle in this leg with a bent knee without real stress being felt over my fibula- it feels as if it will snap. I can hang off a step to stretch it etc but only with straightish knees. If my foot is facing straight forward I struggle to bend my knee forward over my toes on this leg without the fibula feeling really put upon. If I do lunges I have a tendency to let the heel turn in because it isn’t comfortable to bend over the toes with my foot facing forwards and straight. MRI scans show fibula is fully healed. I had a bone scan so know there is no bone density issue. The Physio has been massaging my calves and trying active release techniques etc and this does make a diff to freeing up my ability to stretch the calve and bend the knee. I have been cross training but stretching and doing various glute/hip/ core conditioning exercises too as recommended. However physio has looked at my shoes and both he and the podiatrist say I should not be running in a flat shoe. I was originally running in Brooks adrenaline before the SFX to my fibula. I had my gait analyzed at a running store and they said that as I am a real forefoot runner I would be better in a neutral show despite my Pronation issues. They recommended The Ghost shoe because of its cushioning over the front foot and I also tried the Pure Cadence which is much more a transition to “minimalist” and I found that shoe really light and comfy. I’ve since been alternating both of those shoes. The Physio and podiatrist both think that the lower heel in the pure cadence – which I’ve been wearing the most – are way too low because of my limited ankle range and say I need a higher heel to reduce the impact/stress on the bones as I run so much on the forefoot. They have both looked at my running via a video analyses. So now I’m curious that your article suggests quite the opposite. I am obviously v keen to get out of a long vicious injury circle. I cannot seem to handle any volume of impact without my lower limbs complaining but like all runners I am determined to get the problem sorted as I really hate not being able to run. So … Is there really no place for a more cushioned heel?….

    • James Speck says

      I like your strategy of alternating between the two shoes (ghost/cadence). Other than helping with the transition to a flat shoe, I see no benefit of continuing to run with a cushioned heel. Staying in a raised heel shoe seems counterproductive to the goal of increasing ankle dorsiflexion range of motion. Keeping the ankle in a plantar flexed position with a raised heel shoe will have the opposite effect. Tissue adapts to the positions we use regularly. I wouldn’t consider the cadence (with a 5mm heel elevation) as being “too flat” by any stretch, especially for a forefoot/midfoot striker.

      I also see it as overly simplistic to think that a larger heel will be protective against stress fractures. There is a lot of debate about what exactly causes stress reactions in the lower leg. It might not be all about impact forces. Bending forces are suspected to play a role, as well as the forces transferred to the bone through the actions of the muscles. Raising the heel will reduce the amount the ankle needs to flex to get the foot flat, but the way a heel alters forces on the leg as well as mechanics could increase, rather than relieve, stress on the leg.

      In addition to the cross training and stretching you mentioned, have you worked on any gait modifications (e.g. increasing stride frequency)?

      There are a few articles on this site related to ankle flexibility and calf stretching. I use the dorsiflexion lunge test with runners, and look for 10 cm or greater flexibility. Sometimes it’s a struggle, but I’ve never seen a runner not achieve that within several months of consistent stretching.

  2. Bill Eltringham says

    I have a pair of boots issued through work that have the raised heel feeling. These boots are waterproof and expensive but necessary for work. When wearing these boots at work my lower back and knees don’t last but 10 minutes without hurting. Is there a way to level my foot in these boots? Is there a front of foot insert that will lift the front of my foot to match the heel?

    • James Speck says

      You could try taking them to a shoe repair shop. A good shoemaker/cobbler will be able to tell you if there are any modifications that can be done to bring the heel and forefoot closer to level. A lot depends on the construction of the boot. For inserts, I don’t know of anything that would raise the front of the foot up. There are forefoot pads or metatarsal pads which are designed to provide cushioning under the ball of the foot, but these might give you the effect you’re looking for.

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