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Biomechanics of Sport Shoes by Dr. Benno Nigg

A middle-aged woman arrived at my office last week complaining of heel pain and carrying a bag of custom-made foot orthotics (orthotics are custom made arch supports that are fabricated from a mold of the patient’s feet). Each orthotic this woman had with her was expertly fabricated by a different podiatrist and yet none of them had come close to alleviating her heel pain. At first I thought maybe these podiatrists didn’t know what they were doing. But, when I learned their names, I knew this woman had seen competent, skilled and reputable physicians.

I asked myself “how could this be?” More interestingly, no two sets of orthotics were even remotely alike. Further, given that nearly all podiatrists learn similar principles of biomechanics, shouldn’t orthotics for a given patient be the same regardless which podiatrist makes them?

After reading Biomechanics of Sport Shoes, Dr. Benno Nigg’s newest book, I have the answer. It is sobering, disturbing and I don’t want to believe it. Unfortunately, Nigg is one of the top biomechanic researchers in the field sport shoes, foot inserts and foot orthotics in the world. In fact, I imagine that Nigg spends more time thinking about biomechanics than a 17 year old boy spends thinking about sex. 

Foot Orthotics Debunked!

Nigg reveals that foot orthotics, which are devices designed to align misaligned feet, are actually not aligning the skeleton at all. In fact, Nigg’s book reveals many disturbing facts about orthotics, shoes and inserts: including that there is weak evidence orthotics lessen injury. Furthermore, changes in skeletal alignment due to inserts or shoes are inconsistent and minor.
 
Most importantly, Nigg goes on to warn that one of the dangers of the consistent use of orthotics is that they reduce functional demand on muscles may be associated with the deterioration of the muscles’ strength and function. So even though a foot orthotic often helps in the short term, over the long term Nigg warns their use may cause problems.

Repetitive Impact Not As Bad As We Thought!

Beyond orthotics, Nigg dispels the notion that running injuries are due to directly to impact forces and suggest that the new paradigm should be “muscle tuning” and the minimizing of vibration of the runner’s soft tissue. Nigg asserts that injuries are generally a result of intensity, duration, and recovery time.

Excessive Pronation May Not Be A Problem

Nigg then reviews foot, ankle and leg biomechanic research and shows that there is no evidence that excessive pronation when walking or running is a cause of injury. This finding is dramatic because many podiatrists believe excessive pronation is the root of many foot problems. 

Barefoot Running May Not Be Any Better

Despite Nigg debunking shoes, inserts and orthotics, you may be tempted to believe he must be a proponent of barefoot running. Not so. Nigg does not believe there is any evidence currently that barefoot runners sustain fewer injuries than shod runners. However, rather than closing the proverbial shoe box lid on barefoot running, he does say “barefoot training” is important and admits that barefoot running has a “small” performance advantage, but it may only be beneficial for a small group of runners.

He speculates that the functional adaptations of footwear based on the bare foot are positive and may persist, but the fashion adaptations based on the bare foot will disappear in relatively short time. 

Are You Ready To Be Unplugged?

One has to wonder the long term effects of the Biomechanics of Sport Shoes. Clearly, it should be required reading for every podiatrist. However, it may be difficult for some podiatric physicians, particularly those who have spent their life doing sophisticated biomechanical exams on their patients and meticulously fabricating foot orthotics, to open their minds to the content of this book.

Beyond health practitioners, patients themselves still generally believe arch supports, running shoes and foot orthotics are well-understood and the answer to their running injury woes. Until people begin thinking for themselves and asking questions both to themselves, to their doctors, and to the running shoe and arch support companies, the system will feed them what it always has.

I am reminded of a great quote from the film The Matrix:

“The Matrix is a system, Neo. That system is our enemy. But when you’re inside, you look around, what do you see? Businessmen, teachers, lawyers, carpenters. The very minds of the people we are trying to save. But until we do, these people are still a part of that system and that makes them our enemy. You have to understand, most of these people are not ready to be unplugged. And many of them are so inured, so hopelessly dependent on the system, that they will fight to protect it.”

On a personal note, I vigorously applaud Nigg for not only puzzling-out the mysteries sports shoes, orthotics and running, but for having the courage to put his theories into the public domain.

If you are ready to open your mind to the latest information and theories on running, sport shoes and foot orthotics, I urge you to read Biomechanics of Sport Shoes.


  • http://www.experiencerunning.net NakedRunner

    Very interested to read Dr Nigg's book.
    I can accept use of orthotics for protection/support in the short-term but after that its gotta be all about correcting strength and mobility of all structures up and down the kinetic chain.

  • bikeporn

    Running barefoot does not stop injury. Oh my….the sky will fall in for many. lol

  • Hot Feet need help

    I will ask this… When I run my long runs or races.. around mile 8 the balls of my feet start to feel like they are on fire. My left foot especially. On fire with needles poking at times. Just ran a 1/2 marathon May 1, 2011 and it happened again. The shoes do not seem to matter. I tried Gel inserts yesterday, but I still had the burn during the race. Any idea why? I m not a fluid runner, so that might be a part of it, but still… Love any idea's I could get. The Dr. Orthodics machine at Walmart showed a hot spot or pressure point on the ball of my left foot. I did not drop $50.00 for those though, but would if I thought they would help!

  • Alexis

    Dr. Nirenberg,

    Thank you for the wonderful articles. I have the same problem as “Hot Feet” during long runs.  My initial thought was I had plantar fasciitis, but the pain went away after a day or two. I wear Superfeet insoles in my hiking boots and my running shoes.  Not sure if the Superfeet are initiating the pain or not, I would like to try barefoot running. If a runner suffers from Plantar fasciitis, would you advise them to try barefoot running?

  • Robert d

    Orthotics are a business, any one can make them and that's the reason you get 4 different orthotics for the same person. Most Dpm's use a lab. I worked for a lab for several years and we claimed we knew the scemce and understood the Docs prescription but bottom line the tech pouring the mould and shaping the plaster who is paid minimally is goning to make a different orthotic for the same person on any given day (from identical prescription). That's the reality. DPM's created the mess and the orthotic industry is now just about money. Think anout this. It costs on average $30 to manufacture an orthotic, Lab sells for $80 to $190. DPM sells for $200 to $500, starting to get the picture.

  • http://www.advancedphysicalmedicine.org/podiatry.php Chicago Podiatrist

    It seems unlikely there to be enough data of this barefoot trend to really denounce or support its claims of improved foot health, with time that will change and I am sure there will be lots to say once the research unfolds.

  • Joe Brence

    Nice article.  I am a Physical Therapist and clinical researcher with a large interest in the study of pain (you can read some of my views and work @ http://www.forwardthinkingpt.com).  What are the thoughts of those in the podiatry community in regards to Melzack’s work on the Neuromatrix and the current understanding that pain is an output from the brain?  -Joseph Brence, DPT

  • Bill Gallagher PT, CMT, CYT

    If an orthosis weakens muscles in the long run, why would a conventional running shoe with a chunky heel and ample foam do the same thing.”barefoot” may not work for most people but how about “minimalist”? Minimalist shoes are highly likely (in my opinion based on clinical experience) to improve balance for people at risk of falling.

    This Looks like a book worth reading!

  • Sbors

    I think the underlying message hear is to stop running (jogging) for fitness. It has been proved as a myth.

  • Pt

    I think the main problem is that gait analysis for Orthotic diagnosis and running performance usually only takes the feet into account and not a running body as a whole. Analysis needs to review a full body walking and running, barefoot and shod and an assessment made in the overall running style and techniques, it sounds ridiculous, but most people are simply not using proper running techniques for their body size and shape, also a 30 min assessment is not long enough to reach a conclusion on anyones posture during the running phase, reassessment is vital to long term success

  • Adamoueva

    I dont believe your theory at all about orthotics not helping aleviate pain.  I work at a Pedorthic clinic and believe me, people cant thank us enough for helping them feel pain free.  It took them years of suffering before they found out what Pedorthists can really do for them.  I am also a Reflexologist and I truly believe in touch for the healing hands but please, dont tell me that my orthotics didnt help me with my back pain.   Thank you anyways, I have enjoyed alot of your articles, but this one really through me off ……
    Please, it is not just a business for money, if you are someone who walks and runs and stands all day on the job, have pain , try orthotics…. please.. believe me they work,  they have been around for ages and ages…… think about it…. maybe you shouldnt be wearing those dentures….