Selectingthe Goals ProperAthletic Shoe - Podiatry … · OCTOBER2012| PODIATRYMANAGEMENT|147 A thleticshoesareanim - portantpartoftheequip - mentusedbyhighperfor-manceathletesandplaya

OCTOBER 2012 | PODIATRY MANAGEMENT | 147www.podiatrym.com

Athletic shoes are an im-portant part of the equip-ment used by high perfor-mance athletes and play asignificant role in the out-

come of many events. Good shoes pro-vide cushioning and stability and can

prevent injury as well as enhance per-formance. Wearing the wrong shoes,ones not designed for the playing sur-face and condition, or those that donot fit properly, can lead to injury.

The clinician treating athletesmust be familiar with the type of

footwear used by the athlete patientsince the wrong shoe might very wellbe the cause of that patient’s prob-lem. One study by NFL team physi-cians and trainers looked at the per-formance of 15 different athletic shoes

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Goalsand ObjectivesAfter reading this arti-

cle, the physician shouldbe able to:

1) Properly fit athleticshoes for various sportsactivities.

2) Know how to modifythe lacing of athletic shoesto accommodate differentfoot types.

3) Recognize the signsof excessive wear of shoesused for different sports.

4) Understand the char-acteristics of a good sockfor the athlete.

5) Recommend appro-priate running, soccer,football, baseball, basket-ball, tennis shoes, andminimalist running shoesto athlete patient.

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Following this article, an answer sheet and full set of instructions are provided (pg. 158).—Editor

Selecting theProper Athletic

Shoe

BY MARK A CASELLI, DPM

The correct choice of footwear can enhanceperformance while preventing injury.

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FOOTWEARAND PODIATRY

ATHLETIC SHOE

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on grass and artificial turf underboth wet and dry conditions. They

concluded that wearing shoes underconditions for which they were notdesigned could lead to excessiveforces and cause serious knee andankle injuries.

Sport-specific, and even sportcondition-specific, shoes should beused by anyone who participates in asport for more than three hours perweek. Even though well-made, sport-specific shoes have become relativelyexpensive, choosing the right shoe isimportant and is probably economicalin the long run if frequent foot in-juries can be prevented.

General Considerations inSelecting the Proper Athletic Shoe

One of the most important aspectsof selecting the proper athletic shoe ischoosing the right size. Proper fittingsports shoes can enhance perfor-mance and prevent injuries. An ill-fit-ting shoe can be the root of many

problems. Shoes that are too small areone of the major causes of foot pain,and those that are too large can causeblisters and lack of stability.

Not all brands of footwear fit thesame. An experienced salespersoncan be of great help. He or she canhelp fit shoes properly to address theathlete’s concerns. A good salesper-

son would know which brands arecut wider in the forefoot or narrowerin the heel. Your patients should havetheir feet measured each time theypurchase shoes.

As one ages, foot size often gradu-ally changes. The measurementsshould include sitting, standing, and

heel to toe, heel to ball, and width. Inspite of obtaining a number from theBrannock device, the actual fit on thefoot is the most important considera-tion. The measurement itself is only ageneral guide. The athlete should bereminded that a properly fitting athlet-ic shoe is often not the same size as adress shoe. The right size running

shoe is often a half to a full size larger.Athletic shoes should be fitted at

the end of the day, or after rigorousactivity when the feet are theirlargest. Both feet should be measuredsince they are often different sizesand the shoes should be fitted to thelarger foot. The shoes should also befitted with the socks that will be usedduring the sports activity and withany special inserts or orthoses.

Sports shoes for children shouldnot be purchased with the thoughtthat the next larger size will allow theathlete to grow into them. The exactsize is most important. The shoes thatare being tried on should be re-laced,beginning at the farthest eyelet witheven pressure being applied as theyare crisscrossed-laced to the top of theshoe. The shoe should fit with approx-imately 1/4 to 1/2 inch between thelongest toe and the end of the shoe. Itshould have adequate room for thetoes. The shoe should bend at the ballof the foot. If the heel to ball fit is off,then the break will not match the footand it will create abnormal pressureand irritate the foot. The heel shouldbe stable and not move in and out ofthe shoe. The shoes should be wornfor at least ten minutes in the store.They should feel comfortable as soonas they are tried on. There is nobreak-in period. The most commonerror in purchasing athletic shoes, andone that cannot be corrected bypadding, insole replacement, or or-thotics, is buying a shoe that is toonarrow in the toe box. Though these

Athletic shoes should be fittedat the end of the day, or after rigorous activity when

the feet are their largest.


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TABLE 1

Sport-Specific Shoe FittingSport Toe Area Heel Area

Running Allow thumbnail’s length of Heel can slightly movespace between the end of but should not slip.the longest toe on the largestfoot and the end of the shoe.

Soccer Glove-like fit while standing Snug fit with noup straight. Allow room for movement.toes to move comfortably.

Football Allow room for toes to Snug fit with nomove comfortably while movement.standing up straight.

Baseball Allow room for toes to Snug fit with nomove comfortably while movement.standing up straight.

Basketball Allow thumbnail’s length of Heel can slightly movespace between the end of but should not slip.the longest toe on the largestfoot and the end of the shoe.

Tennis Allow thumbnail’s length of Heel can slightly movespace between the end of but should not slip.the longest toe on the largestfoot and the end of the shoe.



ATHLETIC SHOE

recommendations apply to the fittingof most athletic footwear, there arespecific shoe fit variations for specificsports (Table 1).

Lacing SystemThe lacing system is an important

part of the athletic shoe. It holds it alltogether by securing the shoe to thefoot. Improper lacing can cause dis-comfort and injury. Pulling laces tootight cuts off circulation and may

cause tendinitis on the dorsum of thefoot. If laced too loosely, the shoes fitsloppily and result in foot and ankleinstability. There are three types oflacing systems: variable width withstaggered eyelets to adjust width,speed lacing with plastic D-rings, andconventional eyelets. Various lacingmethods, other than the standardcrisscross system, can be used tomeet individual needs. A narrow heel,high or low arch, or a wide foot canbe accommodated by changing theway the shoes are laced (Figures 1-4).

Worn-Out ShoesWearing worn-out shoes is a haz-

ard in any sport. Worn-out shoesoften result in aches and pains in feet,legs, knees and hips, signaling that itis time to replace the shoes. As a gen-eral rule, most running shoes providecushioning up to 500 miles, thoughmany runners may find breakdown incushioning after as few as 350 miles.Shoes with compression-molded EVAmid-soles vary in durometer. This

means that the cushioning elasticityand life span of each mid-sole is rela-tive to the shoe. Most shoes withpolyurethane mid-soles break downat a slower rate. To avoid injuries, it’sa good idea to rotate running shoesevery 200-250 miles, having two pairsof shoes to wear at all times. A run-ning shoe’s mid-sole cushioning maybe worn out long before the treadshows signs of wear. Since the bot-tom and tread of the shoe may lookfine, identifying when the cushioningis no longer effective is important.

Press TestThe “Press Test” can be used for

this purpose. When an EVA mid-soleis compressed, it creates visible linesor wrinkles in the mid-sole materialthat can be seen from the sidewall ofthe shoe. As the mid-sole is furthercompressed, the lines multiply andgrow closer together. The first appear-ance of these lines indicates that themid-sole is compressing normally. Asimple pressure test can determinewhether or not the mid-sole is com-pacted. Pushing the outsole upwardinto the mid-sole should show themid-sole compressing into these lines.As the shoe breaks down, the mid-sole will compress less with the sameamount of pressure. When the mid-sole shows heavy lines, and the presstest yields a minimal degree of com-pression, the mid-sole has been com-pacted to a point where little or nocushioning remains.

Other Signs of WearSince most cleated athletic shoes

have little or no mid-sole material, theintegrity of the heel counter, condi-tion of the upper, and wear of thecleats must be evaluated. A shoe withnoticeably “ground down” moldedcleats should be replaced. Anotherway of determining whether a shoe


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To avoid injuries, it’s a good ideato rotate running shoes every 200-250 miles, having

two pairs of shoes to wear at all times.

Figure 1: Lacing for Narrow Heel or Foot: Fol-low a normal lacing pattern up to the last pairof holes. For narrow feet, use shoes with stag-gered eyelets. Tighten from the outer eyelets,pulling the body of the shoe towards the cen-ter. At the last hole, tighten the laces andthread into the last hole without criss-crossing.Do not pull the laces all the way through, butleave a loop on each side. Cross the laces andthread them each through the loop on theother side before tightening and tying.

Figure 2: Lacing forLow Arches: Criss-cross lace the shoesas normal halfwayup. Use the looplacing the rest ofthe way.

Figure 3: Lacing for HighArches: Begin lacing as nor-mal, criss-crossing and stop-ping after the first set ofholes. Thread the lacesstraight up each side, criss-crossing only before thread-ing the last hole.

Figure 4: Lacing for WideFeet: Thread the lacesthrough the first set of eye-lets and then straight up eachside without criss-crossing atall. Continue this way for twoor three holes past the fore-foot, and then begin criss-cross lacing as normal.

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ATHLETIC SHOE


should be replaced is by tryingon a new pair of the model that is

currently being worn. Compare thisto the current shoes. If the new shoefeels much better than the old, thenthe old shoes are probably worn out.Heavy athletes and over-or under-pronators should check their shoesfrequently since they tend to wear outtheir shoes quickly.

SocksSocks are often overlooked as an

important component of proper ath-letic footwear. Often, a poorly fittingsock or worn sock is one of the majorcauses of blisters. In general, socksthat fit properly should provide ampletoe room, have a well padded sole, fitsnugly without wrinkles, and feelcomfortable. In a longitudinal, dou-ble-blind study, the effect of sockfiber composition on the frequencyand size of blistering events in long-distance runners was examined. Itwas found that socks composed of100% acrylic fiber were associatedwith fewer and smaller blisters whendirectly compared to socks composedof 100% cotton fiber.

The tube sock has become popu-

lar over the last decade as one sizegenerally fits all. Advising the athleteto wear two pairs of socks is anothermethod of reducing friction and pre-venting hot spots that may becomeblisters. The inner sock is usuallythinner and lighter than the outersock. Lastly, clean socks are a must inwarding off fungal growth and main-taining the overall health of the ath-lete’s feet.

ResourcesThe practitioner treating athletes

can obtain a great deal of informationon athletic footwear by visiting athlet-ic shoe stores, reading sports specificpublications, and visiting the Internet.For example, Runner’s World maga-zine publishes a “Shoe Buyer’s

Guide” four times a year. The Ameri-can Academy of Podiatric SportsMedicine has shoe lists recommend-ing running, aerobic, basketball, hik-ing, walking, soccer, and volleyballshoes on its web site www.aapsm.org

. These sources can be very helpful inguiding athlete patients to the sportsshoe that meets their needs.

Sports-Specific Shoes

Running ShoesGetting a good pair of running

shoes is the most important invest-ment any runner can make. This iseasy to understand when you realizethat the only thing that separates theroad from the runner are the shoes,each of them striking the groundabout 800 times per mile with theforce of about three times the run-

ner’s body weight. A properly select-ed running shoe can definitely de-crease the number of running in-juries. Each of the five major compo-nents of the running shoe: the last,outer sole, mid-sole, heel counter,and upper, should be considered inits selection.

Last ShapeThe shape of the last affects the

shape, fit, flexibility, and stability ofthe shoe. The two basic shapes usedfor the last are straight and curved. Astraight last has little or no curvefrom the heel to toe and providesgreater support under the medialarch. A curved last turns inward fromthe heel to the toes. There are varia-tions that include slightly curved

(closer to straight) and semi-curved(closer to curved) last.

Lasting TechniquesThere are three lasting techniques

used in running-shoe construction:

board, slip, and combination. Inboard lasting, the upper materials areglued to a fiberboard before they areattached to the mid-sole. Straight,board-lasted shoes aren’t very flexi-ble, but are firm and provide a goodplatform if orthoses are needed for ex-cessive pronation. With slip lasting,the upper materials are stitched to-gether and then glued to the mid-sole.This makes a lighter, more flexibleshoe with a softer feel. Combinationlasting uses the board method in theheel for stability and the slip methodin the forefoot for flexibility. Manyrunners prefer combination-lastedshoes that provide some benefits ofboth types.

Treaded OutersoleThe treaded outer sole is designed

to resist wear, provide traction, andabsorb some shock. It should notwear out quickly, and will often be ingood shape after the shoes are dis-carded due to loss of mid-sole cush-ioning. The outer sole should wearprimarily on the extreme outer edgeof the heel and in the center of theball of the foot. There are many soledesigns, most providing adequatetraction. In general, soles are eitherhard or soft. Harder soles are heavier,offer less cushioning, and wearlonger. Softer soles are lighter, havemore cushioning, and wear out faster.

Midsole ConstructionThe mid-sole is located between

the outer sole and the foot bed. It isthe most important part of the runningshoe. It absorbs shock, flexes at toe-off, and adds stability to the shoe.

The shape of the last affects the shape, fit, flexibility,and stability of the shoe.


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The treaded outer soleis designed to resist wear, provide traction,

and absorb some shock

OCTOBER 2012 | PODIATRY MANAGEMENT |151

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ATHLETIC SHOE

Mid-soles are constructed from vari-ous types of foams. Air-bags, gels, andother materials may also be insertedto increase cushioning. Their shockabsorbing properties deteriorate withuse. Studies have shown that mid-soles may lose a significant amount oftheir cushioning when exposed to run-ning in cold temperatures.

Heel CounterThe heel counter stabilizes the

shoe, and therefore, the foot. A rigidcounter covering the entire heel is de-sirable, especially for pronators. It’susually made from plastic. Above thecounter is usually a cushioned anklecollar, which provides protection andhelps prevent Achilles tendinitis. Aheel wedge, located above the mid-sole, adds height to the heel, increas-es shock absorption, and reducesstrain on the foot and leg.

Shoe UppersMost running shoe uppers are ei-

ther nylon, nylon mesh, or a combi-

nation. This creates a light-weight,breathable, washable, soft shoe thatis comfortable and dries fast whenwet. The mesh upper also makes theshoe cooler in the summer.

ConsiderationsWhen recommending a specific

shoe, it is important to determinethe runner’s basic foot type and anyrunning-related complaints and in-juries. Running shoes come in threebasic categories, those specializing

in stability, motion control, or cush-ioning. If the runner has a medium-arched, semi-curved foot that prop-erly pronates, then shoes that offerstability should be recommended.These shoes should have adequatemid-sole cushioning, as well as me-dial support.

A straight-lasted shoe with ahard heel counter and firm mid-soleoffering motion control is best foroverpronators (Figure 5). These run-ners tend to have highly flexible feetwith low arches and they oftenbreakdown shoes on the inner bor-ders. For under-pronators, thoserunners who have high, curved,rigid arches, curved-lasted shoes,which provide plenty of cushioning

and a flexible forefoot, is rec-ommended (Figure 6). These run-ners don’t absorb shock well andare prone to lateral ankle sprains,stress fractures, shin splints andknee pain.

Soccer CleatsSoccer is a game that is primarily

played with the feet; therefore, themost important piece of soccer equip-ment is the footwear. A good pair ofcleats, or boots, as they are some-

times called, is essential. There arevariations of the basic soccer cleat de-signed for different skill levels, weath-er conditions, and field types.

Great care must be exercised inthe selection of soccer shoes sinceeach part of the shoe must serve aunique function. Players wear cleatedshoes for better traction while run-ning. Cleats give them increasedspeed and maneuverability.

The outsoles of the cleated shoeperform a dual function, providingboth support and traction. Since thecleats often do not penetrate fullyinto the playing surface, a base ofsupport is formed on top of thecleats. This condition is exaggeratedon hard dirt. For this reason, cleatedshoes should be selected such thatthe cleats along the shoe edges arepositioned as close to the edge aspossible. Sections of the sole withoutcleats will be relatively less support-ive, especially in the mid-foot archarea.

Shoes with fewer cleats often in-clude internal reinforcement. To ac-complish this, a stiff synthetic or evena metal plate is added to the shoe toensure adequate support. This prac-tice has also been used in an attemptto reduce the incidence of “turf toe”on synthetic turf fields. The negativeside-effect of this modification is a re-duction of forefoot flexibility across


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Figure 5: Straight lasted motion control runningshoe for over-pronators

Figure 6: Semi-curved lasted running shoe withgel enhanced mid-sole offering excellent cush-ioning characteristics

Figure 7: Multi-studded soccer shoe with nu-merous molded cleats offering both good sup-port and traction

The outsoles of the cleated shoeperform a dual function, providing both support

and traction.

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ATHLETIC SHOE


the metatarsal heads whichcould result in irritation of the

plantar fascia.

TractionThe other function of the outsole

is to yield adequate traction on agiven surface. The two modes inwhich traction is desirable are alongthe length of the shoe and in resis-tance to lateral motion. Traction isnot desirable when it resists shoe ro-tation. Fixing the foot against rotationhas been cited as predisposing theknee and ankle to injury.

The best method of minimizing ro-tational fixation is to maximize cleatnumber and diameter, and minimizecleat height. In general, multi-studdedmodels are preferred by most players(Figure 7). These can be worn both

on grassy fields and on hard ground.For rainy weather, screw-in studs

are better because their length can beadjusted (Figure 8). The softer thefield and the taller the grass, thelonger the studs. The longer screw-instuds should not be used on synthetic

turf, as they might get caught in thefibers and cause serious knee andankle injuries. On synthetic turf, spe-cially designed shoes with short studsare advisable. Since the feet and legsoften end up in a tangle during the

match, soccer cleats must be noless than 1/2 inch in diameterand may not project more than3/4 inch from the sole.

Shoe UpperThe main function of any

shoe upper is to center the footsquarely over the base of sup-port. In order to accomplish this,most soccer shoes have overlaysalong the lateral edge of the fifthmetatarsal head and base, toserve as reinforcement and pro-vide a stiff heel counter to anchorthe rear-foot. A unique footwearrequirement for soccer is to serveas an impact surface for the ball.To this end, extra stitching isplaced along the medial and lat-

eral sides of the shoe, which both re-inforces the upper and forms a ballcontrol surface.

Football CleatsFootball cleats are made both for

the position played and the type of

field played on. Football cleats comein three styles, or heights, to accom-modate the varying needs of playersby position. High-tops extend up theankle to provide extra support, espe-cially for lateral movements. Linemenbenefit from this support because ofthe pressure put on their ankles bythe numerous lateral movements dur-ing the course of a game. A mid-cutshoe offers good support while stillallowing maneuverability. This stylebest fits the game of skill players; thedefensive backs, running backs, widereceivers, and quarterbacks. Low-cuts are preferred by some playersbecause they are light-weight. Thelower cut provides extra maneuver-ability to allow for quick cuts on thefield.

Cleats are either molded or de-tachable. Most are designed for ei-ther grass or turf fields. If games areplayed on both grass and turf, multi-purpose cleats can be used. Molded


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Figure 8: Soccer shoe with exchangeable cleats and studsthat can be customized for different field conditions

Figure 10: High-top football shoe incorporatingscrew-in studs to deliver grip on very soft natu-ral fields

Figure 9: Football shoe with molded studs offer-ing both good traction for a variety of playingsurfaces and durability

Figure 11: Metal spikes on baseball cleatsoffer good traction but can cause injury whensliding.

The main function of any shoe upper isto center the foot squarely over the base of support.



ATHLETIC SHOE

cleats are permanently attached tothe outsole on the shoes’ bottom(Figure 9).

Turf shoes usually use moldedrubber cleats to give spring and trac-tion on the harder turf surface (Figure10). Molded cleats are generally lessexpensive than shoes with detachablecleats. Detachable cleats use studsthat can be removed and replaced tofit field conditions on all types ofgrass, hard and dry, or wet and slop-py. Their versatility makes detachablecleats preferable for athletes who playprimarily on grass. Shorter studs canbe used for hard, dry surfaces andlonger studs for a wet, sloppy field.Replacement cleats generally run in1/2, 5/8-, 3/4, and 1-inch sizes. Hav-ing all four sizes gives the player moreoptions for different field conditions.

Baseball CleatsBaseball and softball are consid-

ered low to medium impact sportswhere approximately four to sixtimes body weight is transferred tothe feet. The impact can even begreater on artificial surfaces. Unlikesoccer cleats, baseball cleats have amid-sole to help cushion some of thisimpact. There isn’t much repeatedmotion in baseball, but a lot of lateral(side-to-side) movement. Many play-ers prefer a higher or mid-cut cleat tooffer better ankle support. Baseballshoes are designed with either metalor molded cleats.

Metal cleats feature molded soles

with several small metal spikesdesigned to provide maximumtraction on the field (Figure11). These are beneficial on ex-tremely hard fields. The shoesare usually made of leather,have cushion mid-soles, andare fit much like a standardsneaker. Metal cleats are notpermitted in Little League andinstructional levels because ofthe potential for injury, hap-pening most often when play-ers with metal cleats slide intoa base and the spikes are ex-posed. Molded cleats featuremolded soles with several smallplastic cleats (Figure 12). Mold-ed cleats are most often usedon Little League and instruc-

tional levels since they are significantlyless dangerous than metal cleats.

Basketball ShoesBasketball shoes must offer dura-

bility, support, stability, and shockabsorption. The constant starting,

abrupt stopping, high jumps, andquick side-to-side movements in-volved with basketball make thesefeatures absolutely essential in ashoe. Personal playing style is also animportant factor in shoe selection.

Power players will need shoeswith maximum cushioning andstability. They may have to play withheavier shoes to get those benefits.The all-around player can use shoeswith moderate ankle support andcushioning. There are many shoes tochoose from in this category, andmost are fairly lightweight. The fastplayer will prefer a lightweight shoethat offers moderate support, cush-ioning, and flexibility. Shoes with alower cut are often desired by thistype of player.

Understanding ConstructionUnderstanding the construction of

basketball shoes is essential in deter-mining which features are most im-portant for the player. The function ofthe upper part of the shoe is to keepthe foot snug and securely in placeduring play. There are three shoe cutsavailable, high-, mid-, or low-tops.The majority of players, around 70per cent, choose high tops for theirability to provide maximum ankle

support (Figure 13). Power playersand all-around players usually preferthe stability of this style.

For players who feel restricted inhigh-tops, and who use speed as their

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Figure 13: High top basketball shoe offeringboth good ankle support and excellence forcourt traction

Figure 14: Low cut basketball shoes, sometimespreferred by fast players, are light but offer lessankle support

Figure 12: Only molded baseball cleats are permitted for Lit-tle League play.

Power players will need shoes with maximumcushioning and stability.

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greatest asset, mid-tops, whichextend right to the ankle level, are

their choice. Only about 10 percent ofplayers wear low-tops for regular play(Figure 14). These shoes are lighter,but don’t offer the built-in ankle sup-port that high-tops do.

UppersAll leather uppers have been re-

placed with lightweight combinationuppers, mixing the stability and dura-bility of leather with the breathabilityand flexibility of synthetic mesh. High-tech, all synthetic uppers, which aremore durable than leather, are gainingpopularity for their ability to offer sta-bility in a super-lightweight material.

Closure SystemA good closure system is neces-

sary to keep the foot snug and securein the shoe during the sudden stopsand starts, frequent side-to-side mo-tions, and quick turns encountered inbasketball. Laces are an acceptablechoice for keeping the foot stable inthe shoe. Several manufacturers offernew lacing systems designed to offergreater stability. A good lacing systemshould lock the laces in place, makingthem less apt to loosen or untie, thusincreasing stability during play. Someshoes feature a strap that wrapsaround the upper arch of the shoe toadd more stability and protectionagainst ankle rollover (Figure 15).

Zippers are a fairly new choice forsecuring the foot in a basketball shoe.These are usually covered by somesort of protective material. Velcro,while good for younger players, is notreliable in terms of staying closed,and doesn’t offer good support.

MidsoleThe mid-sole is often considered

the most important part of the bas-ketball shoe because the constructionand the materials used will impactthe levels of cushioning and shockabsorption and can affect the players’ability to explode off the floor. Themid-sole is usually made of EVA,compressed EVA, polyurethane, or acombination of these materials. Pro-prietary cushioning technologies arealso found in many brands of basket-ball shoes. EVA offers lightweight

cushioning, but not as much stabilityand durability. EVA can be com-pressed to make it somewhat moredurable. Polyurethane is a moredense and durable cushioning materi-al. It can add stability to the shoe,but also adds weight.

Cushioning TechnologyProprietary cushioning technolo-

gies are usually found in the heel and

forefoot of the shoe and add an extradegree of cushioning without muchextra weight. Stiff materials are usedin some basketball shoes on the me-dial or inner side of the shoe to re-duce inward rolling of the foot. Heav-ier densities of cushioning materialsmay also be used in the medial areato increase a shoe’s stability. Themid-sole can negatively affect stabili-ty if the cushioning materials are toothick.

OutsoleThe outsole of a good basketball

shoe should be flat and moderatelywide to create a stable base and helpprevent ankle rollover. The herring-bone pattern is most common andprovides enough traction to keep theplayer steady during quick stops andstarts. Most shoes are designed for in-door play. If play is most often onoutdoor courts, a shoe with a moredurable outsole should be used. Somebasketball shoes are designed specifi-cally for outdoor play and featureheavier rubber outsoles

Gender-SpecificMost women should not buy

men’s basketball shoes. Men’s shoesare built on a wider last than wom-en’s shoes and are generally too widefor a woman’s foot, and do not offeran appropriate degree of stability.

Tennis ShoesTennis shoes are very important to

the player, owing to the quick startand stopping, cutting, pivoting, andjumping that is part of the game. Ten-nis is a sport that is rough on shoes,particularly the sole and toe area, sofinding a shoe that is durable enoughis important. The shoes should have afairly wide heel and good heel counterfor rearfoot control. The traction sur-face of the heel should be shock ab-sorbent and of a non-slip material.

The heel cup should fit snugly,which helps prevent the foot fromslipping forward in the shoe. Theshoe should have a medial arch sup-port that is appropriate for the indi-vidual’s arch. There needs to be goodlateral support for the forefoot. Thetoe-box of the shoe must not createpressure and should conform to thegeneral shape of the foot. The vamp(upper front) of the shoe must neverconstrict or cause pressure across themetatarsal area or instep (Figure 16).

Other ConsiderationsCourt surface, style of play, and

foot structure should be consideredwhen selecting a tennis shoe. A com-petitor, who plays mostly from thebaseline, requires a shoe with a lot oflateral support to handle the sideways


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Figure 15: Mid high cut basketball shoe offering awraparound leather stabilizing strap to protectagainst ankle rollover

Figure 16: “High tech” tennis shoe incorporating anadvanced cushion mid-sole, a mid and forefoot stabil-ity system, and a high abrasion court gripping outsole



ATHLETIC SHOE

motion. The shoe needs more side-wall support to stabilize the foot dur-ing the quick lateral, side-to-sidemovements that are encountered.

The baseline player also needsgood support for forward and rear

forces as well as a shoe with a highlydurable sole.

The serve and volley player gen-erates tremendous levels of forwardforces in the forefoot or toe-box areaof the shoe. These players tend to fre-quently charge the net and slide theback foot along the court during theserve, so a shoe with a durable toe-cap (also called a reinforced toe) isessential. Appropriate shoe-wear forthese players includes a large toe-boxto provide adequate room so the toewill not slam against the end of theshoe. Without the appropriate shoe,these players are susceptibleto developing tennis toe (sub-ungual hematoma).

When playing on a hardcourt, shoes with more durablesoles are essential. Clay andgrass courts have softer sur-faces which are more forgivingon shoes, so durability require-ments aren’t as great.

Minimalist Running ShoesLooking back to the first

Olympics, when barefoot-runningchampions competed, many currentrunners have wondered whetherditching their running shoes mightimprove times and reduce injuries.Ethiopian barefoot runner Abebe Biki-la won gold in the men’s marathon inthe 1960 Olympics, and South AfricanZola Budd ran barefoot in the 1984Olympic games. Though theseOlympics brought barefoot runners tothe world’s attention 50 years ago,the popularity of the minimalist run-ning shoe was intensified in thespring of 2009 with the publication ofBorn to Run by Christopher Mc-

Dougall. The book, which became aNew York Times best seller, discussesthe Tarahumara Indians of northernMexico who reportedly suffer fewerrunning injuries than North Ameri-cans do, even though many members

frequently race ultralong distances inthin rubber sandals. Born to Run alsopresents reasons why barefoot advo-cates believe that the best way tolearn good running form is to be com-pletely unshod, letting your legs andfeet feel the subtle changes in impactso the body can be adjusted to lessenthat impact. Today, the minimalistfootwear market, counting only thefoot glove-type shoes with no sup-port, makes up four per cent of theoverall US running shoe business.

The key difference between run-ning in or out of a traditional running

shoe is how the foot strikes theground. Barefoot or minimalist shoerunners land more on the middle orfront of their feet. Runners in tradition-al shoes strike on their heels. Whenthe heel hits first, an immediate forceis sent up the lower leg. When landingon the midfoot, the runner controls thelanding more with their muscles andless force comes up the leg. IreneDavis from the University of Delawareproposes that without a well-cush-ioned shoe inducing a runner to ex-tend their stride, they will take shorter,more frequent steps and land muchmore softly. They will be less likely to

develop tibial stress fractures,plantar fasciitis, and other injuriescommon to runners. Daniel Liebermanof Harvard University found that na-tive runners in Kenya who grew uprunning barefoot most often had aforefoot strike. Their magnitude of im-pact was a third of that of rearfootstrikers in shoes. Many researchers,though, believe that runners needcushioning, both in the forefoot andespecially in the heel, to absorb theshock from the road. But because thecushioning in traditional runningshoes lifts the heel off the ground, ad-ditional hardware such as medial postsand plastic shanks were added to themidsole to provide stability andcounter the effects of overpronation.Fueled by the minimalist shoe phe-nomenon, many shoe makers havebegun to engineer minimalist modelswith new low-to-the-ground designsand ultralight materials that still pro-vide cushioning while increasing flexi-bility. Some of these new shoes haveheel heights of just eight millimeters,compared to 38 millimeters on some of

the popular motion-control shoes.There are two basic types of mini-

malist shoes to choose from; the “bare-foot” shoe and the minimalist runningshoe. “Barefoot” shoes offer the closestfeel to running truly barefoot. Theirsoles provide the bare minimum inprotection from potential hazards onthe ground. Many have no cushion inthe heel pad and a very thin layer (aslittle as 3-4 mm) of shoe between thefoot and the ground. All are character-ized by a “zero drop” from heel to toe(Figure 17). This encourages a more

The serve and volley playergenerates tremendous levels of forward forces in

the forefoot or toe-box area of the shoe.


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Figure 17: Barefoot-type running shoe designed fornatural running and offering a near-barefoot experience

Figure 18: Minimalist trail running-type shoe with azero drop midsole encouraging midfoot or forefootstrike but with ample protection and grip

www.podiatrym.com


ATHLETIC SHOE


natural midfoot or forefoot strike.Traditional running shoes, by con-

trast, feature a 10-12mm drop from theheel to the toe. Runners with higharches tend to have the shortest break-in time and fewest problems with thesetypes of shoes. Runners who are

pronators may struggle to adjust to thelack of arch support. When fitting the-ses shoes, the heel and toes should becomfortably snug and “fit like a glove.”

Minimalist running shoes are across between barefoot shoes and tra-ditional running shoes and offer anexcellent way for many runners toease into barefoot type running. Theseshoes are extremely lightweight inconstruction with little to no arch sup-port and a minimal heel height of 4-8mm to encourage a natural runningmotion and a midfoot strike. Theyoffer some cushioning and flex. Thetoebox is generally roomy to allowtoes to splay inside the shoes, enhanc-ing grip and balance (Figure 18). Sev-eral styles offer some stability postingto help the overpronating runner tran-sition to barefoot-running motion.

Another major consideration whenchoosing a minimalist shoe is the typeof surface that one will be running on.Trail specific shoes feature soles withaggressive tread for more traction.Some models offer rock plates in thesoles, increased torsional rigidity andleather uppers to protect feet fromabrasions. Road-specific shoes tend tohave razor-siped rubber soles for en-hanced slip resistance on slick sur-faces. They offer little protection fromsharp or uneven terrain. Most minimal-ist shoes can be worn with or withoutsocks. The benefits of wearing socksinclude extra warmth, odor deterrence,and blister protection. For “five finger”type shoes, special socks are required.

Just as radically increasing mileageor speed can lead to injury, so canmaking a major change in shoes. Arunner should ease into the use of min-imalist shoes. If someone is used to a

stability shoe, they should start with aslightly more cushioned and supportiveperformance trainer before moving to aracing flat or barefoot shoe. Most run-ners should stick with their regulartrainers for long runs and use theirminimal shoes for shorter distances

until they are used to training on them.They can also build up foot strength bydoing barefoot strides on grass and bywalking in minimal shoes. A gradualtransition should help keep the runnerfrom getting injured. PM

References1 Academy.Com: Different types of cleats.

<http://www.academy.com/index.php?page=content&target=sports_tips/baseball-_softball/types_of_cleats>

2 American Academy of Podiatric SportsMedicine: Selecting an athletic shoe.<http://www.aapsm.org/fit_shoes.htm>

3 American Orthopedic Foot & Ankle Soci-ety: Athletic shoes and playing surfaces affectperformance and injury levels. <http://www.aofas.org/i4a/pages/index.cfm?pageid=3395>

4 American Orthopedic Foot &Ankle Society: Selecting athletic shoes.<http://www.aofas.org/i4a/pages/index.cfm?pageid=3393>

5 Caselli MA: How to recommend shoes formarathon runners. Podiatry Today 13(7), 2000

6 Caselli MA: Getting involved with soccer.Podiatry Management 22(7), 2003

7 Ciullo JV, Ciullo CR: Track and Field. InFu FH, Stone DA (eds.), Sports Injuries, 2nd Ed,Lippincott Williams &Wilkins, Philadelphia,2001

8 Dib MY, Smith J, Bernhardt KA, Kauf-man KR, Miles KA: Effect of environmentaltemperature on shock absorption properties ofrunning shoes. Clin J Sports Med 15(3), 2005

9 Dick’s Sporting Goods: Determiningyour shoe size.<http://www.dickssportinggoods.com/info/index.jsp?catagoryId=222865>

10 Dick’s Sporting Goods: How to lace ath-letic shoes. http://www.dickssportinggoods.com/info/index.jsp?categoryId=690482&infoPath=222981

11 Dick’s Sporting Goods: How to tell whenyour shoes are dead.<http://www.dickssportinggoods.com/info/index.jsp?catagoryId=412022>

12 Dick’s Sporting Goods: How to buy foot-ball cleats. <http://www.dickssportinggoods.com/info/index.jsp?catagoryId=222820>

13 Dick’s Sporting Goods: How to buy bas-ketball shoes. <http://www.dickssportinggoods.com/info/index.jsp?catagoryId=222834>

14 Glover B, Glover SF: The CompetitiveRunner’s Handbook. Penguin Books, NewYork, 1999

15 Harring KM, Richie DH Jr: Friction blis-ters and sock fiber composition. A double blindstudy. JAPMA 80:63-71, 1990

16 Health Link (Medical College ofWiscon-sin): Consider use when selecting athleticshoes. http://www.healthlink.mcw.edu/article/999211949.html

17 Ho SSW: Basketball and Volleyball. InReider B (ed.), Sports Medicine, The School-Age Athlete, 2nd Ed,WB Saunders Company,Philadelphia, 1996

18 JamesonM, Sentinel O: Barefoot-runningtrend has legs, UCF researcher finds. OrlandoSentinel. [Internet]. 2012 Aug 12. Availablefrom: http://articles.orlandosentinel.com/2012-08-12/health/os-barefoot-running-20120812_1_minimalist-shoes-south-a

19 Parks B: Is less more? Runner’sWorld.[Internet]. 2010 Nov. Available from:<http://www.runnersworld.com/article/0,7120,s6-240-400—13691-F,00.html>

20 Quinn E:When to replace runningshoes. http://sportsmedicine.about.com/od/tipsandtricks/a/replaceshoes.htm

21 Reider B, Belniak R, Miller DW: Football.In Reider B (ed.), Sports Medicine, The School-Age Athlete, 2nd Ed,WB Saunders Company,Philadelphia, 1996

22 RomeroM: Expert’s picks: Bestminimalist running shoes.Washingtonian[Internet]. 2011. Available from:<www.washingtonian.com/blogs/wellbeing/guides/experts-picks-best-minimalist-running-shoes.php>

23 Rovel D: Minimalist running shoes arethe next target in court. CNBC [Internet]. 2012.Available from:<http://www.cnbc.com/id/47875555/Minimalist_Running_Shoes_Are_The_Next_Target_In_Court>

24 SafranMR: Racquet Sports. In Fu FH,Stone DA (eds.), Sports Injuries, 2nd Ed, Lip-pincott Williams &Wilkins, Philadelphia, 2001

25 Winn Y: How to choose barefoot/minimalist running shoes. [Internet] 2012.Available from: http://www.rei.com/learn/expert-advice/how-to-choose-barefoot-minimal-ist-running-shoes.html

Dr. Caselli is AdjunctProfessor in the Depart-ment of Orthopedic Sci-ences at NYCPM, Ad-junct Professor atRamapo College of NewJersey, and a Fellow ofthe American College ofSports Medicine.

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Trail specific shoes featuresoles with aggressive tread for more traction.

CME EXAMINATION

1) Sports-specific athletic shoesshould be recommended:

a) Only for competitive ath-letesb) Only when engaged in asport more than three days aweekc) Only when used in competi-tive playd) For anyone participating ina sport more than three hoursper week

2) Which one of the following isnot correct concerning proper ath-letic shoe fitting?

a) Feet should be measuredeach time shoes are purchasedb) Athletic shoe size should bethe same as a comfortably fit-ting dress shoec) Shoes should be fitted at theend of the day or after exercised) Shoes should be fitted to thelarger foot

3) A running shoe should be re-placed at least every:

a) 100 milesb) 250 milesc) 500 milesd) 750 miles

4) Studies have shown that thebest material for an athleticsock is:

a) Cottonb) Nylonc) Acrylicd) Polyester

5) The best running shoe last foran over-pronated heavy athlete is:

a) Straight board lastedb) Curved slip lastedc) Straight slip lastedd) Curved combination lasted

6) Which of the following is not acharacteristic of the treaded outersole of a running shoe?

a) Designed to resist wearb) Primary shock absorber ofshoec) Provides tractiond) The harder the material, theheavier

7) The best running shoe to rec-ommend for an athlete with high,rigid arches is:

a) A shoe offering maximummotion controlb) A straight-lasted shoec) A stability categorized shoed) A curved combination-last-ed shoe

8) The proper fitting of a soccershoe includes:

a) 1/2—3/4 inch of space be-tween the end of the longesttoe and largest footb) Slight heel movementc) Snug, glove-like fitd) Fit one size larger thandress shoe

9) Which one of the followingdoes not affect the shock absorb-ing quality of a running shoe?

a) Running on a cold dayb) Running over 10 miles a dayc) Running in a shoe with agel insertd) Both a and c

10) Soccer cleats should havelonger studs when playing in whichone of the following conditions?

a) Soft field in the rainb) Hard cold groundc) Synthetic turfd) Long studs should not be usedfor any of the above conditions

11) Which one of the followingfootball positions usually prefershigh top cleats?

a) Running backb) Wide receiverc) Linemand) Quarterback

12) A stiff plate is sometimes in-corporated into the sole of a soc-cer shoe to reduce the incidenceof which one of the following con-ditions?

a) Subungual hematomab) Turf toec) Plantar fasciitisd) Ankle sprains

13) The main disadvantage of metalcleats on baseball shoes is that:

a) They afford poor traction onhard fieldsb) They result in an increasedrisk of injuryc) They can only be used inLittle Leagued) They offer no cushionedmid-sole

14) Which one of the followingbasketball shoe cuts would besafest to recommend for most ofyour basketball playing athletes?

a) High topsb) Mid topsc) Low topsd) It makes no difference

15) Which of the following clo-sure systems made for basketballshoes is usually the least desirablefor offering good support?

a) Lacesb) Zipperc) Velcrod) Laces and straps


SEE ANSWER SHEET ON PAGE 159.


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Continued on page <None>

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If you’re not enrolled, you may also submit anyexam(s) published in PM magazine within the pasttwelve months. CME articles and examinationquestions from past issues of Podiatry Manage-ment can be found on the Internet athttp://www.podiatrym.com/cme. Each lesson isapproved for 1.5 hours continuing education con-tact hours. Please read the testing, grading and pay-ment instructions to decide which method of par-ticipation is best for you.

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CME EXAMINATION

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16) Stiff materials are commonly used on themedial side of the mid-sole of a basketball shoeprimarily to:

a) Increase shock absorptionb) Reduce inward rolling of the footc) Prevent ankle sprainsd) Increase shoe life

17) The main reason why many women should notuse men’s basketball shoes is that:

a) Men’s shoes are too heavyb) The lacing system is not designed for awoman’s footc) Men’s shoes are not permitted in women’sprofessional and collegiate playd) They often do not offer an appropriate degreeof stability

18) A tennis shoe without adequate toe-box roomis likely to result in which one of the followingconditions?

a) Turf toeb) Subungual hematomac) Sesamoiditisd) Plantar fasciitis

19) Which one of the following conditions is notassociated with athletic shoes that are fit too large?

a) Blistersb) Ankle sprainsc) Instabilityd) Nerve impingement pain

20) The individual that should select the mostappropriate sports shoe for the athlete is:

a) The sports medicine doctorb) The athletic coachc) The athleted) Each of the above must be involved in theselection.

See answer sheet on page 159.

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LESSON EVALUATION

Please indicate the date you completed this exam

_____________________________

How much time did it take you to complete the lesson?

______ hours ______minutes

How well did this lesson achieve its educationalobjectives?

_______Very well _________Well

________Somewhat __________Not at all

What overall grade would you assign this lesson?

A B C D

Degree____________________________

Additional comments and suggestions for future exams:

__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

1. A B C D

2. A B C D

3. A B C D

4. A B C D

5. A B C D

6. A B C D

7. A B C D

8. A B C D

9. A B C D

10. A B C D

11. A B C D

12. A B C D

13. A B C D

14. A B C D

15. A B C D

16. A B C D

17. A B C D

18. A B C D

19. A B C D

20. A B C D

Circle:

EXAM #8/12Selecting the Proper Athletic Shoe

(Caselli)

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Selectingthe Goals ProperAthletic Shoe - Podiatry … · OCTOBER2012| PODIATRYMANAGEMENT|147 A thleticshoesareanim - portantpartoftheequip - mentusedbyhighperfor-manceathletesandplaya