Thinking Of Changing To Maximalist Running Shoes?

Picture from Nike

I received an email recently on what shoes top Japanese runners want to be wearing. I'm sure not only the top Japanese runners want the shoe, I bet all the top runners in the world would dearly love to get a pair of Nike's Vaporfly.

Better still if they can get a pair Kipchoge's prototype shoe dubbed the Alphafly that he wore during the sub 2 hour marathon in Vienna.

Picture from Nike

Consider Reid Coolsaet, a 2-time Canadian Olympic marathoner who let his shoe contract with New Balance expire in 2019 so he can use the Nike Vaporfly to try and qualify for a third Olympics. He has been sponsored by New Balance and wearing their running shoes since 2008.

If you compete in running races or support your friends or loved one at their races you will surely notice that ultra thick, super cushioned shoes are quite the norm now. This is different from the minimalist, barefoot style shoes that were popular just a few years ago.

Some runners definitely got hurt wearing the barely there, minimalist type running shoes, while others did not like the skimpy feel which probably contributed to the wide swing towards the maximalist  running shoes that are popular now.

Running in these thickly cushioned shoes can affect running form in surprising ways as found by researchers on recreational athletes. As I wrote before in a previous post, these recreational runners pound harder and pronate more in thickly cushioned shoes compared to standard running shoes (Pollard et al, 2018).

In a follow up study to Pollard et al's study (2018), the researchers had the runners run in the maximalist shoes for six weeks (so the runners get used to them) before they repeated the testing.

The runners somehow did not adjust to the shoes. Interestingly, the runners still landed with greater force and pronated more in the maximalist shoes compared to their initial test run (Hannigan and Pollard, 2019).

There was a yet another follow up study which was just published last month on a new group of male and female recreational runners (Hannigan and Pollard, 2020). The researchers got New Balance to custom make a pair of their neutral running shoes to allow them to alter the shoe by adding or removing foam. This shoe can then serve as minimalist, traditional or maximalist shoes to allow the researchers to focus solely on the role of cushioning in the runners' form.

This time, a few of the runners in this study were found to land heavily in the minimalist and maximalist shoes, but they pronated most in the maximalist shoes.

The authors commented that looking at the three studies as a whole would suggest that extra cushioning does influence several aspects of the way we run. The thickly stacked soles of maximalist shoes seem to subtly affect balance, making the shoe more unstable. This is then likely to increase ankle movement and pronation.

With the extra layers of foam, it also affects the way our legs feel the ground when we land. This affects our muscles, brains and our nervous system in coordinating and anticipating foot fall when we walk or run.

Points to note are the researchers did not look at how fast the runners ran nor did they ask how the runners felt in the maximalist shoes. They also did not track actual running injuries in the runners studied so they cannot say if the extra cushioning contributes to or reduces injury.

Even though I have treated runners who have gotten seriously injured while wearing maximalist running shoes, I'm definitely not against any runners switching to them. Provided they have tested them and ease into training with them slowly and finding them suitable.

Reading the 3 articles and interpreting their results has made me wonder if the thicker soled models are right for recreational runners since comfort and injury risks are different compared to elite runners.


*Note -In the 2018 and 2019 running studies, the runners wore Hoka running shoes and not the Nike Vaporfly.

References

Hannigan JJ and Pollard CD (2019). A 6-Week Transition To Maximal Running Shoes Does Not Change Running Biomechanics. AJSM. 47(4): 968-973. DOI: 10.1177/0363546519826086.

Hannigan JJ and Pollard CD (2020). Differences In Running Biomechanics Between A Maximal, Traditional And Minimal Running Shoe. J Sci Med Sp. 23(1): 15-19. DOI: 10.1016/j.jsams.2019.08.008

Pollard CD Ter Har JA et al (2018). Influence Of Maximal Running Shoes On Biomechanics Before And After A 5k Run. Orth J Sp Med. 6(6): 2325967118775720. DOI: 10.1177/2325967118775720.

Influence Of Maximalist Running Shoes On Biomechanics

My patient's new running shoes

I had a runner come in to our clinic today. After finishing the Boston marathon in April recently, he had been taking it easy. But since his next race is the New York marathon later on 4th November this year, he started training again just this past week.

After asking the necessary questions regarding his training, I then noticed he was wearing a new pair of maximalist  running shoes. He'd bought it after running Boston as it was a lot cheaper there than in Singapore.

My patient thought that the mega cushioned maximalist shoes would help protect him from the pounding that comes with the running (since he's in excess of 6 feet). 

It was then really fortunate that I'd recently just read an article on the influence of maximalist running shoes on running biomechanics.

Women's NB 880

In that study, researchers had 15 female runners tested by running 5 km on two occasions on a treadmill. Each time, their running biomechanics were analysed before and after running in a pair of "traditional" New Balance (NB) 880 which had a heel height of 33.3 millimetres and forefoot height of 23.2 mm versus a Hoka One One Bondi 4 (41.6 mm heel, 34.7 mm forefoot height). 

Hoka One One Bondi 4

It is important to note here that the runners were more accustomed to shoes like the NB than the Hokas.

Before reading the article, it seemed logical to me to expect the plush mega cushioned shoes would be more supportive for the tested runners.

However, runners in that study had greater vertical loading rates (the speed at which impact forces affect the body) and peak impact forces (maximum amount of force incurred at one time) in the Hokas than the NB shoes. Meaning, when the runners wore the more cushioned Hokas, the bodies absorbed more of the impact forces of running and in less time. While wearing the regular NB shoes, the impact forces of each step were lower and more evenly spread over time.

The authors noted that even though all the tested runners were assessed to be heel strikers, the higher impact forces while wearing the Hokas cannot be totally attributed to a change in foot strike pattern. In other studies, running in mega cushioned shoes result in runners landing with stiffer knees, resulting in higher impact forces.

Another point to note is that the runners in this study were new to maximalist shoes. I don't know about you, for me, if I get a new shoe to run in (or new tennis racket or any new equipment), my body takes a while to get used to it and run efficiently with it. (Note: even my wife who got a new iPhone X previously took a while before she liked it).

Previously, when minimalist running shoes were more popular caution was advised when trying those shoes. This study suggest such caution if your new running shoes have significantly more cushioning than your previous.

It will be interesting to note what happens to the impact forces when you get used to the maximalist running shoes. The authors of this study are now conducting follow up research on the same runners. The runners are monitored by starting with 20 percent of the weekly mileage in the Hokas, and adding 20 percent the next week and so on.

As I've suggested before, it's probably wiser if you have a few different pair of running shoes so that you can rotate your running shoes to minimize your risk of injury. Now, which runner can resist getting another pair of running shoes to run in?


Reference

Pollard CD, Ter Har JA et al (2018). Influence Of Maximal Running Shoes On Biomechanics Before And After A 5k Run. Orth J Sp Med. 6(6): 2325967118775720. DOI: 10.1177/2325967118775720.

Run Faster With Zero Drop Shoes

And we thought zero drop shoes were 'dead'. Zero drop shoes were all the rage after Christopher McDougall wrote about the Tarahumara Mexican Natives in his book, 'Born To Run', in 2009. Remember those Vibram shoes? Now, Vibrams I will classify as barefoot type and then there were minimalist type running shoes (or racing flats). Maximalist shoes have since replaced minimalist zero drop running shoes.

The research article I read was to determine if shoe heel-toe drop affects running economy. The researchers studied how shoe heel drop affects metabolic energy (total energy usage) in runners during running. 

20 runners were recruited for the study. Running speed was 3.5m/ sec (or 12.6km/ hr) in custom footwear that only differed in heel-toe drop of 0, 10, 20 and 30 mm. Running shoe and weight of the shoe were fixed with a US size 10, Air Pegasus. The heaviest shoe mass was the 30 mm shoe at 260 grams. Small weights were attached to the exterior heel of the shoes with the lower heel drops (pictured below).

During the research, the runners first did a standing 5 minute test and then ran for 5 minutes in their own running shoes at 3.5m/ sec (or 12.6km/ hr) on a force measuring treadmill (Treadmetrix). Each runner then completed a 5 min running trial at 3.5m/ sec in each of the 4 heel-toe drop shoe conditons in a randomized order. Participants rested at least 5 minutes between the runs.

To measure metabolic energy (or total energy usage), open circuit expired gas analysis was done to record oxygen and carbon dioxide uptake. Normalized net metabolic power (W/kg) was derived by subtracting the participants's corresponding standing metabolic power from each running trial and divided by their masses.

The results show that higher heel drop shoes increased plantar flexion in the ankles and knee flexion during ground contact. This we know from past research since runners who previously had knee pain had decreased knee forces and knee pain when they switched to zero drop running shoes.

Higher shoe heel-toe drop also increased metabolic power by 0.08W/kg per 10mm of heel-toe shoe drop.

One limitation in the study was that they only had one relatively large shoe size (US 10) which resulted in only one female participant in their study. Future studies may be warranted to test for potential effects between male and female runners.

Based on the researchers findings, they concluded that decreasing shoe heel-toe drop from 20mm to 0mm elicits a 1.6 percent more economical running which is predicted to improve total marathon performance by 1-3 minutes. 

Perhaps we will see the carbon plated maximalist running shoes come with zero heel-toe drop next?

Reference

Renninger K, Beck ON (2026). Shoe Heel-Toe Drop Affects Running Economy. J Appl Physiol. 141(1): 280-290. DOI: 10.1152/japplphysiol.00886.2025

Don't Always Believe What You Read

Below is an article from yesterday's Financial Times. John Connors, the quoted podiatrist suggests wearing "maximalist" running shoes like him "as we get older, we are the ones who need the most shock absorption underneath our shoes."

Well, my last patient yesterday started having knee pain after he started wearing Hokas. This patient of mine has done the grand daddy of triathlons, the Hawaii Ironman triathlon and has also run the Gobi March race, a 250 km desert race, before you think my patient is a rookie runner. He too was probably "fooled" by what he read from another article about the benefits of Hokas.

My patient's Hokas

My patient's knee is a lot better after yesterday's treatment, but I think he's not going to wear his Hokas for now. Don't get me wrong, the shoe may suit some runners, but not my patient or you for that matter.

Here's the article.

Fat-soled running shoes to protect middle-aged knees

25 February 2014

The Financial Times

As I huffed and puffed down the glorious Bowen Road jogging path during my last visit to Hong Kong, I was surprised to see a line of runners approaching, wearing what appeared to be black gloves on their feet instead of shoes. These, of course, were the now famous Vibram Fivefingers, which helped start the current fad for minimalist trainers.

The idea behind minimalist athletic shoes is simple enough: the closer to running with bare feet, the better. The theory is that raising the heel above the toes causes all sorts of bad things in your feet. Christopher McDougal’s exciting book Born To Run details how Mexico’s Tarahumara Indians run 100km mountain races in leather-thonged sandals without a whimper.

Back at home base I bought a pair of minimalist trainers and took them out for a spin. Eight hours later, it felt as if someone had poked needles into my calves. For an explanation, I turned to John Connors, a New York podiatrist who advises the world’s elite long-distance runners and was physician to the US team at the London Olympics.

Dr Connors laughed and said he had been seeing an increasing number of patients who had tried to adopt minimalist running shoes. “People say to me we weren’t designed to run with trainers,” Dr Connors says. “But we were also not designed to run on concrete and macadam.”

Dr Connors says that when you run, you are hitting the ground with four times your body weight, and hard surfaces such as concrete cannot absorb the shock. So the force goes right back up your leg. “Minimalist shoes are putting more stress and strain on the Achilles tendon, and more stress on the bones of the foot and leg,” he says. “I’ve been seeing a spike in Achilles injuries because of the eccentric load being placed on the tendon.”

He believes middle-aged runners need to take special care even if they are frequent exercisers because cartilage in their knees is beginning to wear down through normal use. His solution? “Lessen the load on the knee by getting something underneath you that reduces the load.”

As if by divine intervention, a new type of running shoe has started to appear in stores in the US, Europe and parts of Asia as an antidote to the minimalist trainer craze. It is called the Hoka One One and is the brainchild of Jean-Luc Diard and Nicolas Mermoud, former executives of French sporting goods company Salomon.

Mr Diard and Mr Mermoud are ultra-marathon mountain runners and wanted a shoe that would not destroy their legs when they ran downhill, which puts more stress on the lower legs. The Hoka idea they came up with, more by trial and error than scientific theory, has between 1.5 and 2.5 times the cushioning of normal trainers, depending on the model. But because the cushioning is evenly layered along the bottom of the shoe, the Hoka’s heel is actually much more like a minimalist shoe in terms of drop to the toe.

After studying the world’s elite runners, Dr Connors says that the best way to land when running is on the mid-foot, because the body then has the ability to absorb the shock and propel the body forward. The Hokas are ideal for this because of the way the cushioning is centred on the mid-foot.

Dr Connors says that while most elite runners use traditional trainers, he now runs in Hokas because he has a torn meniscus, the shock-absorbing cartilage of his knee: “As we get older, we are the ones who need the most shock absorption underneath our shoes.”

Foot Strengthening To Prevent Running Injuries?

We had a 16 year old patient who came in with foot, shin and knee pain this week. She had been prescribed orthotics and had been wearing them for the last ten years. Every time she tried running, her knees and shin start to hurt during and the day after her run. Somehow, the orthotics did not seem to help with the pain.

She also mentioned that she wore her running shoes (with orthotics) everywhere she went as she was told that other footwear and slippers were 'bad' for her.

You have read from a previous post that contrary to several long held beliefs, most biomechanical and structural factors are not reliable at predicting running related injuries. Naturally, I was interested when a recent study investigated whether foot muscle strengthening reduced the incidence of injury rates over a one year follow up. Especially since I wrote that my patient (plus myself included) would be bored doing foot strengthening exercises.

Researchers had 118 runners who ran between 20-100 km a week for their study randomized into two groups. The foot muscle strengthening (FMS) group received 8 weeks of 12 foot-ankle exercises done once a week supervised by a physiotherapist and 8 foot-ankle exercises done three times a week at home with remote supervision.

A second control group (CG), did a 5 minute placebo static stretching protocol three times a week with weekly feedback from a physiotherapist. 

After the 8 week intervention, both groups were instructed to continue their respective exercises three times a week until the end of a 12 month follow up while recording their adherence.

The researchers suggestion that a stronger foot will better dissipate excessive and cumulative loads appears supported as foot strength gains were correlated with time to getting injured. 

Altogether, 28 runners ended up with a running related injury, 20 (32.8%) from the CG and 8 (14%) from the FMS group. The results showed that runners in the CG were 2.42 times more likely to suffer a running related injury compared to those in the FMS group. 

The researchers also found that the larger gains in foot strength over the 8 weeks of training correlated with the runners taking a longer time to get injured. They also reported that by the fourth month of follow-up, differences in cumulative running related injury risk were evident between the 2 groups and suggested that 4-8 months of the regime may already be effective.

However, each runners response to foot strength improvement and how this relates to different injury types or sites will require further investigation.

My thoughts are that this foot muscle strengthening regime is exactly the same as wearing the Vibram Five Fingers shoe. Remember them? They were really popular before the thickly cushioned or maximalist shoes became the rage.

In the study, the foot strengthening program takes 20-30 minutes to complete. This time commitment may be a consideration. As a physiotherapist, I should not be writing his, but if I had extra 30 minutes, I'd rather run outside than do foot strengthening exercises. 

I'm just being honest here. There are plenty of demands on my time being a father to 2 young boys, physiotherapist, business owner and trying to find time to exercise. Probably some of you who are also pressed for time would agree.

Back to our patient. I suggested that she remove her orthotics from her running shoes and gradually increase time walking with them first before attempting to run. The toe spring from her shoes and orthotics would lead to her having weaker intrinsic foot muscles and increase her chances of getting pain in her foot, shin and knees and possibly getting injured.

Reference

Taddei UT, Matias AB and Duarte M (2020). Foot Core Training To Prevent Running-related Injuries: A Survival Analysis Of A Single-blind, Randomized Controlled Trial. AJSM. 48(14): 3610-3619. DOI : 10.1177/0363546520969205.

My own minimalist version of the Vibrams that I use to walk around with and lift weights to strengthen my intrinsic foot muscles. My calfs get too sore when I run with them. My brother bought a few pairs for me when he was working in Shanghai for $RMB 30 (or S$6) , much cheaper than Vibrams ($149-$209 here in Singapore).

My Basic Guidelines For Running

Screenshot from the talk

Thank you to those of you who took time to attend the talk on running we had 3 days ago. From the 'live' questions and those I received via email, it seems like many Singaporeans did take up running last year during the circuit breaker/ lockdown. Good to know that many have continued running since then.

Many of these runners are not aspiring to complete a marathon (not yet anyway). However, they all seem to want to run faster. Well, as runners, we all want to run faster and longer for some reason. 

Over the years, I've put together a set of guidelines for runners, my patients or anyone who wants to keep running for health, fitness or performance.

Some runners swear by their heart rate monitors (HRM). Those who know me know that I do not like training with a heart rate monitor (HRM) even though I was sponsored by Polar Heart Rate Monitors when I was still competing. I just used their HRM as watches. (FYI - Polar was the market leader for HRM before Garmin came along and disrupted that market). 

I am not against anyone training with HRM's. My take is that our bodies do not work in physiological zones where exceeding aerobic zones is a crime. When feeling good, your easy runs can be a little faster, But if you're tired or not recovering quickly, then I'd say your easy run can be at a snail's pace. Better still take a rest day. No doing planks, core exercises etc, just total rest. 

The next few suggestions are specially for those who run ultras. Please don't feel obligated to follow anybody's training, especially if they're pro or semi-pro. This means trying to clock 100 km a week, running twice a day etc. All of these tips/ suggestions on training have too many confounding factors and variables so do not even venture there. Plus in sunny and super humid Singapore, it takes a lot more to recover from all that mileage.

Don't keep chasing mileage and vertical (climbs) totals. They are variables for stress, but they are not the actual stress experienced by your body. A 20 km run is just a 20 km run. Or it may act like a 30 km run if you have been up at night with a sick child or rushing a dateline at work. Our bodies know the distance we've covered, but stress from other non physical factors mentioned above is interpreted as stress by the body too. More stress is not always better. Our bodies can adapt to lower or higher volume as long as the stress is appropriate for you.

I have patients who deliberately fast before training to improve performance. Perhaps it MAY improve energy efficiency in some (very few) athletes, but I rather they eat and find their 'strong' to train harder instead of messing with their sensitive metabolic pathways.

Those of you who listened to my talk will know that I'm not recommending minimalist nor maximalist shoes for everyone. Wear shoes that are comfortable for you and not anyone else. Different shoes work for different people.

Do stay active and engaged in activities and groups you find meaningful and care about you, as they help increase both quality and quantity of life. Social interaction is critical for mental and physical health.