Friday, March 2, 2012

Low Heel-Toe Drop Running Shoes and Achilles Problems...

Found this on Facebook, I tried to find the source on this image but couldn't.
I've mentioned on this blog in the past that I have been having some problems with Achilles tendon pain. So far it hasn't been anything major, just a dull ache that comes and goes depending on how hard the day of training is, the problem is that is directly related to the number of mile I run, for example my muscles and heart are fine with a 50+ miles week, but once I get over that set threshold my Achilles hurts at the point of insertion. Additionally speed seems to hurt my heel as well, if I do a tempo run of say 4 miles at a 6:30 pace, or even just do my long run at a 7:05 pace my Achilles hurts, but I can run virtually any distance at a 7:30 pace and be just fine...

It's been quite a quandary for me over the past few months, but I think I finally have an answer. When I first started running I was running in a pair of high heeled monstrosities that had a heel-toe drop of something like 13mm, which obviously caused problems, especially since I naturally am a mid foot striker, which is impossible with that sort of drop. The dissonance between my preferred mid foot strike and huge heel of those shoes caused me to get the beginnings of shin splints, so in order to avoid that I went the exact opposite direction and started running in Saucony Kinvaras, which served me quite well for the most part, but which I think are the cause of my recent problems. The thing is that those shoes (the Kinvaras) are great for the sort of distances I was running at the time, but now that I'm moving up to greater distances (over 55 mpw) I need to start running in shoes that tailor to greater distances.

I honestly think that the problem stemmed from a lack of understanding on my part regarding physiology, and a feeling that I was tough enough to handle running a lot of miles in a minimal shoe, when in fact all the evidence pointed against this hypothesis. After all you don't see Meb, or Ryan Hall, or even the great African runners like Haile Gebrselassie (who the minimalists point to as examples of minimalism and form) running in very minimal foot ware, the simple fact is that these runners are running vast miles, well over the amount the human body evolved to run in bare feet, or the equivalent minimal foot ware.

As for science, one does not need a medical degree to figure out that a lower heel position such as that found in a minimal shoe will necessarily cause more stress to the Achilles insertion, and cause increased pressure to the retro calcaneal, and subcutaneous Achilles bursas, which are the exact points at which I am hurting. As a person who has done extensive reading on the subject of exercise physiology and who has competed at various sport at a high level I am a bit ashamed to admit that I didn't catch onto this before...

So with this new found knowledge I am going to begin an experiment based on the hypothesis that my heel pain is the result of continual running in low heel-toe drop shoes which cause greater stresses on the Achilles tendon and associated physiology. As such I plan to purchase a new pair of shoes after this weekend's race and see if they help, so far I have looked at the Saucony Guide 5's, Asics Gel-DS's, or the Asics Gel Cumulus. Even though this experiment of mine will have a ton of random variables and next to no scientific validity I hope that it will help me kick this heel pain for good and let me extend my training in the direction I want it to go. I will be sure to update this blog regularly with my experiences in the new foot wear direction. 

For further information on sports injuries and exercise science check out my friends blog ExerSci-Climbing

26 comments:

  1. You might also want to look at the new Saucony Cortanas...they are low drop, but neutral with respect to padding (not minimalist), both heel and forefoot.

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  2. I don't quite get it... So you switched from 13mm heel-to-toe drop shoes to zero drop shoes, and now you're switching back to 12mm drop shoes? How about shin splints you had with 13mm drop shoes?

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  3. Yeah it's kind of confusing, I spoke to my physio therapist and she suggested making the move back to shoes with a larger heel drop but still running in my more minimal shoes a few times a week in order to strike a balance between the two types of shoes. So far it's working and things have been improving. Thanks for the comment.

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    1. Thank you for your reply. It's a great article btw. I have few more questions, if you don't mind :)

      1. Do you think at first the high heel drop shoes will actually change your midfoot strike to heel strike, causing shin splints? So different shoes will change someone's running form?

      2. When you switched to minimal shoes, you got new problems, was that because the shoes didn't have enough cushion? My understanding is that, low heel drop shoes is good for our running form, but for road run maybe it's better to have some cushion. So I think zero-drop shoes with enough cushion may be a good choice. But I didn't have a chance to try that out yet, still adapting to five fingers on treadmill :)

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    2. I think I'll answer your questions individually...

      1. I had this concern when I started to make the switch back to high heeled running shoes, however I didn't notice this to be a problem, and now that I have put a few hundred miles on the new shoes I can say that the wear pattern on them is consistent with a forefoot strike and not the dreaded heel strike I was afraid of going back to.

      2. From what I have heard from others and what I was told by my doctor is that in a lower heal drop shoe the achilles is stretched farther than it would be in a higher heeled shoe, and over the course of many miles the achilles is stretched many thousands of times, it is this added stress and perhaps also the lack of padding that can cause achilles issues. I think the key for me would have been to switch to minimal running shoes even more slowly than I did, perhaps starting with only a run every other week, or only running on flat terrain for several months before starting to run in them full time. Once again thanks for the comment, and it sounds like your being pretty smart about your transition to minimal shoes with the treadmill running, good luck!

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    3. Thank you very much for your reply! It's very helpful! I think you're right, running with shoes having different drops regularly helps us to train/rest different muscles. It's like micro cross training, I guess...

      Again, thanks for your help. Happy running!

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    4. Micro cross training... I like the phraseology, in fact I may have to use that. Glad I could help!

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  4. Thanks for these comments. I run from around 5K to 12K multiterrain distances and have hardly ever had any achilles or calf problems over the years. I recently switched from standard cushioned gel highish heeled Asics ~330g to 4mm drop lightweight ~180g Sauconys(Road/Multiterrain) and lightweight ~180g Saucony Kilkenny spikes or Walsh PB Elite studded fell runners for XC(stiffer and heavier ~280g than Sauconys with minimal drop). I was especially attracted by the lightness of these shoes. My speed improved noticeably and I love the lightness of the Sauconys. However, now I have developed pain and tenderness in both my achilles tendons, especially using the Walsh shoes. I have had to stop running for the time being.
    The minimal drop from heel to toe obviously does put a lot more strain on the ankle. At the point of pushing away, there is no support for the heel and all the weight is taken on the achilles. Whereas, with the standard shoe, the heel is supported through the initial stages of the stride and there is also some rebound from the cushioned heel which helps to raise the ankle. The total ankle raise required is also less. While running I am very conscious of the extra load on the raised ankle. The Walsh shoes have a stiff sole with the toe of the shoe markedly upturned when seen on a level surface. This results in an even higher position of the ankle at the point of pushing away, as you have to be right on the front of the shoe to contact the ground with the ball of the foot.
    I would warn anyone of the danger of slavishly following fashion in shoe design. There are already derogatory comments about high heeled cushioned shoes appearing everywhere and they are definitely seen as old fashioned now. However, they kept me running for years with little or no injuries. Now after a month or two I am injured and unable to run without pain. Come back Asics.......!!!

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    1. Hey GG,

      Great comments, and sorry it took me so long to respond. I'm always glad to hear from another runner about their experiences with low heal drop shoes and the new running trends. Over the past few months I have spoken to a lot of other runners that have had the same experiences, and I think that among serious runners there is a lot of doubt about the minimal craze.

      Good luck with your injury and I hope you are feeling better, I'm finally almost 100% now after months of reduced training volume.

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  5. Finally....I thought I was crazy. Been running with the Shadow 6000 for years, which is a 12mm drop. I tried a lower, lighter shoe like the Kinvara and suffered severe achiles injuries EVERY TIME I SWITCHED SHOES. I will never switch back again. FYI...the Saucony Ignition is lighter, but still with a 12mm differential.

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    1. You're not crazy, I thought I was too until I started talking to more people about the problem, and the more people I talked to the more often I heard stories of people getting hurt in exactly the same way I did. I think this is going to be an increasingly common story as the minimal movement continues, it may work for some people, but it is catastrophic for others.

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  6. I have had a similar experience. Last year in August, I purchased the Kinvara 2 shoes. I didn't research them, they just felt light and comfortable. I ran a few weeks in them, then tested it out on a 4 mile race. My time was 11 seconds faster than the previous year, same race. 2 weeks later, I ran a 10k, same race as the year before, but 30 seconds faster, another 10k and another 5k with also faster times. However, my achilles started to hurt in both legs during the second 10k. By that last 5k in late October, the heel and Achilles became a big problem and had to scrap races for the rest of the year. Did some research and realized that at age 54, I should not have went from a higher heel drop to a low heel drop without transitioning. I took off about 3 weeks from running in January, hoping it would heal. It is a lot better now, but still some discomfort, but doing a lot of light strengthening of the calves. I really liked the low heel drop of the Kinvara 2, nice shoe, but at my age, I am not sure I can risk trying them again. It really train wrecked my running season last year and I am still paying for it.

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    1. It took me month to get even close to being better, I wrote this article when my pain was about at its worse, and today 13 months later I am still not entirely right. Granted I'm much better and my heel only bugs me after long hilly runs, but it still does hurt from time to time. I hope your recovery goes a bit faster!

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  7. Im having similar problems. I ran most of last year in various zero or low drop shoes and pretty much settled on a 4-6mm drop, which i felt catered to my mid/fore foot strike as well as providing some cushioning over longer distances.
    I ended up with runners knee which stopped me running for a few weeks. I started again and quickly ended up with tight calves so I bought a pair of Nike Flyknit Lunars (best upper I have ever used) and some Addidas Boost. I immediately noticed a gradual relaxing of my calves however almost as soon as my calf tightness cleared up I started with posterior heel pain where the tendon joins the bone. Its very stiff in the mornings and gives me some pain throughout the day. Ive tried going back to my old 3mm drop shoes but with no improvement, albeit not surprisingly.
    Im kinda stuck now, not sure if I should run in high or low drop shoes or what was the fundamental cause of what seems to be endless problems/injuries.
    Im thinking I should try sticking with higher drop shoes and see what happens in the long term as I have pretty much done most of my running in low drop shoes.

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    1. Went to see a local physio for some treatment and things seem to be improving. I was told mechanically in fine and as such can run in any shoes. Went to the local running shop and tried a few out including some 'traditional' Cascadias. I have to say I didnt enjoy them that much and came away with some Brooks Pure Grit.
      I tend to think low drop with cushioning is where its at for me. Whilst I enjoy running in very minimal shoes for now im going to stick with the Pure Grit and some Inov-8 Trailrocs.

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  8. finally an answer for my problems since 2006 ....I suffer shin splints with brooks ghost.then asics cumulus nike pegasus( my wife almost kill me for the amount of money I spend in shoes).them I came to the idea of using saucony gruide 6 for track training and mizuno inspire9(which has 11drop heel) and what happened: achilles tendonitis as soon I increase the miles. so 3 weeks left for my marathon I got another pair of asics cumulus 13 to see if works like everybody said......Thanks really thanks because I finally get the solutions to my problems

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    1. So are you going to run your marathon in the asics cumulus 13? I have my first marathon ever in 7 weeks and am having some of the same achilles problems, this started up right after I switched to Saucony hurricane 14 (8mm drop!!). Now I don't know what to try and I'm freaking out a little cause I only have 6 weeks to train for my first marathon!

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  9. Are you still alternating the 4mm shoes and higher heeled shoes, or did you ditch the 4mm's altogether?

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    1. The minimal shoe have been playing less and less of a role in my shoe rotation over the past few months, I am currently only running in a minimal show for the fastest of my speed work, and that is only a few miles a week tops. Sorry of the super late response, my e-mail has been putting my notifications in the trash...

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  10. The natural stride has many benefits, and you don't need a minimal shoe to get most of them. Find a shoe with an 8+ MM drop that flexes well in the mid and fore foot (loved the Cumulus 11), or use an orthotic in your favorite minimal shoe to create a drop. Let the shoe support your heel after a mid-foot plant, not your muscles and tendons. Running pain free is more fun than running in cool minimal shoes once or twice a week (if you can stand them that often).

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    1. I completely agree, one can learn to use a good mechanics without ever running in low drop shoes, and it will likely be better for them in the end. Personally I would like to still be running in 20 years or more and I think the only way to do that is to run in the shoes which do the most save my joints and tendons.

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    2. I have to say, I am sitting with my feet up today waiting for my wife to return from her long run today. I have insertional achilles tendon pain and have been doing heal lift and heal massages for the last 5-6 days. I was hoping to be off for only a few days, but am am quickly rethinking my next shoe purchase. I was thinking of the Mizuno Sayonaras for my trainers. Thank you Lee for writing this blog! Guys like Dr. Mark with the Natural Running Center make minimalist running seem like the ONLY way to run, but I'm not buying it after having struggles.

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  11. Hi. I am a fairly new runner. I started about 3 months ago (5km (aka 3 miles) is my first goal). I was always a sports guy, but now taking up running. I have an upper achilles and arch pain when I run more than 4 minutes (without walking). I'm flat footed and land on the outsite of my foot - It gets too painful to keep going. I tried a heal lift, it helped, but was uncomfortable. Any ideas on a best shoe?

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    1. It sounds like you have pronation issues, thankfully in the modern running world there are lots of options for people with pronation problems. You will likely be best served by a shoe in the "motion control" category, these shoes tend to have what is known as a post running along the middle of the shoe which controls the tendency to role your foot when striking. Shoes like the Brooks Beast, Asics Foundation, and Saucony Omni all fit into this category, however there are many more I am likely not aware of. The best thing for you to do at this point would be to go to a serious running shop, the type where everyone there runs seriously and explain what it is that you need, they should be able to suggest a shoe. Most good shops will have a treadmill on hand and be willing to let you try a few strides in each before you buy, this will also give the salesperson an opportunity to watch you gait and suggest other shoes if needed.

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    2. I am very flat footed and I run in neutral shoes. Do not assume that you need support shoes or shoes to correct over-pronation just because you have flat feet. For years a well know Canadian Running Shoe Store kept insisting I needed support or even motion control shoes due to my flat feet. They watched me walk, bend, etc. I kept having shin splints, knee pain, etc. Then I happened to be in Oregon and went to another store and he actually filmed me running and said while I have very flat feet I actually do not overpronate at all. I bought a pair of Mizuno Wave Rider 16s and Nike Free 5.0s (for fun stuff) and low and behold, after years of being in pain (even if minor, it was always there) I can now run with zero pain.

      I also question why you are using a heel lift? Did someone suggest it?

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  12. Well there's so much information here, it's hard to know where to begin. But lets start with something simple (or seemingly simple): everyone talks about low drop shoes and high drop, but it is not often clarified by the number in mm. Thus, I was wondering: would 8mm be considered a low drop shoe? Of course, everything is relative, but I figure 8mm must be considered something of an average drop: neither crazy low, nor super high.

    But I guess my dilemma, of sorts, is this: I've recently had some heel pain/plantar fasciitis, the cause of which is still in doubt. Could be increase in distance and or/ worn out shoes, which were New Balance 860V2, slight stability with 9mm drop. I was considering something new with a 12 mm drop, because someone pointed out they felt the bigger drop-- and additional padding and cushion--- would be good for someone with some minor heel pain. However, it would seem to me that a 12mm drop would force the issue of a heel strike, which could do more harm than good. Thus, I was considering staying still, or going with the New Balance 870 V3's, which are 8mm. So that's kinda my dilemma: does higher heel drop promote heel striking-- and if so, despite the cushioned ride, is that a good thing for someone with minor heel pain? I know it's kind of a vague question, but I'd greatly appreciate anybody weighing in on it.

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