What is a Runner with Chronic Lower Leg Overuse Injuries to Do?

Here’s a great question that came in for the recent MTA podcast episode on Injury.

Should a person resort to running with “stability shoes” and/or orthotics or minimalistic shoes? What is the role of footwear for runners who are experiencing chronic lower leg overuse injuries?

Footwear for Chronic Lower Leg Overuse Injuries


Here’s my question, and it’s in regards to over pronation and whether a runner’s focus should be on correcting the pronation through orthotics and stability shoes or through corrective exercise. So, on video, consistently I’m an over pronator. I’ve been running regularly for over 10 years, but I have had calf/shin/foot problems for the last 5 years off and on depending on my mileage. Historically I’ve run in minimal, light weight neutral shoes, but I’ve also been plagued with plantar fasciitis or medial shin splits. So I decided to use orthotics and stability shoes in an attempt to keep my foot and ankle better aligned in the hopes of decreasing the strain to my posterior tibialis and other arch supporting muscles.

In the last year or so, I’ve read and been told varying opinions on how I’m further weakening my foot and ankle through the use of the orthotics and stability shoes and that if given enough time working on the right strengthening exercises of my hips and lower legs, I wouldn’t need these “crutches” if you will. So, what say you? How would you inform a runner with chronic lower leg overuse injuries that seem to stem from over pronation? -Jenny M.

Dr. Ben’s Answer:

Thanks for the question, Jenny! It gets right at the heart of several hot debates within the running community. Should a person resort to running with “stability shoes” and/or orthotics or minimalistic shoes? Which is better? What should runners really be doing?

There are strong opinions on both sides of the minimalistic versus stability shoe argument. Both sides have good arguments, but neither side has conclusive research evidence to prove one way or the other. This is nothing new in rehabilitation and medicine. I tend to revert back to common sense and evaluate each person as an individual.

In your case, it seems as though the stability shoes have made a difference as far as fewer injuries. If that is true, then I would recommend you keep on that path. As you pointed out, there are many that say all you need to do is strengthen the feet and hips and that using a more built up shoe only perpetuates the problem. That may be true, but the surfaces you run on, your own personal injury and medical history, and how you function in your daily life all are factors to consider when deciding on the best strategy for you.

To the naysayers I ask, is it natural to run on concrete or to sit at a desk all day? What if you have been hit by a car and suffer a hip or foot injury? We must always look at the individual.

Focus on what is working for you. If the shoes are helping to keep you running injury-free, then that is the most important part of the discussion. Knowing that the footwear may be helping you to compensate, then you should continue to work on foot and hip strengthening and be very aware of your footwear when you’re not running.

I tend to run in a more built up shoe as that is what I started with and have grown accustomed to. When I’m at home, I am barefoot most of the time. I work on other cross training activities to stay strong.

Rehabilitation Recap:

  • Use the shoes that seem to help the most at avoiding injury.
  • Continue with cross training activities that help maintain proper foot and hip strength.
  • Remember that your activities during the day when not running will also affect how you feel when running.
  • Try one of my favorite methods of keeping the foot complex strong: barefoot running for short distances in grass or sand.

Jenny, I hope that helps your particular situation and that I didn’t offend our minimalistic footwear friends!

Become a Resilient Runner

Resilient Runner logoAre you struggling with a running injury? Overuse running injuries are typically due to controllable variables. A vast majority of these injuries could then be considered preventable. However, rarely do runners know that they are about to commit a training error that will place them on the path to injury and pain. This ultimately leads to lost training days, missed races, and unmet goals.

That is why Trevor, Angie and I have created the Resilient Runner program. It’s designed to help you prevent and avoid injury so that you can continue to train and compete in order to meet your goals. If you do sustain an injury, you’ll be able to refer to in-depth information on how to quickly recover from all of the most common running related injuries.

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