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Running Form in Recreational 5K Runners: Slow Motion Video

Running Stride 5KIn my previous post I shared some slow motion video of runners from the 2010 Boston Marathon, highlighting a bit of the variation that can be seen among fairly high level marathon runners. In this post I wanted to share similar video from a recreational level 5K race. These videos were all shot at roughly the mile 3 marker on a flat to slight downhill grade – I have intentionally cropped out upper bodies to remove identities of runners. The first video shows the form of 4 of the fastest runners in the race (all ran sub-17:00, a few sub-16:00). All videos are best if viewed full-screen.

Next is a sampling of typical middle of the pack runners, and so provides a useful reference for what the average runner does out on the road (unfortunately, no barefoot runners that I can find among the thousands that ran this race).

Next, here is a nice series showing the all too common overstriding running form seen among runners in general – watch for the reach with the lower leg and the extended knee (I haven’t quantified it, but this is probably the most common form variant that I see in recreational runners; best if viewed full-screen):

Finally, here is an individual running the race in Vibram Fivefingers – form is pretty typical of most of those who wore Fivefingers in the race, though a few forefoot strikers were also seen. Just goes to show that simply putting on a pair of minimalist shoes may not cause you to immediately kick your heel strike. However, the individual does not seem to be reaching with the lower leg, so I would not call this an overstride:

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About Peter Larson

This post was authored by Peter Larson. Pete is a biology teacher, track/soccer coach, and dad (x3) with a passion for running, soccer, and science. If you'd like to learn a little bit more about who I am and what I do, click here, or visit


  1. I really like this running stride videos.  Great insight into how the top runners run and what can be done to correct running form as a mid packer.

  2. Dan Stoner says:

    So much vertical bounce up and down (visible by watching the hips) !

  3. Jamoosh says:

    I have a theory… I notice when I wear minimalist shoes (like the Five Fingers) I quickly revert to a heel strike on a smooth surface like concrete or black top. Conversely, when running on a trail or other uneven surface, my strike is much closer to my typical barefoot strike. 

    Could it be the reduced (because of the shoe) and consistent ground feel of concrete plays a role in our strike in a minimalist shoe?

    • Paul Henry says:

       very good point, when running barefoot over an uneven terrain or where there are lots of objects (pincones/acorns in my case) on the ground I tend to shorten my stride even more and reach more with the forefoot. On an lang stetch of bare dirt ill revert to a much less forefoot strike.

      Still put me in my Ronin’s and a race on concrete and im heel striking like a champion (or not as most dont seem too)… Im not ready to go to a lower heel toe drop just yet. probably with the next shoes i get.

    • Robert Osfield says:

      I think you have a useful datapoint in understanding what drives the transition between landing types.  I also agree that ground feel as well as heel drop is an important role in pushing us to one landing type or another.My guess is that you aren’t yet a habitual midfoot/forefoot runners so when you revert to landing type it’s heel strike when it can.  Think of the heel strike as your default that you’ll return unless a sufficient stimulus is applied.What happens when you run barefoot on concrete?  My guess is that this will provide a bit more stimulus to the nerve ending in your heel to push you over to landing on your midfoot/forefoot.My own experience is that I still have to consciously land on my midfoot when running in more cushioned and shoes with a heel drop greater than 6mm, but now anything less than this will midfoot strike on all surfaces without thinking about it.  I put this down to the amount of plantar flexion on landing becoming habitualized, that I no longer need a strong stimulus to change my landing type.  I don’t know how long you’ve been transititioning, but I’ve been flirting with midfoot strike for two years now but only seriously running with minimal shoes for the last six months. It’s only in the last six months that I think I’ve started become a habitual midfoot runner – landing on my heel now feels forced and unnatural.

  4. wow, what a difference in foot strike between the first two (and the fourth) runners from all the rest.  Theirs look so much smoother than the others.

  5. Adventure Larry says:

    The videos really make me want to have someone video me. In my mind I believe that I am taking short strides, landing on my mid-foot. I really want to match what I feel with reality. My Kinvara 2’s only have 30 miles on them, and no signs of heel wear. I take that as a good sign, though too soon to tell.

    • Pete Larson says:

      Just try it with a standard cell phone or video camera camera – it can at
      least give you some idea of what you do.

  6. Ruben Berenguel says:

    Oh sh*t, I think I’m running in my VFF like this guy does…

  7. Kevin A. Kirby, DPM says:


    There seems to be a common misconception among many that, somehow, the location of where your foot first strikes the ground is a major determinant of either 1) how metabolically efficient the individual  runner is or, 2) how “properly” that individual is running. As you know, there are many fine athletes who, when running at marathon race pace, are rearfoot-strikers.  The vast majority of these fast rearfoot-strikers have little to no injury problems and are faster than many of the midfoot/forefoot-strikers or barefoot runners behind them in the race. In other words, why would someone want to “kick their heelstrike”, as you suggest in your column, if this is the most metabolically efficient way for them to run and they are running faster and with less injury if they ran with a midfoot/forefoot-striking pattern?

    I know this website is frequented by many who are somehow convinced that running in “minimalist shoes” and running with a midfoot-striking pattern is going to make everyone a more efficient or a better runner. However, there is simply no scientific evidence that shows that midfoot-striking is more metabolically efficient than running with a rearfoot striking pattern. In fact, forward dynamics computer modelling research by Joe Hamill’s group at UMass from 2009 showed that the most energy efficient running form was heel-striking (15.9 W/kg) compared to midfoot striking (16.9 W/kg), a 6.3% difference in metabolic efficiency for the 4.0 m/sec (6:42 mile pace) steady state running velocity chosen by the researchers (Miller RH, Russell, EM, Gruber AH, Hamill J. Foot-strike pattern selection to minimize muscle energy expenditure during running: a computer simulation study. Proc  Am Soc Biomech Conference. State College, PA, 2009).

    From my many years of being a competitive distance runner (heel-striking my way to a 2:28 marathon at the age of 23 in 1980) and my 26 years of being a sports podiatrist, I find this fascination that many now have of looking solely at how a runner’s foot hits the ground at the instant of foot strike, without considering the multitude of other biomechanical, physiological and psychological factors that go into improving running performance and decreasing the injury rate to be analogous of “not being able to see the forest for the trees”. 

    Even though I have been instructing many of my runner-patients to not over stride over the past quarter century of treating runners’ injuries, and I think we agree on this, I feel it is mistake to coach runners to try to make major alterations in their foot striking pattern.  I believe we simply don’t have sufficient information, at this point in time, to know how and why the central nervous system “decides to choose” a certain foot striking pattern during various running speeds and in various shoe constructions.  Factors such as the ability to dorsiflex the ankle with the knee extended, which I have clearly seen to be a factor in how a runner chooses to footstrike during running in the thousands of runners I have examined, is never mentioned in these discussions.  I believe that the metabolic work required to dorsiflex the ankle sufficiently during the latter forward recovery phase of running is a very significant factor in why the central nervous systems of some runners choose to heel-strike and why the central nervous systems of other runners choose to midfoot or forefoot strike during running.

    Therefore, I urge caution to all who make broad, sweeping statements about what is the “best way to footstrike” during running since, as far as the scientific research is concerned, and my clinical experience in treating thousands of running injuries is concerned, it seems to be something that is going to require much more research and clinical investigation before we can fully understand the complex processes which go into the foot striking patterns and how these processes affect the injury rate of the bipedal human runner.
    Kevin A. Kirby, DPM
    Adjunct Associate Professor
    Department of Applied Biomechanics
    California School of Podiatric Medicine

    • Pete Larson says:


      Yes, there is a lot more to it than just where the foot contacts, and that
      is kind of the point I have been trying to make with my last several posts.
      I don’t think we have any real idea whether one strike is more efficient
      than another, and that Hamill paper is a conference abstract with a model
      designed off of a single runner – hardly any kind of solid evidence one way
      or the other. We don’t know the answer, though I am aware of some folks who
      are currently addressing this experimentally in more depth.

      My point when I referred to “kicking the heel strike” referred to the fact
      that many people assume that just putting on a pair of Vibrams will
      automatically result in them running on their forefoot. I thought the same
      thing for a long time, but the video I have indicates to me that not
      everyone does this. Unfortunately, I have no idea how long these people have
      been running in the shoes, so no way to know if there is an acclimation
      period. Looking at form change over time in association with a change in
      footwear would be an interesting study.

      I personally don’t believe everyone needs to go and change their footstrike.
      I think some variance from mild heel to mild forefoot is probably fine, and
      may depend somewhat on the distance being run. I think forefoot striking is
      unwise for the vast majority of people running a marathon for example. Very
      few do it in practice, and those who do often wind up having their form
      break down along the way – it works the calves really hard. What I do
      believe is that if someone is having trouble with injuries, trying a
      different style of shoe or adjusting their form can help. It might not
      always work, but in some cases it clearly does.

      Overstriding really is what I think is the biggest issue. That extended leg
      and locked knee, with the highly dorsiflexed foot. Kicking that has been a
      message promoted way back to the days of Bowerman in his “Jogging” book, but
      I think most people don’t realize just how common it is, and that’s why I
      try to put out some of these videos. I also do think some shoes are much
      more likely than others to allow the overstride to occur. There is evidence
      that shortening stride/increasing cadence can help when it comes to
      injuries, but even here the efficiency question seems to be up in the air.
      If you look at Salo’s work on sprinters, you find that some are stride
      length regulators, some are stride rate regulators. If these is one thing
      that we can state with certainty., it’s that people are variable, and
      blanket generalizations are not good.



    • Robert Osfield says:

      Hi Kevin,

      “However, there is simply no scientific evidence that shows that midfoot-striking is more metabolically efficient than running with a rearfoot striking pattern.”

      There is plenty of evidence in races of all distances, including the race that Pete’s has videos of here, the % of none heel strikes is higher the nearer the front of the field you get.  You do still get top classed elite athletes who heel strike at long distance events, but none as far as I know for the sprint events.  Clearly the sprint events are dominated by power and forefoot landing is critical.  In the long distance events where metobolical efficiency is far more important than maximum power there is still far from the an even distribution of footstrike through the field – this suggests to me that it’s very likely that there is still an advantage with a forefoot or mid-foot strike, but it’s far less significant than differences seen in sprint events.

      If there weren’t this advantage why on earth would there be a disproprotionate number of non heel strikers at the front of races? Should we believe that non heel strikers somehow try harder in training and races?  Or are non heel strikers just genetically more lucky than heel strikers?

      “In fact, forward dynamics computer modelling research by Joe Hamill’s group at UMass from 2009 showed that the most energy efficient running form was heel-striking (15.9 W/kg) compared to midfoot striking (16.9 W/kg), a 6.3% difference in metabolic efficiency for the 4.0 m/sec (6:42 mile pace) steady state running velocity chosen by the researchers (Miller RH, Russell, EM, Gruber AH, Hamill J. Foot-strike pattern selection to minimize muscle energy expenditure during running: a computer simulation study. Proc  Am Soc Biomech Conference. State College, PA, 2009).”

      Quoting what is clearly falty research only undermines you argument.   The 6.3% defict is obviously totally out of wack with reality, are we too believe that all those successfull elite non heel strikers are better than 6.3% in other areas of there make up that than compensate for this deficit??  

      Even with just doing a personally experiment of one – if this research was even close to being correct going from a heel strike to a non heel strike gait will result in an obvious increase in load on the body – observarable by an increased breathing and heart-rate.  I for sure have never observered such a change in altering heart-rate on my monitor when experimenting with gait.  

      The compute modelling contridicts what we see out in the field, it’s broken, horribly broken.  Where the errors come in I can’t say without reviewing the actual model used and the computing implementation.  I’ve done plenty of computer modelling in my time, even some of the same techniques quoted in the paper, so I’m well placed to such a review.  Perhaps I could even spot there mistakes.  Let them publish the codes and model as open source and then perhaps we’d be able to get to the bottom of it.


      • Robert:

        Don’t have a lot of time today to respond, got a busy day at my clinic…lots of injured runners. 

        Of course, as running velocity increases, more and more runners become midfoot strikers and forefoot strikers and as running velocity decreases, more runners become heel strikers.  We have known this for decades.

        What I am referring to is the fact that the research tends to support the idea that many runners choose to heel strike while in running shoes (70% or more) since they are probably more metabolically efficient in running like this than running with a true midfoot-striking or forefoot-striking pattern at slower running speeds.  

        Here is one study where a group of triathletes were trained to run with a Pose method (more midfoot-striking) for 12 weeks and suffered from decreased metabolic running efficiency as a result (Dallam GF, Wilber RL, Jadeles K, Fletcher G, Romanov N: Effect of a global alteration on running technique on kinematics and economy. J Sports Sciences, 23:757-764, 2005.)  Please note that inventor of the Pose technique, Nick Romanov, was one of the researchers in the study.

        By the way, the computer modelling done was a forward dynamics research study by one of the world’s leaders in running biomechanics research, Joe Hamill (a friend of mine).  I would be interested to hear how you think Dr. Hamill’s research methods were improper.

        • Robert Osfield says:

          “Of course, as running velocity increases, more and more runners become midfoot strikers and forefoot strikers and as running velocity decreases, more runners become heel strikers.  We have known this for decades.
          What I am referring to is the fact that the research tends to support the idea that many runners choose to heel strike while in running shoes (70% or more) since they are probably more metabolically efficient in running like this than running with a true midfoot-striking or forefoot-striking pattern at slower running speeds. “I don’t think the releationship between running speed and landing type can explain why a dispropproptionate fewer number of heel strikers are at the front of races, as when you look at the nature of the transition from heel strike to non heel strike it’s quite different for different classes of runners.  Habitual midfoot and forefoot runners will transition directly from heel strike when transitioning from walking to running, it’s not a matter of running speed effecting the landing – they always land on their midfoot or forefoot.  From my own experience, and looking at others accounts, what can break this direct transition is wearing trainers with a significant heel drop.Habitual heel-strikers will only transistion to a midfoot and forefoot landing as they approach sprinting speeds.  I would very much doubt a habitual heel-striker to transition to non heel-striking at marathon speeds.   I would also suspect that the amount of heel drop will effect the speed at which transition occurs.Research that Pete has previously discussed in his blog illustrate that habitual heel-strikers will remain heel strikers even with very low or zero drop shoes.  For habitual heel-strikers it seems to take going barefoot to prompt a transition at low running speeds.  It’s not a matter of metabolic efficiency that forces the transition – it’s comfort as heel striking without any padding or distribution of the impact loads are just plain painful.Things work the other way – a habitual midfoot or forefoot runner will resist a heel landing until the heel drop becomes too great to make comfortable for land on their midfoot/forefoot.  A higher heel drop shoe makes a midfoot/forelanding less comfortable due to the unnatural amount of planter flexion required to avoid the heel strike and the movement of the foot within the shoes on landing due to the sloping surface presented by the insole.  Again I’d stress it’s not matter of finding a footstrike that maximizes metabolic efficiency it’s a case of doing what is comfortable.For the majority of running shoes sold today it’s just unpleasant to try and run on your mid-foot let alone forefoot, the only comfortable way to run in most modern running shoes is to heel strike.  And… what do we have out there… the majority of recreational runners are heel striking and throwing in a heap of over striding with it.  Are you going to tell us all those runners are landing with locked knees because it’s more efficient metabolically???  “Here is one study where a group of triathletes were trained to run with a Pose method (more midfoot-striking) for 12 weeks and suffered from decreased metabolic running efficiency as a result (Dallam GF, Wilber RL, Jadeles K, Fletcher G, Romanov N: Effect of ….”

          Pose method is based on psuedo science nonesense, trying to run anything like what the method suggest is the ideal is doomed as it’s a phyically impossible form.  Given this runners trying to force themselves towards this impossible form are very likely to increase there risk or injury and reduce efficiency.  

          Good habitual midfoot and forefoot runners won’t be trying to run with a “Pose method” rather they will be running relaxed with a fluid combination of active and passive motion.  Go look at the top east african distance runners for an example of how to do it well, and go measure their running economy while you are at it… 

          On the subject of running economy – it’s one of the factors that takes the longest time to train, with VO2Max and Lactate threashold maxing out pretty early in an athletics career, but running economy can keep improving year and year, mile after mile.  This is on interest in this topic because it’s likely that a proportion of the RE improvements will be gait specific, so if you transition from heel striker to midfoot/forefoot it’s likely your RE won’t be maximized until long after your soft tissue and bones have adapted – it could take years till you see the full benefits.  This also apply the other way – going from midfoot/forefoot to heel strike is likely to be loose the gait specfic tunning that you’ve learnt over the years and will take years to make the best of the heel strike.

          Not that I’d imagine many athletes wanting to transition from midfoot/forefoot to heel strike. If you aspire to be the best then you’ll want to emulate the best, and right now almost all the best runners in world are mid-foot/forefoot strikers.   But hey, perhaps they’ve got it wrong and you’re right – adopting a heel strike and high heel drop shoe will finally bag humanity a sub 2hr marathon.

  8. Hey Pete,

    Thanks for keeping a great blog. I’d be really interested in hearing your thoughts on how custom orthotics relate to the minimalist running debate. Basic stuff like does it make sense to put a custom orthotic into a minimalist shoe or does this completely miss the point?

    I started using custom orthotics about 10 years ago at the recommendation of a sports med doc due to my unusually high arches; the orthotics seemed to help but I’ve still faced a lot of knee problems associated with running.

    Do you put orthotics in the same class as big cushioned running shoes in terms of promoting an unnatural gait? I’d be curious to hear your perspective.

    • Pete Larson says:

      I am not as up on the literature on orthotics, so rather than making
      an uniformed statement I simply say that studies that I have read show
      mixed results. Just like shoes, if they work and allow you to run pain
      free, maybe best to go with it. If they don’t solve your problem,
      maybe better to try a different approach. Personally, unless arches
      are really extreme, I don’t think the data on arch height being
      related to injury are all that compelling.


    • Paul:

      There are many varieties and styles of custom foot orthoses that are used to treat running injuries.  These custom foot orthoses (i.e. orthotics) can be made with thousands of design permutations in order to accomplish the goals of foot orthosis therapy.  Therefore, one must first understand that custom foot orthoses can have a wide range of shapes, lengths, widths,  stiffnesses, thicknesses, cushioning and ability to control or encourage certain foot and lower extremity motions that 1) will decrease the stress on the injured structure(s) of the runner’s body, 2) will optimize their running gait, and 3)  will not cause other new problems to occur.

      Most sports podiatrists try to design their running orthoses based on the patient’s weight, foot type, running style, individual biomechanics and specific foot and/or lower extremity injury, to name a few factors.  We also try to “tune” the orthosis/shoe combination in order to get the runner back on the road as soon as possible with the best results and with the least chance of injury in the future.  This may include getting the runner into a lighter weight less controlling shoe, into a heavier weight more controlling shoe, into a minimalist shoe, etc.

      The scientific research on the foot orthoses in running supports the principle that foot orthoses perform their therapeutic effects by altering the kinematics (i.e. motion patterns) and the kinetics (i.e. forces and moments) of running gait.  Foot orthoses are designed to facilitate normal motion and normal forces/momentsand to eliminate abnormal motion and abnormal forces/moments.  They can certainly be used along with “minimalist shoes” and, if designed correctly, can be used in practically any running shoe.

      By the way, Paul, you seem to suggest that “big cushioned running shoes”, (whatever that means) promote “an unnatural gait”.  Do you have any scientific evidence of that?  I would be very interested if you could point me toward any scientific research that supports the interesting notion that cushioned running shoes cause an “unnatural gait”  since, as far as I know, there is no research that comes close to supporting that idea.

      Kevin A. Kirby, DPM
      Adjunct Associate Professor
      Department of Applied Biomechanics
      California School of Podiatric Medicine

      • Thanks Kevin and Pete for the replies and continuing honest and interesting discussion here. I continue to read with interest.

        Kevin, clearly I didn’t pick up on the complexity of foot orthoses… my experience as a patient was limited to stepping into a mold and getting an insole in a couple weeks, so I presumed the process was pretty standard.

        I’m afraid life is too short to generate a big enough personal sample size on what works and doesn’t work for me. In any case, I’m running further and with less pain than ever before right now, so I’ll keep my fingers crossed and keep doing what I’m doing…

        • Paul:

          I lecture frequently nationally and internationally on foot and lower extremity and foot orthosis theory and biomechanics, have written three books on the subject, and have a busy practice with lots of referrals for custom foot orthoses, so I am very interested in this subject.  Unfortunately, there is not a great deal of standardization in the custom foot orthosis industry so that the type of custom foot orthosis you receive from one clinician may vary widely from a custom foot orthosis made by another clinician.  This may explain why your experience may have been different from others and from what I , or other sports podiatrists, offer to my patients.

          The bottom line is that, if designed properly for the runner, custom foot orthoses can make a huge difference in allowing a runner to train harder, faster and with less pain.  They are an invaluable treatment option for many injuries and pathologies we see in athletes and non-athletes and are used widely by professional athletes and recreational athletes in order to allow them to perform their activities without pain or disability.  They are not a panacea, but certainly, for many runners, they couldn’t train injury-free for long without them inside their shoes.



          • Pete Larson says:


            I’ll admit that I have not read extensively on the science behind foot
            orthoses, but I have read a lot of Benno Nigg’s work, including his
            recent book. From the standpoint of the patient and given varying
            experience that people have with orthoses (clearly some do benefit,
            others do not from a given pair), as well as cost, is there an
            effective way for a patient to be sure that the professional they see
            is going to give them what they need? For example, would you recommend
            that a runner see a podiatrist who is a runner themselves and who has
            a solid knowledge of running mechanics? A lot of PT’s seem to give
            advice similar to this as some professionals simply don’t understand
            running mechanics. I’ve met many people who hate their orthotics, and
            others who swear by them. What’s the primary reason why a person has
            one experience and not the other?


          • Pete: 

            Probably the best advice I can give to an injured runner who is possibly considering getting custom foot orthoses is to ask their runner-friends or their local running shoe store what their opinion is regarding who the best sports podiatrist is in their area.  This may, of course, mean that the injured runner may need to drive, or even fly, out of their home town to a podiatrist who treats lots of runners, but this is better than wasting their hard-earned money on a pair of foot orthoses that are either ineffective or uncomfortable.

            Even though there is a significant amount of scientific research and new theories on how foot orthoses function, the actual making of an effective foot orthosis is based not only on science but is also a lot of what I call “arts and crafts”.  All of the podiatrists that I lecture with at seminars on foot orthosis therapy, and who I consider the best in the country on the subject, will have a grinder, glues, adhesive felts, sheets of EVA and other orthosis fabrication materials in their office by which to modify either their own or another clinician’s foot orthoses for patients.  I would be worried about a clinician that couldn’t modify their own orthoses, or another clinician’s orthoses, in their own office within a few minutes since I firmly believe that being able to modify foot orthoses on the spot (i.e. “arts and crafts”) is a necessary part of having a successful foot orthosis practice. 

            Another complicating factor in foot orthosis therapy is that there are a huge number of permutations in orthosis design that may spell the difference between orthosis success and orthosis failure.  For example, when I teach orthosis design to podiatry students and podiatrists, here is a partial list of the various orthosis modifications that may affect foot orthosis comfort and function:

            -Negative casting type
            -Foot joint position during negative casting
            -Frontal plane balancing position of positive cast
            -Medial heel skive or lateral heel skive thickness
            -Medial expansion plaster thickness
            -Plantar fascial accommodation thickness
            -Orthosis plate material
            -Orthosis plate thickness
            -Rearfoot post material
            -Rearfoot post angle and motion
            -Heel contact point thickness (i.e. heel lift)
            -Anterior orthosis edge length, shape and thickness
            -Metatarsal pad size, shape and location on orthosis plate
            -Topcover material
            -Topcover length
            -Forefoot extension material
            -Pattern, thickness and shape of forefoot extension material
            -Medial and/or lateral longitudinal arch filler material and thickness

            The subject of orthosis design, orthosis function and the body’s response to different orthosis designs comprise much of the academic material that I have published in my scientific papers, I have written in my books and have taught in my lectures over the past quarter century.  By its nature, it is a very complex subject.  Suffice it to say, that there are probably tens of billions of foot orthosis design permutations if you factor in all the materials, shapes, thicknesses and angles that a foot orthosis can be made, with only a fraction of these orthosis design permutations being able to be worn daily by the runner, make them run with less injury and with more comfort.  Luckily, the human body is quite adaptable so that orthosis imperfections do not always translate into problems for my patients, with some individuals being quite like the “princess and the pea”, feeling every little surface imperfection, with other individuals being more tolerant of imperfections in their shoes, their socks and their foot orthoses. 

            Hopefully, I have been able to at least partially answer your question.  I could go on and on since this is a fascinating subject for me and is a subject I have spent most of my adult life researching, thinking about, writing about and teaching.  For those of you who want to learn more about both over-the-counter foot orthoses and custom foot orthoses, you may want to check out some of the excellent discussions we have had over the years (in the archives) on Podiatry Arena at   


            Kevin A. Kirby, DPM

          • Robert Osfield says:

            Hi Kevin,

            Your explanation of a little of the ins-and-out of custom orthothotics struck me that this personalised approach is something that shouldn’t really be limited to just othotics.  Personally I’d love to have an world where everyones
            shoes can be tailored from the ground up for them.  

            Roll back a hundred years and many people who could afford shoes had them made for them by a cobbler.  Mass manufacture has taken us long way from this.  From your description a skilled podaristist is adding back in the personalized tailoring.

            I have an engineering and computing background so can’t help but wonder if technology combined with a little local craft skill might be able to bring personallized shoe manufacture to all.  Do you know if inserts ever been manufactured using 3D printing?


          • Robert:

            About a third of all custom foot orthoses now are being made by cad-cam system, where the foot orthoses are generally being milled out of a block of polypropylene.  Scanners at the orthosis lab will convert the shape of the negative cast of the foot into 3D information that can then be combined with the specific modifications the podiatrist wants to include in the shell of the orthosis to make the necessary orthosis prescription in the orthosis design milling computer.

            There is currently some discussion of using 3D printing for orthosis manufacture, but my understanding currently is that 3D printing is fairly slow and expensive process compared to cad-cam or hand pressed/hand ground manufacture of foot orthoses.  Of course, future research and technological advances may change that scenario within the coming years.

            As far as personalized shoe manufacture is concerned, that is a possiblity but would probably greatly add to the cost of shoes.  To my mind, it seems more logical to have a custom foot orthosis made that will last 5-15 years, and then move it from running shoe to running shoe as the shoes become bottomed out and/or worn over the months and years, if there is a mechanical need for such therapy in the runner.



          • Pete:

            I wanted to make a few other comments on your post about Benno Nigg and foot orthoses.
            I have been a fan of Benno Nigg’s work ever since I did my Biomechanics Fellowship back in 1984-85.  I even lectured with Benno and toured his lab with him in Calgary eleven years ago.  However, since Benno is not a clinician, his terminology for what he considers an “orthotic” is not the same as what most podiatrists consider to be an “orthotic”.
            Benno, and many other biomechanics researchers, tend to include research using pads inside the shoes as being research about “orthotics”, when, in fact, a medial arch pad is very different from a custom foot orthosis. Therefore, when Benno talks about “orthotics” in his most recent book (I have all of his books in my library), you must realize that he may be talking about a simple medial arch cookie, an over-the-counter arch support that doesn’t fit the arch of the patient’s foot, or a custom foot orthosis that very closely fits the contours of the patient’s foot.  I consider this a very important distinction since, clinically, I often can take an over-the-counter foot orthosis that doesn’t work for the patient, add a few specially designed pads to it, and then make it a very effective foot orthosis for the patient.  In other words, in terms of therapeutic efficacy and biomechanical function, the three-dimensional shape and stiffness of a foot orthosis are critical.  Not all in-shoe inserts, or what many researchers consider to be “orthotics”, are the true custom foot orthoses that we prescribe for our patients.

            One last comment is that, as you know, Benno Nigg’s “Preferred Motion Pathway” model is certainly something we consider when teaching the biomechanical function of foot orthoses to students and clinicians.  What is important about the Preferred Motion Pathway model is that it emphasizes the very important controlling effect of the central nervous system on determining how a foot orthosis will alter the kinematics and kinetics of an individual’s foot and lower extremity.

            As far as research is concerned, we are just beginning to explore why one individual might pronate more with one orthosis while the same orthosis might supinate another individual.  My research and theoretical papers have focused on the large inter-individual variation in subtalar joint axis location being responsible for much of this varied response from foot orthoses, but there is also likely a huge central nervous system component to this response, in addition to other factors we simply don’t understand at this time.  Suffice it to say that even though custom foot orthoses work extremely well for many individuals and not so well for others, we are not scientifically certain why this is the case, even though we do have plenty of theories to explain their biomechanical effects.  The good news is that there is more foot orthosis research being done now than ever before so that, every year, we are gaining more insight into their mechanical and central nervous system effects.  It is truly an exciting time for those of us who specialize in this field of clinical research.



  9. Marty Zaleski says:

    The shoes worn by the first four have pretty tiny heels compared to the rest of the pack.  That’s pretty telling.

    • Running shoes with “pretty tiny heels”, have been called “racing flats” for at least the last four decades. Many runners, who are new to running and are not familiar with the history of running shoes, may think that “minimalist shoes” are something new, never before available until a few years ago.  Nothing could be further from the truth.  “Minimalist shoes” are a new term used to describe what has been continuously available in specialty running shoe stores since I was a competitive high school distance runner in the 1970s….we called these shoes with very little midsole and thin heels, “racing flats”. 

      In fact, a “minimalist shoe” (i.e. racing flat) with a “pretty tiny heel”, made by Onitsuka Tiger (now called Asics), won the Boston Marathon in 1951 (  This “Tabi style shoe” with a pocket for the big toe, was available in Japan a full 60 years ago, long before Vibram decided to make shoes with five toe pockets that people now run in and call “minimalist shoes” or, even better yet, “barefoot shoes”. 

      Therefore, is it unique or new or surprising to see runners winning races in shoes with “pretty tiny heels”?  No.  Intelligent distance runners have been winning races in them for at least the last 60 years.



      • Pete Larson says:


        Nobody’s arguing that flats haven’t been around for a long time. The point,
        as we have discussed before, is that the average runner has either not had
        access to them (because they don’t shop in specialty stores) or they didn’t
        think it was possible to run in them because they have been told they need
        cushioning and stability, despite a lack of any controlled trials looking at
        the efficacy of pronation control shoes (as emphasized by the Ryan paper in
        BJSM). Now, people see them as a valid option for more than just racing, and
        they are available much more widely. As just one example, Running Warehouse
        only recently (this year) included flats in their regular men’s and women’s
        running store webpages. They used to be only found in the competition store.


        • Pete:

          I don’t know what you mean by the “competition store”.  Of course, being here in Sacramento, with lots of runners like myself, and with the original Fleet Feet store starting here on J Street 35 years ago, maybe my view or definition of a running specialty store is different from yours.  I also sold running shoes at two different running shoe stores in San Francisco while I was a podiatry student (1979-1983) and I clearly remember racing flats, what you now call “minimalist shoes”, being on the shelves for runners to purchase if they wanted to.  I know because I sold them to runners back 30 years ago.  If the runner wanted the shoe, there were absolutely no restrictions from them buying them.  So, maybe in your neck of the woods, “minimalist shoes” have only been available for 5 years, but in my neck of the woods, they have been available for decades.

          I do agree with you, however, that having the “minimalist shoe” option can be a good thing for some runners and that it should be made more accessible to runners.  However, I also see lots of runners jumping on the “minimalist shoe bandwagon” and getting injured doing so.  And this is despite any controlled trials looking at the efficacy of “minimalist shoes” preventing injuries.

          And the reason I brought up the racing shoe history is that Marty made it sound like wearing racing flats with thin heels was something new or special or unique.  We were all doing it in the 70’s and 80’s when I was in peak racing form. Therefore, I do believe that the argument needs to be made that runners have been wearing thin soled shoes to race in and train in for decades and that to suggest that this interest in “minimalist shoes” is something new, to me, sounds like people are trying to create something that sounds new, when, in fact, it is an old idea, with a new name: analogous to instead of “used cars” we now call the same items,  “pre-owned cars”.



          • Pete Larson says:


            Running Warehouse is one of the biggest on-line sellers of running gear.
            They have three stores that you can access from their homepage – men’s,
            women’s, and competition. Until very recently, you could only buy flats in
            the competition store – you wouldn’t find them in the men’s or women’s store
            where non-competitive runners shop. Flats are not new, and runners have used
            them for a long time, I don’t disagree at all with that. Your perspective
            may also be colored by the fact that you have been a high-level runner for a
            long time. I’d bet that most people who run (not just compete) do not even
            know about specialty running stores. I’ve run on and off my whole life
            starting in middle school, but until I got serious about it four years ago I
            had never set foot in a specialty running store. I bought my shoes at a
            Dick’s or a Footlocker like most runners in a local level race probably do.

            What’s more, there is a big difference between flats and a shoe like the
            Vibram Fivefingers. I have put a lot of miles on shoes like the Saucony Grid
            Type A4 road flat or the Brooks Mach series of spikeless XC flats. I have
            also put in a lot of miles in Vibrams. They are completely different styles
            of shoes – there is no flat currently on the market with as little between
            the foot and ground as you would find in the Vibrams (nor the flexibility).
            There is no flat with a forefoot as wide as something like the Vivobarefoot
            Neo. There is no flat shaped like the Altra Instinct. Believe me, I’ve
            looked, and I have personally tried out a lot of shoes. Flats are a type of
            minimalist shoe, but not all minimalist shoes can be put in the same
            category as flats (for a comparative anatomist like me, it’s equivalent to
            saying that all toads are frogs, but not all frogs are toads). Almost every
            flat I have ever tried on is narrow through the toebox, with the exception
            of maybe the Mizuno Wave Universe. I actually bought a pair of retro Saucony
            Bullet flats out of curiosity – I don’t know if they are an exact replica of
            the original 1985 shoe, but they have an 18mm heel lift, way bigger even
            than any standard running shoe on the market today!

            When it comes to minimalist shoes, I’m fully aware that there are currently
            no trials looking at their efficacy, but they are some already underway (it
            took decades for anyone to look at the pronation control spectrum).
            Minimalist runners are generally very open about the risks involved in
            transitioning, and manufacturers of minimalist shoes have been very good
            about providing educational materials about the risks involved. Heck, New
            Balance wouldn’t even sell their Minimus shoes online at first so that they
            could educate people about the risks before sending them home with a pair.
            But, do you think Brooks puts a warning in boxes of the Beast saying that
            every highly pronated runner wearing motion control shoes in Ryan’s study
            got hurt? Small sample size, but to me that’s pretty astonishing.


          • Pete:

            You make some good points.  Thanks for that.

            From my 26 years of treating athletes in my sports podiatry practice, I can give you a few of my observations regarding running shoes.  First of all, some runners, especially those runners who are heavier and have pronated feet do very well in shoes like the Brooks Beast, which are designed with heavier motion-control features.  Sometimes, these shoes seem to be the only shoes they can run in pain free.  However, I also see many runners being put into shoes that are too stiff and “clunky” for them, which makes running less comfortable for them, so I recommend they try a more cushioned, lighter weight stability shoe.  Shoe selection is such an individual thing and even the best of us gets it wrong sometimes.  Do you have any suggestions on how to improve the shoe selection process for all runners rather than the trial and error method (a process that is very expensive for many runners)?

            As far as recommending a shoe like the Vibrams, I honestly can’t recommend these shoes at this time due to the incidence of metatarsal stress fractures we are seeing in these shoes.  Certainly some of the minimalist shoes seem more reasonable and may have a place for some of my runner-patients, but, for now, I feel the jury is still out as to whether these shoes are actually causing runners to get fewer injurues or whether they are simply causing runners to get different types of injuries, and possibly at an increased rate.

            By the way, Pete, thanks for taking the time to respond to my posts.  Even though you don’t agree with me much (which I really don’t mind), I feel your responses are always intelligent and honest….personal attributes which seem very difficult to come by these days when the topic of minimalist and barefoot running comes up.



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