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Do I Need a Stability Shoe, or a Neutral Shoe?

September 28, 2017

I get asked this question very frequently, and it’s pretty easy to understand why.  There is plenty of information on the internet or your local store, but some of the information out there is either conflicting, or just a regurgitation of old adage that has already been shown to be incorrect. For instance, I’ve read and heard countless times that over pronators and people with flat feet need stability or motion control shoes, and people with high or normal arches need neutral cushioned shoes.  In fact, research has not shown any protective benefit of this, except perhaps on the extremes of flat feet and high arches. I've found this to be true in my own patients as well. So where does that leave us?

 

Before I answer this question, I’ll briefly go over the different types of running shoes. The lightest and most “minimal” shoe is the minimalist or barefoot shoe, containing just enough padding to give your foot a slight layer of protection while attempting to promote a barefoot gait. They have no arch support. These can be great for forefoot strikers or midfoot strikers, but they certainly aren’t for everyone. I’ll attempt to tackle this subject in another post, but I don’t think that most runners should jump straight into these types of shoes without significant gait re-training, as improper form can lead to injuries.  

 

On the opposite end of the spectrum is the motion control shoe. These are very heavy shoes meant specifically for the worst flat feet. They often have firm midfoot arch foam and heel posting to create a stiff shoe that attempts to block over pronation in the arch and heel. As such, they are fairly rigid and much more conducive to walking than running, which requires more fluidity than these shoes often allow.  These shoes do have a place in running, but it’s my opinion that they should only be used by the select few runners who have extreme over pronation and are symptomatic from it. For example, a runner with posterior tibial tendonitis, an injury to the tendon that supports the arch, may benefit from a shoe such as this, but that doesn’t mean that they’ll always need to use this type of shoe. Commonly, once the injury resolves and the runner has made an effort to strengthen the tendon via physical therapy or home therapy, I’ll commonly have them attempt running in a stability shoe, but will have them still walk in the more stable motion control shoe.

 

This leaves the neutral shoe and the stability shoe, by far the most common types of running shoes. Nowadays the lines have blurred between these two types, but traditionally a neutral shoe is one without heel posting and with one uniform layer/density of foam.  The foam of the midsole is usually one color to represent this, and the shoe is often lighter as a result.  They come in many shapes and sizes, and have varying amounts of foam protection.

These are all neutral shoes.  Note the single color of the foam but also the significant differences in their appearances

 

Stability shoes on the other hand usually have a dense secondary foam in the arch and sometimes the inside of the heel in an attempt to prevent excessive pronation or arch collapse.  This is usually represented by a darker foam in the arch area as pictured below. They are not as rigid or heavy as motion control shoes, but they are usually heavier and less flexible than a neutral shoe. They can come in different weights and with different amounts of stability and arch height, but are usually less variable in appearance than neutral shoes.

Traditional stability shoe. Note the darker grey color in the arch area, signifying the denser foam here.

 

As I stated above, the lines are often blurred now between the two types.  One example of this is that neutral shoes may be very low in cushion in an attempt to be more minimalistic, or they may have very wide foam at the bottom of the heel. The former can actually result in more injuries because the increased padding over a traditional minimal shoe gives a false sense of security but prevents proper form.  The latter, on the other hand, acts somewhat like a stability shoe in that it prevents excessive heel and ankle motion, which is an essential part of pronation and arch collapse.  This means that some of the more structured neutral shoes feel and function almost exactly like a stability shoe.

If your doctor just told you to go to the store and get a neutral shoe, then either of these would technically be correct.  The one on the left, however, clearly has maximal padding and a wide heel for stability.  The one on the right is my racing shoe, and has the minimal padding needed to still allow for any gait type, while also having some rigidity to help propel you forward.

 

Now that I’ve probably confused you, I’ll give my recommendations. For the uninjured runner without a rigid high arched foot or a painful flatfoot, the most important factors are not neutral vs stability.  The most important factors are actually shoe FIT, and shoe COMFORT. For fit, this means that there should be at least a half thumb’s width, and not more than a full thumb’s width, from the end of your longest toe to the end of the shoe.  This will help prevent blisters and toenail injuries.  For the ball of the foot, there should be a half thumb’s width from the edge of the shoe to the ball of the foot on either side.  This is probably less important, especially with modern mesh being much more accommodative to the sides of the foot than older designs. Finally, and most importantly, the heel should be snug and unable to slosh from side to side easily once the shoe is laced.  This is especially true of women with narrow heels or anyone with a higher arch, as a loose heel in these individuals is going to result in irritation, blistering, or potentially even bursitis or tendonitis where the achilles attaches to the heel bone. Fortunately, more and more shoes are being made with thinner heels or with increased padding on either side of the heel to allow for multiple shapes and sizes. In the absence of this padding, you can always try a silicone heel cup or using the top most lacing hole to keep the heel in place.

 

As for comfort, it should go without saying that a shoe should be comfortable.  I would try on both well padded neutral shoes and stability shoes and try walking and running around the store in them. Try to go to shoe stores with a variety of models and brands, and try to go to a store with a treadmill or that offers exchanges after a trial period. Sometimes this means paying slightly more money for a pair of shoes, but it offers you protection and peace of mind should you decide after a few miles of running that the shoe just isn’t cutting it. Lastly, there should be no break in period with a shoe as far as comfort is concerned.  If it isn’t comfortable to begin with, then it likely won’t get comfortable over time, and your foot just might not be ideal for that shoe.  Just because your best friend or sibling raves about a specific shoe doesn’t mean that it’s right for your foot.  Let the comfort of the shoe decide, both in the store and on the road, and have fun trying on as many shoes as you can.

 

Do you have any questions? Feel free to comment below and I'll get back to you as soon as I can.

 

 

 

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