Michael L Gross, MD  
Male, 64
Hackensack,Westwood, NJ

Specialties: orthopedic surgery, sports medicine

Interests: Orthopedics, Knee and Shoulder Arthroscopy
Active Orthopedics & Sports Medicine
Hackensack, NJ
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If The Shoe Fits...

Aug 23, 2009 - 8 comments

If the shoe fits…

As the fall season approaches, runners are gearing up for the peak of the running season.  Whether you’re a hard-core runner or a novice, choosing a good running shoe is essential for preventing injury and helping you enjoy your running.  When running, your foot absorbs up to four times your body weight every time your heel hits the ground, and this event is repeated almost 1000 times with every mile you run.  To put it in perspective, 150 pound runner absorbs about 120 tons of force during a one mile run.  Your running shoe is your first line of defense in protecting your body from these tremendous forces.  Unfortunately, running shoe technology has become so advanced; it is difficult for most runners to keep up.  In order to choose the best shoe for you, it is necessary to learn some basic facts about shoes, feet, and running.  

First, you need to know the 5 basic components of a running shoe:  last, upper, outsole, midsole, and heel counter.  

Last:  the last determines the three dimensional shape of the shoe.  There are straight, semi-curved, and curved lasts.  Last shapes are determined from average foot shapes.  IN reality, there is no such thing as an average foot.  If you trace the outline of the bottom of your foot, you can get a good idea of the right last for you.  The shape of the last will determine if there is enough room for your longest toe to push off.

Uppers: the main portion of the shoe that surrounds your foot.  Modern shoes have synthetic uppers rather than leather or other natural fibers.  Newer materials are lighter, washable, breathe better and are more flexible, requiring little or no break-in. Be sure to choose the upper best suited to your expected usage.

Midsole:  The midsole is located between the outsole and the upper. Many believe it is the most important part of any running shoe.  It controls excessive foot motion and provides cushioning, and shock absorption.  Some synthetic foams are used for the midsole, they are light, but not durable.  Polyurethane is also commonly used, although durable, it is denser, heavier, and harder.  Many shoes are now cushioned with gel, airbags, silicone, or foam capsules. These are all attempts to increase cushioning and durability at the same time.  

Outsole:  The outsole is the treaded layer on the bottom of the shoe glued to the midsole.   The outsole resists wear, provides traction, and absorbs shock.  The outsole is usually made of blown rubber, gum rubber, hard carbon rubber, or some combination of the three. Blown rubber is the lightest, but least durable.  Solid rubber materials are considered the best material for training shoes.  Stud or waffle outsoles are good for running on dirt or grass.  Today, most shoes have a ridged sole which is more flexible, and best for running on asphalt or cement.

Heel Counters:  The heel counter is the rigid material that surrounds the heel.  Its function is to stabilize and support the heel.  An additional external counter is usually added between the midsole and the base of the heel for extra support.  Sometimes a wedge is used to add height to the heel. This enhances the ability of the shoe to absorb shock and reduce injury.

The second step in learning how to choose the correct running shoe is determining what type of foot and running style you have.  As you run, your foot goes through multiple phases known as the gait cycle.  When your foot strikes the ground, it turns inward (pronates) and flattens; this makes it more flexible.  Then it begins to roll outward (supinates) and arches so it becomes more rigid as you push off.  Many runners either over pronate or over supinate.  
A simple method for determining which group you’re in is known as the wet foot test.  Step barefoot in water, and then leave a footprint in on the ground.  The neutral footprint shows the heel, outside of the midfoot, and the entire forefoot.  An excessive pronator shows the entire foot.  A supinator shows the heel and forefoot, but little or none of the midfoot.  .  Pronators will have excessive wear on the inside of their soles; supinators on the outside.
Excessive pronation or supination that is not controlled by your shoes can cause injuries to you knees, hips, and lower back. Pronators have flexible flat feet.  This may lead to injuries such as runner’s knee (chondromalacia patella) tendonitis, or shin splints.  A pronator needs a shoe that is broad lasted, and rigid.  Supinators have rigid high arched feet.  They are more prone to stress fractures and plantar fasciitis.  Supinators need a shoe that is cushioned and slip lasted or combination lasted.  

Finally, here are 12 simple guidelines to help you when you hit the running shoe store:
1.  Try on both shoes and walk, and jog around the store.  Climb stairs if possible.

2.  Try on as many pairs as needed to make a good comparison.  Don’t rush.

3.  Make sure the shoe is padded where your foot needs it.

4.  Check the quality of the shoes.  Lay them on a flat surface and make sure they lay flat at the middle of the shoes.  Check the quality of the eyelets stitching, gluing, and laces.

5.  Make sure the shoes flex at the same place your foot flexes.

6.  Try shoes after a work out and later in the day. This is when your foot is the biggest.  

7.  Try shoes on standing up.  Allow a half inch in front of your longest toe.

8.  Don’t rely on a break in period.  Shoes should feel good on the day you by them.

9.  The key to finding the best shoe is comfort, not price.  

10.  The heel should fit snugly and shouldn’t rub or slip.
11.  Try shoes on with the socks you run in.

12.  Sizes vary among shoe brands and styles.  Chose shoes based on comfort, not the size printed inside.

13.  Ask questions.  Make sure the sales man is knowledgeable.  If the sales person doesn’t know the answers, find someone who does.

Good luck!

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by ChitChatNine, Aug 24, 2009
This is great info! Thanks Dr. Gross.  I will print this out for my daughter come track season when she competes on the high school team.  


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by peekawho, Aug 26, 2009
Great tips!

I go to a store that has a top notch local reputation with runners.  They watch how I walk, look at the soles of my shoes, and let me try out several pairs.  

Good shoes are well worth the money to have properly fitted.  They must be comfortable from the outset.  

Avatar universal
by epochone, Oct 01, 2009
As a supinator, I noticed the need for "slip" lasted shoes but there's no definition of that; only straight,semi and curved. Almost 40 years of running and I don't know this.

Avatar universal
by Kelsei, Oct 01, 2009
Dr. Gross, Please read over this! I need any suggestions, I am in so much pain, and I need help from something. I don't know of any other way of getting ahold of you, so please look me back up and ask my any questions, I can answer them!!

Feb. 11, 2008 I slipped on the ice at work and fell directly onto my right shoulder, and then the rest of my body collapsed. Two days after my injury I had an MRI done, and nothing came up, but I was in a sling for 4 weeks. Since Feb. 11th, I have had X-Rays, and of course the initial MRI, and also have had 3 cortisone injections into the AC Joint and into the shoulder itself. During this time until now, I am in constant pain, my shoulder is always popping and making squishy noises (of course I can only hear them when I am laying in bed or when it is quiet). Also, I have done atleast a full year's worth of physical therapy already and we have ruled out frozen shoulder. My shoulder has popped out of place one time, and it was when my arms were above my head. I can move my arm and I have a decent range of motion, but it is not the greatest. I am seeing an orthopedic surgeon, but he is not helping me out a lot. I have lost a lot of hope right now because as much pain as I am in I am not getting much help. I refuse to take pain medication because it doesn't help, and also anti-inflammatory medication doesn't help either. Every 5 minutes or so I have to move my shoulder around, in a stretching motion; and this is hard to explain because even my doctor doesn't understand. I am only 20 years old, and I have only had 2 surgeries my entire life, so I am really healthy! and one of those surgeries was wisdom teeth, so that should tell you that I don't ever need surgeries. I am married and have a great life ahead of me, and I use to be so active in softball and everything, but now I can't do ANYTHING!

On Oct. 1st, 2009-today- I went for my second MRI because the pain has progressively gotten worse. The doctor that was giving my the injection into my shoulder under the live X-Ray a kept telling me that it was giving it a hard time because he was positive I had some kind of a tear in my shoulder. Even after he had put lidocaine numbing medication into my shoulder, I was still feeling the dye injections, so I was bawling. He kept apologizing, and repeatedly kept telling me I had something wrong with my shoulder and was positive there was something. So, after that I went to my normal orthopedic doctor and he showed me my MRI and said its clean and there is nothing. Now he is wanting to give me another cortisone shot, but THEY DON'T HELP ME!

I would appreciate ANY help...  I read all of your information! -Kelsei

Avatar universal
by Faith1794, Oct 02, 2009
Thanks for the information on this. It'l really help out with marching season.

Avatar universal
by CATNOEL, Oct 02, 2009
What do you do if you have a narrow foot with a narrower heel?  Nobody carries shoes to fit my feet.  

Avatar universal
by hoppy7, Oct 08, 2009
catnoel: Check out the website for Road Runner Sports. Some brands that they carry come in narrow widths. Even if you don't buy from them, you can find out what to ask for. I buy exclusively from them for this very reason... and because my feet are very small besides.

Avatar universal
by mcdadekm0917, Jan 20, 2010
I am trying to find out some information about a plate that was put in my husbands arm and it has broken.  The doctor that put it want give us any information about the maker of the plate. They say they have no info. They want take the plate out and put a new one in because we don't have$ 5,000.  I have the first plate that was inserted with the one that is still in his arm. The one I have had to be removed because it came through the skin.  My question is how can I go about tracing the plate.  I have the numbers on the first plate. Can I trace this plate? Please I need help...Krystal McDade   ***@****

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