Why the AAPSM does not Rate, Review or Recommend Footwear

In January 2010 the AAPSM Board voted to discontinue the process of reviewing, rating or recommending footwear.  To date there has not been a reliable, repeatable methodology of footwear assessment that meets the standards of evidenced based medicine.  For that reason the AAPSM Board felt it was disingenuous to engage in the practice of testing footwear and making recommendations based on those tests.  One of the main goals of the AAPSM is to serve as an authoritative source of educational material for both the public and medical professionals.

Athletic shoe fitting is a process that must be done one-one-one with an experienced shoe fitter.  Making shoe recommendations over the internet or recommending one shoe over another for the masses is an exercise in futility.  Footwear’s effects on comfort and performance cannot be reliably predicted for an individual using current methods of testing. The ultimate test of any shoe is the individual experience that the user has with it. Because gait patterns, biomechanics and foot shapes are so unique, individuals have to understand that they are their own expert on footwear. The AAPSM will work to provide meaningful information for our readers so they can make informed choices but the bottom line is that the shoes must be worn and experienced in order to understand how they work for any given person.

Members of the AAPSM recommend that individuals be fit by a reputable footwear retailer and seek out a sports medicine podiatrist for concerns on injury or footwear.  It is extremely difficult to accurately recommend footwear without assessing first hand, an individual’s gait pattern, range of motion, biomechanical profile and foot type. Other factors such as injury history, body mass index, weekly miles or hours of training, training goals, training philosophy, and training surface are all important in selecting the right shoe. These things cannot be done via the internet. While unreliable forms of self-assessment have been used elsewhere, we avoid advocating these means.  Research has not validated wet paper towel tests, shoe wear patterns and the ability to rates one’s own degree of pronation as reliable or meaningful in terms of biomechanics. In addition, weightbearing balance measuring devices and treadmill analyses performed outside of a professional office setting may also not be predictive of footwear needs.

Some footwear and foot type information may be helpful to those who are overwhelmed with the abundance of footwear choices but the AAPSM suggests that individuals keep in mind these caveats:

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Reliability of Testing Methodology

Research has not yet shown that current methods of testing footwear provide meaningful information in terms of injury prevention, performance or comfort.  Even automated testing methods that use machines to simulate running or walking on the shoe are flawed because running shoes perform differently with a living human moving on top of the shoe.

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User Reviews

The internet has provided a forum for individuals to rate shoes and post feedback on their experience.  Shoes affect our comfort and performance on every step of every day and we all have different foot shapes, body types and gait patterns and we experience comfort in very unique ways.  So while user reviews may be helpful in terms of quality and/or durability, they are irrelevant in terms of comfort or performance from one individual to another.

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Forms of Assessment

A significant flaw in recommending footwear via the internet is that whoever (or whatever) is making the recommendation requires the individual to classify themselves according to their level of pronation and their arch height.  There are two problems with this scenario; unless one has been examined by a medical practitioner or has a slow motion video of themselves running barefoot then there is no way to accurately judge how much they pronate.  Only a podiatrist or other sports medicine specialist can classify their range of motion and level of pronation.  The second issue is that there is no agreed upon definition of what constitutes overpronation or even how much intervention may be necessary to manage it. 

In terms of arch height, the wet paper test is commonly recommended as a simple way to assess arch height which is assumed to be indicative of pronation level. However, the problems with this are that research has shown that arch height in a standing position is not a reliable means of assessing pronation and the test is done while standing but running and walking are dynamic movements in which the arch height changes from heel strike to toe off.

Shoe wear pattern has also been touted as a reliable means of assessment but it is a small part of a more thorough exam process and is, by itself, an inaccurate way of evaluating foot and ankle characteristics.