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When a running shoe retail store uses a treadmill and video for gait analysis, does anyone actually have any idea what they are looking for and how that information is then translated into a specific shoe recommendation? How do they recommend one shoe over another on the basis of the video gait analysis?

It can’t really be just to decide if they are a “supinators”, “neutral” or “pronator”, as you can do that just by looking at a foot.

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Craig Payne
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I would suggest that it is just a very good sales gimmick.

as for what there looking for - If you ask them it would be the changes in biomechanics from shoe to shoe and the help them decide what shoe is best for the person buying the shoe.

But what the treadmill brings is marketing hype and better sales figures.

We run different on a treadmill v´s overground , I´ve seen where they get someone to run barefoot on a treadmill and then pick out a shoe from that. So then you have barefoot, treadmill running which is ment to give a good idea on shod running - go figure ??

So sales figures and marketing, a little bit of knowledge is a dangerous thing !

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Mike Weber.



Crazy Mary

They seem to go from a video of the gait, through some sort of black box, to a shoe recommendation. I really want to know what goes on in that black box if its not a gimmick.

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Craig Payne
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God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.

I have been puzzling over this one for a while and would really like to know. What spured me on to ask this today was this video that just turned up You Tube:



I was mildly interested in it until it got to the bit near the end on the "wet footprint test"

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Craig Payne
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God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.

That's a lot of emoticons Craig!!

I think it is exactly what you descibe. Functional foot typing with three types.

That said, very few podiatrists I know in real life appreciate the difference between kinetics and kinematics so we can't really be surprised that the shoe shops arn't there yet!

Truth be told, this is probably not so different to how many podiatrists, certainly in the UK, prescribe orthoses.

We can but try to educate. The problem, I think, is the breadth of the gulf which has formed between the leaders in the field and the workers in the trenches.

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Robert Isaacs
Specialist in Biomechanical Therapies
www.Footprintspodiatrysolutions.co.uk

small, yellow, leech-like, and probably the oddest thing in the universe

Semper in excretum sum sed alta variat

What I trying to work out is why do they need a video of treadmill gait to do this, when you can get that information by just looking at someone standing.

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Craig Payne
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God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.

Hi Craig,
When I was retailing bushwalking boots and ski boots I had a black box process in my head, which must be a bit what you are asking about. We had knowledge of the static fit shapes of shoes, knowledge of the static dimensions of feet, knowledge of the dynamic functional nature of each boot, knowledge of the basic dynamic nature of the foot, knowledge of the intended use of the footwear, such as walking, skiing Alpine or XC or XC skating all of which are different. The black box process was where having taken in all the info you could get your head around you try to find the best match up to the foot. No real way to explain except to say that after 10 yrs of measuring feet(and keeping records), feeling feet and boots, watching feet and considering the uses our ability to fit boots with less returns and problems seemed to go up. We offered a money back guarranty even after outdoor use and from hundreds and hundreds of prs a year we probably only took 3 or 4 a year back
I have always thought the ability resides in the ability to visualise the nature of foot and boot as a bit of an overlay.....and lots of learning by trial and error.
regards Phill

"Its a bit bare in here today!"

"Yes. "

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Robert Isaacs
Specialist in Biomechanical Therapies
www.Footprintspodiatrysolutions.co.uk

small, yellow, leech-like, and probably the oddest thing in the universe

Semper in excretum sum sed alta variat

I wish someone could really explain to me what they think they are doing. For example what do they base the decision on to give someone, for example, a Asics Gel Kayano, a Nike Equalon or a Brooks Beast ... all good shoes, so how is the decision made? What goes on in that black box?

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Craig Payne
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God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.

Craig, let's assume that by looking at the person standing, watching them run on the tmill for a few minutes or even running around the parking lot, and asking a few key questions like, "do you experience any pain before, during or after you run" ? If so, where? The salesperson looks for wear patterns on the current pair of shoes, asks if those shoes work. Given your example, the salesperson adds all this information together and concludes that a stability shoe is probably a good choice. Given that, the store carries 3 possible shoes in the persons size, the Kayano, Equalon and Beast.

Starting with the Beast, kind of the standard for motion control. Unless the person really has big issues and other stability shoes haven't worked, I would use this as a last resort type of shoe. The reason is that these shoes weigh a ton, well they weigh 14 OZ for a men's size 9. That is just really heavy to run in, especially long runs. If you can get away with less shoe, why would anyone want to wear big heavy shoes? Why would a sales person even recommend them unless as a last resort? Good shoes, if you need them but only if you need them.

Now we are down to two pairs of good stability shoes. A key factor that hasn't been discussed is fit. The shoes are made on different lasts and will fit the same foot differently. It is now time for the runner to try on both pairs. I would ask the runner which shoe feels the most supportive and the most comfortable. If it is a toss up at this point, I would recommend the Equalon over the Asics for two reasons. 1) The Asics is still a heavy shoe, not as heavy as the Beast but at 12.7 OZ's it is still on the heavy, clunky side for doing long runs. The Nike on the other hand weighs 11.8 OZ which is the perfect balance of weight and support and makes a great all around shoe. If you can get away with an 11.8 OZ stability shoe, I would go with it every time. 2) The second reason I would select Nike over Asics is that from my point of view and experience, Nike shoes have always proven far more durable than Asics. The blown rubber in the forefoot in Asics just doesn't last that long.

So, my "black box" would be to first determine if a stability shoe is in order, then start with the Nike Equalon assuming your example. I would go through the same thought process for cushioned shoes, performance shoes and trail shoes. Another word to describe a "black box" would be a simple decision tree to get you quickly to the right shoe.

As far as the treadmill goes, if it helps get the customer in the door, why not? Frankly I think if the salesperson knows what they are looking for, they can send the person out for a few strides in the parking lot to see what they need to see.

Dana

Part of my reason for asking this is the data we have comparing a wide range of shoes from several companies and looking at the subject specific response of each runner to the different shoes (its what I presented at WCB in Singapore) ... it was clear that each runner had a better reponse to a few of the shoes and a bad response to a few of the shoes -- but it was not consistently the same shoes .... one runner may have had a -ve response to the Equalon, but the next runner had a +ve response ... it was all over the place - it was the same pattern for all the shoes tested. I am keen to know more about what happens at the retail level regarding the "decision tree", but my experiences to date tell me is really is a "magical black box".

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Craig Payne
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The decision tree is another name, lets not debate semantics Craig. I agree that for relatively young and inexperienced fitters it is a monkey see monkey do thing
(we never let our staff fit boots until they had been around for at least a couple of years and they were closely supervised)with very little insight into the factors that should influence the shoe buyer. It took us 5 plus years to get to the point where our confidence in our fit ability became high enough to stop offering the choice to the customer. In most stores including Athletes Foot it is really about identifying a few basic points and then giving the customer three shoes to choose from, their policy tends to be that more is too confusing. The individual reaction to a shoe can be influenced by loads of factors including footwear history, foot anatomy and nature, intended use of shoe blah blah blah, it's probably impossible to list everything.
The end resuly is as you say really idiosyncratic. In our business between 1984 and 1989 we realized that at least with ski and bushwalking boots the experience we had developed made it more likely that our decision would be better than the relatively inexperienced customer so we went to the extent of offering a money back guarranty if they bought what we said to buy....not what they wanted to buy, if the two were not the same.
This is an area I can blather on about for ever, I don't want to bore anybody, and of course for all the years of doing it we have not one double blind study.....Running shoes are not necessarily the same because the consequences of a poor choice are not necessarily as severe, the shoes are softer and more forgiving in the first place and the use duration by most users is much shorter on any given day.
regards Phill Carter

Craig, just to make sure, -ve response and +ve response are referring to ventilation? If so, does that correlate to metabolic cost? I would imagine, ve and metabolic cost go beyond the scope of what a retail store can deal with.

My impression of a typical retail store is that they will be doing great if they can at least assess a runner and get them into the right class of shoes. In other words stability shoes, ANY STABILITY shoes if that is what is needed, cushioned shoes for neutral runners, performance shoes for racing IF the runner can handle them and so on. Expecting the retail store to dial it in further than that and I'm sure they'll need to pull out the magical black box.

Given that a certain class of shoe has been determined appropriate. A typical retail store might only have 2 or 3 models to chose from. I really don't know how much of a black box they need. With only 2 or 3 models, it then comes down to shoe weight, comfort, price and possible prior history. For example, the runner may say that whenever they've run in Asics, their left knee hurts. Well if that's the case, then the other option, the Nikes for example might be the better choice. In this example does a -ve response or a + ve response matter? By default, if it comes down to a coin toss between one pair of shoes over another, without access to experimental equipment, I would always recommend going with the lighter pair of shoes.

Now if the runner has a choice of every single shoe that is on the market, for example, they buy their shoes on the internet, the need for a really good magical black box becomes very important. I know I personally have had 40 years of trial and error with my running shoes. Without the use of experimental equipment, my own shoe selection comes down to a few factors, fit, weight, shoe stiffness and durability.


Dana

My interest is how they assess runners and deem what class of shoe is needed. How do they decide a stability shoe would be the most appropriate? When an individual who is new to running and knows nothing about shoes enters the store - how do they decide what shoe that individual walks out with?

My guess is they do it based purely on an old, outdated, non validated kinematic based system. Or to put it another way they look at the alignment of the rearfoot and put them into one of 3 groups. Rocket science it aint.

No idea what a neutral runner is Dana.

Ian.

The parameter we measured was the timing of load coming off the heel. This is based on a number fo assumption - we clinically see delays in a number of pathologies; an earlier heel unweightig could be considered a sign of a more efficient gait. ie if the running shoe/orthotic/whatever combination is right, the CoP and CoM should presumably progress ahead faster or sooner. When in comes to foot orthotics we have moved on from that paradigm (or at least those who are up with play have), but the running shoe industry is lagging behind. Robert and Ian hit the nail on the head: Every "clinical" study that has looked at the current running shoe prescribing paradigm has shown it is wrong. eg
Effect of three levels of footwear stability on pain outcomes in runners
Plantar foot shape, choice of running shoes and injury prevention

If we accept the methodology of these two studies (and they both have some non-fatal issues), then the conclusion means one of two things:

1. Running shoes are crap; or
2. The current running shoe paradigm is wrong

My reason for starting this thread was to work out how to move this forward. I do have a meeting later this week and this is the topic of the meeting...

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Craig Payne
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God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.

I know what I would do for a new runner, have them run in the parking lot or on a treadmill while I'm watching what is going on with their feet and ankles. If they are rotating inward in grotesque proportions, I would consider a stability / motion control shoe. I would also look at whatever shoes they are wearing to see if I can see any compression of the medial side of the midsole, excessive wear of the medial side of the outer sole or excessive deformation of the medial upper. Not a lot of rocket science there with no specific measurement of how much grotesque proportion is, how much compression or wear is too much or what excessive means.

What I mean by a neutral runner is that they exhibit little pronation or supination. In otherwords, when landing, the runner doesn't need any external devise that limits movement. Little is not defined specifically because we are talking about a retail store.

Dana

If you Really want to know what they look for Craig, there is an easy answer to this.

Go in as a client and get an assessment done and see what they supply you and why, or get one of your students to apply for a job in one of these stores.

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David Sutton
C.Ped.CM.Au
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www.bilbyshoes.com

Or get Cam White to tell us - He owns a running shoe shop, sells shoes for a living and seems pretty switched on. He should be able to tell us whats in the magic black box.

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Mike Weber.



Crazy Mary

So what you're saying Dana is that you would recommend shoes based on kinematic measures/visual alignment?

I think the question we need to be asking is whether stability/motion control shoes predictively alter kinematic patterns in every individual (which they don't in my opinion), and even if they did are these changes always going to be beneficial?? If the answer to either of these questions isn't a firm yes (which I think it isn't), then the current way that running shoes are prescribed needs reviewing.

The big issue is that at present we probably don't have much better. Look forward to Craig's thoughts on this following his meeting.

Ian, thanks for your help.

Often when I am in running events that involve a lot of people such as marathons, I like to latch on to people ahead of me and let them "pull" me along. When I'm doing this, my attention will eventually make it's way down to their feet. I have found it quite interesting to watch the movement of the foot while it hits the ground, rolls forward and pushes off. Sometimes I'm shocked by the amount of medial rotation I'll see. I have to wonder how some people can run even 10 minutes without injury. Usually I'll see the medial part of the midsole all squished and compressed. You would think that a pair of stability shoes would help. Even if they didn't help, I'm not sure they would hurt. I don't know how they could possibly be worse than a pair of shoes with highly cushioned midsoles.

I have one pair of stability shoes that someone gave me as a gift. I hate wearing those shoes. There is a very firm medial post that feels like I'm running with a block of wood under my arch. Because of this, I feel the shoes are making it difficult for my feet to naturally roll from the anterior portion of my heel after landing to the big toe and second toe for push off. I don't think the shoes will cause injury but I do think the shoes are getting in the way of natural foot mechanics.

If someone who doesn't need stability shoes feels that type of shoe is more of a detriment than a help, how can stability shoes really allow for proper foot movement with someone who does have issues? Is it possible that a better shoe for people with pronation pathology be something that simply contains a thinner, firmer midsole? (I'm thinking of a good trail shoe)

Dana

I used to think that too, but that is where our understanding is changing. It does not seem to matter how much or how bad they pronate (kinematics), its the force that is driving that motion or needed to stop that motion (kinetics) that is important. If those forces are high --> tissue damage. If those forces a low, it may not be a problem how much you pronate. (and vitually all of the prospective overuse injury risk studies have shown that the amount of pronation is not a risk factor for injury).

Even the foot with next to no "pronation" or even the theoretical normal amount may be a problem if the magintude of the forces needed to stop it are high.

Theorectically, the motion control shoes should be resevered for those with the high forces pronating the foot and not how much the foot pronates.

This is why I highlighted the quotes from Roberts and Ian's posts: .... watch this space for more

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Craig Payne
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God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.

Perhaps this dialog can be expanded into the ever-growing threads on the site regarding running shoes vs. barefoot running. Is there logic in the possibility that running injuries are not coming specifically from the use of shoes themselves, but perhaps in being improperly being assigned/recommended shoes that could lead to injury in a particular consumer's gait type? That would seem to bring greater credence to Craig's initial post. How are they making their observations, and extrapolating those observations into their shoe recommendations?

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Jeremy Long C Ped
Smoky Mountain Foot Clinic

In my experience the majority of times the runners are looked at to get the best STJ neutral looking shoe. In the stores that run (for example) Silicon Coach, the customer is viewed in bare feet, then again using the same parameters in a number of different brands of similar control.
For example a moderately pronated foot type would be chosen an Asics 2100 series, brooks adrenaline, structure triax etc

The shoe videos and bare foot video would be brought onscreen together and the shoe that brings the leg into the "best looking position" would be the one recommended in terms of control.

The customer would 90% of the time get that shoe unless a different shoe felt much better to the customer, or was a better colour!

Here's a young man, 21 years of age. He plays football, squash, tennis, surfs, does yoga and runs once a week for approx. 30 mins. Here are a couple of stills: of his feet and of him running in a pair of relatively cheap neutral Adidas shoes. What shoes would you put him in and why?

Attached Images

	standing.jpg (56.5 KB, 936 views)
	running.jpg (60.0 KB, 932 views)

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Who? What? When? Why? Yeah? And? So? What?

"My mission drive is to open up my eyes, 'cause the wicked lies and all the sh!te you say..." http://www.youtube.com/watch?v=V4NW5S1UTPQ

"Science is the antidote to the poison of enthusiasm and superstition."

Easy... Vibram Five Fingers

Shut up you tart and ask the right question...... P.S. i think he could deal with a bit more knee flexion, let's stick him in some vibrams and see what happens......... err no.

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Who? What? When? Why? Yeah? And? So? What?

"My mission drive is to open up my eyes, 'cause the wicked lies and all the sh!te you say..." http://www.youtube.com/watch?v=V4NW5S1UTPQ

"Science is the antidote to the poison of enthusiasm and superstition."

What's his pathology/symptoms?

Is the right question. None, is the answer.

So what kind of shoe would you prescribe on the spectrum: neutral.........motion control?

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Who? What? When? Why? Yeah? And? So? What?

"My mission drive is to open up my eyes, 'cause the wicked lies and all the sh!te you say..." http://www.youtube.com/watch?v=V4NW5S1UTPQ

"Science is the antidote to the poison of enthusiasm and superstition."

So Ackers (or any one else), do you know what is the cost of such a service is?

The entire job including, bare foot run, consult, measure, fit, consult, then the test run in the first shoe, consult and another of all the above for another pair, cost of equipment and the extra floor space?

l am going to guess that each shoe, if done properly, would cost 45 min to 1 hour of the sales persons time at least and if they try three pair on that would have to be 3 hrs(?) plus cost of shoes, does that sound right?

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David Sutton
C.Ped.CM.Au
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