Well+Good Article: The Best Sneakers for Your Knees (& Other Thoughts on Footwear)

Dr. Henry recently contributed to an article about footwear and orthopaedic health. Read it here!

Although there are no direct studies of how specific sneaker types affect knee function, we know that every time you take a step, so many things are happening in your body to give you stability and propel you forward! A specific series of muscle activations and joint motions occur throughout one phase of a step – that is, from the time your heel hits the ground to the time your toes leave the ground. Throughout the step, your hip muscles contract to stabilize your hip, your quads and hamstrings fire at specific times, and muscles in your lower leg activate in a chain of events. In addition, we know that the knee mobility that occurs when you take a step specifically functions to stabilize your center of gravity, decrease your energy expenditure, and absorb the “shock” of your heel strike hitting the ground. We see this taken to an extreme in people who wear high heels – a simple change in footwear and the position of the foot completely changes the gait pattern and compromises your performance and balance. But studies have shown that even changing the “wedge” of a shoe on the inside or the outside of the foot can alter pressures throughout the knee joint by changing the mechanics of how you load the foot, and by extension, the knee.

We know – mostly from high-heeled shoe studies – that shoes with a significant drop-off from heel height to toe height puts additional forces through the knee joint. So, I definitely recommend that patients with foot and knee problems avoid or limit their high heel wear. If you do have to wear high heels for an important work event, look for shoes that have a lower heel height, a thicker/chunkier heel (rather than a stiletto), or a “platform”/wedge design, which gives you the semblance of height without forcing your foot into as much of an abnormal position. However, that doesn’t mean that a completely flat, unsupportive shoe is the right answer, because this can often exacerbate foot and ankle problems, even if you didn’t have them to begin with.

I typically recommend a sneaker with a stable, supportive sole and a design that cradles the foot. Ideally, this maintains ankle motion and absorbs the shock when your heel hits the ground, which are both factors that are important to minimize excess force across the knee. One way to check this – if you can take the sneaker in your hands and curl it into a ball, it’s often too flexible for patients with foot/ankle or lower extremity problems.  You also want something that fits your foot well, so you don’t feel like there is an area that is too loose/unsupportive or too tight. Some footwear brands make gender-specific shoes, which account for differences the width of the heel or the forefoot, and may be better tolerated by some patients. In addition, it’s important to routinely replace old shoes that have worn out – running experts typically recommend every 300-500 miles, or about every 6 months. Finally, if you’re noticing that your shoes are wearing unevenly, it may be time to see a professional – we can identify if there’s an alignment or gait issue that can be addressed to maximize your performance.