Look down at the feet around you at the gym or around town. Plenty are standing on little mattresses. Max-cushion shoes carry as much as 2 inches of foam between the sole and the upper. They started with Hoka in 2010, and now it's hard to find a running or walking shoe without the platform. Kate Murphy asked doctors about them in Tuesday's Journal. Several worry about what the soft ride does to ankles, knees and hips.
Dr. Kenrick Dennis, a Houston podiatrist who served as the Houston Marathon's medical director, explains it with a marshmallow. Stand on one and your foot torques in and out a little more. The leg rotates to follow it. That rotation travels up through the ankle, the knee and the hip. The wobble, plus the extra height, raises the risk of twisting an ankle or falling. The foam also dulls your sense of where the ground is.
The research is mixed, and Murphy says so. Fans of the shoes, especially the ones with a carbon plate, point to studies showing 4% better running economy and 2% better performance. But a 2018 study in Nature found the shoes increase the total load on muscles, bones and joints. Part of the reason is that the foot stays on the ground longer. A 2023 analysis in Sports Medicine suggests the shoes can shift where you land and push off, which might raise the risk of foot fractures. Each foot strikes the ground about a thousand times a mile. Run 20 miles a week and that's a million strikes a year.
The lawsuits, and the fit test
Track stars, including an Olympian, have sued shoe makers, alleging that high-stack shoes with carbon plates caused injuries that derailed their careers. Nike (NKE) faces one such suit in federal court in Northern California. Puma and some of its divisions and partners are named in three cases in Massachusetts. These are allegations. Nike says in court filings that its product isn't defective. Puma strongly denies its shoes cause injury and is countersuing in a German court. Scott Christensen, who trains endurance coaches for USA Track & Field, adds a cost nobody expects. The shoes are so comfortable that runners don't get sore, and soreness, he says, is “the governor of training.”
In the store, there's no one right answer, Christensen says. People's bodies, workouts and injuries differ. Murphy's starting point is simple, though. The best shoe is the one that fits. A 2018 study in the Journal of Foot and Ankle Research suggests as many as 72% of people wear shoes that don't fit their width or length. So start with fit. Then test balance before softness. Rise onto your toes and hold. Rock back on your heels and hold. Do a few quick turns. Rotate between shoes with different cushioning, and break any new pair in slowly.
Our read
This is Health Costs, and for our retired readers it's about falls. A fall can be the medical bill that rewrites a retirement plan. It can mean a broken hip, a rehab stay, and months when someone else drives. The doctors here are mostly talking about runners. But Dr. Dennis's warning is about wobble and height, and those matter on a walk with the dog too. The right shoe for a fast college runner may be the wrong shoe for your mother. Nike (NKE) is held at weight in 1 book; nothing added.
Here's the check for this week. Look at the shoes you or your parents wear for the daily walk. Try the toe raise and the heel rock in the kitchen, with a hand near the counter, and notice any wobble. Then find the line in your plan that would pay for a rehab stay after a fall, whether that's a long-term-care policy or the emergency fund. If that line is blank or thin, bring it to your next review and we'll talk through the health-costs part of your plan.