Footwear Foundations for Runners
A Guide to Shoes, Orthotics, and Socks for Natural Foot Function
Where to start
When I evaluate runners in my clinic, I always start with footwear. Your shoes influence every step you take, how you load your joints, and how the rest of your body stabilizes during gait. One of the most misunderstood but important concepts is the difference between pointed toe box shoes and foot shaped toe box shoes.
A foot shaped toe box is not the same thing as simply ordering a “wide” shoe. Foot shaped shoes are intentionally designed to mirror the natural splay of the toes. This allows the toes to spread, anchor, and distribute force during walking and running.
Toe splay is essential. It improves balance, stabilizes the arch, and allows the foot to act as the foundation it was designed to be. When the toes are compressed inside a pointed toe box, like the majority of mainstream running shoes, the foot loses this natural base of support. The rest of the limb has to compensate.
The analogy I use with my patients is simple:
It is like balancing on a narrow ice skate versus a wide ski.
A barefoot foot with splayed toes gives you the ski. A pointed toe box shoe gives you the ice skate.
My experience as an NCAA runner
When I was an NCAA cross country and track athlete, like most runners at that level, I logged countless miles in pointed toe box shoes. None of us were doing any toe or foot strengthening. We weren’t doing mobility work. We weren’t undoing the effects of being “casted” inside those shoes every day.
Over time, narrow toe boxes act like a cast on the forefoot. When toes cannot spread, the small intrinsic muscles of the foot lose leverage, weaken, and atrophy. They simply are not allowed to function. Even elite runners — athletes capable of huge workloads — often have surprisingly weak toes because their footwear never allowed those muscles to engage, instead overcompensating with other muscle groups in the lower leg and foot. Predictably, these other muscles can overload and become injured as they work in isolation, rather than in concert with the other 30+ muscles in the lower leg and foot complex.
This is one of the biggest reasons I advocate for footwear that supports natural foot function in daily life and long distance running.
Not a call to run barefoot
I am not suggesting everyone switch to barefoot running. Most people in first world countries have spent their entire lives in pointed toe box footwear. The intrinsic foot muscles have adapted to that environment. Jumping straight into barefoot or ultra minimal shoes can expose those weaknesses.
This is also why I caution runners about transitioning suddenly to zero drop shoes after decades in elevated heels. Years of running in heel lifted footwear shortens the Achilles tendon and calf complex. A sudden switch to zero drop lengthens that system aggressively and can easily trigger a tendon injury.
If you are unsure how to transition safely, consult a clinician who understands both foot mechanics and running.
Brands that get it right
Companies like Topo Athletic design running shoes with a natural toe box and reasonable heel drop options (for example 3 mm, 5 mm, and 0 mm). These are excellent transitional models that support natural mechanics without overloading tissues too quickly.
For additional guidance, healthy footwear lists and transition guidelines can be found at:
healthyfeetalliance.org
Orthotics: when they help and when they don’t
Orthotics can absolutely be useful, but they are often misused. In my practice, I rarely prescribe orthotics as a long term fix. Instead, I use them as a temporary tool during injury recovery while we strengthen the foot.
Flexible low arches
A flexible low arch is not a problem — it is one of the most adaptable structures in human anatomy. It provides shock absorption and adjusts beautifully to variable terrain. In trail running communities, this can actually be a strength.
However, if a runner with a flexible low arch is injured, a temporary orthotic can help distribute load and calm symptoms while we simultaneously train the intrinsic muscles of the foot.
High rigid arches
A high rigid arch behaves very differently. It does not adapt well to terrain or absorb shock, and these runners often overload the lateral foot and ankle. A common mistake is prescribing a rigid orthotic into an already rigid foot, which can push the foot into excessive supination and increase the risk of inversion ankle sprains.
For these runners, I rarely recommend rigid orthotics. Instead, I focus on mobility, strengthening, and sometimes a flexible insert to help distribute forces more evenly.
Store bought vs custom orthotics: who actually needs what
If a runner wants to trial orthotics, I typically recommend flexible over the counter inserts such as:
Superfeet
Currex
These offer support without locking the foot into a rigid pattern, making them safer during transition phases and less likely to interfere with natural foot mechanics.
There are cases, however, where custom orthotics are appropriate. These are usually more complex presentations — significant structural deformities, post surgical changes, progressive neurological conditions, or chronic instability that does not respond to strengthening alone. Custom devices have a place, but they should be reserved for runners who truly need them, not used as a blanket solution.
For the majority of runners with common overuse injuries, a flexible OTC insert plus a progressive strengthening program is usually the most effective, evidence aligned approach.
Socks: the most overlooked piece of gear
Socks may seem insignificant, but they can completely undo the benefits of a foot shaped shoe. Most conventional socks squeeze the toes together, mimicking the same compression of a pointed toe box.
Even if you buy the best foot shaped shoes on the market, if your socks pull your toes inward, the foot cannot function correctly.
Choose socks that allow toe splay
I encourage runners to choose socks designed with a natural toe box or individual toe sleeves. These support toe splay, reduce friction, and help maintain a wide, stable forefoot.
Popular options include:
Injinji
Xoskins
Correct Toes compatible socks
ToeSpacer wide toe socks
These socks help restore natural toe alignment, reduce blister risk, and improve force distribution with each stride.
Rethink your sock wear
If we want natural foot function, stability, and healthy toe splay, we need to rethink the socks we wear just as much as the shoes we buy.
A note on toe spacers
Toe spacers can be a helpful tool, but I do not recommend running in them. When the toes are suddenly placed into a fully splayed position, the intrinsic foot muscles are forced to work much harder than they are accustomed to. For most runners, those muscles are not yet conditioned for that level of activation. Running with toe spacers often leads to rapid fatigue and can irritate tissues that are already sensitive.
That said, toe spacers do have a valuable role in foot health. Performing gentle stretches, mobility drills, and toe strengthening exercises while wearing toe spacers is beneficial for people with bunion formation or loss of big toe alignment. In these cases, toe spacers help reestablish the natural position of the hallux, improve neuromuscular control, and serve as a tool for restoring healthy forefoot mechanics.
Think of toe spacers as a rehabilitation accessory — not a running accessory.
It is never too late to improve your footwear
One of the most encouraging things I tell runners is this: it is never too late to transition into healthier footwear and rebuild natural foot function. Your feet are adaptable. The intrinsic muscles can strengthen. Toe mobility can return. Your arch can become more stable and responsive. Age does not eliminate the body’s ability to adapt.
However, if you are experiencing pain, dealing with recurrent injuries, or navigating a more complex foot condition, you should always get guidance before making significant footwear changes. An abrupt shift in shoe design or heel drop can overload tissues that are already irritated.
Consult with a clinician who is trained and knowledgeable in foot and running mechanics, such as:
a physical therapist
a sports chiropractor
or a podiatrist
Healthy footwear is a powerful tool, but like any tool in rehab, it is most effective when paired with individualized guidance.
Keep moving, keep balanced.
—
CB Movement Co.
Sports Rehab & Chiropractic | Crested Butte, CO
References
1. Foot shaped toe box, intrinsic muscle activation, and toe splay
Miller EE, Whitcome KK, Lieberman DE, Norton HL, Dyer RE. “The effect of minimal shoes on arch structure and intrinsic foot muscle strength.” Medicine and Science in Sports and Exercise. 2014.
Hashimoto T, Sakuraba K. “Effect of intrinsic foot muscle training on the medial longitudinal arch and dynamic function of the foot in recreational runners.” Journal of Physical Therapy Science. 2014.
2. Narrow toe boxes and forefoot compression (“foot casting”)
Frey C. “Footwear and stress fractures.” Clinics in Sports Medicine. 1997.
Thompson MA et al. “Toe box shape and its influence on hallux valgus and foot discomfort.” Gait and Posture. 2017.
3. Achilles load and heel drop evidence
Sinclair J, Taylor PJ, Atkins S, Vincent H, Hobbs SJ. “Influence of footwear designed to mimic barefoot running on knee and ankle loading during running.” Gait and Posture. 2014.
Johnson AW, Myrer JW, Mitchell UH, Hunter I, Ridge ST. “The effects of a transition to minimalist shoe running on lower extremity running mechanics.” International Journal of Sports Physical Therapy. 2016.
4. Orthotics as short term vs long term solutions
Nigg BM, Nurse MA, Stefanyshyn D. “Orthotic design and biomechanical function.” Gait and Posture. 1999.
Chevalier TL, Chockalingam N. “Effects of foot orthoses: a review.” Journal of the American Podiatric Medical Association. 2012.
5. Rigid foot types and risk of inversion sprains
Willems TM et al. “Intrinsic risk factors for inversion ankle sprains in male subjects: a prospective study.” American Journal of Sports Medicine. 2005.
Feger MA et al. “Diminished foot and ankle muscle volumes in young adults with chronic ankle instability.” Journal of Athletic Training. 2016.
6. Peroneus longus function in running and gait stability
Kelly LA et al. “Intrinsic foot muscles contribute to elastic energy storage and return in the human foot.” Journal of the Royal Society Interface. 2015.
Farrokhi S et al. “Peroneal muscle dysfunction and lateral ankle instability.” Journal of Orthopaedic & Sports Physical Therapy. 2011.
7. Socks and toe splay (toe socks, blister reduction, foot mechanics)
Hupperets MDW et al. “Toe socks for blister prevention in endurance athletes.” Journal of Sports Sciences. 2012.
Gibbon WW, Long G. “Effect of moisture wicking hosiery on foot skin condition.” International Journal of Sports Medicine. 2011.
8. General running footwear and injury mechanics
Napier C, Willy RW. “Footwear and running related injury prevention: A review.” Current Sports Medicine Reports. 2018.
Theisen D et al. “Footwear and running related injury: A systematic review.” British Journal of Sports Medicine. 2014.
