Are high‑drop (≥8 mm) running shoes detrimental for individuals with tight calves, Achilles tendinopathy, plantar fasciitis, or a history of knee or hip pathology?

High-Drop Running Shoes: Impact on Lower Extremity Pathology

For individuals with tight calves, Achilles tendinopathy, plantar fasciitis, or knee/hip pathology, high-drop (≥8 mm) running shoes are generally detrimental and should be avoided in favor of lower-drop footwear, though the transition must be gradual for regular runners.

Evidence for Harm from High-Drop Shoes

High heel-to-toe drop running shoes create several biomechanical disadvantages that can worsen existing lower extremity conditions:

Patellofemoral Joint Stress

• Running in shoes with drops ≥10 mm increases peak patellofemoral joint stress by more than 15% compared to zero-drop shoes, primarily due to increased knee extension moments 1
• This elevated stress occurs because high-drop shoes increase knee flexion angle during stance phase, which compounds loading on the patellofemoral joint 1
• For individuals with knee pathology, this represents a significant mechanical disadvantage that can perpetuate pain and dysfunction 1

Achilles Tendon and Calf Loading

• Contrary to traditional clinical assumptions, heel lifts do not consistently decrease Achilles tendon loading during running 2
• The maximum plantarflexion moment at the ankle—which indicates Achilles tendon loading—is not significantly reduced by increased heel height in most runners 2
• When transitioning to minimalist (negative 8 mm drop) shoes, gastrocnemius lateral, Achilles tendon, and flexor hallucis longus muscle forces actually increase initially, indicating heightened injury risk during the adaptation period 3

Plantar Fasciitis Considerations

• For plantar fasciitis management, the American College of Foot and Ankle Surgeons recommends avoiding flat shoes and using heel cushions or arch supports 4
• However, this refers to adequate cushioning and arch support rather than excessive heel-to-toe drop 4
• The key is proper arch support and pressure distribution, not simply elevating the heel 4

Running Regularity Modifies Risk

The relationship between shoe drop and injury risk depends critically on running experience:

Regular Runners (≥6 months of weekly practice)

• Low-drop shoes (0-6 mm) are associated with 67% higher injury risk in regular runners compared to 10 mm drop shoes (HR 1.67,95% CI 1.07-2.62) 5
• This increased risk likely reflects the substantial biomechanical adaptation required when changing from habitual footwear 5

Occasional Runners (<6 months of weekly practice)

• Low-drop shoes reduce injury risk by 52% in occasional runners (HR 0.48,95% CI 0.23-0.98) 5
• Occasional runners may benefit from lower-drop shoes as they have less ingrained movement patterns to overcome 5

Practical Recommendations

For Achilles Tendinopathy

• Use open-backed shoes to reduce pressure on the posterior heel 4
• Incorporate heel lifts or orthoses, but recognize these primarily reduce shoe pressure rather than Achilles loading during running 4
• Avoid high-drop running shoes (≥10 mm) as they do not reliably reduce Achilles tendon forces and may increase patellofemoral stress 1, 2
• Focus on calf stretching and strengthening rather than relying on shoe modifications alone 4

For Plantar Fasciitis

• Prioritize proper arch support and cushioning over heel elevation 4
• Use customized orthotic devices when over-the-counter options fail 4
• Avoid barefoot walking and thin-soled slippers 4
• Select footwear with moderate drop (4-8 mm) that provides adequate arch support rather than excessive heel elevation 4

For Knee/Hip Pathology

• Strongly avoid shoes with drops ≥10 mm due to the >15% increase in patellofemoral joint stress 1
• Consider zero to low-drop shoes (0-6 mm) to minimize knee extension moments 1
• If transitioning from high-drop shoes, reduce running volume by 50% initially and progress gradually over 8-12 weeks 4, 5

For Tight Calves

• Prioritize aggressive calf stretching programs over shoe modifications 4
• If using lower-drop shoes, expect temporary increases in calf and Achilles loading during the 6-8 week adaptation period 3
• Do not assume high-drop shoes will "protect" tight calves—they may actually perpetuate the tightness and create compensatory problems at the knee 3, 1

Critical Transition Guidelines

When changing shoe drop for any reason:

• Reduce running distance by 50% initially and progress by no more than 10% weekly 4
• Temporarily reduce speed when increasing distance 4
• Monitor for pain during and after running; if pain exceeds 3/10, rest and resume at lower level 4
• Allow 6-8 weeks minimum for biomechanical adaptation 5, 3
• Incorporate concurrent calf strengthening and stretching throughout the transition 4

Common Pitfalls to Avoid

• Do not prescribe high-drop shoes based solely on the assumption they reduce Achilles loading—evidence does not support this for most runners 2
• Do not transition regular runners abruptly to low-drop shoes without a structured progression plan 5
• Do not ignore the 67% increased injury risk when regular runners switch to low-drop footwear 5
• Do not use shoe drop as a substitute for addressing underlying biomechanical deficits, muscle imbalances, or flexibility limitations 4