Zero drop minimalist shoes are all the rage right now. Unfortunately, just because a shoe has zero height differential — between the ball of the foot and heel — doesn’t mean it will work for you.
Case in point: One patient I saw today is an ultrarunner who switched from a structured shoe to a zero drop minimalist style two years ago to reduce unilateral infrapatellar pain. Fortunately, the pain resolved, but within the last several months he started to experience increasingly painful peroneal (outer foot) pain and medial (inner) meniscal knee pain. He did not have either pain prior to training in the zero drop shoes.
A quick evaluation of his zero drop shoes, identified an hourglass-shaped midsole/outsole.
The arrow shows the narrow midsole width and the rectangle shows how much of his midfoot was only being supported by the upper (25%). This significant lack of support mid-arch caused his arch to negatively drop below the plane of the heel and forefoot, altering his knee and foot mechanics enough to produce compensatory pain in other areas.
The following image shows the top view of his foot in the shoe. As you can see the grey midsole disappears from the entire arch — and this is where support is needed the most.
If you’re running in minimalist or zero drop shoes, you will still want to match the shoe to your foot type — otherwise new injuries can occur.