When Zero Drop Doesn’t Work

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.

4 responses to “When Zero Drop Doesn’t Work

  1. Thank you so much for posting this! I sell running shoes and I’m constantly reminding my (overpronating) customers who want to ‘go minimal’ that they can’t immediately jump from a structured shoe to a minimal shoe without risking injury. Some customers listen; most don’t.

  2. Another great post.

    Can an overpronating runner ever go minimal?

    • Absolutely. It all depends on how excessive of a pronator you are, and whether or not you have experienced injury because of over-pronation. I evaluate all of my runners both with and without shoes while treadmill running, to determine whether minimalist shoe running is an option or not. If someone looks fine running in minimalist shoes and they want to continue running this way, then I won’t object. If however, someone looks worse running in minimalist shoes (more pronation/poorer shock absorption) than in non-minimalist shoes, I strongly recommend the latter. At the end of the day (for me) – it’s about rehabilitation and injury prevention, with an emphasis on injury prevention. Thanks for your question!

  3. Nice article, Dr Jenny!
    Check out my article “What Shoe Companies Don’t Want You To Know” that is on the same subject.
    Dr Cathleen A McCarthy

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