Stiff Running Shoes Linked to Outer Knee Pain

Are you a forefoot runner who struggles with outer knee pain? The problem is most likely not you, it’s your running shoes. You can positively affect your knee by avoiding running shoes that are too stiff because stiff running shoes generate bad mechanics that challenges knee-joint stability. The best way to resolve sharp knee pain while running is by wearing flexible, barefoot-like running shoes. Here’s why.

Stiff Running Shoes Linked to Outer Knee Pain

  • This is the typical running shoe worn by most runners. However, these shoes are very stiff and force the feet into extreme positions that project more strain on the IT band. Eventually, a runner will experience outer knee pain when running.

Stiff Running Shoes Linked to Outer Knee Pain

According to an ocean of studies, stiff running shoes appears to breed ITBS, a common running-related injury characterized by outer knee pain when running.

ITBS Not Caused By Weak Hips

For the longest time, experts believed that outer knee pain when running was due to weak hip abductors because they facilitate a crossover running gait, or a narrow step width.

  • However, Garu et al. (2008) revealed that strengthening the hip abductors had little effect on preventing outer knee pain when running.

The researchers also noticed that dynamic and static strength did not differ between healthy runners and runners with outer knee pain. Therefore, outer knee pain when running has nothing to do with hip strength or weakness, rather the problem is our running shoes.

How Stiff Running Shoes Cause Outer Knee Pain

Phinyomark et al. (2015) found that runners with outer knee pain had higher levels of ankle internal rotation, a process that is strongly affected by running shoes.

Many joggers wear cushioned running shoes with the heel being the most thickly cushioned, but the main problem with such footwear is that they are too stiff, and alter the kinematic chain of the lower leg during running. The researchers found the following:

  • A stiff running shoe increases torsional stiffness which increases rapid rearfoot motions during the stance phase of running.
  • The extra movement commotion of the foot occurs in response to thick compressible materials that are stiff in the longitudinal direction.
  • As a result, landings are destabilized during running, causing the ankles to make more effort to reinforce balance, which projects more strain on the IT band.

Similar findings were also made by Stacoff et al. (1991). They found that stiff soles forced the feet into extreme positions which provoked ankle instability during running.

  • The researchers also speculated that fast motor actions of the ankle in response to faster eversion or inversion of the foot, may emphasize more work, stress, and strain on the IT band, resulting in outer knee pain when running.

The researchers then mentioned that the movements of the foot in thick, cushioned running shoes is a whole other ball game whereby cushioned materials may provide additional plantar stimulation that may host kinematic changes that have implications to injury.

The Take Home Message

Running shoes causes outer knee pain when running because they induce torsional movements of the foot that compromise ankle stability. Thus, it would then follow that two central approaches should be used to treat and prevent running-related ITBS: run barefoot or in barefoot like shoes (shoes without compressible materials and under heel cushioning)

Doing so will force the feet to develop the muscle strength needed to control rearfoot movements in order to control ankle stability.

  • Barefoot conditions provides an enriched environment for natural supination to take place at touchdown, thereby accelerated foot/ankle movements that lead to outer knee pain during running are prevented.

When shoe stiffness is removed from the equation, ankle instability is not an option for the runner, and neither is ITBS!

More From Run Forefoot:

Forefoot Running – If you want to run injury-free, you need to consider forefoot running!

Why Heel Running is Dangerous – Find out why when you heel strike, you’ll eventually get hurt.

Midfoot Strike and Injury – In terms of preventing injury, learn why a midfoot strike is not good enough to keep injuries away.

Arch Pain – Discover how a forefoot strike landing reduces unnecessary stress on the arch during running.

Running Shoes for Forefoot Runners – Injury free running starts at the feet! See my reviews on the best shoes I feel will help you with your forefoot strike.


Grau et al. Hip abductor weakness is not the cause of ITBS. Int J Sports Med, 2008; 29(7):579-583.

Phinyomark et al.Gender differences in gait kinematics in runners with ITBS. Scand J Med Sci Sport Exer, 2015;DOI: 10.1111/sms.12394

Stacoff et al. The effects of shoes on the torsion and rearfoot motion in running.Med Sci Sports Exerc, 1991; 23(4):482-490.

Bretta Riches

"I believe the forefoot strike is the engine of endurance running..."

BSc Neurobiology; MSc Biomechanics candidate, ultra minimalist runner & founder of RunForefoot. I was a heel striker, always injured. I was inspired by the great Tirunesh Dibaba to try forefoot running. Now, I'm injury free. This is why I launched Run Forefoot, to advocate the health & performance benefits of forefoot running and to raise awareness on the dangers of heel striking, because the world needs to know.
Bretta Riches

P.S. Don't forget to check out the Run Forefoot Facebook Page, it's a terrific place to ask questions about forefoot running, barefoot running and injury. I'm always happy to help!

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