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“Do I need a neutral shoe or an anti-pronation shoe?” is a common question. Those labels describe broad design categories, but they do not tell us whether a particular shoe fits your foot, feels comfortable during activity or suits the demands of your sport.
At Steps Podiatry & Gait in Inverness, our starting point is the person wearing the shoe: your activity, symptoms, previous footwear and how the shoe works for you.
Why the label is only part of the picture
Shoes within the same category can differ in width, cushioning, stiffness, heel-to-toe drop and sole shape. “Neutral” does not mean a shoe has no support, and “anti-pronation” does not tell us how an individual will respond to it. Footwear combines multiple features that need to be considered together. [1,2]
A 2022 Cochrane review found that selecting shoes according to static foot posture probably made little or no difference to injury rates. The studies supporting that particular finding involved military recruits, so they should not be treated as a direct answer for every recreational runner. They do challenge the idea that arch shape alone provides a reliable shoe prescription. [3]
Comfort and injury risk: what the evidence shows
Research supports taking your experience of a shoe seriously. A 2025 study by Malisoux and colleagues analysed 527 recreational runners using injury and running data collected over six months. Greater perceived cushioning and higher overall appreciation of the shoe were associated with lower injury risk. [6]
This supports using comfort and perceived cushioning in shoe selection. It was a secondary analysis, however, and some comfort ratings were collected after an injury had occurred, so the association does not establish that comfort itself prevented injury. [6]
Earlier research in military personnel also found fewer injury and pain outcomes among participants using inserts selected for comfort compared with a control group. That supports the relevance of individual preference, while relating specifically to inserts used during military training. [7]
The “comfort filter” concept brings these ideas into footwear selection: how a shoe feels to the wearer is clinically relevant feedback. [4] At Steps, we combine that feedback with fit, the demands of your activity and the findings of your assessment.
Fit, comfort and function: what we look at
- Fit and shape: sufficient length, width and depth, a secure heel and an upper that accommodates the foot without unwanted pressure.
- Comfort in movement: how the shoe feels when walking, running or performing relevant movements, including any pressure points or symptom provocation.
- Function: the grip, flexibility, cushioning and stability needed for the activity and surface. Road running, trail running and court sports have different demands.
- Your response: what has worked previously, what has changed and how your symptoms behave during and after use.
These are the practical checks we use at Steps. Most of the research discussed here concerns running; it should not be assumed to establish the best footwear for every sport.
Can supportive footwear still be useful?
Yes. Moving beyond labels means selecting support for a reason. A randomised trial of 372 recreational runners found fewer injuries with a particular motion-control shoe than its standard counterpart, with a greater apparent benefit in the subgroup with pronated feet. That finding does not establish that every shoe in that category is best for everyone with a similar foot posture. [5]
We may recommend a supportive shoe when its features suit your symptoms, comfort and activity. Equally, a comfortable shoe that is working well does not automatically need replacing because of a category assigned to your feet.
How footwear advice fits into care at Steps
If pain is driving repeated shoe purchases, a sports injury assessment can help establish what needs addressing. Bring your current footwear and any orthoses so we can consider fit, loading and symptoms together.
Where a more detailed movement question is relevant, 3D gait analysis can contribute to that assessment. Its purpose is to inform clinical decisions alongside your history and examination. It does not identify a guaranteed injury-proof shoe.
We explain which footwear features may be useful, why they are being considered and how to review your response. Footwear advice then supports your rehabilitation and activity goals.
Contact Steps for advice on the right assessment, or explore our sports injury service in Inverness.
Evidence behind this article
- Footwear recommendations for runners: influencing factors and professional perspectives. Physical Therapy in Sport, 2025.
- Honert EC et al. Shoe feature recommendations for different running levels: a Delphi study. PLOS ONE, 2020.
- Relph N et al. Running shoes for preventing lower-limb running injuries in adults. Cochrane, 2022.
- Nigg BM et al. Running shoes and running injuries: mythbusting and a proposal for two new paradigms. BJSM, 2015.
- Malisoux L et al. Injury risk in runners using standard or motion control shoes: a randomised controlled trial. BJSM, 2016.
- Malisoux L et al. Association of Shoe Cushioning Perception and Comfort With Injury Risk in Leisure-Time Runners: A Secondary Analysis of a Randomised Trial. European Journal of Sport Science, 2025.
- Mündermann A et al. Relationship between footwear comfort of shoe inserts and anthropometric and sensory factors. Medicine & Science in Sports & Exercise, 2001.
Evidence checked September 2026. Practical recommendations are individualised following assessment.