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Justin Vanderleest

Health Advisor is a regular column where contributors share their knowledge in fields ranging from fitness to psychology, pediatrics to aging. Follow us @Globe_Health.

For many runners, the perfect pair of shoes can be critical for optimal performance and injury prevention. But there are seemingly endless footwear options. The most popular shoes these days are unrecognizable from their predecessors, some little more than slippers, having shed much of the support that characterized shoes of the eighties and nineties.

After Nike debuted the "Nike Free" a decade ago, these minimalist designs have sparked a revolution in footwear and are wildly popular with runners, trainers, and fashionistas alike. All footwear companies have followed suit and there is a glut of minimalist shoes on the market. More extreme yet, barefoot running has a niche following and is increasingly popular as a training adjunct among competitive runners. But the more supportive shoes of the past haven't disappeared. And for more personalized support, you can have custom orthotics made by various health professionals.

More than ever, people are asking me what kind of shoes they should buy and whether orthotics are good for them. This has become a polarizing debate.

In 2009, journalist Christopher McDougall published a bestseller Born to Run, which chronicled his personal journey to health as an injury-prone runner. He undoubtedly fuelled the minimalist footwear movement.

McDougall tells of a tribe of people known as the Tarahumara, who live in the remote recesses of the Copper Canyons of Mexico, avoiding modern society and living a lifestyle centred around ultra-endurance running. They run amazingly well, even into their senior years, without the advantages of modern footwear technology, orthotics or sport medicine.

In the book, McDougall is also critical of orthotics and running shoe companies for contributing to injury rates by creating footwear with the wrong kind of support. These companies added excessive heel height and cushioning in the late 1970s, enabling a generation of people to adopt an unnatural running technique, landing on their heels too much, instead of on the midfoot. For overpronators (people whose feet flatten and roll inward too much or too fast), they developed motion control shoes to limit that pronation, sometimes excessively, causing people's feet to weaken over time.

McDougall doesn't have any health care or science training; his philosophy is borne of common sense, elementary anthropology and evolutionary biology, and, of course, his personal experience. As a physiotherapist, I see a wide variety of foot shapes and fitness levels; different people have different needs.

People with strong feet and good technique can do with less supportive footwear. But for those with weak feet or technique flaws, too little support may stress the situation further. On the other hand, too much support and the feet can be constrained and weaken over time.

When people ask me whether I'm for or against orthotics, my answer for the average runner is, "I believe customized footwear is better, but I have a minimalist philosophy."

I must disclose that while I have no specific footwear brand affiliation, I do make orthotics in my practice.

There are some structural faults and abnormalities that shouldn't be ignored. Orthotics can help, but they are never the whole answer. Most of all, people need to have strong feet and practise good technique. That may require some strengthening exercises and basic running drills.

When people ask about barefoot running, I tell them it can be a good adjunct to training, but they need to be ready for it.

Exercises such as single leg standing for balance or various rocker board exercises can help strengthen your feet over time. Physiotherapists, trainers and running coaches are excellent at prescribing these types of exercises and improving running technique.

If your feet are weak, orthotics can help support the needs of the feet while you work on strengthening.

Aside from being uncomfortable, rigid orthotics that prop up the arches of the feet do contribute to foot weakening, as McDougall suggested. They can help with symptoms in the short term, but may cause orthotic dependency and may cause long-term problems.

But if you didn't grow up running barefoot through Mexico's Copper Canyons, and your feet are relatively weak from inactivity or an injury, or from wearing excessively supportive footwear, you may need more support than a minimalist shoe provides.

Orthotics can bring your minimalist shoe to the appropriate level of support. This can help bridge the gap while you strengthen your feet.

If the ultimate goal is strong feet that move normally, the orthotics must allow the foot to pronate normally. For this reason, a newer generation of orthotics made using a foam material called ethylene vinyl acetate (EVA) – like the cushion material of your running shoe – are becoming more popular.

By replacing the generic factory insole of your shoe with a low durometer (softer) EVA foam orthotic that matches the foot shape, the neutral shoe becomes a custom shoe that still allows the foot to move normally. The level of support should be just enough to reduce symptoms and facilitate a better movement pattern. The professional consulting on footwear or making the orthotics should understand your long-term strengthening objectives.

For the average runner, I tend to recommend a neutral shoe without too much heel height or cushioning – less than an 8mm heel to toe drop. The right pair of orthotics made with a minimalist philosophy in mind can help optimize the fit of the shoe and your performance. Also important is a tailored strengthening program, which may include some training without the orthotics and even occasional barefoot training on safe surfaces.

Justin Vanderleest is a Toronto-based physiotherapist at Athlete's Care and LiveActive Sport Medicine. He has a Master's of Clinical Science in Advanced Orthopaedics and Manipulation from the University of Western Ontario. He is a Fellow of the Canadian Academy of Manipulative Physical Therapists. An elite squash player and former national champion sprint canoeist, Vanderleest has developed special interests in training programs and injury prevention. You can follow him on Twitter @JDvanderLeest