Most runners know the feeling. You are a few miles into a run and something starts aching a foot, a knee, an ankle and your immediate instinct is to question your footwear. Maybe the cushioning has worn down, or the shoe was never quite right for your foot shape. It is a convenient explanation, and sometimes it is even the correct one.
But board-certified podiatrist and foot and ankle surgeon Dr. Bobby Pourziaee says the shoes are often taking the blame for something else entirely: the way you run.
Small inefficiencies in a runner’s gait can go completely unnoticed at low mileage. At one or two miles a week, the body absorbs those minor mechanical flaws without much complaint. The problem arises when mileage climbs. Each flaw is repeated thousands of times per run, and what was once a barely noticeable irregularity becomes a reliable source of injury. As Pourziaee puts it, increasing mileage does not create new problems so much as it magnifies the ones that were already there.
The most common gait flaws that lead to injury
Excessive overpronation is among the most widespread biomechanical issues Pourziaee sees in runners. It occurs when the foot rolls inward more than 15 degrees during the landing phase, causing the arch to flatten with each stride. Over time, this places significant stress on the posterior tibial tendon, which can lead to tendonitis or the gradual development of flatfoot symptoms. Runners with flat feet are particularly prone to this pattern.
High arches present the opposite problem. Rather than rolling inward, a rigid high-arched foot absorbs shock poorly, distributing impact forces in ways that increase the risk of stress fractures. Where a flat foot is too flexible, a high-arched foot is too stiff and both extremes come with consequences as training volume grows.
Excessive vertical oscillation, or bouncing too high with each stride, is another common culprit. Runners who move more up and down than forward are multiplying the repetitive impact forces their bodies must absorb with every step, which accelerates wear on joints and soft tissue.
Hip weakness is a less obvious but equally significant contributor. When the glutes are not doing their job, the body compensates through abnormal loading patterns that travel down the kinetic chain, placing excess strain on the knee and ankle. Runners who experience recurring knee or ankle problems without a clear cause are sometimes dealing with a hip strength issue rather than a local one.
Limited ankle dorsiflexion, the ability to flex the foot upward toward the shin may be the most underappreciated issue of all. When ankle mobility is restricted, the body shifts load toward the forefoot during each stride, putting the metatarsal bones under repeated stress that can eventually lead to fractures or chronic pain.
How to address these issues before they become injuries
Pourziaee is clear that most of these patterns are correctable, and that addressing them before pushing mileage higher is far more effective than trying to manage injuries after the fact. His starting point for most runners is ankle dorsiflexion mobility, which can be improved through a simple knee-to-wall stretch performed consistently over time. Limited dorsiflexion quietly alters running mechanics in ways that affect the entire lower body, and restoring it can produce noticeable improvements in overall form.
Beyond that, building strength in the foot, ankle and hip complex provides the structural foundation that running at higher volumes demands. Exercises targeting the glutes, single-leg stability work and foot strengthening drills are all worth incorporating into a training routine before mileage begins to climb.
The investment is modest a few focused minutes of mobility and strength work several times a week. The alternative, managing a stress fracture or tendonitis through weeks of forced rest, costs considerably more in time, money and frustration.
Before the next shoe purchase, it may be worth taking a closer look at what the stride is doing first.
