Zero-to-Low Drop Footwear

A Breakdown on Zero-to-Low Drop Footwear

By Dr. Courtney Conley, DC, Founder of Gait Happens

December 20, 2024

What is heel to toe drop in a shoe?

A popular discussion topic amongst movement professionals and runners alike is the heel to toe drop or the offset in a shoe. What does heel to toe drop mean exactly?

Put simply, heel-to-toe drop refers to the difference in height between the heel of the shoe and the toe area (forefoot). It is the measurement, in mm, of how much higher the heel sits in the shoe when compared to the forefoot. A higher heel to toe drop is a shoe that typically will have an offset of 7mm or more. A low heel to toe drop will typically have an offset from 0–6mm (1).

What are the benefits of a zero-drop shoe?

Promotes Natural Biomechanics: Mimicking barefoot or natural running conditions, low heel to toe drop running shoes may allow for better engagement of the foot's intrinsic muscles and tendons (2).

Provides a more natural and efficient running style as it encourages landing on more of the midfoot and forefoot rather than the heel: This strike pattern from shoes with 0mm heel to toe drop will reduce ground reaction forces going through the knee and the low back (3). It is important to note that when running on the midfoot/forefoot, this force is transferred to the foot and ankle. However, our feet were designed to handle these loads and can handle up to many times our body weight when running and/or walking.

Improved proprioception: In its natural position, standing barefoot on the ground, our heel and toes sit in the same plane. This enables us to have good proprioception, or our joints’ ability to detect where in space our body position should be.

Requires more lower leg strength: When running in a zero-to-low drop, the foot and calf have to work harder. There is nothing cheating the system. This is not a bad thing. We want our feet and calves to work. We need strength in our feet and ankles to maintain our balance, keep us upright, and prevent falls as we age. If you want to encourage long-term strength in these areas, zero could be the best heel to toe drop for you.

Encourages foot flexibility: With a lower heel stack height relative to the forefoot, a lower heel to toe drop on running shoes may allow for greater natural flexion and movement of the foot and ankle, which can contribute to a more agile and responsive feel.

What is the transition when switching from a higher heel to toe drop to low or zero heel to toe drop running shoes?

There are many benefits of low heel to toe drop running shoes. It’s important to take care when swapping shoes with high heel to toe drops for running shoes with low or zero heel-to-toe drop.

Start with small increments of time: You have to walk before you can run. I will often tell my patients to wear the new shoes for 10 minutes a day. Monitor how you feel that evening and the next morning. If there are no surprises, keep adding a bit of time each day. Be prepared for a little bit of discomfort. This is normal especially if you have been wearing shoes with high heel to toe drop and you have a history of foot pain, and/or weakness. If you have a history of chronic ankle sprains, limited ankle mobility, or Achilles tendinopathies, starting off in a shoe with a little drop may be an excellent place to start. The Altra Experience line has a 4 mm heel to toe drop. This is still considered a low heel-to-toe drop shoe, but it does put a little less tension on the posterior compartment of the leg.

Wear a shoe with greater stack height: The Altra Olympus even though it is a zero-drop shoe is often a very good transition shoe as it is less flexible. You still will gain the benefits of having a wide toe box and zero drop, but the increased stack height and stiffness enables this shoe to be worn by almost anyone.

If you are a runner, practice landing on your midfoot: We know that running in a zero-drop shoe can alter the strike pattern of the foot. If you’ve been running in average heel to toe drop running shoes or high heel to toe drop running shoes, we will often recommend running barefoot in grass for small increments of time to simply feel how the strike pattern changes. This new strike pattern will more than likely lead to a shorter stride and higher cadence.

Increase distance slowly: We typically will advise our patients to not increase their running load by more than 10% per week. Even if you have shoes with the best heel to toe drop for running, overexerting yourself and doing too much too soon can lead to injuries.

Transition in the off season: This will allow the appropriate time to make the adjustment while also focusing on increasing strength and mobility.

What symptoms might occur during this transition and what should I do about it?

Tight/sore calves: Even though zero can be the best heel to toe drop for calf pain, this is often a common complaint as the foot and calf are forced to do more work. This is especially more common in those that run in hilly or mountain areas. This will often occur on both sides.

Stretch your calves, especially post run. We like to focus on both straight leg and bent leg stretches for long hold times.
Strengthen your calves. Straight leg and bent leg calf raises should be implemented 2-3x a week.
Take a day off! Yes, you know who I’m talking to here (me included). It’s okay, you’ll live

Sore/tired feet: The muscles, tendons, bones, and ligaments in our feet go under more load in a more minimal shoe.

Roll the bottoms of the feet. Massaging your feet is a great way to relax the tissue.
Do your foot exercises! This includes foot awareness drills, toe strength and foot strength. (Gait Happens has a 12-week FIT FEET program that works on preparing your feet to move better and handle this transition wisely)
Wear toe spacers. Toe spacers will help splay the toes enabling better forefoot stability. You can either wear them around the house or try to wear them in the shoes.
Take a day off!

When should I be concerned about these symptoms if they don’t go away?

Soreness should typically be gone within 24–36 hours. If you have pain that seems to linger, we suggest seeing a local provider for an evaluation.

Localized redness on the top of the foot. This may typically be more common in our running population as there is simply more load through the bones of the foot. Again, we recommend seeing a local provider to rule out any stress reaction in the bone. This is why the transition is nice, easy, and slow.

Whether you’re looking for the best heel to toe drop for plantar fasciitis or the best heel to toe drop for achilles tendonitis, we recommend exploring zero-to-low drop running shoes. We firmly believe that zero-to-low drop shoes can be a useful tool to improve your foot and ankle strength. It can also ensure better posture and movement efficiency. However, make sure you approach the transition carefully and gradually to avoid injury.

References:

1. Coetzee DR, Albertus Y, Tam N, Tucker R. Conceptualizing minimalist footwear: an objective definition. J Sports Sci. 2018 Apr;36(8):949-954. doi: 10.1080/02640414.2017.1346816. Epub 2017 Jul 7. PMID: 28686085.

2. Davis IS, Hollander K, Lieberman DE, Ridge ST, Sacco ICN, Wearing SC. Stepping Back to Minimal Footwear: Applications Across the Lifespan. Exerc Sport Sci Rev. 2021 Oct 1;49(4):228-243. doi: 10.1249/JES.0000000000000263. PMID: 34091498.

3. Almeida MO, Davis IS, Lopes AD. Biomechanical Differences of Foot-Strike Patterns During Running: A Systematic Review with Meta-analysis. J Orthop Sports Phys Ther. 2015 Oct;45(10):738-55. doi: 10.2519/jospt.2015.6019. Epub 2015 Aug 24. PMID: 26304644.