Choosing running shoes with pain at the front of the knee

Related guides

• Front of shin · A slightly quicker step rate helps both, and both guides favour lighter, lower shoes.

Before you change shoes

A shoe is one of several things that load this area, and usually not the biggest. Before or alongside a shoe change, look at how much you run, how fast, how hilly, and whether anything changed recently. If your current shoes are comfortable and not worn out, you may not need new ones.

What helps more than the shoe: Advice and load first: in a trial in runners with this pain, education on managing symptoms and training load improved pain as much on its own as with an added exercise programme or gait retraining. Consensus guidance recommends exercise therapy, especially hip and knee exercises together, and supports foot orthoses. A slightly quicker step rate (10 % more steps per minute) lowered the peak force on the kneecap joint by about 14 % in a lab study in healthy runners. (Esculier 2018; Collins 2018; Lenhart 2014)

Free exercise guide by physiotherapists at E3 Rehab: Patellofemoral pain. We are not affiliated with E3 Rehab, and they have not reviewed this page.

What loads it

What to look for in a shoe

A lighter shoe

In runners with this pain, lighter shoes went with a quicker step rate and lower kneecap-joint force, but heavier shoes may simply have belonged to bigger runners. In a lab study a light racing flat did not lower knee load compared with runners' usual shoes; shoes that were lower and more flexible as well as lighter did.

A moderate drop, 8 mm or less

A lower heel tends to shift work from the knee to the ankle and calf: with otherwise identical shoes, a higher drop raised knee moments in a lab study. Go down gradually: a sudden drop decrease adds calf and Achilles load.

A lower heel rather than the tallest stack

More minimal shoes, which are lower as well as lighter, went with less kneecap-joint load. A very tall shoe is not needed for knee pain.

Comfort first

No shoe has been shown to treat kneecap pain. A comfortable shoe that lets you keep running at a level the knee tolerates matters more than any single feature.

Where the load goes

A lighter, lower and more flexible shoe tends to take some load off the kneecap joint and put more on the calf and Achilles: barefoot-style shoes lowered kneecap-joint load but raised Achilles tendon force in a lab study (see the research below). That is why a big, sudden drop decrease can swap knee pain for calf or Achilles pain.

What to be careful with

• Jumping straight to zero-drop or barefoot shoes: they may load the knee less, but they load the calf and Achilles much more.
• Long downhill runs and lots of stairs while the knee is sore.
• Racing shoes for every run: they are light but tall and less stable; keep them for races.
• Increasing mileage or hills in the same weeks as changing shoes.

Terrain

Best

Flat road, track and treadmill at an easy pace, where the load per stride is predictable.

Be careful with

Downhills (the knee bends further under load to brake), steep uphills and stairs.

Trail

Rolling trails are fine; walk the steep descents with short steps while it settles.

Combine the shoe with

Hip and knee strengthening

Consensus guidance puts exercise therapy first; a physiotherapist can set a starting level the knee tolerates.

Foot orthoses

Supported in consensus guidance to improve pain or function; a shoe with a removable insole and enough depth makes room for one.

A slightly quicker step rate

About 5–10 % more steps per minute shortens the stride; a metronome or a watch alert helps. Change it gradually.

Taping or a brace

Some runners use kneecap taping; consensus guidance is uncertain whether it helps.

Check in the shop

• Bend the shoe: it should bend at the ball of the foot (or barely at all, for a stiff big toe or forefoot pain), never in the middle.
• Twist it: it should resist.
• Press the heel counter with your thumb: it should not collapse.
• Length and width: about a thumb's width beyond the longest toe, and the widest part of your foot over the widest part of the sole.
• Try shoes later in the day, in your running socks and with any insert you use.
• Judge comfort over a few real runs, including some at your usual pace, not only in the shop.

What the research shows

Each point says whose evidence it is: runners, walking, a clinical group not studied while running, or mechanical reasoning that has not been tested.

• Load advice firstRunning evidence

  In a trial in 69 runners with patellofemoral pain, education on managing symptoms and training load improved pain and function as much on its own as with an added exercise programme or gait retraining, over 20 weeks. (Esculier 2018)

• Exercise and orthosesClinical evidence, not in runners

  A consensus statement based on systematic reviews and trials supports exercise therapy (especially hip and knee exercises combined), combined treatments and foot orthoses for patellofemoral pain; it is uncertain about taping, bracing and gait retraining. It covers people with this pain generally, not only runners. (Collins 2018)

• A quicker step rateRunning evidence

  In 30 healthy runners, 10 % more steps per minute than preferred lowered the modelled peak force on the kneecap joint by 14 %, mainly through less knee bend in stance. It was not tested in runners with pain. (Lenhart 2014)

• Lighter, more minimal shoesRunning evidence

  In 69 runners with patellofemoral pain, more minimal shoes went with lower peak kneecap-joint force, and lighter shoes with a quicker step rate (moderate correlations, not a trial). In recreational runners, barefoot and barefoot-style shoes lowered kneecap-joint load but raised Achilles tendon force. In highly trained runners, only barefoot running lowered knee load; a minimalist shoe and a racing flat did not differ from their regular shoes. (Esculier 2017; Sinclair 2014; Bonacci 2013)

• Highly cushioned shoesRunning evidence

  In a very highly cushioned (maximalist) shoe, runners stiffened their legs and impact was about 11 % higher at faster running than in a conventional shoe; the study did not look at knee pain. (Kulmala 2018)

• A minimalist shoe and step rate, in runners with this painRunning evidence

  In runners with patellofemoral pain, a minimalist shoe lowered kneecap-joint stress by 15 %, a quicker step rate by 16 %, and both together by about 29 %, in the lab. (Bonacci 2018)

• Drop with everything else equalRunning evidence

  In 20 runners in custom shoes that differed only in drop (0 to 30 mm), higher drops raised knee moments. (Renninger 2026)

• Carbon plates and the kneeRunning evidence

  In competitive runners, hip and knee mechanics were similar in three marathon racing shoes, one of them carbon-plated. (Hoogkamer 2019)

Not known

• No trial has tested a running-shoe feature as a treatment for kneecap pain.
• Whether a lighter or lower shoe changes kneecap pain over time, rather than knee load in the lab.

Switching to these shoes: weeks 1–6

A common way to introduce a new shoe, as a rule of thumb rather than a tested plan:

Weeks 1–2

One or two short, easy runs a week in the new shoe; the rest in your current pair.

Weeks 3–4

If the mornings after are no worse, about half of your easy runs.

Weeks 5–6

Long runs, then faster sessions.

Bigger changes take longer: a drop 4 mm or more lower, 10 mm or more of stack difference, a first plated shoe, much more toe spring (a strongly rockered shoe), or zero drop, which can take months. In one study, more than half the runners who moved to minimalist (barefoot-style) shoes, gradually over 10 weeks, showed early bone stress in the foot on scans. (Ridge 2013)

• Do not change shoes in the same weeks as you increase mileage or speed.
• Do not race in a shoe you have not run in several times, including at race pace.

For this area: If the new shoe is lighter or lower than you are used to, expect the calves to work harder for a few weeks. Judge the knee by how stairs and squatting feel the day after a run, not only during it.

How big is your change? Compare your current shoe with a new one

Keeping more than one pair in use was linked to fewer injuries in an observational study of recreational runners. (Malisoux 2015) Use the list as a shortlist of a few shoes to try on, then let comfort decide: researchers have proposed that runners choosing the shoe that feels most comfortable tend to pick one that suits how they move. That is a proposal, not a proven rule. (Nigg 2015)