Ultra-cushioned Hoka shoes, widely adopted by athletes, healthcare workers, and the general public for their comfort, are raising concerns among some experts regarding potential long-term health implications. While designed to absorb impact and reduce stress on joints during activities like trail running, the shoes' thick midsoles and other design features may inadvertently lead to issues such as knee pain, muscle atrophy, and altered biomechanics with prolonged everyday use.
Dr. Zac Cartun, an orthopedic insole specialist, noted that Hoka's signature thick foam midsole, often measuring 30mm to 40mm compared to the typical 15mm to 30mm in standard running shoes, is effective for its intended purpose of impact absorption. However, he suggests that for walking and prolonged standing, these shoes might not be the optimal choice. The increased height of the foot off the ground can create greater torque around the ankle if the shoe rolls sideways, potentially transmitting stress to the knee, which is less equipped to handle such rotational forces.
This can lead to knee pain, as the knee primarily moves forward and backward, and may not effectively compensate for side-to-side twisting forces. Furthermore, Cartun posits that the extensive cushioning could reduce the foot's natural sensory feedback from the ground. This may lead to the underutilization and potential weakening of the small muscles that support the foot's arch over time. Such weakening could increase the risk of conditions like plantar fasciitis and general foot injuries due to a less stable foundation.
IMAGE5 Experts told the Daily Mail that the extra cushioning in Hoka shoes can result in knee pain and muscle atrophy after prolonged periods. Pictured above is the Carbon X 2 model
The elevated heel design common in many Hoka models, known as a heel-to-toe drop, could also contribute to metatarsalgia, an ache in the ball of the foot. This design can also shorten the Achilles tendon over time, increasing the risk of tendonitis and ankle injuries. For individuals who spend extended periods standing, such as nurses and teachers, Cartun expressed concern that the shoes' cushioning might hinder the natural support provided by the toes. The foam under the big toe can compress, diminishing its role in providing stability and potentially exacerbating foot fatigue.
President Joe Biden has been seen wearing Hoka trainers. IMAGE2 Pictured President Joe Biden prepares to board a helicopter outside the White House while wearing his Hoka trainers in 2024
While there is currently no definitive evidence directly linking Hoka shoes to these specific problems, and some specialists find them beneficial for runners or those with existing foot pain, the concerns highlight the importance of matching footwear to activity. Dr. Brandon Haghverdian, an orthopedic foot and ankle surgeon, emphasized matching shoes to the intended activity and transitioning gradually when changing footwear. He advised that individuals experiencing persistent discomfort should seek evaluation to determine if a different shoe style better suits their biomechanics.
For everyday wear, Cartun suggests considering firmer sneakers with a wider toe box that allows toes to splay, such as Altras. Alternatively, he recommends using a firm orthotic insert within Hokas to provide structural support and ground feedback, potentially mitigating some of the risks associated with the shoe's cushioning.
Hoka, which reported sales exceeding $2.5 billion this year, has seen rapid growth in popularity, worn by celebrities like Harry Styles, Reese Witherspoon, and Natalie Portman. The brand also offers discounts for healthcare workers, acknowledging their long hours on their feet. The Daily Mail has reached out to Hoka for comment.