Can a High-Drop Running Shoe Be Causing Your Patient’s Leaking?

Dr. Becky Allen answers a DM question about whether higher drop shoes can contribute to urinary leaking, arguing that they can by altering gait biomechanics from the ground up. Shoe drop is defined as the heel-to-toe height difference inside the shoe, with high heels as an extreme high drop and flat flip-flops as zero drop. A higher drop places the foot in relative plantarflexion, limiting dorsiflexion and midfoot pronation, which reduces the normal internal-rotation cascade up the kinetic chain (subtalar motion, tibial and femoral internal rotation) and leaves the pelvis more externally rotated. With less pelvic internal rotation, the pelvic outlet stays smaller and the pelvic floor cannot lengthen and re-ascend automatically to manage pressure, potentially worsening leaking during walking or running. Clinically, Dr. Becky urges assessing footwear, midfoot mobility, dorsiflexion, and rotation mechanics, and suggests working runners from ~10 mm drop toward low/zero drop (e.g., 4 mm and under).(00:00) - Introduction(00:45) - Why Shoe Drop Affects Leaking(02:10) - What Shoe Drop Means(03:41) - Ground Up Kinetic Chain(04:37) - Internal Rotation Cascade(07:06) - How High Drop Blocks Motion(08:50) - Clinical Assessment Checklist(09:24) - Lower Drop Shoe Options(11:01) - Don’t Ignore The Foot(12:35) - Wrap Up And ShareJoin my No Kegels Course before we start on 3/23! https://www.thepelvicpowerhouse.com/treating-the-pelvic-floor-without-kegels Grab your free guides:* From the Ground Up: The Foot + Pelvic Floor Connection: https://www.thepelvicpowerhouse.com/fromthegroundup* From the Top Down: From the Ribcage to the Pelvic Floor: https://www.thepelvicpowerhouse.com/fromthetopdown Clinicians, be sure to learn about Dr. Becky and Dr. Corrie’s Pelvic Powerhouse Clinical Mastermind: https://www.thepelvicpowerhouse.com/group-clinical-mastermind-2026-live Follow Becky on Instagram: https://www.instagram.com/drbeckypelvicpt/ Follow Genesis PT and Wellness on Instagram: https://www.instagram.com/genesisptwellness Subscribe to "From the Ground Up with Dr. Becky Allen”: * Apple Podcasts: https://apple.co/47eQP84 * Spotify: https://open.spotify.com/show/4QMmH0LDL0CrCEvVpJaOzd * YouTube: https://www.youtube.com/@FromTheGroundUp-u4n/ Pelvic health professionals, if you want to grow your practice, provide great patient care, and create the life and business you love, then visit The Pelvic Powerhouse: https://www.thepelvicpowerhouse.com/ "From the Ground Up with Dr. Becky Allen” is the podcast for pelvic health pros who are done playing small in the clinic or in business. Your host is Dr. Becky Allen, a physical therapist and the founder and visionary of Genesis PT & Wellness. As your coach, Becky will share with you what it really takes to lead a mission-driven, team-powered, game-changing pelvic health practice.