Medical experts are issuing an urgent warning over ultra-cushioned Hoka shoes, warning that the popular footwear can cause silent, long-term damage to joints and muscles. Dr Zac Cartun, an orthopedic insole specialist and chief medical officer at Stride Soles, told the Daily Mail that while the sneakers excel at their original purpose, they may pose significant health risks when worn for extended periods of standing or walking.
The thick-soled sneakers have exploded in popularity, worn by marathon-running pop icon Harry Styles, former President Joe Biden, amateur athletes, nurses, and busy moms. Sales for the brand have topped $2.5 billion this year, up 16 percent from 2025, with shoes costing between $150 and $275 a pair.
Thick foam cushioning
Hoka shoes were originally designed as trail-running sneakers with a signature foam midsole measuring between 30mm and 40mm under the foot. In comparison, standard running shoe midsoles are typically between 15mm and 30mm thick. The extra cushioning absorbs impact forces before they reach the ankles, knees, hips, and lower back.
"Hokas are really good for what they were originally designed for," Dr Cartun told the Daily Mail. "But particularly for walking and standing, I don't think they're the best option."
The extra foam also dampens sensory feedback from the ground, which benefits runners on rocky terrain by spreading pressure evenly across the foot. "It means you don't feel every rock on the path," Dr Cartun said. "If you step on a rock, not only is it going to absorb the impact, but it's also going to distribute pressure really well, so you don't feel pain in one particular area."
Knee pain and joint torque
However, the added stack height positions the foot farther off the ground. If the shoe rolls sideways during a step, that extra distance creates a larger twisting force, known as torque, around the ankle and leg.
"That kind of torque is particularly difficult for joints that aren't able to flex in all directions," Dr Cartun said. "The ankle can handle that pretty well. The knee, however, really only bends forwards and backwards. So when you're applying those twisting forces from side to side, the knee can't account for them as well. That's why we see a lot of knee pain from people wearing these shoes."
Altered walking mechanics caused by the shoe height can also lead to aches and pains higher up the body in the knees, hips, and lower back.
Weakened foot muscles and balance
Dr Cartun warned that relying on heavily cushioned shoes for everyday wear can weaken the small muscles that support the foot arch. "If you're cushioning the foot over a long period, the muscles that support the arch may not have to work as hard because you're getting less sensory feedback from the ground," Dr Cartun said. "Over time, that can weaken those muscles and potentially lead to other problems."
This muscle weakness increases the overall risk of injury and can trigger plantar fasciitis, a painful condition caused by inflammation of the thick band of tissue running along the bottom of the foot. "It also just increases the risk of injury because your foot isn't as strong, and you're more likely to twist something when you don't have that strong foundation," he added.
The lack of sensory ground feedback can also impair balance over the long term. "Basically, you could be left without as much ability to correct for uneven terrain," Dr Cartun said. He noted this is particularly dangerous for older adults who face age-related declines in balance, muscle strength, and bone density, making falls a leading cause of fractures and head injuries.
Heel drop and toe extension
Most Hokas feature a slightly raised heel, known as a heel-to-toe drop, sitting a few millimeters higher than the forefoot. This design puts extra pressure on the ball of the foot, increasing the risk of metatarsalgia, which causes swelling and pain under the second, third, or fourth toes. "You're putting extra pressure on there than you typically wouldn't," Dr Cartun said. "And of course, this is a slow, insidious process."
Consistently elevating the heel also shortens the Achilles tendon at the back of the lower leg. Over time, this tightening increases the risk of ankle injuries and Achilles tendonitis, leading to persistent stiffness and swelling.
Hokas have become widely popular among workers who stand all day, including nurses, teachers, and factory workers, with the company offering a 15 percent discount code for healthcare workers. However, standing for hours in ultra-cushioned shoes can worsen health risks like muscle fatigue and back injuries.
Dr Cartun explained that the soft foam squishes under the big toe when it pushes down, preventing the toe from extending outward to provide natural support. "It kind of cancels out the effect of what your toes are naturally doing to provide more support and essentially prevent foot fatigue," he told the Daily Mail. "This is kind of a counterproductive feature for foot fatigue."
Risk factors and expert recommendations
Dr Cartun warned that long-term use of highly cushioned shoes poses the highest risk for people under age 50 who stand for long hours at work. "That's how people tend to stick with them and wear them over that long period of time, allowing those injuries to occur," he said. "So I worry about people under the age of 50 who are nurses, doctors, teachers, who stand a lot."
However, Dr Cartun noted that Hokas remain a solid option for trail runners, short-term wear, or people recovering from foot injuries who need soft cushioning to relieve pressure on damaged tissue.
For daily wear, Dr Cartun recommends firmer sneakers such as Altras, which feature a zero drop and a wide toe box, or using a firm orthotic inside Hokas. He said a firm orthotic "doesn't have too much cushioning and that can replicate a lot of what the ground would be giving," which can "mitigate a lot of the problems while still giving that feedback and structural support that Hokas diminish."
Dr Brandon Haghverdian, an orthopedic foot and ankle surgeon at the Hoag Orthopedic Institute in California, told the Daily Mail that the primary goal of any shoe "is to improve comfort, decrease repetitive loading on joints and soft tissues, and reduce fatigue during prolonged walking or running." He stressed that users must "match the shoe to the activity and transition gradually if you're changing footwear styles."
Dr Haghverdian added that runners should avoid sudden increases in mileage when switching shoes, and anyone experiencing persistent discomfort should seek an evaluation. Currently, there is no direct scientific evidence proving Hoka shoes cause these health issues, and the Daily Mail has reached out to Hoka for comment.
