The hidden dangers of Hokas: They’re the must-have comfy shoes for runners, nurses and busy moms – but experts are now issuing an urgent warning over the silent damage they could be causing

They are worn by marathon-running pop icon Harry Styles, former President Joe Biden, amateur athletes, nurses and busy moms.

Originally designed as a trail-running shoe with a thick, ultra-cushioned sole to absorb impact over long distances, Hoka has become the go-to sneaker brand for millions of people seeking all-day comfort.

And in the past few years, they have exploded in popularity. Sales have topped $2.5 billion this year, up 16 percent from 2025.

But while the shoes – which cost between $150 and $275 a pair – are now seemingly everywhere, experts warn that there may be some significant downsides to wearing them for long periods. 

‘Hokas are really good for what they were originally designed for,’ Dr Zac Cartun, an orthopedic insole specialist and chief medical officer at Stride Soles, told the Daily Mail.

‘But particularly for walking and standing, I don’t think they’re the best option.’

Hoka’s signature feature is its thick, foam midsole, which measures around 30mm to 40mm under the foot. By comparison, the midsoles of most standard running shoes are typically between 15mm and 30mm thick.

The idea is simple: every time your foot strikes the ground, the impact sends force up through your ankles, knees, hips and lower back. The extra foam is designed to absorb more of that impact before it reaches your joints, reducing the stress placed on them.

The thick cushioning also dampens the sensation of the ground beneath your feet. While that may sound like a disadvantage, it’s one of the reasons Hokas became so popular with trail runners.

On uneven, rocky terrain, the foam absorbs impact and spreads pressure more evenly across the foot, making long runs more comfortable.

‘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.’

However, the extra height means the foot sits farther off the ground. If the shoe rolls sideways during a step, that greater distance creates a larger twisting force, known as torque, around the ankle.

While the ankle is designed to cope with some rotation, those forces can also be transmitted higher up the leg to the knee, which is far less able to twist from side to side.

‘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 can also affect the knees, hips and lower back, potentially leading to aches and pains higher up the body. 

Dr Cartun also believes relying on heavily cushioned shoes for everyday wear may mean the small muscles in the feet have to work less, potentially weakening them over time.

‘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.’

Dr Cartun believes that relying on highly cushioned shoes for everyday wear could, over time, affect small muscles that support the foot’s arch.

Over time, this could increase the risk of plantar fasciitis, a painful condition caused by inflammation of the thick band of tissue that runs 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.

However, there is currently no good evidence that wearing Hoka shoes causes these problems, and other foot specialists say highly cushioned shoes can be beneficial for many people, particularly runners and those with existing foot pain.

Dr. Cartun also believes there may be a longer-term effect on balance, due to the lack of sensory input from the gound.

‘Basically, you could be left without as much ability to correct for uneven terrain,’ he said.

He said this could be particularly important for older adults, who are already at greater risk of falls because of age-related declines in balance, muscle strength and bone density. Falls are a leading cause of fractures and head injuries in this age group.

Unlike some shoes that keep the heel and forefoot at the same height, most Hokas have a slightly raised heel. Known as a ‘heel-to-toe drop,’ this means the heel sits a few millimeters higher than the front of the foot. 

This increases the risk of metatarsalgia, or swelling and aching in the ball of the foot, usually right under the second, third or fourth toes. 

‘You’re putting extra pressure on there than you typically wouldn’t,’ Cartun said. ‘And of course, this is a slow, insidious process.’

Consistently having the heel elevated also shortens the Achilles tendon at the back of the lower leg. Over time, this tightens the Achilles and raises the risk of ankle injuries and Achilles tendonitis that results in stiffness and swelling.

Additionally, Hokas have become increasingly popular among people who spend all day on their feet, nurses, teachers and factory workers, among others. The brand even offers a 15 percent off code for health care workers. 

Standing for hours on end has long been linked to a plethora of health risks from muscle fatigue to back injuries and blood clots in the legs. But doing so in ultra-cushioned shoes may exacerbate those risks. 

Cartun explains that Hokas’ design do not allow the big toe to extend outward, which provides additional support for the foot when standing. The soft foam gets squished underneath the big toe when it pushes down rather than the toe hitting the ground.

‘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.’  

Cartun believes long-term use of ultra-cushioned shoes like Hokas could pose the greatest risk for younger people ‘because a lot of the injuries are due to compounded things that happen again and again and again.’

‘That’s how people tend to stick with them and wear them over that long period of time, allowing those injuries to occur,’ he added. ‘So I worry about people under the age of 50 who are nurses, doctors, teachers, who stand a lot.’

However, he notes these shoes can be a solid pick for trail runners or shorter-term use. Additionally, people recovering from foot injuries may also benefit from the soft cushioning to take the pressure off the damaged areas.

For everyday use, Cartun recommends firmer sneakers like Altras, which are zero drop and have a wide area for the toe to fully extend. 

But for those who aren’t ready to give up the shoes entirely, Cartun suggests wearing a firm orthotic ‘that doesn’t have too much cushioning and that can replicate a lot of what the ground would be giving.’

‘This can kind of mitigate a lot of the problems while still giving that feedback and structural support that Hokas diminish.’

Dr Brandon Haghverdian, orthopedic foot and ankle surgeon at the Hoag Orthopedic Institute in California, told the Daily Mail that the 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 emphasizes that the ‘most important principle is to match the shoe to the activity and transition gradually if you’re changing footwear styles.’

‘Runners should avoid making sudden increases in mileage at the same time they switch shoes, and anyone who notices persistent discomfort should consider being evaluated to determine whether a different shoe is a better fit for their biomechanics,’ he added. 

The Daily Mail has contacted Hoka for comment.