I've been using Altra for several years and have never had any foot or knee problems. However, these Paradigm shoes have some sort of adjustable lace support and I've had knee or ankle pain on a couple of runs. Every time I unlace it's impossible to know what "setup" I have on for the assist and it's only after a few miles that I start to feel pain. Otherwise, fit and cushioning are as expected from the Altra, which is excellent.