More on Minimalistic Shoes: Great Video

https://youtu.be/x_rDFa6kZfI

     I love shoes period. I think shoes protect our feet and give us support and cushion when we need it. And, as a podiatrist, I treat injuries or patients who are biomechanically stressed. By that I mean, some patients (whether they are runners, hikers, cyclists, etc) need a correction in their gait or structure, just to be aligned right to avoid injury. The video above is very well done and fun to watch. My problem is that their thinking is too narrow. They should come out and say that some people may get injured going without cushion and without support, and that those patients should be able to wear shoegear that corrects. It is up to the health care provider, athlete, and shoe stores to figure out what they need. I certainly could not walk as much if I did not have cushion and support. Some people do just fine with a minimalistic approach. But, my waiting room is filled with patients who can not walk without aids, and cushioned shoes, and who may be trying to slow down their knee arthritis from needing a replacement. I think a healthy runner should have traditional, maximalistic and minimalistic shoes in their closet. Alternating is very very healthy. Staying in the same enviroment is unhealthy. We all have to learn from each other. Everyone should do more strengthening and flexibility work. Everyone should do various forms of exercises. Everyone should try to find out how to do these things safely and with no pain. I have no idea why 30 years of sports medicine knowledge is being completely thrown away for the potential gains from minimalistic shoegear. Rich

Joseph Hamill, PhD, Challenges the Idea that Forefoot Strike Patterns seen in Barefoot Running Reduce Runer's Injury Rate

http://www.lowerextremityreview.com/wp-content/uploads/2012/05/LER-Steps_Ahead.pdf

     In the above article, Dr Joseph Hamill, PhD, UMass at Amherst, discusses research related to the benefits and disadvantages of running with a forefoot strike. Forefoot landing at impact is the key to various running techniques including the barefoot running technique. Dr Hamill is a natural forefoot striker himself when he runs.

Some of the points I thought summarized the article:

• Whereas the barefoot running group highlights rearfoot or heel strike as the source of many injuries, running injuries are complex and multi-factorial.
• From a pure Biomechanics standpoint, there is no benefit to run barefoot or a forefoot strike.
• Forefoot strike decreases vertical impact peak, also called vertical ground reactive force, but there are still impact peaks just lower in her frequencies (intensity).
• Lower impact frequencies are attentuated (absorbed or dealt with) by muscle activity, higher impack peaks by bone. Muscles are weaker at handling impact stress than bone. Muscle injuries should occur with more likelihood with forefoot strike, and bone injuries more with heel strike.
• Loading rates may actually not be lower in barefoot running as claimed. Changing technique may be the most significant driver of change. When natural forefoot strikers switch to rearfoot strike, their loading rates went down. 
• Even though heel strike may have more ground reactive force, it is less delicate of tissue than the forefoot, and can handle that stress.
• There are different strike patterns for different functions. Rearfoot strike for maximum energy efficiency. Forefoot strike for maximum speed. So Forefoot strike not designed for all purposes. It will work for some, and not for others. 

To All Runners: Barefoot Running Survey---Please Respond!! Research is Needed

From Dr Blake: Barefoot or Minimalistic Running Shoes are a hot topic. Please take time to help these 2 great podiatrists do research which may help to prevent many injuries.  February 21, 2012 RE: Barefoot & Minimalist Running Survey To Members of the American Academy of Podiatric Sports Medicine: I would like to request your assistance in a research project on barefoot and minimalist running. The linked document below is the preamble to a survey we have constructed that attempts to ascertain the scope of barefoot and minimalist running both in practice and runners' attitudes. David Cauthon and I wrote one of the most comprehensive reviews of barefoot running to date that was published last year in the Journal of the American Podiatric Medical Association. The survey we created is a follow-up to that publication. We ask your help in distributing our survey link as widely as possible to reach as many runners as we can. The survey population need not be barefoot or minimalist runners as one of the parameters we are investigating is the scope of these practices so ALL runners are encouraged to take the survey. If you work with any running shoe stores, clubs or teams please pass on to them. If your practice has a web site, please post there. Practice newsletters or practice email updates could be other venues. The preamble to the survey is at: http://www.aapsm.org/survey-preamble.pdf The link to the survey is: https://www.surveymonkey.com/s/RMYTMJJ We greatly appreciate your assistance in furthering research that has the ultimate goal of answering so many questions we have about barefoot and minimalist running. Please distribute this link as you see fit and if you have any additional questions, please do not hesitate to contact me at the e-mail below. Thank you in advance for your assistance. Most sincerely, David W. Jenkins, D.P.M., F.A.C.F.A.S., F.A.A.P.S.M. Professor, Arizona School of Podiatric Medicine /Midwestern University Board Member of the American Academy of Podiatric Sports Medicine Clinical Director of Special Olympics Arizona Fit Feet Program djenki@midwestern.edu

Barefoot Running: Pros and Cons

When I make decisions in life, I like to write up a pro and con list to help me see the whole picture. In compiling my list, I may talk to friends, family, or expects, read, watch video, etc. Here is a my pro anc con list for Barefoot Running.

Pro:    Run Faster Potentially due to         Con: Slow Process on adapting
           stronger muscles and lighter                     my body to different shoes
           Shoes

Pro:   Revert back to the way we were      Con: Loss of Support from shoes
          meant to run                                               could make me more prone
                                                                              to injury
Pro:   Shoes presently wearing could        Con: Loss of Shock Absorption
          be causing abnormal motion and              could make me more prone
          injury                                                          for injury

Pro:   Barefoot Shoes are lower to            Con: New Running Style would
          ground and more stable for                       need to be learned
          side to side activities

Pro:   If I have pain, I could see if the        Con: Since new style and shoes will
          new shoes and technique                            will lead to new injuries, will
          eliminate my pain                                       the established medical world
                                                                               know how to treat them.

                                                                     Con: Who do I trust to tell me how
                                                                               to train with them, transition
                                                                               into them, avoid injury while
                                                                               wearing them?

Barefoot Running: The New Merrell Shoes

This was a wonderful email from my patient Kate. The Merrell Barefoot Collection could prove to be the barefoot shoe that podiatrists and barefoot enthusiasts both like ---image that!!! Probably can put an orthotic temporarily in that if symptoms occur.

Dr. Blake,

Thank you again for fixing my toe. I can't tell you how much better I feel. You were also the most personable doctor I've ever met in a doctors' office, so thanks for that too.

Here's a link to the new Merrell answer to the Five-Fingers shoes. I swear by the trail glove. http://www.merrell.com/US/en/Barefoot_Collection

- Kate

Here are also more information seen on the Merrell website. Go easy, be smart, be safe, but be barefooting!!

Barefoot Running Controversy

     Many have asked me my opinion on Barefoot Running that has seemed to catch everyone's attention. Marc Evans, world renowned Triathlete Coach, asked this of me recently and this was my quick reply:
Marc Evans said..
Dr. Blake,
Do you have an opinion on minimalist running trends? I have read many of the studies and am impressed with the research, but mostly in terms of how running shoes may contribute to some over use injuries. In my case, running with shoes causes sharp pain (immediately) in the low back. Whereas without shoes there is none.
Marc

April 2, 2010 9:17 AM

DrRichBlake said...

Marc, since I have spent my entire podiatric life making feet more stable and more protected, this concept is a new paradigm. However, biomechanics is the basis of most problems and solutions in some many activities like running, cycling, swimming, etc, where there is repetitive motion. Running shoes in general have around 1/2" heel height, increasing low back curve (lordosis), and, in some patients, producing low back pain. The high heel effect also can cause many runners whom land on the lateral (outside) border of the running shoe to either excessively supinate (lateral instability), or rapidly pronate (arch collapse). Both of these problems can cause foot/ankle/knee/hip/low back pain. Both of these problems also get worse with as little as 200 miles of shoe wear. I will have a later post dealing with the weakest link in the chain syndrome. Serious, if not all, runners need to link up with a good running shoe store, and/or knowledgeable sports medicine practitioners, whom can evaluate the function of an athlete shoe purchased or possibly causing problems. I will also have a post on generalizations in choosing the right running shoe.

So, yes, shoes can produce problems. I have mentioned only a few. But, does the answer lie in a minimalist approach to foot wear? For some, definitely. For others, a fatal running mistake. Who will help them decide? My best advice with any new device, shoe, technique, is to listen to your body (Golden Rule of Foot). Go gradual, and use common sense on what surfaces to wear them. Avoid pain. Any thing that causes pain weakens the body. Will feet get stronger with this type of shoe? I hope the physical therapist/runners out there will tell us. Is the answer more in prescribing foot strengthening exercises for every pair of stable running shoes and/or foot orthotic devices purchased or prescribed. I hope this helps. Dr Rich Blake
April 2, 2010 10:19 AM

Marc Evans said...

Thanks for the advice...I believe we'll see ever more shoe options which should help those with special biomechanic and musculoskeletal needs...In my case, the elevated heel in running shoes causes a heel strike where forces collide...without running shoes (and I've video taped both) I land on the foot pad with a more reactive strike and quicker turn over...Love the Golden Run of Foot...great advice...
April 2, 2010 10:38 AM
 
     Marc's comment on heel strike causing problems is definitely worth noting. I have found the most smooth and effective running styles involve full foot strike or fore foot strike, not heel strike. When you land at your heel hard, too many problems can arise. For years, cross country and track coachs have known to minimize over striding as a way of running faster. You can run faster by either lengthening your stride (emphasizing harder heel strike) or by increasing stride rate (moving your muscles faster and more efficient). Over the last 10 years or so, I have heard more and more patients told to emphasize in gait a heel to toe motion. Supposedly, this makes a smoother, less jarring gait to ease the stress on your muscles, tendons, and joints. But, this is very hard to learn, and not necessarily the best for most patients. I prefer a solid full foot or forefoot land, based on you speed of walking and a de-emphasis on heel strike. For 5 years our clinic did video analysis on our biomechanical patients, both walking and running. The running gait cycle was so much smoother than the walking cycle. I felt it was the elimination of heel strike in running that smoothed the gait out. Smoother gait should mean less stress on the body overall. So I think some running shoes if they force unusual heel strikes because of their heel lifts or their out flares or their outersole bumps should not be used. The athlete, with the help of the running shoe store, and perhaps with the help of the personal trainor, coach, health care provider, should make sure the gait is smooth. At least in the big cities, it is common practice for running shoe store personel to be runners, and to watch the athletes run to check for this before purchasing a shoe.
 
     As podiatrists, we look at people with very weak structural feet everyday. These feet can/may be helped with a progressive foot strengthening program over the course of 2 to 3 years, if they choose to spend that effort. I find this the hardest part of rehab, restrengthening, since patients normally don't hurt much in this phase. The motivation goes out the window. And this will only help some. Many patients with weak foot structure, very sensitive nervous system, loose ligaments, auto-immune deficiencies, to name a few, would have their feet ruined by attempting to run/walk without good shoe protection. Unfortunately, I have seen too many patients injure themselves so far that there is permanent damage. No health care provider would ever want to take that risk with their patients. Therefore, this minimalist shoes/barefoot trends will never get a medical endorsement.
 
     So, what to do? Here are some recommendations:

1. Make sure your shoes allow you to run smoothly. Work with experts to insure your gait is smooth.
2. Do not emphasize a heel to toe walk/run, land more flat footed for stability.
3. Change your gait pattern gradually, and only if you are forced because of injury. It is a very hard process to accomplish.
4. If you wear motion control or stability shoes, and orthotic devices, make sure that 3 times a week you are doing a foot/ankle strengthening regimen. The regimen should be progressive from month to month to make sure you gradually get stronger feet and ankles.
5. If you have strong feet, no history of any problems in feet, ankles, knees, hips, or low back, and you decide to run barefoot or with minimalist shoes like Vibram Five Fingers, progress very slowly, and listen to your body. Choose soft safe surfaces. Get the advice from a running coach on how to start slow, and then go even slower and shorter.
6. If you develop pain with any new trend, stop immediately, make sure the pain has resolved, and think extra hard if this is really worth the risk.