Slap Me Silly

Here’s a story in today’s Boston Globe, Minimalist sneakers send runner limping away, also titled, “You’re crazy.” It’s about the authors attempt to use Vibram Five Fingers.

Now, I’m sure you are all aware that I don’t think much about Vibrams, simply because they are not really barefoot. But, when it comes to having something on your feet, they are almost assuredly better for muscle/tendon/ligament development than hard leather soles or super-padding. But I have also warned that you just cannot expect to suddenly go barefoot and do heavy lifting (so to speak) than you can suddenly, after years of couch-potatohood, go to a gym and do (literally) heavy lifting.

Anyways, the author of the article doesn’t seem to understand that, and he also doesn’t seem to understand the results of various studies that you DO NOT run barefooted the same way you do in shoes.

The clue? Right here in his third paragraph:

On my first run, the FiveFingers sounded odd as my feet slapped the pavement in the thin rubber soles.

He’s slapping his feet? Well, that’s your problem right there.

HuffPo HuffPoo

The Huffington Post has a bit of a reputation among real scientists for promoting quackery, or at least promoting “medicine” that is not backed up by science. See, e.g., The Huffington Post’s war on medical science is noticed, Why is there so much medical misinformation in The Huffington Post?, and A science section for the Huffington Post? More like a pseudoscience section! (2010 edition). Now they have an article on barefoot running from Dr. Robert Kornfield, an “alternative medicine” advocate: Barefoot Running Shoes: How Effective Are They?. Dr. Kornfield is a DPM (Doctor of Podiatric Medicine), and I’m afraid his article reads much the same as others we hear from a lot of other podiatrists who are unfamiliar with barefoot or minimalist running.

As far as he is concerned, barefoot running (or, in this case, running in minimalist shoes) is a fad.

Barefoot running shoes are designed to re-create a “natural,” barefoot running dynamic on “unnatural” surfaces like concrete, asphalt, red top, black top, etc. How can we have a barefoot running shoe? Doesn’t barefoot denote without shoes?

Choosing to run on non-yielding surfaces without the protection afforded by proper running shoes can be harmful to the foot and ankle and cause even more problems downstream from compensation patterns. So what really are these pedal marvels and why is everyone running to take their shoes off?

Hey, at least he recognizes that a “barefoot running shoe” is not “barefoot.” But he also starts off with misconception number 1, that there is something different about “unnatural” surfaces. He goes on to say

Barefoot running shoe manufacturers believe that the human foot, unimpeded by synthetic surfaces and restrictive running shoes, should function at its best. That is a correct assumption, save for the fact that the human foot was designed long before the paving of roads. In fact, uneven, grassy surfaces are the most natural surface for the human foot because it helps the body navigate and respond to uneven terrain, while at the same time absorbs shock, stabilizes weight and propels the body forward. In order for this to occur successfully, most of us are born with a flexible forefoot and a rigid or stable rearfoot. In other words, at heel strike — when your heel hits the ground — your leg from the hip down is aligned for optimal function and is stabilized during normal walking.

OK, stop right there. He somehow seems to think that the human foot evolved in some sort of grassy park. Has he never gone hiking? You know, out in nature? There are all sorts of surfaces, from mud to sand to grass to rocks to hard pan. Those latter two are not all that different than asphalt or concrete. They also tend to occur a lot in the parts of Africa we all came from.

And then he talks about heel strike. I guess he just hasn’t heard about the research from Dr. Lieberman at Harvard. Barefoot runners who have been doing it any length of time don’t heel strike. What he does is introduce some sort of false dichotomy about heel strike: that is has something to do with whether you run on a natural or unnatural surface:

The lack of heel strike on unnatural surfaces is not mimicking the way the foot would perform barefoot on natural surfaces. For this very reason, these shoes will eventually come up short, as the foot requires either cushioned heel strike on an unnatural surface or minimal heel strike on natural surfaces.

No. When you run barefooted you simply do not heel strike, regardless of the surface (and if you do heel strike, you are doing it wrong, keeping the lousy habits you picked up from wearing shoes, in which the elevated heel guarantees a heel strike).

He then tries to give us a demonstration of this at work, and tells us that this decreases the propulsion of the big toe:

Try this. Hold your first metatarsal and pull it up as hard as you can, then with your other hand try to pull your big toe upward toward your ankle. You will find the joint will jam up and feel restricted. Now, hold your first metatarsal and apply pressure down toward the floor, then with your other hand, pull your big toe up toward your ankle. You will find a dramatic increase in the upward range of motion of the big toe — this is normalized function.

Huh? Ok, you can test this. The first metatarsal is the long bone just behind the toe bones. It runs from around the ball of your foot back to near the ankle bone (and of course, you have one for each toe). The one he is talking about is for the big toe, which does most of the work, which means its the one at the highest part of your arch.

So, go ahead, do what he says. Just inside your arch, pull up as hard as you can, then see if you can pull you big toe up. It’s really hard, isn’t he. So he is right about that. And if you let go of that first metatarsal, it’s really easy.

But what does this have to do with hard surfaces versus soft surfaces? Absolutely nothing. You see, under your first metatarsal there is a tendon (the one for pulling your toe down and applying force when you are running). When you press the tendon against the metatarsal, that prevents it from moving (you can feel it trying to work as you hold it down). So of course that prevents the big toe from moving against it. Duh.

However, there is a situation in which pressure is regularly applied to the bottom of your arch there (and which would then lead to decreased propulsion). That’s right: when you are wearing a shoe with arch supports, which nearly all running shoes do. The embedded arch presses the tendon against the metatarsal, reducing its range of motion. I have rather flat feet, and back when I wore shoes, those embedded arches always gave me a lot of discomfort as they severely restricted decent (and natural) motion.

And then he finishes with our favorite shibboleth: that only “special” people with “special” feet can get away with running barefoot. Because everybody else evolved with the shoes they came out of the womb with. Right. Oh, and for all those non-special people?

you can safely wear conventional running shoes manufactured by companies who have spent years on research and technology with the addition of a proper running orthotic.

(Emphasis added.)

Yup. Prescribing more orthotics to try to fix the problems that the shoes themselves cause. I’ve said it before and I’ll say it again: these podiatrists have never seen feet that have not been damaged (and had that damage perpetuated) by shoes. They have no idea what a strong foot looks like, or what a strong foot can do.

Flat Feet versus Fallen Arches

A couple of weeks ago, over at America’s Podiatrist, Dr. Nirenberg asked, “Can Barefoot Running & Walking Fix Flat Feet?” He references a study, The Influence of Footwear on the Prevalence of Flat Foot: A Survey of 2300 Children, by Udaya Bhaskara Rao and Benjamin Joseph (The Journal of Bone and Joint Surgery, Vol. 74-B, No. 4, July 1992, p. 525. The study was conducted on children in India.

Below is the criteria they used for grading an arch as high, normal, or flat:

Definitions of arch types

What they found was that while 2.8% of the children who went barefoot all the time had “flat” feet, 8.6% of those who wore footwear had “flat” feet. They also found that the more shoe-like the footwear, the more of the children had “flat” feet.

There was a related study done a few years later, “The Influence of Footwear on the Prevalence of Flat Foot: A Survey of 1846 Skeletally Mature Adults“, by V. Sachithanandam and Benjamin Joseph (The Journal of Bone and Joint Surgery, Vol. 77-B, No. 2, March 1995, p. 254. In this one, they compared the prevalence of flat feet based on the reported age at which the adult started wearing shoes. They found a 1.75% rate of flat feet in those who didn’t start wearing shoes until over the age of 16, and about 3.25% for those who started wearing shoes earlier.

It sure looks like wearing shoes contributes to a lower arch.

But what does that have to do with flat feet? Many folks confuse a flat foot (that is, a foot with a low arch) with fallen arches. In fact, Dr. Nirenberg says as much as he starts his blog entry:

Flat feet is a condition where the arch of the feet undergo collapse and flatten: That is why it is often also referred to as fallen arches. Individuals with flat feet can suffer from a variety of foot ailments, pain, and fatigue, which can also extend to the legs and back.

I do not think this correctly describes the situation. To understand what is going on, we have to go way back to a much earlier study, “Conclusions Drawn from a Comparative Study of the Feet of Barefooted and Shoe-wearing Peoples, by Phil. Hoffman, M.D., St. Louis. (The American Journal of Orthopedic Surgery (1905)). Dr. Hoffman had a chance to examine barefoot natives at the Louisiana Purchase Exposition in 1904. He checked their arches and found a fair proportion of them did have low arches. However, and this is important, he did not see any pathologies associated with those “flat” feet. As he put it

If these statistics are a fair index for all feet, the conclusion is justified that weakness of the longitudinal arch rarely results in its depression, and that flat foot as a pathological entity hardly exists.

The height of the arch appeared to bear no relationship to the gait. In shoe-wearers, the affection commonly called flat foot is often associated with more than ordinary eversion of the foot on standing and walking. This eversion is due not to the low arch, but to the associated weakness or stiffness of the joints of the foot and weakness of the muscles controlling them.

In other words, among the barefooted, having a low arch, or “flat” feet, has nothing to do with whether you have a “fallen” or “weak” arch. A weak or fallen arch, a result of wearing shoes and thereby failing to keep those muscles and tendons and ligaments strong (also pointed out by Dr. Nirenberg), is a different condition than merely having a flat foot (or naturally low arch).

So, can walking and running barefoot fix a flat foot? No. But can it fix a fallen arch? Almost assuredly. Will it raise the arch? Maybe.

Obviously, as any physical therapist can tell you, using a previously inactive body part will strengthen it. It will not only strengthen that part, but all the other parts associated with it. Muscles, bones, ligaments, tendons will all respond to the greater use. I can see how it would be possible that toning all those parts could raise the arch as they are all strengthened. Obviously, there is some anecdotal evidence that this is so, but I’ve not seen studies that demonstrate it.

However, as the Hoffman study shows, who cares? It doesn’t matter! It’s not the height of the arch that matters, it is the underlying physiological structure, and you get that from going barefoot whether your arch rises or not.

In my own case, I have no idea if my arches are really raised since I started going barefoot. They do look raised, though. However, much of that just could be the appearance caused by the much thicker pads on my feet now. Since the pads get thicker on the non-arch parts of the foot, that can give the appearance of a higher arch.

One more point: There are reports of over-use injuries in those who just start going barefoot. These are the sorts of people who try to run long distance before all the muscles and bones and stuff have had a chance to properly strengthen (this can take around 6 weeks, and probably it is not fully there until 6 months). Since I also play tennis, I can relate this to tennis. If you never played tennis before and suddenly picked up the sport and starting playing hours on end, hitting as hard as you can, you have a very good chance of picking up tennis elbow. The parts of your arm need strengthening first, and it has to be worked up to (it also helps to work on technique!). Same with any sort of extended or extreme barefooting.

A Report from the Detroit Marathon

There is a great write-up from John Yohe at John’s Barefoot Running Blog on his running the Detroit Marathon barefooted. I really don’t know how he managed to reproduce his thoughts from the time, but it is a great read.

Here are a few snippets, but go read the whole thing.

He starts out:

I’m exhausted already. I had to get up at four o’clock in order to drive from Jackson to be here in Detroit at six. The race is at seven, and already parking is congested. But I fine a good spot, close to the finish for a quick get away. The one time I decided to actually get a hotel room the night before, planning way ahead so as to ensure getting a room, the hotel goes out of business a month before. Ok, well, that’ll save me a hundred buck, but man, seeing as how I was nervous the night before, I’m not running on much sleep.

A few comments about the runners around him:

And oh yes, the comments on my feet are happening all the time. More gasps. More, “That guy doesn’t have any shoes!’ said from ten feet behind me. I wish people would at least acknowledge that I can hear them. But, I do have to say that I might have been wrong about me being the first most people have heard about barefoot running. I’m getting lots of “Good job barefoot runner!” comments as well, meaning that people know the phrase “barefoot runner,” meaning that the idea, the concept now exists in the mainstream, as a ‘meme,’ meaning that, if people know the term, it may be coming into more widespread acceptance. That’s my theory anyways.

More comments (I guess I enjoy these the most):

A guy passes me on the left. “Man, you are crazy.”

I nod and say, “Thanks.”

He laughs and goes on.

I pass two women and get the gasps, but one says, “Wow, that’s stupid.”

Ok, I can’t not say anything. I turn around and say, “Thanks, I can hear you.”

Their eyes go wide. The one who spoke says, “I love you and respect you, I just wouldn’t do it myself.”

I wave. “Fair enough.” But as I’m pulling away, I hear her say, “They say that only fifteen percent of people are able to do that.”

Wtf? Whatever lady. Keep living a life of excuses.

And how did he do at the end?

Well, go read it.

Massage Therapy

This is just a pointer to an article on the Massage Therapy Schools blog about barefoot running. Of course, foot massage is very relaxing, and there are even members of the Society for Barefoot Living who do foot massage There is a lot of good information in the article.

The article, in short bullet points, addresses such things as “Running shoes may cause more injuries,” “We run better barefoot,” “You’re not going to catch a disease and die,” and “Don’t let other people’s ignorance set you back.”

I do think they are overly cautious on one of their bullet points, “Start on soft surfaces”:

Your feet and eye-foot coordination aren’t going to be prepared to navigate the pavement, glass shards or pebbles right away, so practice on sand or grass first.

All practicing on sand or grass will do is teach you how to run on sand and grass. The way to learn to run barefoot is to run barefoot, everywhere. Use the sensation provided by your soles to give you valuable feedback. If running on asphalt or concrete hurts, you are doing it wrong, and you need to consider your form. Sand and grass just don’t give you that sort of feedback, so you may be training yourself to run incorrectly for being barefoot. Also, don’t run “barefoot” using those “minimal” shoes like the Vibram Five Fingers. Those don’t let your soles tell you when you’ve had too much—yeah, they let you keep going, but if your soles have had too much (and you don’t know it), then all the muscles and tendons in your feet have also had too much, but you have not been warned by your soles. That can lead to injury.

I’m not much of a runner (it just bores me—sorry). I have found that hiking really builds up the feet. The stimulation of various pebbles and sticks and such built up both my muscles and padding, so that whenever I do try something a bit more adventuresome, like running or rappelling or playing tennis, my feet have already been in such great shape, that I can do the extra activity with ease.

A Barefoot Running Injury Epidemic?

Here is a new article talking about The Barefoot Running Injury Epidemic. The author notes

Darwin Fogt, PT, owner of Evolution Physical Therapy in Culver City, CA, is alarmed by a stark new trend at his facility: runners with injuries caused by barefoot (or virtually barefoot) running. Fogt says he has four or five current patients with heel injuries clearly resulting from a switch to barefoot running and has recently treated another 12 to 15 others.

These injuries are happening both for real and fake barefoot runners. (Yeah, I’m using “fake” to gently tweak those who call running in shoes such as Vibrams “barefoot”.) The article does wonder whether the increase is due solely to the increase in barefoot running, due to books such as Christopher McDougall’s Born to Run. If all runners are getting injured at the same rate, but there are more barefoot runners now, one would expect there to be more injured barefoot runners.

But I suspect that there is more going on. Others, such as Ken Bob Saxton, note that if you try to start minimalist running in things like Vibrams, you will not be getting good feedback from your soles, which can tell you when you are overdoing it. How the heck are the runners being discussed getting specifically heel injuries? About the only way to do that is to run barefoot as if you are still wearing shoes.

There is something else, too. If you just go right out and try to run barefoot after having encased your feet in shoes for 20-50 years, you should expect the internal muscles, tendons, ligaments, and bones to look just as pasty as the outsides of your feet. It is well known that you have to use your body to strengthen it. Shoes are crutches; shoes are support. When you take your feet out of shoes, they will be weak. Incredibly weak.

It’s like taking your leg out of a cast. You wouldn’t expect to be able to do weightlifting or sprinting, yet people take their feet out of shoes and expect to immediately be able to run just like they did with their support. Instead, you really do have to work up to it. Just as when you get a cast off, you have to undergo rehabilitation in order to regain strength and the underlying supportive tissue, so too do your feet need similar rehab.

You also need to retrain your brain. If you run in shoes, you’ve learned a specific way to run in them. That won’t necessarily work when you run barefoot. If you had started as a kid, you would have slowly and methodically worked out the right technique, but if you take your adult technique and try to retrofit it to barefoot running, it’s no wonder things don’t necessarily work right.

More on the Barefoot Running Story

The Nature Video channel on YouTube has put up a very nice video regarding Dr. Lieberman’s study. It shows some nice pressure pad results synchronized with the foot landings on a treadmill.

In addition, we find out that, as a part of his research, Dr. Lieberman has started running barefoot himself, and really enjoys it.

Here’s the video: