Barefoot running: an evaluation of current hypothesis, future research and clinical applications

[Sid]

Barefoot running: an evaluation of current hypothesis, future research and clinical applications

The body of literature examining the mechanical, structural, clinical and performance implications of barefoot running is still in its infancy. Recent research has found significant differences associated with barefoot running relative to shod running, and these differences have been associated with factors that are thought to contribute to injury and performance. Crucially, long-term prospective studies have yet to be conducted and the link between barefoot running and injury or performance remains tenuous and speculative.

I came across the article above through Dr. Craig Payne's blog. While he states that there is no evidence that barefoot running reduces the risk of injuries, he also says the same of cushioned shoes.

The onus is also on those who claim that running shoes are better to come up with the evidence also. ... I never claimed there was any evidence [for cushioned shoes](in fact those who heard me lecture over 20+ yrs ago know that I was raising alarm bells back then).

I thought that his theory on the arch and barefoot running was very interesting.
Does Barefoot Running Lead to a Higher Arch of the Foot?

 

[Barefoot TJ]

That's the thing though. When are we going to stop reading about the studies that "need" to be done, and start reading about the studies that "have" been done.

About the arch height, I know that my arches raised when I was running barefoot all the time. Too bad, I am considered "only anecdotal" though.

About Does Barefoot Running Lead to a Higher Arch of the Foot? I hope he means to say barefoot running when he is talking about barefoot running and minimalist running when he is talking about minimalist running. I noticed he's using both terms. Perhaps having the arch bare to the ground (without a minshoe) could be the defining factor.

 

[Sid]

http://www.mensfitnessmagazine.com.au/2012/03/the-barefoot-revolution-2/

Griffiths says it will take more to be sure. “What we need are prospective studies,” he argues, a sentiment echoed by Lieberman himself on his Harvard website. “You need a big group of people to have statistical power, and you need them ideally to be all injury-free, and they need to be matched for pretty much everything: age, weight, fitness level, weekly distance. You’ve got to have a control for these other factors, because running injuries are multi-factorial. It’s not just about the shoe.”Griffiths emphasises the practical problems of arranging for such a study, admitting that it would be “nearly impossible to do”.

It's not clear that this type of research is even realistic.

Even when research is available on health concerns such as high heels, tobacco, alcohol, obesity, junk food, auto accidents, etc, people have a hard time changing their behavior.

What the barefoot community shows is that this is a viable alternative for many, despite living in a Westernized society where shoes are the norm.

 

[Longboard]

There are probably a variety of reasons why a foot may be low arched or flat, and possibly some of those are responsive to barefoot training while others aren't. I've read many anecdotal accounts of arch height increases, yet neither my wife's nor my own very low arches have increased in height at all. Our feet are much stronger and healthier in many ways, and our insteps have gained height due to muscle building, but our arches are still practically non visible under standing load.

 

[Bare Lee]

Barefoot running: an evaluation of current hypothesis, future research and clinical applications I came across the article above through Dr. Craig Payne's blog. While he states that there is no evidence that barefoot running reduces the risk of injuries, he also says the same of cushioned shoes.
I thought that his theory on the arch and barefoot running was very interesting.
Does Barefoot Running Lead to a Higher Arch of the Foot?

"However, what I think that the evidence might show is that the risk for some injuries will be decreased (eg anterior compartment syndrome) and the risk for other injuries will be increased (eg ‘top of foot pain‘), so it still will not be a panacea or ‘once size fits all‘."

Isn't the problem always that idiots like Payne are comparing the chronic injuries of (cushioned, stabilized) shod running with the temporary injuries that occur while transitioning to barefoot/minimalist running? These are apples and oranges comparisons.

If everyone started running minimalistically or barefoot when young, there simply wouldn't be any transition period, and hence no injuries besides the occasional barefoot-specific injuries like abrasion, frostnip, or a stubbed toe--all easily preventable with a little common sense and care.

 

[Barefoot TJ]

What the barefoot community shows is that this is a viable alternative for many, despite living in a Westernized society where shoes are the norm.

BRAVO!

 

[Barefoot TJ]

http://www.mensfitnessmagazine.com.au/2012/03/the-barefoot-revolution-2/
It's not clear that this type of research is even realistic.

Excellent points in this article. I'm glad Dr. Richards took the time to evaluate all the available data.

In fact, while there’s limited evidence about barefoot reducing injuries, there’s even less about running shoes doing the same. We know this thanks to Dr Craig Richards, a researcher at the University of Newcastle in New South Wales. In 2008, he conducted a review of all existing research to find “controlled trials or systematic reviews” that evaluated the effectiveness of cushioned heels and orthotics in reducing injury. They failed to find a single one.

 

[Sid]

I can appreciate that due to lack of rigorous evidence for injury reduction for both shod and unshod running, that podiatrists are hesitant to recommend change from the status quo.

To be fair, those same podiatrists should be scientifically honest enough to recommend against wearing shoes for the habitually unshod who don't have any problems.

The appropriate question is not "Would you as a health care professional recommend barefoot running?", but rather "Would you recommend that someone start wearing shoes, if they are successfully running barefoot?"

 

[Bare Lee]

I can appreciate that due to lack of rigorous evidence for injury reduction for both shod and unshod running, that podiatrists are hesitant to recommend change from the status quo.

To be fair, those same podiatrists should be scientifically honest enough to recommend against wearing shoes for the habitually unshod who don't have any problems.

The appropriate question is not "Would you as a health care professional recommend barefoot running?", but rather "Would you recommend that someone start wearing shoes, if they are successfully running barefoot?"

I agree, given years of shodded adaptation, changing to barefoot, especially if done hastily, could bring about its own problems. But the problem for me is that podiatrists seem to be skeptical about barefootedness as the default, whereas in every other medical specialty I can think off, the assumption seems to be that healthy bodies are pretty well-evolved, and no intervention is needed unless there's injury, illness, or neglect.

 

[Sid]

I hear you, and I can also appreciate the podiatrists' position.
For example, one of the most amazing organs in the body is human skin. It is quite unique. It has cooling abilities that are hard to match, even with the most expensive technical fabrics. In many cases skin beats shirts for comfort. Sure, there are exceptions, but many of us spend a good amount of time in climate controlled environments, where protection is not really needed. Yet, I would imagine that very few people would recommend or tolerate that people go bare or strip down to their skivvies, when out in public. Wearing clothes is a convention that nearly all people accept. Many native populations have some sort of expected or customary garb or covering, no matter how minimal.

 

[Bare Lee]

I hear you, and I can also appreciate the podiatrists' position.
For example, one of the most amazing organs in the body is human skin. It is quite unique. It has cooling abilities that are hard to match, even with the most expensive technical fabrics. In many cases skin beats shirts for comfort. Sure, there are exceptions, but many of us spend a good amount of time in climate controlled environments, where protection is not really needed. Yet, I would imagine that very few people would recommend or tolerate that people go bare or strip down to their skivvies, when out in public. Wearing clothes is a convention that nearly all people accept. Many native populations have some sort of expected or customary garb or covering, no matter how minimal.

Good analogy Sid; there's no escaping culture/fashion and the embodied presentation of social selves.
But how many dermatologists would recommend antiperspirants to stop normal people from sweating?
OK, you may surprise me and say the majority, but if so, it would be the same perverse logic of podiatrists saying people need to stop pronating so much.

 

[Longboard]

Podiatrist's recommend spraying anti perspirant daily on the feet of those patients that complain of sweaty feet while shoe wearing.

 

[Longboard]

Seriously! If a patient presents to a podiatrist and complains that their feet get really sweaty while wearing enclosed footwear in temps ranging from room to well above, that is what they are advised to do!
One more reminder that podiatrists are not experts on feet, but are physicians who are well trained in helping people survive despite being stuck living in a shoe wearing world.

 

[Sid]

Much more concerning is habitual shoe wearing. There is now good research to indicate that shoes cause foot problems. It is generally a slow and insidious process. The failure of mainstream podiatry to acknowledge this is neglectful. It's one thing that makes it hard to have much faith in the profession. This is highly concerning as it is generally accepted that podiatrists are foot experts.

In their defense, one might argue that as a surgical specialty, podiatrists are expected to be less concerned about causation than remedy.

Yet, orthopedic surgeons directly acknowledge that shoes cause problems. They're quite to the point.
orthoinfo.aaos.org/topic.cfm?topic=a00140

What Causes Bunions?

By far the most common cause of bunions is the prolonged wearing of poorly fitting shoes, usually shoes with a narrow, pointed toe box that squeezes the toes into an unnatural position. Bunions also may be caused by arthritis or polio. Heredity often plays a role in bunion formation. But these causes account for only a small percentage of bunions.

A study by the American Orthopaedic Foot and Ankle Society found that 88 percent of women in the U.S. wear shoes that are too small and 55 percent have bunions. Not surprisingly, bunions are nine times more common in women than men.

In contrast, podiatrists dance around the topic and wax on about forces, development, and heredity, with a passing mention of shoes, and the extreme example of ballet dancers. www.apma.org/Learn/FootHealth.cfm?ItemNumber=979

Causes

Bunions form when the normal balance of forces that is exerted on the joints and tendons of the foot becomes disrupted. This disruption can lead to instability in the joint and cause the deformity. Bunions are brought about by years of abnormal motion and pressure over the MTP joint. They are, therefore, a symptom of faulty foot development and are usually caused by the way we walk and our inherited foot type or our shoes.

Although bunions tend to run in families, it is the foot type that is passed down—not the bunion. Parents who suffer from poor foot mechanics can pass their problematic foot type on to their children, who in turn are prone to developing bunions. The abnormal functioning caused by this faulty foot development can lead to pressure being exerted on and within the foot, often resulting in bone and joint deformities such as bunions and hammertoes.

Other causes of bunions are foot injuries, neuromuscular disorders, or congenital deformities. People who suffer from flat feet or low arches are also prone to developing these problems, as are arthritic patients and those with inflammatory joint disease. Occupations that place undue stress on the feet are also a factor; ballet dancers, for instance, often develop the condition.

Wearing shoes that are too tight or cause the toes to be squeezed together is also a common factor, one that explains the high prevalence of the disorder among women.

While it would probably be too much to ask either group to go against social convention and recommend going barefoot, at least orthopedic surgeons plainly acknowledge the cause of the problem.

Since podiatrists claim to be evidence based, we could ask them what evidence is there that all these various problems listed are the cause of the majority of bunions, vs shoes?
(silence)

 

[Barefoot TJ]

There is now good research to indicate that shoes cause foot problems. It is generally a slow and insidious process. The failure of mainstream podiatry to acknowledge this is neglectful. It's one thing that makes it hard to have much faith in the profession. This is highly concerning as it is generally accepted that podiatrists are foot experts. Here! Here! They are not shoe experts. I asked a podiatrist long ago what shoe he recommended, and he said they were all basically the same. sigh. Then I came across a site a couple of nights ago where a podiatrist recommended people visit him to get a "shoe diagnosis." Can you imagine that?!

In their defense, one might argue that as a surgical specialty, podiatrists are expected to be less concerned about causation than remedy. They have a responsibility to prevent people from having to come to see them in the first place. This should be part of the "first, do no harm" (Primum non nocere) oath. If a doctor can safely prevent an accident from happening, then they should, especially if they play any part in that accident.

Since podiatrists claim to be evidence based, we could ask them what evidence is there that all these various problems listed are the cause of the majority of bunions, vs shoes? (and hammer toes, and Athlete's Foot, and Morton's Neuroma, and etc., etc., etc. sigh.

 

[Sid]

Clearly, podiatrists perform several procedures such as bunionectomies and toe shortening which are intended for feet to better fit shoes.

They have a responsibility to prevent people from having to come to see them in the first place. This should be part of the "first, do no harm" (Primum non nocere) oath. If a doctor can safely prevent an accident from happening, then they should, especially if they play any part in that accident.

Isn't there a word for those people who swoop in to profit off the injured?

 

[Barefoot TJ]

Isn't there a word for those people who swoop in to profit off the injured?

I can't say that word here.