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Colleagues:

I will be debating Irene Davis, PhD, in a few weeks on Barefoot vs Shod Running at the annual American College of Sports Medicine meeting in San Francisco on Saturday, June 2, 2012. I am interested to see if anyone is aware of any published articles/case reports of injuries from running in minimalist shoes or while barefoot.

Any references would be appreciated. pdfs can be privately e-mailed to me at kevinakirby@comcast.net.

Thanks in advance.

__________________
Sincerely,

Kevin

**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

e-mail: kevinakirby@comcast.net

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
**************************************************

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Only one I can think of is this case report:
http://www.orthosupersite.com/fulltext.aspx?rid=85248

__________________
Who? What? When? Why? Yeah? And? So? What?

"My mission drive is to open up my eyes, 'cause the wicked lies and all the sh!te you say..." http://www.youtube.com/watch?v=V4NW5S1UTPQ

"Science is the antidote to the poison of enthusiasm and superstition."

So its going to be anecdote vs anecdote. Anecdotes are easily to find. Barefooters claim that you get less injuries running barefoot; you only have to go to any barefoot website and notice the zillion barefoot runners asking for advice on their injury ... don't figure?

Why not focus on the lack of evidence?
Why not focus on the way the barefooter's misuse and lie about the science?
Why not focus on the load on specific tissues that are increased by forefoot striking?

Recent:
http://www.newslettersonline.com/use...1538&P=summary

__________________
My location

Craig:

I don't think our debate will be "anecdote vs anecdote". The last time Irene and I debated on barefoot vs shod running at the California Physical Therapy Associations' Annual Meeting in Long Beach in September of last year, we talked mostly of the scientific research on barefoot vs shod running while I spoke a little bit about the history of shoes and history of barefoot running. It was a standing room only audience in the 200 person capacity auditorium.

For the ACSM meeting in a few weeks, we only have 15 minutes each to give our lectures on our sides of the debate followed by about 30 minutes of question/answer from the audience. It will be interesting to see how big the audience will be for this one. I figured that the references that Simon and Nat provided would be the only anecdotes that I would provide for my lecture. Nearly all the rest of the remaining 14 minutes of lecture will be a review of the scientific research on barefoot vs shod running and footstrike biomechanics.

Should be fun.

__________________
Sincerely,

Kevin

**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

e-mail: kevinakirby@comcast.net

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
**************************************************

Kevin,

Here's some ammunition:

1. Rothschild CE: Primitive Running: A survey analysis of runners' interest, participation, and implementation. J Strength Cond Res. 2011 Oct 12. [Epub ahead of print].

Fear of possible injury greater than motivation to prevent injury. Runners know the score!

Abstract
A recent survey of 785 runners: 630 (75.7%) indicated they were at least somewhat interested in running barefoot or in minimalist shoes. 172 (21.9%) runners had previously tried barefoot running while 239 (30.4%) had previously tried minimalist shoes. The primary motivating factor for those running barefoot or minimalist shoes (n=283) was to prevent future injury (n=97, 34.3%). Advice from friends (n=68, 24.5%) or books (n=68, 24.5%) were the most commonly utilized resources in transitioning to barefoot or minimalist shod running. Fear of possible injury (n=424, 54%) was the most prevalent perceived barrier in transitioning to barefoot or minimalist shod running. An overwhelming 671 (85.5%) indicated they were at least somewhat likely to continue with or to add barefoot or minimalist shod running if provided sufficient instruction. Runners who are men, of younger age, and who consider themselves elite runners are somewhat more likely to be interested in barefoot or minimalist shod running.

2. Jung DY, Koh EK, Kwon OY. Effect of foot orthoses and short-foot exercise on the cross-sectional area of the abductor hallucis muscle in subjects with pes planus: A randomized controlled trial. J Back Musculoskelet Rehabil. 2011 Jan 1;24(4):225-31.

The muscles got stronger in the orthotic only group. Counter to the paper: Brugemann G., Potthast W., Braunstein B. et. al.: Effects of increased mechanical stimuli on foot muscles functional capacity. ISB XXth Congress – ASB 29th Annual Meeting, Cleveland, OH: American Society of Biomechanics 2005: 553

3. The American Council on Exercise (ACE) said an independent study on Vibram FiveFingers found the while the glove-like shoes may be beneficial for those who suffer from chronic running injuries, using Vibrams and barefoot-style shoes for running can pose additional risks if runners do not adopt the correct foot-to-ground strike style. The independent study was conducted by the University of Wisconsin, La Crosse, Exercise and Health Program, and led by John Porcari, Ph.D., and Caitlin McCarthy, M.S. www.acefitness.org/getfit/research.aspx. The kicker is that the Hasegawa and Kaminski references below show that many forefoot strikers actually become heel strikers during an event!

4. Hasegawa H, Yamauchi T, Kraemer WJ: Foot strike patterns of runners at the 15-km point during an elite-level half marathon: J Strength Cond Res. 2007 Aug;21(3):888-93.

5. Kaminski J, Decker T, Preble J, Lyons D, McIntyre K, Normile A. Larson P, : Foot strike patterns of recreational and sub-elite runners in a long-distance road race. J Sports Sci. 2011 Dec;29(15):1665-73. Epub 2011 Nov 18.

6. Hashish R, Samarawickrame S, Powers C, Salem G: Foot contact patterns and joint demands in novice barefoot runners before and after exertion. CSM 2012 Sports Physical Therapy Section Abstracts: Poster Presentations SPO1100-SPO1125J Orthop Sports Phys Ther 2012;42(1):A114-A124

Hashish, et. al propose that the exertion required to change the running gait cycle to attain an initial forefoot contact phase changes barefoot running mechanics in a way that negates any potential benefits associated with this running style. In particular, subjects reverted to a heel strike gait pattern and exhibited an increase in the biomechanical demand at the knee following exertion due to fatigue.

7. Franz JR, Wierzbinski CM, Kram R. Metabolic Cost of Running Barefoot versus Shod: Is Lighter Better? Med Sci Sports Exerc. 2012 Mar 2. [Epub ahead of print]

Running barefoot has no metabolic advantage over running in lightweight, cushioned shoes.

8. Stacoff A, Nigg B, et. al.: Tibiocalcaneal kinematics of barefoot versus shod running. J Biomech. (2000) Vol 33; 11, pp 1387-1395.

Authors demonstrated no difference in frontal plane rearfoot function (i.e. tibio-calcaneal or rearfoot motion) between shod and unshod runners, which suggests that the significant changes in foot function between the shod and unshod conditions occur mostly in the sagittal plane (essentially at the knee and the ankle) and not in the frontal and transverse planes. This study suggests that runners will maintain their frontal plane biomechanical compromise when transitioning from a shod to an unshod running condition.

Only two reference on injuries I'm afraid:

9. Giuliani J, Masini B, Alitz C, Owens BD. Barefoot-simulating footwear associated with metatarsal stress injury in 2 runners. Orthopedics. 2011 Jul 7;34(7):e320-3.

Abstract
Stress-related changes and fractures in the foot are frequent in runners. However, the causative factors, including anatomic and kinematic variables, are not well defined. Footwear choice has also been implicated in contributing to injury patterns with changes in force transmission and gait analyses reported in the biomechanical literature. Despite the benefits of footwear, there has been increased interest among the running community in barefoot running with proposed benefits including a decreased rate of injury. We report 2 cases of metatarsal stress fracture in experienced runners whose only regimen change was the adoption of barefoot-simulating footwear. One was a 19-year-old runner who developed a second metatarsal stress reaction along the entire diaphysis. The second case was a 35-year-old ultra-marathon runner who developed a fracture in the second metatarsal diaphysis after 6 weeks of use of the same footwear. While both stress injuries healed without long-term effects, these injuries are alarming in that they occurred in experienced male runners without any other risk factors for stress injury to bone. The suspected cause for stress injury in these 2 patients is the change to barefoot-simulating footwear. Runners using these shoes should be cautioned on the potential need for gait alterations from a heel-strike to a midfoot-striking pattern, as well as cautioned on the symptoms of stress injury.

10. Salzler MJ, Bluman, EM, Noonan,S , Chiodo, De Asla, RJ: Injuries Observed in Minimalist Runners, Foot & Ankle International April 2012 (Vol. 33, #4).

Eight metatarsal stress fractures and one plantar fascia rupture occurred in 10 experienced runners within 1-year from transitioning from a standard training shoe to a minimalist running shoe.

Good luck,

Ray

Ray:

Thanks a bunch for the list of references. I have most of these but there are a few that I don't have in my files. Thanks for the list!

__________________
Sincerely,

Kevin

**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

e-mail: kevinakirby@comcast.net

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
**************************************************

You may also want to get in contact with the medicos cited in this article...

Born this way, but barefoot running not all it's cracked up to be:

__________________
- alias: Matthew Thomas - Podiatrist.
Back On Track Podiatry.

"To give anything less than your best is to sacrifice the gift": Steve Prefontaine.

Joe Hamill presented this at iFab-

http://www.jfootankleres.com/content/5/S1/K1

This included the results of a forward dynamics simulation which demonstrated that a rearfoot strike is most metabolically efficient- (lowest oxygen consumption) , a forefoot strike is faster (but least efficient) and a midfoot strike is somewhere in between...
All makes sense!

__________________
Craig Tanner
Podiatrist
ASPETAR-
Qatar Orthopaedic and Sports Medicine Hospital
Doha
QATAR
http://www.aspetar.com/

I think he was referencing this paper...

http://www.ncbi.nlm.nih.gov/pubmed/22072601

__________________
Craig Tanner
Podiatrist
ASPETAR-
Qatar Orthopaedic and Sports Medicine Hospital
Doha
QATAR
http://www.aspetar.com/

Joe Hamill and I have been corresponding privately on barefoot running ideas and he has sent me his i-FAB lecture that discusses his forward dynamics research on heel-striking being the most energy efficient mode of running. Joe's a good guy to have on our side!

__________________
Sincerely,

Kevin

**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

e-mail: kevinakirby@comcast.net

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
**************************************************

Kevin, when you say "on our side", it sounds a bit like us verses them! Are there really different sides? If so, what are the different sides?

My experience is that people generally fit more on a spectrum when discussing this issue, with people sitting at different points on a continum, depending on whatever factors have so far influenced their point of view. These influencing factors could be personal experiances, clinical experiance, their understanding of (or lack thereof) of the biomechanics of running, or published research they have read. Obviously there are some particularly exotic ideas at the extreme barefoot zealot end of the spectrum!

As we all know, there's not much evidence connecting shod vs barefoot running to injury, so you've got to expect a lot of personal and clinical annecdotes, plus some homegrown or secondhand philosophies about being more "natural" or not. Some of the most rewading conversations I've had with health professionals from other specialities (mostly GPs and physiotherapists) regarding barefoot running has been by not discouraging barefoot running per se, but by helping them understand some basic lower limb biomechanics, e.g. STJ location, tissue loading in shod vs barefoot running. Pretty soon they are able to describe to me what are the logical limitations and risks of barefoot running, and also the possible benefits!

I suppose what I'm trying to say is that when you say "on our side", I hope that you mean the side of all sincere enquirers who seek an unbiased synthesis of all current knowledge of the subject, as opposed to the "other side" being those who do not, or will not, accept the current evidence, or lack thereof, so they can believe what is most convenient or profitable to them.

I make these comments with the greatest respect of all writing in this thread, as I've learned most of what I know about this whole topic from the contributors of this forum.

All the best at the ACSM meeting!

Phil

__________________
Phil Marshman
Mackay, Queensland Australia

Phil:

Thanks for the post.

All I meant to say is that both Joe Hamill and I have debated on the "shoe side" of the "barefoot vs shod debate" against Irene Davis (who is on the "barefoot side" of the debate) on at least one occasion. In addition, I was asked to be on the "shoe side" of the barefoot vs shod running debate in the February 2010 issue of Runner's World.

Maybe I was assuming too much when I suggested, by using the phrase "on our side" that most of those following along here on Podiatry Arena think it is overall best to run in shoes than run barefoot.

Phil, how many of your patients do you suggest that they run barefoot to cure their running injuries?

__________________
Sincerely,

Kevin

**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

e-mail: kevinakirby@comcast.net

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
**************************************************

Is it really all about running injuries?

Dana

While discussing the merits of barefoot running and shod running, having Jason's thoughts in mind that he so eloquently wrote on the Barefoot University:
http://barefootrunninguniversity.com...eed-to-change/
might actually lead to a constructive discussion. I look forward to the day when those with knowledge work together on solutions that genuinely help the running population at large. I sincerely believe we all want the same thing, to help those who need help.

Dana

Dana, we're podiatrists, we treat injuries. We attempt to heal people so that they can go out and enjoy their run/sport. Your response was to a quote that was asking whether or not we should recommend barefoot running as a treatment for an injury. If I saw a patient with a long 2nd metatarsal and stress fracture symptoms I'm pretty confident in saying that running barefoot would not be a good treatment for this person. Would a barefoot zealot recommend running barefoot to strengthen this foot? I'd hope that some barefoot proponents would at least recommend rest for this injury.

Eric

Eric, the quote was part of a thread about being on one side or another of a debate. You are right, podiatrists treat injuries.

The decisions made about footwear are not always based on injury prevention or recovery.

Dana

Choosing your shod or unshod condition in running is a different beast than a foot with a lack of protective sensation. The insensate foot is all about prevention of injury.

Eric

The whole world does not look like a nail said the screwdriver to the hammer.

Zero! Never have advised a runner with an injury to run barefoot to cure their injury. Because there is no good evidence to suggest that this would fix their injury. If the evidence changes, then I will change my practice. Should I be suggesting barefoot running as a treatment for running injuries? If so, which injuries?

I get very good results using custom orthoses for lots of running injuries. And there is good evidence base to encourage this approach.

I do, however, discuss barefoot running with many of my runners, particularly if they bring up the topic. I never suggest it as a treatment for a current injury. Usually I'm discussing the theoretical reasons for why it might be a useful adjunct to their current training, once the injury has resolved.

Phil

__________________
Phil Marshman
Mackay, Queensland Australia

Hi Dana,

could you please define "nail" "screw" and "hammer" for me, in the above context?

is the "nail" an injury? cause if it is, you'll need a "hammer", not a "screwdriver". if there is confusion over whether it's a nail or a screw, then there is a problem. but if it's definitely a nail, and there is good evidence that you can hammer a nail with a hammer, then just nail it.

that being said- have you ever seen one of those helical decking screws? you hammer them in, but because they have a thread they stay in better.

I think I've stretched this analogy beyond it's plastic deformation point and it's about to break! Sorry. Kinda like posterior tibial tendon rupture, an good example of a "nail" needing a "hammer" sooner rather than later?

Phil

__________________
Phil Marshman
Mackay, Queensland Australia

Phil:

I talk quite a bit with my runner-patients about barefoot running since they seem to want to know what my thoughts are on this subject. Generally I tell them that it is fine as a training aid and as a tool to better understand the mechanics of their running stride, but that there is also no evidence that barefoot running either prevents injuries or is a safer or better way to run than running in shoes. Most runners I speak with haven't read "Born to Run" and have never run in Vibram FiveFingers but have heard about these two favorites of the barefoot running advocates.

One thing I do tell my runner-patients is that if they want to know more about what I think about barefoot running then they simply type: "Kevin Kirby, barefoot running" into Google and they will be spending at least a few hours learning more than they ever probably wanted to know about the subject.

__________________
Sincerely,

Kevin

**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

e-mail: kevinakirby@comcast.net

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
**************************************************

As stated not many runners have read Born to Run but most do read glossy running/tri magazines.

Attached is an article from a UK triathlon magazine (it's from 2010 so may have been posted before...apologies if it has) and this is where entry level athletes get their info from. Some interesting snipets in there especially the line "the barefoot movement is backed by a suprising amount of science". I believe a few of the forum regulars may have something to say about that (especially the study they have quoted)

Thanks
Phil

Attached Files

220 Barefoot article.pdf (1.30 MB, 20 views)

I'll bet it was quite a succesful article for the magazine. It filled the spaces between the adds with some new and different entertainment. There's not a lot of new stuff in running. There are only so many diet fads that you can report on. This year it's the high carb low protien, low fat diet. Next year it's the low carb, high protien, low fat diet. You can only change the variables so many times before you have to repeat. You can get away with it for a few years. Maybe the average subscription length is less than 5 years.

Eric

I still trying to figure out how normally smart people can get so deluded. None of the "science" quoted in that article showed that barefoot was any better!

Yeah, but it did have photos of Chris McDougall running barefoot at about 7 minutue mile pace with a bandana on his head...that's got to be worth some science...

__________________
Sincerely,

Kevin

**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

e-mail: kevinakirby@comcast.net

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
**************************************************

I can only speak from a UK point of view but I'm in 2 triathlon clubs (one a large running club with a triathlon section) and I don't think barefoot has really taken off over here. Nobody in my running club wears Vibrams, runs true barefoot, or runs in Newtons. There are a lot of mature athletes in this club and they certainly won't be changing their ways.

Army Triathlon (my other club and generally a younger average age) I've see one bloke in Vibrams and a few in Newton's but it's a very large club (I think the UK's largest) so you would maybe expect more people to be wearing this type of footwear. Strength and Condtioning (S&C) is the main focus for most the army elite triathletes and these training sessions are placed in higher importance to actual swimming, biking and running...these are the sessions that they will not miss. And is S&C not something that can be applied to all running forms? I think I read someone asking the same question in a previous thread...

Looking forward to bio summer school in Manchester this year where I think barefoot vs shod is on the menu.

Barefoot running shoes, clipless pedals you clip in and out of. How confusing is sports footwear terminology?

Look at what has happened in the running shoe industry over the past 3 years. The fact is, Chris McDougall questioned the mode of thinking about running shoes that has been in place for 40 years. With that questioning and subsequent book, I can not think of a single person that has had any where near the impact that Chris McDougall has had on the running shoe industry other than possibly Phil Knight and Bill Bowerman themselves.

It is not about whether he is right or wrong, us against them, our side or their side, it is about taking what has been generally accepted as "correct, accepted or proper" over the past 40 yrs and have all those who care, revisit whether a common line of thinking that has spanned 40 yrs was right.

After 2 1/2 years of reading the podiatry arena, I am still amazed at how much energy and effort has been spent rebuking a guy running barefoot with a bandana on his head.

I am grateful that Chris McDougall had enough creativity to question the 40 year product direction of the running shoe industry and the desire to write a book about it. I have truly benefited from what has happened in the shoe industry over the past 3 yrs. My only regret is that this didn't happen 30 yrs ago. My benefit has nothing to do with injury prevention, how fast or how long I can run. Rather, it is about the whole direction of the shoe industries products and that the products that have become available over the past few years have brought great joy to my running.

I couldn't be happier and I thank the guy with the bandana and bare feet for getting the attention of the running shoe industry. I applaud Chris McDougall and say good job. At this point it is fairly safe to assume that Chris McDougall's name will be tied to running and running shoes for years to come. I'm frankly surprised that Nike hasn't approached McDougall to come up with the Chris McDougall line of running shoes. Like the Bowerman series or the Jordan line or basketball shoes.

Dana Roueche

The above cited barefoot article - "Barefoot In The Park" is just your usual barefoot rubbish - but hey, what do you expect from a triathlon mag. It's an insult to runners with at least half a brain! It's getting to the point where I shy away from anything relating to "barefoot" these days - particularly media articles... & as for Bill Bowerman coming up with the "heel-to-toe concept of jogging" - what absolute rubbish! He would turn in his grave reading such stupidity (as would Steve Prefontaine). We also have equally moronic notions in the past such as the founder of "Pose" coming up with forefoot/midfoot running... & with a forward tilt (or was that the “chi” guy) & yet now we have the apparent inventor of heel-to-toe running announced. Anybody else out there wants to put their hand up for a running trait not yet claimed – high chest/rib cage running per chance? Does swimming or cycling attract such nonsense?!

The thing is, I am now what is deemed a "minimalist runner" – that is I run in shoes which are less robust, lighter, lower heel to forefoot pitch to the traditional 80's, 90's, 00's training shoe... been doing so for about 23-24 years. I have even been called the "barefoot podiatrist" by the owner of a popular running store in Sydney - which I cringe at... why, because of material like the above & characters like the following (& there has been plenty of it)... such as the likes of McDougall. I even sometimes where a bandana for crying out loud (practical reason due to protection from the Australian environment - I have had sun spots on my forehead)... which according to current trend may soon adopt as McDougall’s own style (if it hasn’t happened already). Just like what seems to be happening with that “100-up” exercise (Google search). I was doing this exercise as a 14 – 16 year old as instructed by my coach June Ferguson (who also coached Betty Cuthbert - fourfold Olympic Champion, of which known for her high knee lift as stated), yet this exercise is said to be invented by a miler, Walter George in the 19th century (fair enough). Yet, why is it that these apparent egotistical characters need to attribute basic fundamental activities as their inspiration... or at least condone the case via others? Frankly, I’m getting fed up with it.

Like I’ve said before, it would appear to me that the above traits have more to do with fame & fortune than with serious science, performance & another’s running welfare... & the internet is now a great medium to promote such views (turning them into evangelistic "gurus") to the masses – regardless of the consequences. The claims made by the cardinal exponents of the barefoot brigade may have given rise to a new era in running: one of smoke & mirrors, in which ego, style & individuality triumphs over substance, science, logic & reasoning.

I feel minimalist running shoes were bound to develop into a genre regardless of McDougall’s fictional tale inspired by endurance Indians wearing tyre sandaled foot attire... it was just a matter of time & the direction was heading that way before the release of that book in 2009. As far as the current trend of minimalist running shoes are concerned, I was running in the Nike Free 5.0 (only model at the time) in 2004 & was running in the Vibram Classic when it first came out in 2007... as was many others. Speaking of which, I’ve got to now christen my new Bikila shoes .

__________________
- alias: Matthew Thomas - Podiatrist.
Back On Track Podiatry.

"To give anything less than your best is to sacrifice the gift": Steve Prefontaine.

Funny you should mention that. Hear is an article on the 100-up I just wrote: