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Foot Bone Marrow Edema after 10-week Transition to Minimalist Running Shoes

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  #1  
Old 27th February 2013, 12:58 PM
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Default Foot Bone Marrow Edema after 10-week Transition to Minimalist Running Shoes

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Foot Bone Marrow Edema after 10-week Transition to Minimalist Running Shoes.
Ridge ST, Johnson AW, Mitchell UH, Hunter I, Robinson E, Rich BS, Brown SD.
Med Sci Sports Exerc. 2013 Feb 22.
Quote:
PURPOSE:
Minimalist running shoes are becoming a more popular choice for runners in the past few years. However, there is little conclusive evidence about the advantages or disadvantages of running in these shoes. While performance benefits may exist, injury may also occur from the added stress of running without the benefit of cushioning under the foot. Bone marrow edema can be a manifestation of added stress on the foot. This study measured bone marrow edema in runners' feet before and after a 10 week period of transitioning from traditional to minimalist running shoes.

METHODS:
Thirty-six experienced, recreational runners underwent MRIs before and after a 10 week period. Seventeen subjects were in the control group (ran in their traditional shoes only for 10 weeks), while the other 19 were in the experimental group (gradually transitioned to VibramFiveFinger running shoes over 10 weeks). The severity of the bone marrow edema was scored on a range of 0-4 (0 = no bone marrow edema, 3 = edema in more than 50% of the length of the bone). A score of 4 represented a stress fracture.

RESULTS:
Pre-training MRI scores were not statistically different between the groups. The post-training MRI scores showed that more subjects in the Vibram group (10 of 19) showed increases in bone marrow edema in at least one bone after the 10 weeks of running than in the control group (p = .009).

CONCLUSIONS:
Runners interested in transitioning to minimalist running shoes, such as Vibram FiveFingers should transition very slowly and gradually in order to avoid potential stress injury in the foot.
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Old 27th February 2013, 01:14 PM
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Default Re: Foot Bone Marrow Edema after 10-week Transition to Minimalist Running Shoes

Related threads:
Other threads tagged with bone marrow edema
Bone Marrow Oedema Syndrome
Medial tibial stress syndrome and bone marrow edmea
Bone stress injury
Injuries occuring in the transition from shod to barefoot running
Transitioning to Minimalist Running Shoes
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Old 27th February 2013, 01:26 PM
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Default Re: Foot Bone Marrow Edema after 10-week Transition to Minimalist Running Shoes

"CONCLUSIONS:
Runners interested in transitioning to minimalist running shoes, such as Vibram FiveFingers should transition very slowly and gradually in order to avoid potential stress injury in the foot."

How gradually and how slowly? How do we know (from the above study) that transitioning any more slowly than over a 10 week period should result in any different outcomes? Viz. How can they draw that conclusion from that study? Rather, the conclusion should read something along the lines of: "transitioning to minimalist running shoes over a ten week period results in an increased risk of bone marrow oedema compared to running in traditional running shoes". How many in the traditional group developed bone marrow oedema?
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Old 27th February 2013, 01:28 PM
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Default Re: Foot Bone Marrow Edema after 10-week Transition to Minimalist Running Shoes

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Originally Posted by Simon Spooner View Post
"CONCLUSIONS:
Runners interested in transitioning to minimalist running shoes, such as Vibram FiveFingers should transition very slowly and gradually in order to avoid potential stress injury in the foot."

How gradually and how slowly? How do we know (from the above study) that transitioning any more slowly than over a 10 week period should result in any different outcomes? Viz. How can they draw that conclusion from that study? Rather, the conclusion should read something along the lines of: "transitioning to minimalist running shoes over a ten week period results in an increased risk of bone marrow oedema compared to running in traditional running shoes".
Agreed; its a very odd conclusion they made. Even though the conclusion is probably a correct statement, I do not see how it is supported by the research that they actually did.
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Old 27th February 2013, 01:31 PM
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Default Re: Foot Bone Marrow Edema after 10-week Transition to Minimalist Running Shoes

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Agreed; its a very odd conclusion they made. Even though the conclusion is probably a correct statement, I do not see how it is supported by the research that they actually did.
Hold your horses there Craig, how is it "probably a correct statement"?
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Old 27th February 2013, 01:34 PM
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Default Re: Foot Bone Marrow Edema after 10-week Transition to Minimalist Running Shoes

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Originally Posted by Simon Spooner View Post
Hold your horses there Craig, how is it "probably a correct statement"?
Its make intuitive sense that you should transition slowly.
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Old 27th February 2013, 01:48 PM
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Default Re: Foot Bone Marrow Edema after 10-week Transition to Minimalist Running Shoes

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Its make intuitive sense that you should transition slowly.
Does it? If we believe that the stress reaction occurs in response to excessive stress within the bone, then with graded loading one might expect an increase in bone strength over time. However, there will always be a threshold level of stress that each specific bone is able cope with, without filling with oedema or fracturing. If this loading level is exceeded the bone will always enter the "stressed state". Despite a graded introduction of loading, there will always be an upper stress limit each bone can attain. How do we know that shoes such as Vibrams will not cause the loading on specific foot bones to be in excess of the upper stress limit in a statistically significant majority, regardless of the transitional period? We don't even have any normative data: what would be the level of bone marrow oedema in habitually barefoot runners such as those recruited for the Lieberman study? Which begs the question, how many of those in the study who developed bone oedema displayed any clinical symptoms? Does bone oedema always lead to pathology or is it just part of the bone adaptation process?
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Old 27th February 2013, 02:03 PM
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Default Re: Foot Bone Marrow Edema after 10-week Transition to Minimalist Running Shoes

I agree with Craig. Generally bone edema is considered to be indicative of microscopic damage to the bone and is also apparent in stress reactions in bones (metatarsals and tibias are most commonly seen sites in athletes) and also commonly correlates to symptoms. MRIs are also now being used as a way to detect bone stress (bone edema) patterns in college level and professional athletes even before symptoms occur.

Therefore, I see nothing wrong with the authors' conclusion: "Runners interested in transitioning to minimalist running shoes, such as Vibram FiveFingers should transition very slowly and gradually in order to avoid potential stress injury in the foot." Seems like a common sense recommendation, not only from a clinical aspect, but also from the results of the study.
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Old 27th February 2013, 02:04 PM
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Default Re: Foot Bone Marrow Edema after 10-week Transition to Minimalist Running Shoes

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I agree with Craig. Generally bone edema is considered to be indicative of microscopic damage to the bone and is also apparent in stress reactions in bones (metatarsals and tibias are most commonly seen sites in athletes) and also commonly correlates to symptoms. MRIs are also now being used as a way to detect bone stress (bone edema) patterns in college level and professional athletes even before symptoms occur.

Therefore, I see nothing wrong with the authors' conclusion: "Runners interested in transitioning to minimalist running shoes, such as Vibram FiveFingers should transition very slowly and gradually in order to avoid potential stress injury in the foot." Seems like a common sense recommendation, not only from a clinical aspect, but also from the results of the study.
So where is the evidence that transitioning more slowly results in any less bone oedema? How many weeks would you recommend, Dr Kirby?
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Old 27th February 2013, 02:14 PM
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Default Re: Foot Bone Marrow Edema after 10-week Transition to Minimalist Running Shoes

Interesting point Simon 're bone edema in traditional shoes, until that is know the results of the study have limited meaning.
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Old 27th February 2013, 03:28 PM
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Default Re: Foot Bone Marrow Edema after 10-week Transition to Minimalist Running Shoes

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Interesting point Simon 're bone edema in traditional shoes, until that is know the results of the study have limited meaning.
For those of you who want to familiarize yourselves with the progress being made in understanding the significance of bone marrow edema on MRI in athletes, and nonathletes.

http://www.ajronline.org/doi/full/10.2214/AJR.10.5880

Quote:
Similarly, multiple foci of bone marrow edema may be seen in physically active individuals after strenuous exercise or as a result of altered gait or weight bearing [4]. The cause, again, is unclear and may reflect marrow hyperplasia, microfracture, or bone repair. Initially asymptomatic, the process can evolve, with continuous overuse, to symptomatic stress reaction or stress fracture [3].


Read More: http://www.ajronline.org/doi/full/10.2214/AJR.10.5880
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Old 27th February 2013, 03:44 PM
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Default Re: Foot Bone Marrow Edema after 10-week Transition to Minimalist Running Shoes

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For those of you who want to familiarize yourselves with the progress being made in understanding the significance of bone marrow edema on MRI in athletes, and nonathletes.

http://www.ajronline.org/doi/full/10.2214/AJR.10.5880

Yep, but with all due respect that doesn't answer the questions, Kevin. To reiterate: how can the above study conclude that: "Runners interested in transitioning to minimalist running shoes, such as Vibram FiveFingers should transition very slowly and gradually in order to avoid potential stress injury in the foot." When they have not looked at transitioning for any longer than 10 weeks? Is there any evidence which you know of which suggests that transitioning over a longer period might result in a lower incidence of bone marrow oedema?

You stated that this: "Seems like a common sense recommendation, not only from a clinical aspect, but also from the results of the study." Ignoring the fact that the results of the study do not show this, I guess you believe that transitioning over a longer period should result in a lower incidence of bone marrow oedema and potential for clinical symptoms. Can you explain your rationale for that, and provide an indication of the time period which should be allowed for transitioning, please?
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Old 27th February 2013, 04:18 PM
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Default Re: Foot Bone Marrow Edema after 10-week Transition to Minimalist Running Shoes

Wolff's Law...

http://en.wikipedia.org/wiki/Wolff%27s_law
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Old 27th February 2013, 10:51 PM
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Default Re: Foot Bone Marrow Edema after 10-week Transition to Minimalist Running Shoes

Be interesting to know how much bone edema was found in x runners who changed nothing but strike position.

Ie heel strikers becoming forefoot strikers.

My intuitive guess there would be significant edema after 10 weeks
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Old 27th February 2013, 11:19 PM
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Default Re: Foot Bone Marrow Edema after 10-week Transition to Minimalist Running Shoes

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Yep, but with all due respect that doesn't answer the questions, Kevin. To reiterate: how can the above study conclude that: "Runners interested in transitioning to minimalist running shoes, such as Vibram FiveFingers should transition very slowly and gradually in order to avoid potential stress injury in the foot." When they have not looked at transitioning for any longer than 10 weeks? Is there any evidence which you know of which suggests that transitioning over a longer period might result in a lower incidence of bone marrow oedema?

You stated that this: "Seems like a common sense recommendation, not only from a clinical aspect, but also from the results of the study." Ignoring the fact that the results of the study do not show this, I guess you believe that transitioning over a longer period should result in a lower incidence of bone marrow oedema and potential for clinical symptoms. Can you explain your rationale for that, and provide an indication of the time period which should be allowed for transitioning, please?
As Paul suggested in regards the Wikipedia reference to Wolff's Law, I would think that it is common knowledge within the podiatric and orthopedic medical professions that bone placed under stress will strengthen over time with repetitive stresses, so long as the repetive stresses are not of such high magnitudes and/or occurring over too short of a duration of time to lead to bone injury. This is a function of magnitude of stress, repetition frequency of the stress and the duration of the applied stresses to the bone. The old adage for running injuries being basically a function of "too much, too fast, too soon" is a corollary of Wolff's Law.

At the microscopic level, increased stress to the bone will initially increase osteoclastic activity that will iniitially weaken the bone, but then, over time, osteoblastic activity will increase which will, in turn, increase the strength of the bone versus before the bone stress episode(s) occurred. Since these bone adaptive processes are time dependent, then running too much, too fast and in too short of a period of time will increase the risk of bone and soft tissue injury.

Personally, I don't see how these authors are making a leap of faith in suggesting that the increase in bone edema (i.e probable microfractures) seen in runners trying to transition to minimalist shoes could be lessened by a more gradual and prolonged transition into the changes in bone stress patterns that would occur in running in minimalist running shoes.


Stress Fractures: Current Concepts

Mechanical Strain and Bone Cell Function: A Review
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Old 28th February 2013, 01:11 AM
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Default Re: Foot Bone Marrow Edema after 10-week Transition to Minimalist Running Shoes

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Personally, I don't see how these authors are making a leap of faith in suggesting that the increase in bone edema (i.e probable microfractures) seen in runners trying to transition to minimalist shoes could be lessened by a more gradual and prolonged transition into the changes in bone stress patterns that would occur in running in minimalist running shoes.
But it is a leap of faith because it is an extrapolation beyond their study data set. It is certainly not what their study demonstrated, so why was it their conclusion? It's a hypothesis generated by the study, but it should not have been their conclusion. To the best of my knowledge, no-one has performed a similar study with transitioning over a longer period, so we can guess but we just don't know. What if running in Vibrams exceeds the threshold stress for bone marrow oedema in a statistically significant proportion of runners irrespective of transitional period? How do we know that this is not the case based on the results of this study?
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Old 28th February 2013, 11:30 AM
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Default Re: Foot Bone Marrow Edema after 10-week Transition to Minimalist Running Shoes

Quote:
A representative for VibramUSA said the company was declining to comment on the study, due to ongoing litigation.
http://www.ibtimes.com/vibram-fivefi...-study-1107490
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Old 7th March 2013, 09:05 PM
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Default Re: Foot Bone Marrow Edema after 10-week Transition to Minimalist Running Shoes

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Old 8th March 2013, 11:17 AM
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Default Re: Foot Bone Marrow Edema after 10-week Transition to Minimalist Running Shoes

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Even a lay person can see how flawed this study is, but whatever.

I limited my use of VFF to walking for the first two months of transitioning. I then limited their use to running in them one day per week for several months. After that I very gradually added a day per week when it was comfortable to do so and when I felt like wearing VFF to run in. It took me over 2 years to fully transition from traditional running shoes to running in VFF full time. I still wear traditional running shoes but only once or twice per month and most of my walking is done in traditional running shoes. During the transition I found no need to rush, what would be the point? I just used the running shoes I have been wearing all along. For that matter, I really didn't plan on fully transitioning to VFF at the start. I just discovered that the more I wore them, the more I wanted to wear them. The transition happened simply out of desire to wear the shoe that provided the best running experience. In the future, I will also be guided to wear the shoe that I enjoy running in the most. I could care less what the current trend is or what the "experts" think.

10 weeks is WAY to fast for the body to accommodate a change as big as going from traditional shoes to something like VFF. I don't see the findings as surprising at all. It also seems that they let the subjects interpret and apply the transition on their own instead of by a prescribed succession of steps. How can you have a controlled study when it is left up to the interpretation of it's subjects? What were the subjects doing for the rest of the day when they weren't running and what were they wearing on their feet? Any other factors during the other 23 hours of the day that might have influenced the findings? Vibram's transition plan might be at fault but it also might be the fault of incorrect interpretation.

If bones are to grow and strengthen from their current state, wouldn't there be some edema as a precursor? Kind of like weightlifting or basic physical training principles that require some tearing down in order to promote building up? Micro tearing of the muscle is a precursor to the muscle growing stronger, it is also a precursor to injury. Can the presence of edema be differentiated between what is the precursor of bone strengthening vs bone injury? The study assumes/implies all bone marrow edema is bad as a part of training, is that true?

What is an experienced recreational runner? Wouldn't it have been better to describe the runners as having x years of running experience at y miles of running per year and at an average pace of z? For all we know experience was defined as running for 2 months and recreational means they run less than 30 miles per week. Or experienced could mean running more than 10 years at 100 miles/week and they are recreational because they are not elite runners or earning money from running. Who knows?

The biggest flaw in all of this is the expectation the VFF are for everyone. They simply aren't. They are fantastic running shoes for those who they happen to work for. That is all there is to it. One size does not fit all and in the case of VFF, patience is the key factor to healthy running. Patience is actually the key factor for all running, regardless of what is worn on the foot.
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Old 8th March 2013, 04:31 PM
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Default Re: Foot Bone Marrow Edema after 10-week Transition to Minimalist Running Shoes

No one is questioning your right to do whatever you want and whatever works for you Dana. THIS is what I question.. straight from the VFF website
"And there is ample evidence that training without shoes allows you to run faster and farther with fewer injuries.'
No there isn't!
"It allows you to land on your forefoot, directly below your center of gravity, resulting in optimum balance, increased stability, less impact and greater propulsion.'
If one lands directly under ones COG, one cannot run! VFF does not necessarily allow you to land on your forefoot either.
"Running in FiveFingers delivers sensory feedback that improves agility and equilibrium and allows immediate form correction. In addition it stimulates and strengthens muscles in the feet and lower legs."
I have yet to see a single study supporting these claims in ANY way.
And I just do not understand why, if wearing VFF is NOT a risk inducing practice for most runners, Vibram has produced a glossy brochure imploring runners to go very slowly.. produced incidentally by Dan Lieberman and nick Campitelli.
Finally, within this brochure, I wonder why they say the following.."• in the beginning, remember to carry your traditional footwear in your hands as a backup. If you need to stop in
the middle of a workout, you can put on your cushioned running shoes and return home.'
yeah.. of course you can,because those shoes won't hurt you!! And what a pain in the butt that is to run carrying your normal shoes!!
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Old 8th March 2013, 04:47 PM
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Craig Payne Craig Payne is offline
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Default Re: Foot Bone Marrow Edema after 10-week Transition to Minimalist Running Shoes

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Originally Posted by Dana Roueche View Post
Even a lay person can see how flawed this study is, but whatever.
What flaws might they be?

I have gone through the paper and can't see anything that is flawed. The inclusion criteria was ok; the randomization process could have been better, but was OK; the baseline and follow-up measures have validity and reliability and were done by blinded observers; the transition protocol followed was the one published on the Vibram website; the stats analysis was appropriate.

The only issue I can see is how the handled the couple of dropouts and which groups they were in - more detail would be appropriate, but I would hardly call that a flaw.

Quote:
Originally Posted by toomoon View Post
straight from the VFF website
"And there is ample evidence that training without shoes allows you to run faster and farther with fewer injuries.'
Which the judge in the class action suit has certainly ruled last week that Vibram have a case to answer that they were involved in deceptive practices!
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Old 8th March 2013, 05:07 PM
Dana Roueche Dana Roueche is offline
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Default Re: Foot Bone Marrow Edema after 10-week Transition to Minimalist Running Shoes

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No one is questioning your right to do whatever you want and whatever works for you Dana.
Thanks Simon. The approach Vibram took to sell their shoes is unfortunate. They could have followed a different path. They have something that enhances the running experience in a way that differentiates them from everyone else, which might have been a marketing panacea for them. It is too bad they didn't focus on the experience rather than running farther, faster, being able to leap tall buildings and doing it with less injuries.

There are runners that exist who do not run for the purpose of running faster, who do not run for the purpose of running further and who are not in the least bit concerned about developing injuries. There are runners out there that run simply because they like to run. They like the running experience and yes, the shoe that is worn, the vehicle that provides the interface between the person and the ground can greatly influence the quality of that experience.

Based on what I've read on this forum over the years, I suspect few even have a clue with respect to what I'm talking about. I have tried to explain but it has been futile so I'll accept things as they are.

Have a great weekend.
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Old 8th March 2013, 05:15 PM
Dana Roueche Dana Roueche is offline
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Default Re: Foot Bone Marrow Edema after 10-week Transition to Minimalist Running Shoes

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What flaws might they be?

I have gone through the paper and can't see anything that is flawed. The inclusion criteria was ok; the randomization process could have been better, but was OK; the baseline and follow-up measures have validity and reliability and were done by blinded observers; the transition protocol followed was the one published on the Vibram website; the stats analysis was appropriate.

The only issue I can see is how the handled the couple of dropouts and which groups they were in - more detail would be appropriate, but I would hardly call that a flaw.

Which the judge in the class action suit has certainly ruled last week that Vibram have a case to answer that they were involved in deceptive practices!
Did you read my post? Can you respond to my questions?

Quote:
Originally Posted by Dana Roueche View Post
10 weeks is WAY to fast for the body to accommodate a change as big as going from traditional shoes to something like VFF. I don't see the findings as surprising at all. It also seems that they let the subjects interpret and apply the transition on their own instead of by a prescribed succession of steps. How can you have a controlled study when it is left up to the interpretation of it's subjects? What were the subjects doing for the rest of the day when they weren't running and what were they wearing on their feet? Any other factors during the other 23 hours of the day that might have influenced the findings? Vibram's transition plan might be at fault but it also might be the fault of incorrect interpretation.

If bones are to grow and strengthen from their current state, wouldn't there be some edema as a precursor? Kind of like weightlifting or basic physical training principles that require some tearing down in order to promote building up? Micro tearing of the muscle is a precursor to the muscle growing stronger, it is also a precursor to injury. Can the presence of edema be differentiated between what is the precursor of bone strengthening vs bone injury? The study assumes/implies all bone marrow edema is bad as a part of training, is that true?

What is an experienced recreational runner? Wouldn't it have been better to describe the runners as having x years of running experience at y miles of running per year and at an average pace of z? For all we know experience was defined as running for 2 months and recreational means they run less than 30 miles per week. Or experienced could mean running more than 10 years at 100 miles/week and they are recreational because they are not elite runners or earning money from running. Who knows?

The biggest flaw in all of this is the expectation the VFF are for everyone. They simply aren't. They are fantastic running shoes for those who they happen to work for. That is all there is to it. One size does not fit all and in the case of VFF, patience is the key factor to healthy running. Patience is actually the key factor for all running, regardless of what is worn on the foot.
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Old 8th March 2013, 05:23 PM
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Craig Payne Craig Payne is offline
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Default Re: Foot Bone Marrow Edema after 10-week Transition to Minimalist Running Shoes

In answer to your question:
Quote:
Originally Posted by Dana Roueche View Post
10 weeks is WAY to fast for the body to accommodate a change as big as going from traditional shoes to something like VFF.
The study followed the transition protocol and advise that was recommeded on the Vibram website. How is that a flaw?

It may or may not be too rapid; but researchers have to make judgement calls when it comes to protocols and as long as what they are doing is based on a rational and logical reasoning, then its difficult to fault. Surely following the advice from the Vibram website is logical, makes sense and can easily be defended by the researchers.
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Old 8th March 2013, 05:30 PM
Dana Roueche Dana Roueche is offline
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Default Re: Foot Bone Marrow Edema after 10-week Transition to Minimalist Running Shoes

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In answer to your question:The study followed the transition protocol and advise that was recommeded on the Vibram website. How is that a flaw?

It may or may not be too rapid; but researchers have to make judgement calls when it comes to protocols and as long as what they are doing is based on a rational and logical reasoning, then its difficult to fault. Surely following the advice from the Vibram website is logical, makes sense and can easily be defended by the researchers.
They let the subjects interpret the transition plan with NO control over the interpretation. Who knows if the subjects even followed the plan!

What about bone marrow edema? Isn't it a precursor to building stronger bones? Their interpretation is that it was leading to injury, could it have been leading to stronger bones? Their interpretation of the findings might be totally out to lunch.
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Old 8th March 2013, 05:38 PM
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Mark Russell Mark Russell is offline
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Default Re: Foot Bone Marrow Edema after 10-week Transition to Minimalist Running Shoes

Quote:
Originally Posted by Dana Roueche View Post
What about bone marrow edema? Isn't it a precursor to building stronger bones? Their interpretation is that it was leading to injury, could it have been leading to stronger bones? Their interpretation of the findings might be totally out to lunch.
It is also a precursor to osteoporosis, which will offer a much weakened structure.
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Old 8th March 2013, 05:39 PM
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Craig Payne Craig Payne is offline
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Default Re: Foot Bone Marrow Edema after 10-week Transition to Minimalist Running Shoes

Quote:
Originally Posted by Dana Roueche View Post
They let the subjects interpret the transition plan with NO control over the interpretation. Who knows if the subjects even followed the plan!
That is a good thing! It mimics real life and what probably happens in most transitions!!! It was not a rigid protocol and allowed flexibility based on the response ... based on what Vibram said they should do! All subjects kept training logs, so what they did is documented.
Quote:
What about bone marrow edema? Isn't it a precursor to building stronger bones? Their interpretation is that it was leading to injury, could it have been leading to stronger bones? Their interpretation of the findings might be totally out to lunch.
Bone marrow edema is indicative of injury.
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Old 8th March 2013, 05:40 PM
Dana Roueche Dana Roueche is offline
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Default Re: Foot Bone Marrow Edema after 10-week Transition to Minimalist Running Shoes

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It is also a precursor to osteoporosis, which will offer a much weakened structure.
Maybe the study should have claimed that as well.
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Old 8th March 2013, 05:41 PM
Dana Roueche Dana Roueche is offline
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Default Re: Foot Bone Marrow Edema after 10-week Transition to Minimalist Running Shoes

Vibram deserves a slap on the wrist, they deserve to be made to refund the money to their disgruntled customers, they deserve to be made to retract the BS claims and they deserve to be made to pay the small amount in damages that are being asked for. I suppose the $5M is the lawyers cut in this, $1M to each of the vulture firms that jumped on the Sue Vibram bandwagon.

I hope this ends soon and Vibram can get back to making Fivefingers.
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Old 8th March 2013, 05:47 PM
Dana Roueche Dana Roueche is offline
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Default Re: Foot Bone Marrow Edema after 10-week Transition to Minimalist Running Shoes

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Originally Posted by Craig Payne View Post
That is a good thing! It mimics real life and what probably happens in most transitions!!! It was not a rigid protocol and allowed flexibility based on the response ... based on what Vibram said they should do! All subjects kept training logs, so what they did is documented.
Bone marrow edema is indicative of injury.
Craig, give me a break..... on both responses. Wow.

Have a great weekend.
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