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Dr. Nirenberg wearing his Vibram Five Fingers

Dr. Nirenberg wearing his Vibram Five Fingers

As one of the first podiatrists to recommend barefoot running, I was surprised to see the results of a recent survey conducted by the well-respected Podiatry Management magazine.

On the week of May 20th this year, the publication’s online newsletter asked podiatrists:

Do you recommend barefoot running?

The results were as follows:

Yes, but only for certain foot types: 14.19%

Yes, for all runners: 2.21%

No: 83.59%

For those of you who are not math-whizzes, this means one in six podiatrists recommend barefoot running.

The survey had superb participation from the podiatric community, with a 768 podiatrists responding.

It is great to see such a robust number of podiatrists beginning to explore the possibility that our feet do not need all the support and padding that the billion dollar shoe, insole and orthotic industry has been touting.

As background, Podiatry Management’s editor, Dr. Barry Block, has featured a wide-range of content in his magazine, website and newsletter. He brings to light new innovations and technologies, and other  advances related to podiatry and feet.   I often learn more about what is going in the podiatry profession from his publications than from the American Podiatric Medical Association.

However, Dr. Block’s survey implies that a key factor in whether or not barefoot running should be recommended is “foot type.” In fact, 14% of podiatrists believe foot type IS a determining factor.

“Foot type” is a broad term. It often refers to whether your foot is flat, high arched, normal or something in-between. From a biomechanical perspective foot type refers to whether your foot excessively pronates, supinates or is neutral. Some say your foot type can best be determined by looking at your footprint, and in this vein, these podiatrists advocate the “wet test” whereby you wet your foot and then look at your footprint. There are many other methods of foot typing (i.e. Rossi’s Podometrics, the Greek foot, Egyptian and so on) Dr. Block did not specify what he meant by “foot type” but he probably was thinking of the first description (flat, high arched or normal).

Today I know that foot type has no bearing on your ability to run barefoot.

     Many years back, I too (like these podiatrists) did not realize the remarkable ability of some runners to “tune in” to their own biomechanics and run barefoot, regardless of their foot type.

Years ago, when I was fighting off painful plantar fasciitis (heel pain) and my feet were beholden to wearing orthotics while walking and running, I believed foot type was a factor in whether someone should run barefoot. Even after I transitioned to running barefoot and in the process rid myself of plantar fasciitis, I still held onto this notion. In time though, I began to study barefoot activity and I began to treat barefoot runners. I have had barefoot runners come to my practice from almost every state in the country.

I have seen first-hand the incredible achievements of people who are committed to running (and walking) barefoot. It has totally turned everything I thought I knew upside down. I have seen severe high arched people run bare, as well as people whose feet are like two pancakes. One barefoot runner was even able to make suction noises with his feet on my office floor! I have seen the young and elderly; the thin and morbidly obese all run barefoot. I have even seen a man with a serious brain injury run barefoot (he believes it helps his mind function better than shod running).

Who Shouldn’t Run Barefoot?

When I say “barefoot” I am talking today about minimalist shoes or barefoot. If you are running in an area where you fear cuts or scratches to your feet, then you should opt for minimalist shoes. If you fear a puncture wound from rusty nails or worse, then you should not run there. Period.

Personally, I always wear minimalist shoes: in my office, at meetings, weddings and so on. I do go completely barefoot at times but this is infrequent and only in the safest of areas. I never wear orthotics or “supportive” shoes anymore. (In case you just found my website, orthotics, supportive shoes and arch supports weaken foot muscles, decrease sensation, and only reinforce the need for more foot support. They do have their place, but in general, they are over-prescribed.)

If you have a health issue or injury that impairs sensation, function or circulation of your feet (or anywhere in the lower extremity), you should speak with a knowledgeable podiatrist before doing any barefoot activity, running or walking. (This advice goes for all people with health issues who want to run–whether barefoot or in shoes!).

Who Should Go Barefoot?

Everyone else! This, of course, assumes you want to. There are people who prefer to rely on thick, supportive shoes and supports. That is fine. It is a choice one makes. If you choose to be free from these devices, you have the power to do this.

Barefoot running is exhilarating and can even be life changing, but like most sports it is not without the risk of injury. Like those who run with their feet encased in thickly padded footwear, you should use proper form (albeit ‘barefoot” form), choose a safe place to run and go slowly at first.

Summary

Years ago I said that very few podiatrists would recommend barefoot running. I was wrong. I admit it. And I am happy about it.

Run On! (and Run Bare!)

Woman tying her shoes and getting ready for train

Most women know that high heels are not good for their feet. Clearly, a high heeled shoe forces women to adjust their posture unconsciously as they stand and walk. Today, I want to talk about the effect that a heel of ANY height can have on our entire body. So men this article applies to you too!

Any Heel Height is Too High

When I talk about a high heel, I am talking about any shoe that causes your heel to sit higher than the ball of your foot. This is the kind of high heel found on running shoes, walking shoes and even some women’s “flats” and male dress shoes. effect of low heel on our bodyIn simple terms see the diagram above, which shows how even the smallest heels can cause us to tip forward (or even fall forward!).

Of course, most of us do not tip forward because our joints, muscles, ligaments and other soft tissues adjust. These unconscious adjustments take our body from its natural, aligned position to a highly  unnatural, misaligned position. Unfortunately, it is a posture that many people who have heels on their shoes are “normally” positioned in when standing and walking. 

In the short term these adjustments may seem minor but given that most Americans walk an average of 6000 steps a day (even though we should do at least 10,000), walking in shoes with a heel of even a low height creates a cumulative, detrimental effect on our body over time. The process is slow. But when it occurs day after day, week after week, it’s effects begin to add up.

The Biomechanical Effects of Heels

Wearing a shoe with a heel of any height increases muscle and joint strain throughout our entire body. Most running, walking and dress shoes with a low, 1 inch heel height, acts to tilt the average person about 12 degrees forward.

To stay upright most every joint in our body that bears weight moves out of its correct position. Specifically, our ankle joints bend, our knees and hips will flex, and our back muscles work harder.

What Do These Compensations Mean For Us?

When we use our body in ways that nature did not intend (i.e. walk around with our heels an inch or more off the ground) we put ourselves at increased risk for pain, injury, and even arthritis. Running shoes with even the most minimal heels, cause:

1. Excessive knee flexion and moderate hip flexion acts together to reduce shock absorption. Less shock absorption puts our bones, joints and soft tissues at risk for stress and injury.

Beyond shock absorption, our muscles must work harder when we wear a shoe with a high heel.

Very briefly, a team of scientists in the UK led by Edwards looked at muscle activity around the knee joint in persons wearing shoes with a increased heel height. At a heel height of a mere 3cm, the researchers found significant increased muscle activity. A group of scientists led by Mika found similar findings for lower back muscles with shoes that had heels. They found increased muscle activity in the small muscles of our back and suggested that this could lead to low back pain.

2. Joints throughout our body endure abnormal force. That is, the point in the joint that was meant to take on the force of walking or running is now misaligned; force impacts the joints elsewhere. This chain reaction of abnormal joint position and force going through the joints abnormally can lead to cartilage destruction, increased risk of injury, and even arthritis.

3. The achilles tendon and related calf muscles tighten, impacting the flexibility of our legs and contributing to hamstring tightness.

4. Lastly, heels throw your weight onto the front of your foot, increasing the strain on your toes and causing problems such as hammertoes and pinched nerves.

A Common Foot Problem

Many people develop pain in their big or great toe joint. Often, they begin to get a very localized form of arthritis in this joint. The medical term for this problem is called hallux limitus or rigidus. The problem is often caused or worsened by wearing a shoe with a heel (even a low heel).

The increase in heel height raises the force on the big toe joint with every step. In cases where the degree of damage to the joint is mild, many of these people who have come to me as patients have had good success at alleviating the pain simply by switching to shoes without a heel. The key has been in catching this problem early, before shoes have done irreversible damage to the joint.

Given that many common foot problems are related to wearing improper shoes, this solution should not be surprising.

What Shoe Is Best?

I get this question a lot. The answer is simple; barefoot is best. But in our world of concrete and rusty nails, some protection is often required. Plus, some people have medical issues, deformities or are overweight, and because of these issues, cannot or should not go barefoot. I always suggest anyone with medical, health or weight issues, work with a podiatrist when transitioning to a more healthy shoe.

In my office, I wear Terra Plana dress shoes. When I am walking around my neighborhood, I wear Altra or go barefoot. For running, I generally go bare or wear Vibram Five Fingers.

All of these shoes are lightweight, flexible and most importantly, the heel is the same height at the forefoot. Some people refer to these types of shoes as “zero drop.”

Whatever shoe you choose to wear, the bottom line is you should wear as low a heel height as you are able. With this simple change, you will walk, run and stand with much improved posture. Your joints will thank you, and with your chance of injury reduced, you may just save yourself a doctor visit.  

Step Well!

References:

Edwards L, Dixon J, Kent JR, Hodgson D, Whittaker VJ. Effect of shoe heel height on vastus medialis and vastus lateralis electromyographic activity during sit to stand. J Orthop Surg Res. 2008 Jan 10;3:2.

Mika A, Oleksy L, Mika P, Marchewka A, Clark BC. The effect of walking in high- and low-heeled shoes on erector spinae activity and pelvis kinematics during gait. Am J Phys Med Rehabil. 2012 May;91(5):425-34.

Photo credit:

Ready to train Photos by Pond5

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