Fox In Socks is a Dr. Seuss book I just read to my five year old son. I doubt Seuss based the book on a real fox, but if the good doctor were still alive he could write the true-life story, Doc In Socks, about Dr. Steve Gangemi. Gangemi is a chiropractic physician who has earned the moniker Sock Doc from his habit of wearing only socks or even going barefoot in his chiropractic office. Unlike other habits that could land you in jail, shunning your shoes isn’t only legal, it is good for you.

Gangemi has been trained in a variety of specialties ranging from functional neurology to applied kinesiology. Although he does not specialize in the treatment of foot ailments, he believes that healthy people have healthy feet which do not require cushioned, supportive shoes. Gangemi proposes the concept that feet can send you signs and signals about your overall health, and that these clues are well worth pursuing in order to arrive at a state of complete health, literally from head to toe!

Gangemi states that the feet are the foundation of your body. With approximately 7,000 nerve endings in each foot, feedback from your feet can affect your overall health. Any foot impairment, injury, pain, dysfunction, or the wearing of footwear can (and often does) impair sensory feedback, balance and y muscle-skeletal function. Given that we take thousands of steps a day, day after day, the end result can be injury, arthritis, pain or other problems.

Gangemi also explains that an ache in one part of our body may be (and often is!) the result of a problem somewhere else in the body. For example, he explains that pain in your knee may be due to a muscle imbalance in the foot, improper footwear, poor diet, or even stress.

One of the fundamental tenets of his practice is that rarely will an unhealthy person not present with problems in their feet, and it is these bases of the entire human anatomy which can reflect and influence the health of the organism as a whole. Wearing improper footwear can disrupt the normal walking gait, and that can have a knock-on effect which can point to problems being experienced elsewhere in the body.

Gangemi prides himself on dealing with his patients’ health problems on a cause oriented individual level, and highly recommends the barefoot lifestyle. He believes that everyone can benefit from walking barefoot, not just multiple sport athletes and dedicated runners. The wearing of built up shoes featuring supportive orthotics and plush padding benefits few if any people, since going barefoot equates with improved lower leg function and balance which has an impact on overall health.

Steve “Sock Doc” Gangemi’s website (http://sock-doc.com) is a treasure trove of information on every aspect of educating athletes and other interested people about injury, prevention, and treatment to help them live longer and healthier lives. Gangemi provides cutting edge information on injuries, training, racing, nutrition, gear and much more.  Dr. Seuss would be proud of him. And so am I.

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Dr. Nirenberg wearing his Vibram Five Fingers

Mark Anders is one of those top journalists who live the sort of romantic adventurous lives the rest of us can only dream about. Whether he’s surfing the Zambezi River, racing mountain bikes in the 24 Hours of Moab, or is embedded with Navy SEALs in desert war games, he brings to his readers a vivid portrayal of the esoteric experiences to be found in the most exotic locales on Earth. Mark’s work has been featured in Life, Wired, Popular Science, Outside, Men’s Journal, New York, and many other major magazines. He recently wrote an article for the American Council on Exercise Certified News which dealt with an University study of the benefits of minimalist footwear for runners.

Mark writes that John Porcari, Ph.D., and Caitlin McCarthy, M.S., researchers from the Exercise & Health Program at the University of Wisconsin, La Crosse, conducted a study on 16 young adult female subjects who were habitual joggers and free from injury. Two weeks before the testing each was fitted with a set of Vibram FiveFingers Bikila model, and asked to run with that minimalist footwear three times a week for two weeks. Once this “breaking in” period was passed, the test runners were brought into the laboratory at the University for 3-D motion analysis under three separate conditions: barefoot, with the Bikilas; and with New Balance 625 running shoes.

The results of the testing showed that all 16 subjects landed primarily on their heels when wearing the running shoes, while half of the subjects became forefoot strikers when wearing the Bikilas or running barefoot. Even though the researchers were encouraging all the runners to adopt a forefoot strike, the heel strikers were not able to make the switch. The reason for preferring the forefoot strike is that the ankle becomes more plantar-flexed at the moment the foot hits the ground, and it is this greater degree of flexion which seems to absorb the running impact forces to a greater degree. The research also showed that the barefoot and Bikila runners displayed a lower degree of flexion in the knee which is generally correlated to fewer injuries.
 
The research proved that when some runners adopt minimalist footwear they do not necessarily display the correct running stride, in which case the possibility of discomfort and potential injury actually increases over conventional running shoes. The reason for this phenomenon is that minimalist footwear such as the Vibram Bikilas have virtually no cushioning in the heel area and thus subject the foot to higher impact loads. Dr. Porcari concludes that runners “may need very explicit instruction and time spent practicing how to land on the ball of the foot” when first starting to run in minimalist footwear such as Bikilas as continuing to run in a heel strike gait pattern actually negates the benefits of ditching the running shoes. The increased flexion advantages displayed by the forefoot striking runners in both barefoot and minimalist footwear styles are notable as the impact loads are minimalized and that can lead to a decreased risk of injury.

The bottom line is simple: Minimalist footwear works but has to be matched with a forefoot strike. All you heel strikers out there, start practicing your forefoot gait pattern to gain the maximum benefit from your Vibrams!

Check out Mark Anders’ unique life experiences at http://www.markanders.com/markanders.com/home.html , and you can read more about the study at http://www.acefitness.org/certifiednewsarticle/1641/

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Myfivefingers.com’s attractive website badge

Brian Patterson is a Vibram Five Fingers enthusiast who has been driven by his dedication to minimalist footwear to tackle the task of compiling and meticulously maintaining an encyclopedic site dedicated to the sport and science entitled myfivefingers.com. The site is segmented into various sections featuring specific articles, reviews, and guides relevant to minimalist footwear with content which continues to burgeon by the day.

Brian’s reviews are especially illuminating, with numerous large clear photos dealing with every aspect of the footwear he is testing, as well as complete specifications and even recommendations as to the type of person that would be best suited to that particular set. The site also features a remarkably easy to use Five Fingers Sizing Wizard which in a few simple steps will allow anyone to find the perfect fit in the minimalist footwear of their choosing. Brian has also created a set of very striking badges which other minimalist footwear aficionados can place on their websites to link back to myfivefingers.com, complete with the necessary HTML code ready to drop into any page.

Brian recently interviewed me for his site, and we covered the medical reasons supporting minimalist footwear, and touched on a variety of different topics, from the scenarios whereby I recommend inserts or orthotics, and the specific cases where minimalist shoes are not recommended due to neurological or circulatory impairments or other significant deformities.

I gladly share Brian’s enthusiasm for this important subject and highly recommend that any reader should check out myfivefingers.com, especially if you are interested in learning about the state of the art of minimalist footwear, and would like to delve into the most suitable models for your own needs and preferences. It’s an extremely well-produced website and best of all it is very obvious that the entire project is a labor of love for Brian.

Check out Brian’s site at http://www.myfivefingers.com

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Barefoot activity has proven medical benefits

Do shoes contribute to knee pain, joint deterioration and arthritis? According to new research published by Drs. Andy Oliver Radzimski and Gisela Sole at the prestigious University of Otago, and Dr. Annegret Mundermann at the University of Constance, Germany, in most cases the answer appears to be a resounding yes.

For many barefoot runners and walkers who have avoided or alleviated their painful knees by shunning supportive shoes, arch supports, and orthotics (custom made arch supports), this research is nothing new. The barefoot community has known for years that barefoot activity is good for our knees, but now science is catching up.

Dr. Radzimski and his co-researchers reviewed the scientific literature on the effect of footwear and arch supports/orthotics on the knee. They looked at the external knee adduction moment (EKAM) when we are wearing shoes and when we are barefoot. EKAM represents knee load distribution from the inside to the outside of the knee joint. The higher the EKAM is, the greater and faster the progressions of deterioration (osteoarthritis) of the knee joint. In simple terms, a high EKAM is bad for our knee, while a low EKAM is good for the knee.

These researchers stunning findings came about after looking at a grand total of 348 scientific articles and including 33 studies in their research. In plain English: these highly educated and respected scientists evaluated all current knowledge and scientific information on the effect of footwear on the knee joint of healthy people and those with knee disorders with regard to EKAM. This impressive analysis of the literature is important because the ardent lovers of supportive shoes believe that our feet need to be encased in footwear will have a difficult time refuting the voluminous amount of scientific research analyzed.

Remarkably, these researchers found that sneakers and running shoes increased EKAM when compared to barefoot walking and barefoot running. Specifically, the knee has a greater load on the inside of the joint when wearing shoes as compared to going barefoot. In fact, the authors of this astounding research say that shoes that provide “stability” (or support) create increased load on the knee joint (again when compared to simply going barefoot).

Radzimski and his co-writers conclude by suggesting that people with knee arthritis on the inside of their knee joint should consider walking barefoot when possible. I recommend this too. Not only will your knees thank you, but your whole body will too.

This new, groundbreaking research is not proof that barefoot is better than wearing shoes, but if you will excuse the pun, it is yet one more step (in fact, a big step) in that direction. I do not expect this amazing research will convince the tiny percentage of supportive-shoe-loving zealots out there to take a step without their feet firmly encased in their thickly-padded shoes, but for the vast majority of people with an open mind, I urge them to give this research a read. More importantly, give barefoot activity a try!

Note: if you do decide to make the leap to barefoot walking or running, begin slowly, read up on the techniques of giving up your supportive footwear or shoes, and if you have any medical problems, proceed only under the care of your physician.

References:

Radzimski AO, et al, Effect of footwear on the external knee adduction moment – A systemic review, Knee (2011), doi:10, 1016/j.knee. 2011.05.013

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The Canadian Medical Association Journal (CMAJ) has just published a two part news feature article on barefoot running, The Rise of Barefoot Running  and Low Tech Running Shoes in High Demand. Its conclusions as to the state of current medical research and the overall progress of the sport are definitely worth reviewing.

CMAJ Scrutinized The Research On Both Sides Of The Issue

The CMAJ articles are extremely fair and balanced, eloquently discussing both sides of the issue. On behalf of barefoot running, the association stated that it “encourages people to take shorter strides and to land more softly on the middle or front of their feet, which some people believe reduces injuries and strengthens foot muscles”, and “there is no scientific evidence that all the cushioning in high-tech running shoes provide a health benefit”.

Experts Agree That More Research Is Needed To Support Barefoot Running

CMAJ quoted a number of experts in podiatry and running kinetics supporting barefoot running, including articles published in Nature and Dan Lieberman, professor of human evolutionary biology at Harvard University who stated “the key thing is not being barefoot, but using a barefoot style, and not colliding into the ground with your heels.”

Dr. Kevin Kirby, an adjunct associate professor at the California School of Podiatric Medicine in Oakland examined the paucity of clinical research in the field on both sides of the issue and stated that “there is also no research that indicates running shoes reduce injuries.“

I Provided CMAJ With Information To Bolster The Benefits of Barefoot Running

The CMAJ articles quoted me in stating that “there is a lot of research that is leaning in (the) direction” of supporting that running barefoot has beneficial effects. To help bolster the case against running shoes, I stated that “there are four layers of muscle in our feet. The majority of the muscles are used less, if at all, when the feet are in supportive footwear.”

In my CMAJ interview I also stated that “there’s an idea that our feet need a lot of help or support. The truth is that feet are really strong and resilient”.

Runners Of All Styles Can Look Forward To More Rigorous Scientific Dialogue

The CMAJ should be lauded and commended for focusing on the full breadth of scientific evidence with regards to barefoot running. Further clinical research is certainly called for in this field, and all runners can look forward to more authoritative medical organizations like CMAJ publishing their findings and supporting the sport through rigorous scientific dialogue.

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Can Barefoot Activity Cure Flat Feet?

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. This condition is present in up to 30% of all people, and it is unfortunately not reversible by the use of arch-shaping shoe inserts, whether over the counter or prescribed by a doctor.

Studies Suggest Shoe Wearing Predisposes To Flat Feet!

A very interesting Indian study ⁽¹⁾ analyzed the footprints of 2,300 children. It is commonplace in India for typical children to be barefoot most of the time, with only the higher classes usually shod in shoes. It found that the incidence of flat feet among children that used footwear was over three times greater than those who commonly played and ran in bare feet. The study unequivocally states that “shoe wearing predisposes to flat foot”. Flat feet can also be due to other factors, such as genetics, injury, etcetera.

A Remarkable Example of Barefoot Running Helping Raise the Foot’s Arch!

There have long been anecdotal reports that barefoot running can actually raise the arch of the foot and reverse flat feet, but now we have available the remarkable case study presented by a 41 year old male who recorded his foot print prior to engaging in a six month campaign of walking and running barefoot.

This individual has no history of medical problems and after a lifetime of conventional shoe wearing began to average 35 kilometers per week in running barefoot. He also shunned his footwear for most of this time in his everyday activities.

Remarkable Before & After Foot Prints!

The Before & After footprints posted above clearly show how the remarkable transition from a flattened foot (or  flat foot) to a healthy and normal arch. The individual also reports that since he has been barefoot, he has been suffering far less knee and ankle pain and swelling through his running.

Supportive Shoes Limit The Motion Exercise Of Foot Muscles!

This person’s fascinating experience is an example that even the most advanced shoes cannot provide the incalculable benefits of walking and running in bare feet. Indeed, supportive shoes tend to limit the motion exercise of foot muscles which can lead to further flattening of the arch!

Perhaps, it’s time to shun your shoes and regain flexibility and strength in your feet! Your arches will thank you!

(BTW, I would love to hear more “foot” reports – good and bad -  from other barefoot runners and walking! Please feel free to post comments with any foot-altering changes you have noticed as a result of barefoot activity.)

Key To References

1) Rao UB, Joseph B. The influence of footwear on the prevalence of flat foot. A survey of 2300 children. J Bone Joint Surg Br 74 (4): 525-7.

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Here I am at work, feeling great in my Vivo Barefoot Shoes.

Al Gauthier of  ‘Living Barefoot’ just posted a frank, detailed audio interview with me about barefoot activity and barefoot running. Al and his partner, Tina Dubois, were a pleasure to speak with and they asked many insightful questions. In particular, they asked what I thought it would take for barefoot running to be accepted by the medical community—my answer may surprise you.

To hear this loose and open discussion about barefoot activity from the perspective of a podiatrist who has spent 20 years treating foot problems and has become a strong proponent of the benefits of barefoot activity, listen to the interview HERE.

I look forward to speaking with Al and Tina again in the future on more narrow aspects of barefoot activity.

Links: Living Barefoot
Living Barefoot Show Featuring Dr. Nirenberg

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Essentially, Sandler’s book is a great follow up to  Born to Run by Christopher McDougall. Sandler takes McDougall’s observations of the Tarahumara Indians amazing ability to run many miles regularly in flimsy sandals (Huraches) and adds the science of barefoot activity and a reasonable training regimen, and much more!

Sandler’s personal journey to barefoot running began with his realization that fewer injuries occur in less expensive running shoes than expensive ones, that there is a higher impact on the body in shoes than out of shoes, and balance is better in thinner, less cushioned shoes, and lastly, children who did not wear shoes were less likely to have fallen arches or other foot deformities. Starting slowly, Sandler describes his successful transition to barefoot running.

Barefoot Running is a comprehensive book, covering everything you could possibly want to know about barefoot running. Among the topics Sandler addresses: Barefoot running verses running in shoes, the philosophy and science of barefoot running, how to run barefoot, stretching exercises, foot care tips for barefoot runners, dealing with weather extremes, nutrition, minimalist shoes and much more. Other topics covered include:

• A brief history of barefoot running
• The latest science behind the benefits of barefoot running, including findings of Dr. Daniel Lieberman’s 2010 British Science Journal Nature study (very important!)
• How to heal and stay injury free
• Building balance, strength, endurance
• Building strong feet, legs, hips, muscles, tendons & joints
• Developing strong pads on the bottoms of your feet
• Training routines including cross training
• How to use shoes as a helpful tool
• Adjusting to different surfaces & terrain
• Children and Barefoot Activity (also very important!)
• Meditation, quieting the mind and connecting with nature

The book itself is well organized, beautifully designed and printed with an easy to read text, high quality paper, and great photographs (though I wish there was an index!).  

Critics of Sandler’s book will say that the scientific fact for barefoot running is thin, and it is, but scientific evidence that expensive, thickly cushioned running shoes are better for you is even thinner. 

Final Thoughts on Barefoot Running

Barefoot Running is not for everyone, nor is it safe for everyone, but if you are interested in learning about the incredible benefits of running bare or how to barefoot run safely, Barefoot Running is a must read!

I give Barefoot Running my highest rating — 5 Toes Up  

Links:

Michael Sandler’s Barefoot Running site

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I know most people think their feet get enough exercise, but walking—even a lot—in supportive shoes, does NOT exercise your feet. It may exercise your legs and your triceps, but not the 18 muscles in each arch of our feet or  many of the other muscles entering our feet.

Supportive shoes, arch supports, and orthotics allow our feet to function without needing to work most of our foot muscles. As the saying goes, use it or lose it. Worse, without strong muscles our feet are at risk for injury.

In general, shoes are detrimental to feet. Scientists and doctors have known about the effects of footwear on our feet for over 50 years, but most of the public believes feet require expensive, supportive shoes. In fact, in 1949 The Journal of the National Association of Chiropodists published “Survey of Feet in China and India That Have Never Worn Shoes.” The researchers concluded:

“People who have never worn shoes acquire very few foot defects, most of which are painless and non-debilitating. Shoes are not necessary for healthy feet and are the cause of most foot troubles. Footgear is the greatest enemy of the human foot.”

Clearly, the first step to healthy feet is to give up supportive shoes—or at least limit the amount of time your feet are in shoes.

By simply walking barefoot, you will start to use your foot muscles and your feet will soon become stronger. (Note: Only healthy people should give up their shoes. Persons with diabetes, poor circulation, impaired sensation or other serious problems should wear shoes.)

The best way to wean off supportive shoes and increase barefoot activity is by going slowly, and by supplementing barefoot activity with foot exercises.

Now, there are two sources for foot exercises. One is the book Fantastic Feet by Aliesa George and the other is the FootBook by Dr. Paul Conneely.

Fantastic Feet and the FootBook are both great little books with plenty of photographs and detailed, easy to understand instructions. Fantastic Feet is for the public, written in layperson’s terms. The FootBook is for physicians, written in medical terms. Some of the exercises in the books are the same but many are different, and for those who are serious about their foot health, both books offer unique and highly beneficial exercises.   

These books provide a superb workout for your feet, ankles, toes and arches. In fact, many of the exercises will benefit your entire lower extremity! From each book you can choose a handful of exercises that suits your needs and soon you will be on your way to healthy, strong feet.

References:

FootBook

Fantastic Feet

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Barefoot or Shoes?

Running barefoot may seem odd and even dangerous, but a new study published in the prestigious Journal of American Academy of Physical Medicine and Rehabilitation found that barefoot running puts less damaging torque on our hip, knee, and ankle joints than wearing supportive running shoes.

The study was written by D. Cassy Kerrigan, M.D. et al and titled: The Effect of Running Shoes on Lower Extremity Joint Torques.” The researchers compared barefoot to shoe running and found a remarkable 54% increase in the hip torque and 38% in knee varus torque in running shoes. The study used the most technologically advanced non-invasive techniques to asses the biomechanics of running.

For thousands of years Man ran without supportive footwear. It is only in the last few decades that some people, mostly shoe companies, told us our feet needed support, control, and stability. This research shows a huge reduction in joint torques on the main weight-bearing joints of our lower extremities. Could the barefoot runner have been on to something?

Interestingly, I have not found one published study showing any detrimental effects to running without shoes or in just minimalist footwear.

The paper says, there is no clinical evidence to support that  modern running footwear promoted long-term health in runners. That line is worth reading again!

The running shoe business is huge and yet none of these billion dollar companies can provide ANY clinical evidence that running shoes promote long-term health!

And now this paper supports less torque on runners’ joints when they wear nothing—just running barefoot. Who would’ve thunk it?!

To be clear, Dr. Kerrigan’s study found that the effect of the typical modern-day running shoes is to increase joint torques at the hip, knee, and ankle. This doesn’t mean every running shoe will increase torque, but given the huge difference in torque between barefoot and shod, it is reasonable to expect that just about every shoe will have some increase in joint torque over going barefoot.

The good news is that Kerrigan’s study advocates that running shoes should encourage or mimic the foot’s natural function. Thankfully, she is in the shoe design business! This is what the shoe industry needs—someone who backs up their work with sound research. It is time runners demand clinical evidence a shoe works; not million-dollar ads!

I am sure the shoe, insole and arch support lovers (and business people), will find ways to discredit this research or try to simply dismiss it.

These studies are rarely perfect and ultimately, just because there is more torque, does that mean there will be more injury or damage to the joints? The answer is obvious–of course! But, this study hasn’t proven that. To show actual damage to a joint, a long-term study would need to be done with MRIs or CAT Scans or some such technology. Regardless, this study is a huge first step, and all the hole-poking in the world will not negate the magnitude of this study’s findings.

Final Thoughts on Proof Running Shoes Increase Torque on Our Joints

This study is but one. I hope that more scientists will begin to investigate the effects of running with shoes or barefoot. It is time for a rational discussion on the proven benefits and hazards of running in hundred and eighty dollar trainers or just your bare skin.

References:

Science Daily

Better Health Research

Telegraph

Medical News Today

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