The Adam's Effective Sipes

As a profound adherent of the minimalist footwear lifestyle, I looked forward to trying out Altra’s new Adam. I found it to be an extremely versatile, balanced, and comfortable shoe that is supremely well adapted to everything you can do with your feet: from walking, to running, to just loafing around. This shoe is so advanced that just like the Adam who launched the human race, it is sure to launch a new era in minimalist footwear.

Comfort through technology

The comfort level of the Adam minimalist shoe truly has to be experienced to be believed. It seems to be a cliché that they are as comfortable as wearing nothing at all, but in the case of this advanced Altra shoe it’s very true. They are supple, flexible, and snug while still allowing plenty of room for your feet to move unhindered. The Adam seems to have taken minimalist footwear technology, design, and engineering to the next phase, and walkers, joggers, and runners everywhere can rejoice… and throw their expensive, heavy, and stultifying traditional running shoes in the nearest river!

Seamless removable footbeds

The performance rubber outsole of the Adam is what Altra has termed the BareSole, and at an almost paper thin 3.4 mm it starts to feel like an extension of your own feet. Footbeds are included to be fitted within the Adam but they can be left out if you prefer to really get that just-about-barefoot feeling when you’re walking, jogging, or running. The footbeds are free of stitches or seams so they also contribute to the heavenly level of comfort of this amazing minimalist shoe. I also never had the secure-cinch strapping budge by one millimeter all the time I was wearing them! These shoes are more secure than a Swiss bank account!

Razor sipes provide phenomenal traction

The Altra Adam not only does a great job protecting the feet from any roadside or trail hazards such as broken glass and sharp rocks, but it also provides cat-like traction on wet, slippery, and icy surfaces. The soles are molded with what Altra calls razor sipes and the best way to describe how they work is to drive your car in snow with regular street tires, and then change over to an aggressive tread winter tire. The difference is palpable as when you’re wearing the Altra Adam, you feel like you have so much traction you can walk or run anywhere at any time. Except straight up walls. Leave that to Spiderman.

Protects and cools your feet

Even though I’m writing this in Northern Indiana in January when I can only dream about heat, the Altra Adam seems like one of the best choices for barefoot runners on hot asphalt. The sole’s design and the breathable stretch fabric upper are so well thought out and engineered that the Adam should do a great job of keeping your feet cool through the warmest days on the most sizzling tarmac: The kind that would leave bare feet looking like you just walked across hot coals! On a nice hot summer day you want a nice T-Bone steak charred on the outside, not the soles of your feet!

The Altra Adam is a very impressive minimalist shoe which I recommend to anyone. It’s exactly what you want for casual and competitive running, and with the Adam shoe’s comfort, balance, and traction, it’s a natural complement to anyone engaging in my FloWalking method of better walking (http://www.flowalking.com/)!

To learn more about the amazing Altra Adam, check out http://www.altrazerodrop.com/

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One of the most notable problems that people who practice yoga have with regards to their feet is that in some positions their bare feet can slip and cause a fall. There are few things worse in yoga than doing a Garudasana Eagle Pose and end up crash landing on your beak because your foot slipped out from under you! Socks and slippers do not allow the toes to be free enough to grip and balance properly, plus they can overheat the foot causing it to sweat and slip even further.

Maximum traction, foot (and toe) flexibility, and breathability

Stick-e Yoga Socks http://www.stick-e.com/yogaaccessories.html solved all of these problems by engineering special socks specifically for the practice of yoga, pilates, karate, dancing and other athletic pursuits where maximum traction and foot flexibility is a prerequisite. Libby Andrews of Stick-e Products LLC invented this remarkable new form of minimalist footwear, and I can confidently say that she did a magnificent job. They’re really amazing!

 Stick-e Yoga Socks have cut outs for your toes so can better grip the floor or mat, and more importantly, so they can work! Most people do not think much about using their toes when walking or doing activities, yet toes are very muscular or as I say in my FloWalking http://flowalking.com/ workshops: “toes are tiny but mighty.” Men, in order to keep your self-respect, only use this motto about your toes and no other part of your anatomy.

Andrews has also designed the socks with a Stick-e bottom, so the next time you are doing the Adho Mukha Svanasana Downward Dog pose, you are less likely to end up sprawled out like a greyhound on a skating rink! The Stick-e surface held up well, even after I spent 90 minutes on the treadmill doing my FloWalking workout.

1/3 of yoga practitioners still wear basic socks or shoes

It’s estimated that yoga currently has over 20 million followers and about a third of them continue to wear socks or even shoes during their exercises because they are shunning going barefoot. All yoga enthusiasts, whether barefoot or wearing socks or shoes should try the Stick-e Yoga Socks to experience the ultimate in foot comfort, traction, and flexibility. Once you try some of the most basic yoga exercises while wearing these socks, you’ll never do yoga in any other way!

Superlative for FloWalking

I recommend Stick-e Yoga Socks to all my patients who do yoga, but now I’m able to encourage people on yet another activity which these amazing socks are absolutely perfect for: All of the features that allow Stick-e Socks to provide such superlative advantages when practicing yoga are equally applicable to individuals who are engaged in FloWalking [http://flowalking.com/]! The additional comfort, freedom, control, and traction allowed by the Stick-e Yoga Socks can be a boon to any FloWalker! Let me leave you with a bit of yogic wisdom: Blessed are the flexible, for they shall not be bent out of shape!

To learn more about Stick-e Yoga Socks and Andrews’ other amazing Stick-e products go to http://www.stick-e.com/yogaaccessories.html

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Some people consider the fact that more and more people are successfully running barefoot some kind of scientific enigma. The “Free Your Feet” graphic below makes some of the science behind barefoot running easy to understand simply and eloquently. This artistic and pleasantly graphic interpretation of the various statistics and historical facts which support barefoot running makes some exceptional points:

Bulky Shoes Are Failing Us – Running while wearing athletic footwear exerts more strain on the joints of the leg and foot than walking in high heels!

The History Of Running Shoes – The Tarahumara of Mexico can run for two full days, covering up to 300 miles non-stop, wearing only leather thongs or tire strips!

The Science Of Barefoot Running – A comparison of the heel strike which is predominant when running with shoes vs. the more relaxed position of the bare foot landing on its ball.

The graphic goes on to show that traditional running shoes have been proven to create an extra:

• 54% hip rotation torque
• 36% knee flexion torque
• 38% knee varus torque

The graphic does close with a warning that transitioning to barefoot running is a process which should be done gradually, starting out with brief jogs before graduation to longer runs. It’s a recommendation which I heartily endorse!

Check out the entire graphic at: http://www.xraytechnicianschools.net/free-your-feet/

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Photos show a young woman with a tumor in the big toe of her foot.

Every so often people come to see me with the most interesting foot problems. Most recently, a young woman came to see me with a tumor in her foot. 

Having seen my share of cancers in the feet of my patients, that was my first concern. The Worst Case Scenario is the way that we doctors are trained to think. Most days I provide my patients with reassurance: “it isn’t fracture”, “you do not need surgery” etc.

Giving reassurance is great. It eases a patient’s anxiety and they feel better, even if their foot is still sore. It’s like a verbal placebo. I’m sure that if someone marketed a talking box that had a reassuring doctor’s voice telling prospective patients that everything is alright, medical workloads would diminish considerably!

Telling a patient they have a tumor or fracture or need an amputation is difficult. In fact, some sources say that the term “cancer” is one of the most terrifying words there is in many languages. People fear cancer more than “heart attack” or “stroke,” even though these can also be lethal.

When my staff tells me I have a phone call from a pathologist, it is rarely if ever good news. Pathologists are like the tax collectors of the medical industry: Everyone knows they have to pay taxes but whenever they call you, get ready to feel the pain. Even though I try to be positive, I have found patients are generally grateful when I promptly tell them bad news.

Fortunately, in this young woman’s case, the tumor turned out to be benign. She went on to heal up well and has never seen this ugly beast again. Below are the surgical photos and a photo of the woman’s foot when it was all healed up.

Warning: They are very graphic so you might not want to scroll down to see them if you just had a big meal.

Though I find such cases interesting, I hope no one reading this has to ever deal with this type of problem.

I recall an experience I had as young intern. At a meeting one night at the hospital I had asked an older doctor, “Did you see anything interesting today?” He replied, “No, and that’s just the way I like it.”

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Biomechanics of Sport Shoes by Dr. Benno Nigg

A middle-aged woman arrived at my office last week complaining of heel pain and carrying a bag of custom-made foot orthotics (orthotics are custom made arch supports that are fabricated from a mold of the patient’s feet). Each orthotic this woman had with her was expertly fabricated by a different podiatrist and yet none of them had come close to alleviating her heel pain. At first I thought maybe these podiatrists didn’t know what they were doing. But, when I learned their names, I knew this woman had seen competent, skilled and reputable physicians.

I asked myself “how could this be?” More interestingly, no two sets of orthotics were even remotely alike. Further, given that nearly all podiatrists learn similar principles of biomechanics, shouldn’t orthotics for a given patient be the same regardless which podiatrist makes them?

After reading Biomechanics of Sport Shoes, Dr. Benno Nigg’s newest book, I have the answer. It is sobering, disturbing and I don’t want to believe it. Unfortunately, Nigg is one of the top biomechanic researchers in the field sport shoes, foot inserts and foot orthotics in the world. In fact, I imagine that Nigg spends more time thinking about biomechanics than a 17 year old boy spends thinking about sex. 

Foot Orthotics Debunked!

Nigg reveals that foot orthotics, which are devices designed to align misaligned feet, are actually not aligning the skeleton at all. In fact, Nigg’s book reveals many disturbing facts about orthotics, shoes and inserts: including that there is weak evidence orthotics lessen injury. Furthermore, changes in skeletal alignment due to inserts or shoes are inconsistent and minor.
 
Most importantly, Nigg goes on to warn that one of the dangers of the consistent use of orthotics is that they reduce functional demand on muscles may be associated with the deterioration of the muscles’ strength and function. So even though a foot orthotic often helps in the short term, over the long term Nigg warns their use may cause problems.

Repetitive Impact Not As Bad As We Thought!

Beyond orthotics, Nigg dispels the notion that running injuries are due to directly to impact forces and suggest that the new paradigm should be “muscle tuning” and the minimizing of vibration of the runner’s soft tissue. Nigg asserts that injuries are generally a result of intensity, duration, and recovery time.

Excessive Pronation May Not Be A Problem

Nigg then reviews foot, ankle and leg biomechanic research and shows that there is no evidence that excessive pronation when walking or running is a cause of injury. This finding is dramatic because many podiatrists believe excessive pronation is the root of many foot problems. 

Barefoot Running May Not Be Any Better

Despite Nigg debunking shoes, inserts and orthotics, you may be tempted to believe he must be a proponent of barefoot running. Not so. Nigg does not believe there is any evidence currently that barefoot runners sustain fewer injuries than shod runners. However, rather than closing the proverbial shoe box lid on barefoot running, he does say “barefoot training” is important and admits that barefoot running has a “small” performance advantage, but it may only be beneficial for a small group of runners.

He speculates that the functional adaptations of footwear based on the bare foot are positive and may persist, but the fashion adaptations based on the bare foot will disappear in relatively short time. 

Are You Ready To Be Unplugged?

One has to wonder the long term effects of the Biomechanics of Sport Shoes. Clearly, it should be required reading for every podiatrist. However, it may be difficult for some podiatric physicians, particularly those who have spent their life doing sophisticated biomechanical exams on their patients and meticulously fabricating foot orthotics, to open their minds to the content of this book.

Beyond health practitioners, patients themselves still generally believe arch supports, running shoes and foot orthotics are well-understood and the answer to their running injury woes. Until people begin thinking for themselves and asking questions both to themselves, to their doctors, and to the running shoe and arch support companies, the system will feed them what it always has.

I am reminded of a great quote from the film The Matrix:

“The Matrix is a system, Neo. That system is our enemy. But when you’re inside, you look around, what do you see? Businessmen, teachers, lawyers, carpenters. The very minds of the people we are trying to save. But until we do, these people are still a part of that system and that makes them our enemy. You have to understand, most of these people are not ready to be unplugged. And many of them are so inured, so hopelessly dependent on the system, that they will fight to protect it.”

On a personal note, I vigorously applaud Nigg for not only puzzling-out the mysteries sports shoes, orthotics and running, but for having the courage to put his theories into the public domain.

If you are ready to open your mind to the latest information and theories on running, sport shoes and foot orthotics, I urge you to read Biomechanics of Sport Shoes.

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The Mysterious Foot Orthotic

Orthotics Sales Approach $5 Billion Per Year

The term “Foot Orthotic” refers to everything from the inexpensive drugstore pre-fabricated insoles to costly, custom-made devices specifically molded to the foot. Podiatrists generally consider orthotics to be custom-made devices, specifically made from a mold of the patient. Podiatrists spend a great deal of time and energy understanding the biomechanics of the foot and when designing an orthotic for patients, consider the patient’s biomechanics and other factors. The CMAJ article quoted a study by Global Industry Analysts showing that the orthotics market is booming and could reach total sales of nearly five billion dollars in the next few years.

I Discussed the Problem of Possible Muscle Atrophy

The CMAJ article quoted me in saying that “You can’t guarantee anything is going to work for everyone, because people are so variable. Orthotics can do amazing things for many people, but not for everyone.” I stated that “there isn’t even a consensus on what an orthotic is,” and discussed the risk of foot muscle atrophy when relying on orthotic devices. “When you brace the foot, that may alter the function of the foot for the better, but in doing so it negates the need for many of the muscles in the foot to do anything. Common sense tells us that if you don’t use a muscle, it’s going to weaken.“

The Mechanics Of Orthotics Are Still Largely Unknown

Benno Nigg, professor of biomechanics and codirector of the Human Performance Laboratory at the University of Calgary, Alberta stated that there is no conclusive evidence of the actual mechanism of function of orthotic devices. “Orthotics can work and can have fantastic effects, but we don’t know how they work,” adding that “we don’t really understand what we do.” Nigg discussed the hypothesis that orthotics help shift improper skeletal alignment. “Maybe we should not think of pushing the skeleton around, but rather about finding ways to give signals to the body to do the right thing,” Nigg said.

Dr. Nigg has just published a new book, Biomechanics of Sports Shoes, and I’ll be posting a review of that work in an upcoming blog.

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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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Television series such as CSI and Bones have popularized and glamorized forensic science, but even the most avid viewers of these shows might not be aware that the analysis of footprints on the ground or inside a shoe can be a valid way for podiatrists to provide detectives with indisputable identification. Hollywood may be slowly realizing the potential of this science, as recently a writer from Bones called me to discuss in what ways a forensic podiatrist could assist in criminal investigations.

A Footprint Can Be Like A Fingerprint

Every person’s footprint is unique to them. Based on a footprint, a trained and skilled podiatrist can link an individual to a crime scene and sometimes even provide information on how the suspect walks!

Before Forensic Podiatry There Was Footwear Forensics

The earliest recorded application of footwear forensics dates back to the late 18th century when a Scottish murderer’s bootprint was matched from the crime scene to one he left while attending the victim’s funeral. In 1989 in my paper Forensic Methods and the Podiatric Physician, published in the Journal of the American Podiatric Medical Association, I advocated the need for a forensic podiatry organization. In September of 2003 the American Society of Forensic Podiatry was established.

Foot Impressions Inside Shoes Tell Tales

I am proud to have contributed to the development and acceptance of this unique forensic science and have originated one method of helping to analyze foot impressions inside a shoe with a fiberoptic camera. My work was recently noted in The Untrodden Path of Forensic Podiatry.

First “Bones”, Now “Feet”!

The future of forensic podiatry will surely see the science continue to develop valuable tools to help law enforcement, and who knows, maybe someday a Hollywood producer will determine that the next hit forensic television series might be about a crime-solving podiatrist!

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Barefoot Running May Be Better

As a podiatrist, my teachers, professors and peers, espoused that feet need help, specifically they need good support, cushioning, and padding. But, more and more, I started reading about people and cultures that go barefoot and not only do they have fewer foot, ankle, knee and even back problems. Now, I am re-thinking everything I learned.

Was The Human Foot Designed to Walk and Run Barefoot?

The human foot is incredible, strong, dynamic and adaptable. For thousands of years our feet survived and functioned fine (maybe even better?) without elaborately padded, supported $100 Nikes. Further, persons without their hands can learn to drive and paint with their feet. Take a look at the masterpieces created by the Mouth and Foot Painter Artists association. Why can’t a runner learn to run barefoot?

Recently, Christopher McDougall has reinvigorated the barefoot running debate with his book Born To Run. Previously, some runners have had great success barefoot, including the late, great Abebe Bikila from Ethiopia.

Runners have been plagued with foot, ankle and knee problems. It comes with the territory: two to three times the weight of the runner’s body coming down on each foot with each stride. The advocates of barefoot running claim they can literally feel the ground and as a result, the biomechanics of their running gait changes to lessen the force of your foot landing.

Advocates of barefoot running contend that shoes worsen the chance of injury.

The scientific literature on barefoot running (and barefoot walking) is scarce, but at this point the published research leans toward running and walking barefoot, and I would have to agree—barefoot is better!

I just may be the first podiatrist to advocate running barefoot, but let me clarify this statement: I don’t believe barefoot running  is for everyone. I will discuss who and who shouldn’t run (or walk) barefoot in just a moment. First, let me talk briefly about the medical and scientific literature.

The scientific literature on barefoot running is sparse. But, what is out there supports more foot and ankle injuries in people wearing running shoes than in persons going barefoot. This is also true of plantar fasciitis, some knee problems, and other injuries. It appears that running shoes decrease sensory feedback, interfering with the body’s natural shock absorbing tendencies. Further, running shoes may actually decrease the runner’s awareness of their foot and the foot’s position, increasing the risk of injury.

Our feet have many muscles within each foot and many that attach to our feet that originate in the leg. Wearing running shoes may lessen or diminish the “firing” of some of these muscles. When the foot is not in shoes, it adapts—rapidly—to uneven surfaces, and in theory, forcing us to “use” all the muscles in our foot.

Who Should Run Barefoot (and who should not!)

Reasonably experienced runners in good condition with healthy feet should try barefoot running (when conditions and terrain warrant it). By “healthy feet” I mean their foot has a good, stable structure, and good sensation. Their foot does not have an excessively high arch or low arch and they are not diabetic. Further, their foot should be free of any significant deformities—no bunions, hammertoes, or other bone problems. Persons who are diabetic, have decreased sensation, or a foot that is not healthy or flat or high arched etcetera, likely needs corrective support, such as good running shoes and/or orthotics.   

Learning to Run Barefoot

Barefoot runners have a different gait than shoe-wearing runners. Learning to run barefoot takes time and training. I imagine not everyone will be able to teach themselves and their feet to adapt to barefoot running. Remember, some of the superstar athletes who run barefoot may have grown up in cultures where shoes were not the norm and as result, you have someone whose foot is more use to being bare than in a shoe. Further, persons who are in these “barefoot” communities may have a foot with genetic adaptations geared toward barefoot running—meaning, generations of going barefoot have essentially bred a foot that works better when bare.

What to Watch Out For When Running Barefoot

Barefoot running isn’t without risks. Start slow and build up gradually. Research the right way to build up proprioception reflexes in your feet, ankles and legs, and build up the muscles. Don’t run where you can injure your feet—avoid nails, rocks, broken glass etcetera.. (Part of the reason the medical community has strongly advocated shoes is because of the risk of puncture wonds. Every podiatrist has seen his or her share of glass and nails inside their patients’ feet. Further, cold weather can cause frostbite on unprotected feet.)

Vivo Barefoot Running Shoe

Vibram makes a shoe that increases the ability to feel the ground, as does Terra Plana and Nike Free (see links below). One scientific study does support that Vibram’s Five Finger’s reasonably simulates barefoot conditions.

I would be interested to hear about your experiences running barefoot. Specifically, I am curious if there are any successful barefoot runners who have a poor foot structure (i.e. flat foot, bunions, pronation etc.)

Resources for Barefoot Running

The point of this article is to get people thinking about barefoot running and decide for themselves if it is right for them. Here are some resources to help you learn more about barefoot running (and I would recommend reading Chris McDouball’s book Born To Run):

Running Barefoot

Society for Barefoot Living 

Wikipedia on Barefoot Running

Barefoot Runner

Living Barefoot

Vibram Five Fingers

Terra Plana

Go Barefoot

Enjoy Going Barefoot

Review of Nike Free

Nate Luzod – A barefoot runner’s journal

Barefoot Ted’s Adventures

Barefoot Running in Seattle

How to Begin Barefoot Running

Freeing the Captives… 2 Barefoot Soles at a Time

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Ask the Foot Doctor Your Questions

Today we start a new feature: the chance to ask Dr. Nirenberg a foot or ankle question.

The Internet has changed how we learn and understand our world, and our medical problems and conditions—especially our foot and ankle problems. Information is now literally at our fingertips! I firmly believe knowledge is power. However, due to legal issues and restrictions on physicians practicing telemedicine, answers to questions are strictly for informational purposes. Readers will still be able to learn much by asking questions, but the answers are not a substitute for medical care (for a more medical detailed disclaimer read this site’s Terms of Use).

As for your questions, we are looking for great, fascinating foot and ankle questions that our readers will find interesting.

The questions can concern anything related to our feet and ankles, from simple warts or corns to arthritic or weak ankles, and everything in-between. Questions do not have to be strictly medical related. (For example, I was recently asked why our feet are ticklish, and soon I will post an entire article on this fascinating question.)  

So start asking your questions right now! Click Ask a Question.

America’s Podiatrist GROWS by word of mouth! If you liked this article, click below on “Tell a Friend” and tell your friends! If you have not subscribed, please SUBSCRIBE NOW.

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