Below is the article that Podiatry Today had featured as an exclusive article to discuss the common concerns of running barefoot. The article had generated a lot of interest amongst my colleagues as well as many runners. For those who have not read it I am reposting here on my blog as well as the link to the original post by Podiatry Today.
http://www.podiatrytoday.com/tackling-10-myths-barefoot-running
Barefoot running, minimalist running, and natural running are all terms that describe running in a manner that allows our foot to function the way it was designed (or has evolved) through the use of little or no shoe at all. Many runners suffering from chronic injuries are adopting this way of running and are experiencing relief of symptoms to find themselves running with enjoyment and relaxing form. I too have been cured of a running injury that I suffered from for over 8 years after transitioning my gait to that of a “barefoot” runner. When I was asked to write this article I couldn’t wait to get the chance to share all of my research and experience on this rather “new” way of running. However, I only have 1500 words so without further do, here are the 10 myths of barefoot running.
- Stress Fractures: Without a doubt the most common concern with barefoot or minimalist running is the development of a stress fracture. While there have been documented cases of this in the literature, it occurs as a result of a change in activity without gradual adaptation and not directly related to the shoegear or lack of (1). We actually should see a decrease in the likelihood of stress fracture given the change in stride and cadence that one acquires while running in this manner (2). Stress fractures occur secondary to overuse without the body having adapted adequately, as proven by Wolff’s Law (3). In fact if we adhere to Wolff’s law, in theory we should see weaker bone trabecular patterns on those wearing cushioned running shoes due to decreased intrinsic muscle strength resulting in a proportional decrease in the force acting on the respective bone (4).
- I have flat feet and I need support: Lees and Klemerman have demonstrated that there is no correlation between foot type and running injuries, specifically with a pes planus deformity (5). During barefoot running we avoid heel striking and land more on our forefoot or midst foot. Once the forefoot strikes the ground, pronation of the entire foot begins (not isolated pronation of the subtalar joint) and continues until the point where the heel touches the ground. Arch height becomes irrelevant as does the commonly described concept of pronation with the heel striking the ground first. With a forefoot/midfoot strike, pronation is very beneficial and helps to absorb shock.
- I weigh too much: While a common excuse to not run, this does not hold true for reason enough to not run barefoot or in a minimalist shoe. Leiberman et al in 2010 were able to demonstrate that habitually unshod runners were able to generate smaller collision forces then shod heel strikers (6). In other words, by forefoot striking, we decrease the force that is transmitted through the lower extremity thereby reducing torque forces to the ankle, knee, and hip joints (7). Clearly we can see that if a person weigh 250 lbs, they would be placing more force through their joints by heel striking then by landing on their forefoot.
- I have bad knees: Osteoarthritis of the knee is a common concern amongst many runners, especially upper aged individuals who have run the majority of their lives. There are many theories as to why running is bad or even good for your knees. So many in fact that elliptical machines were invented to be used as a form of exercise similar to running without causing excess pressure to the joints (8). These “ellipticals” however do not reproduce anatomical motions and we see that when in vivo force analysis were performed there is less force with walking then with an elliptical trainer (9-11). As discussed previously we know that GRF are greater with heel strike as compared to unshod or barefoot runners who adapt a more forefoot strike pattern (6). Numerous studies have demonstrated higher GRF and mechanical stresses to the knee while running in traditional running shoes as opposed to barefoot(12-13). A recent study published in British Jounal of sports Medicine looked at subjects with knee osteoarthritis over 12 months and found no difference with wearing a lateral wedge orthotic vs a control flat insert (14). Similarly a systematic review of literature demonstrates that external knee adduction moment and pain associated with knee osteoarthritis is increased in individuals wearing sneakers as compared to barefoot walking (15).
- I can’t because I need to wear my orthotics: Orthotics have become more over utilized in the practice of podiatry then ever before. It is very common for me to see runners present in my office with plantar fasciitis, have a normal arch, wearing cushioned running shoes, and have been given orthotics. When running barefoot or in a minimalist shoe, we do not need to control motion at the rearfoot because heel striking is not occurring and “excessive pronation” as described by root does not occurr. While we have numerous studies that do not support the use of orthotics for running injuries alone, it becomes a challenge to convince the patient it is not needed (16-20).
- I have plantar fasciitis, this would be too painful: This article was not intended to discuss the pathomechanics or treatment options of plantar fasciitis, however, we are anecdotally seeing resolution of symptoms in those who adopt this style of running. One potentially explanation is the development in strength we see to the intrinsic musculature, specifically the abductor hallucis muscle which is a primary supporter of the arch (21-25). Another overlooked phenomenon is the fact that the majority of running shoes place your ankle into plantar flexion which forces the body to compensate by increasing lumbar lordosis as well as increasing pressure to the heel as opposed to more evenly distributed throughout the foot.
- My fat pad is atrophied: This is another common myth that patients acquire from various sources, including medical professionals. Most, if not all, of us have experienced a patient who complains of forefoot pain or calluses and then simply blame the problem on lack of adipose tissue or cushioning below the metatarsal heads. While those seems a possible etiology, to date we have no evidence that the fat pad of the sole of our foot actually atrophies on the forefoot or the heel region (26,27). With common forefoot pathology such as hammertoe deformities, we do see the fat pad migrate distally producing more prominent metatarsal heads, but typically this is in severe cases, ie rheumatoid arthritis (28). Patients at this stage of a deformity are typically not runners.
- You will get severe calluses: Calluses on our feet form as a result of shear fore on the plantar surfaces of the skin that produces excess friction. Shear force that occurs in the horizontal plane is the key to understanding this. Direct pressure does not produce calluses or we would see a high preponderance of heel calluses in runners as the majority of runners heel strike. Root discussed the formation of forefoot calluses secondary to shearing forces associated with propulsion as well as to the central metatarsals due to increased loading for an excessive period of time and abnormal shear (29). Root’s observations hold true for someone who heel strikes when running, as we see increased force placed upon the forefoot during what he described as the propulsion phase. Observation of the gait of barefoot runner or one that strikes with the forefoot/midfoot demonstrates that the propulsion phase as described by root becomes very minimal in existence if even at all. Good Form Running in association with New Balance provides training to adopt this style of running and we can see that by developing forward momentum, we carry the contralateral limb forward instead of pro-pulsing with the forefoot (30). By doing this we decrease the force present to the forefoot, especially the shear force. Not only is this beneficial for reduction of the shear force, but we see a decrease in the ground reactive forces acting on the 1st MPJ which can reduce sesamoiditis.
- I run long distance and can’t do that barefoot: What many of us fail to realize is that we have been running for thousands of years and without going into the debatable discussion of evolution, we know that early runners began running either barefoot or with very minimal shoegear such as moccasins (31). In 1960, Abebe Bikila won the Olympic Marathon in a record time of 2:15:16.2 while running barefoot (32). Zola Budd recorded numerous middle distance world records while running barefoot in the 1980s. Ken Saxton (well known among the sub cultural of barefoot runners) finished 14 marathons in 2006 unshod, and has since completed a total of 56 marathons, including Boston, all while running barefoot (33).
- You could step on glass: Finally, my favorite. Numerous times I am asked the question of “what happens if you step on glass?” while lecturing and debating this topic amongst medical professionals as well as early adopters to this style of running. My answer, “Don’t step on glass.” This concept of “barefoot running” is not about what you are wearing on your foot, it is about HOW you are running and allowing the foot to perform they way it was designed and intended to. Once the form is perfected and heel strike is abandoned (which can typically be learned on a treadmill barefoot), the next step is to protect the skin of our foot while not compromising the proprioceptive feedback from ground.
There are numerous options available which have recently become known as Minimalist Shoegear. Vibram FiveFingers, The New Balance Minimus, and the Merrerl Trailglove to name a few. FiveFingers has quickly become the leader of the market share due to its ability to allow the toes to function individually and allowing full range of motions of the forefoot, as well as the midfoot and rearfoot joints with a zero drop (34). Nike as well was one of the very first to introduce a less supportive shoe in 2004 known as The Nike Free (35). While this is a very flexible and non-supportive shoe, it does have a considerable amount of cushioning which can interfere with feedback and increase muscle recruitment to provide control.
In summary, barefoot running is about learning to run the way our body was intended to using the foot as an ideal shock absorber and not relying on a shoe that compromises the anatomical position of the foot placing one at risk for injury. Using a true minimalist running shoe can achieve this and still protect the foot from the environmental dangers.
- Giuliani J, Masini B, Alitz C, Owens BD. Barefoot-simulating footwear associated with metatarsal stress injury in 2 runners. Orthopedics. 2011 Jul 7;34(7):e320-3. doi: 10.3928/01477447-20110526-25.
- Edwards WB, Taylor D, Rudolphi TJ, Gillette JC, Derrick TR. Effects of stride length and running mileage on a probabilistic stress fracture model. Med Sci Sports Exerc. 2009 Dec;41(12):2177-84.
- Stedman’s Medical Dictionary. Definition of Wolff’s Law.
- Wolff J. “The Law of Bone Remodeling”. Berlin Heidelberg New York: Springer, 1986 (translation of the German 1892 edition)
- Lees A, Lake M, Klenerman L. Shock absorption during forefoot running and its relationship to medial longitudinal arch height. Foot Ankle Int. 2005 Dec;26(12):1081-8.
- Lieberman DE, Venkadesan M, Werbel WA, Daoud AI, D’Andrea S, Davis IS, Mang’eni RO, Pitsiladis Y. Foot strike patterns and collision forces in habitually barefoot versus shod runners. Nature. 2010 Jan 28;463(7280):531-5.
- Kerrigan DC, Franz JR, Keenan GS, Dicharry J, Della Croce U, Wilder RP. The effect of running shoes on lower extremity joint torques. PM R. 2009 Dec;1(12):1058-63.
- http://en.wikipedia.org/wiki/Elliptical_trainer
- Burnfield JM, Shu Y, Buster T, Taylor A.Similarity of joint kinematics and muscle demands between elliptical training and walking: implications for practice. Phys Ther. 2010 Feb;90(2):289-305. Epub 2009 Dec 18.
- Lu TW, Chien HL, Chen HL. Joint loading in the lower extremities during elliptical exercise. Med Sci Sports Exerc. 2007 Sep;39(9):1651-8.
- D’Lima DD, Steklov N, Patil S, Colwell CW Jr. The Mark Coventry Award: in vivo knee forces during recreation and exercise after knee arthroplasty. Clin Orthop Relat Res. 2008 Nov;466(11):2605-11. Epub 2008 Jun 19.
- Franz JR, Dicharry J, Riley PO, Jackson K, Wilder RP, Kerrigan DC. The influence of arch supports on knee torques relevant to knee osteoarthritis. Med Sci Sports Exerc. 2008 May;40(5):913-7.
- Burkett LN, Kohrt WM, Buchbinder R. Effects of shoes and foot orthotics on VO2 and selected frontal plane knee kinematics. Med Sci Sports Exerc. 1985 Feb;17(1):158-63.
- Bennell KL, Bowles KA, Payne C, Cicuttini F, Williamson E, Forbes A, Hanna F, Davies-Tuck M, Harris A, Hinman RS. Lateral wedge insoles for medial knee osteoarthritis: 12 month randomised controlled trial. BMJ. 2011 May 18;342:d2912. doi: 10.1136/bmj.d2912.
- Radzimski AO, Mündermann A, Sole G. Effect of footwear on the external knee adduction moment – A systematic review. Knee. 2011 Jul 4. [Epub ahead of print]
- Stackhouse CL, Davis IM, Hamill J. Orthotic intervention in forefoot and rearfoot strike running patterns. Clin Biomech (Bristol, Avon). 2004 Jan;19(1):64-70.
- Fields KB, Sykes JC, Walker KM, Jackson JC. Prevention of running injuries. Curr Sports Med Rep. 2010 May-Jun;9(3):176-82.
- Gross ML, Napoli RC. Treatment of lower extremity injuries with orthotic shoe inserts. An overview. Sports Med. 1993 Jan;15(1):66-70.
- Kilmartin TE, Wallace WA. The scientific basis for the use of biomechanical foot orthoses in the treatment of lower limb sports injuries–a review of the literature. Br J Sports Med. 1994 Sep;28(3):180-4.
- Razeghi M, Batt ME. Biomechanical analysis of the effect of orthotic shoe inserts: a review of the literature. Sports Med. 2000 Jun;29(6):425-38.
- Jung DY, Kim MH, Koh EK, Kwon OY, Cynn HS, Lee WH. A comparison in the muscle activity of the abductor hallucis and the medial longitudinal arch angle during toe curl and short foot exercises. Phys Ther Sport. 2011 Feb;12(1):30-5. Epub 2010 Sep 15. PubMed PMID: 21256447.
- Headlee DL, Leonard JL, Hart JM, Ingersoll CD, Hertel J. Fatigue of the plantar intrinsic foot muscles increases navicular drop. J Electromyogr Kinesiol. 2008 Jun;18(3):420-5.
- Wong YS. Influence of the abductor hallucis muscle on the medial arch of the foot: a kinematic and anatomical cadaver study. Foot Ankle Int. 2007 May;28(5):617-20.
- Fiolkowski P, Brunt D, Bishop M, Woo R, Horodyski M. Intrinsic pedal musculature support of the medial longitudinal arch: an electromyography study. J Foot Ankle Surg. 2003 Nov-Dec;42(6):327-33. PubMed PMID: 14688773.
- Emmerich J, Wülker N, Hurschler C. [Influence of the posterior tibial tendon on the medial arch of the foot: an in vitro kinetic and kinematic study]. Biomed Tech (Berl). 2003 Apr;48(4):97-105.
- Waldecker U. Plantar fat pad atrophy: a cause of metatarsalgia? J Foot Ankle Surg. 2001 Jan-Feb;40(1):21-7.
- Waldecker U, Lehr HA. Is there histomorphological evidence of plantar metatarsal fat pad atrophy in patients with diabetes? J Foot Ankle Surg. 2009 Nov-Dec;48(6):648-52. Epub 2009 Sep 4.
- Mickle KJ, Munro BJ, Lord SR, Menz HB, Steele JR. Soft tissue thickness under the metatarsal heads is reduced in older people with toe deformities. J Orthop Res. 2011 Jul;29(7):1042-6.
- Root ML, Orien WP, Weed JH. Normal and Abnormal Function of the Foot -Volume 2. Clinical Biomechanics Corp., Los Angeles, CA, 1977
- http://www.goodformrunning.com/
- http://en.wikipedia.org/wiki/Shoe
- http://en.m.wikipedia.org/wiki/Abebe_Bikila
- http://www.marathonandbeyond.com/choices/clift.htm
- “Trend Insight: Minimalist Footwear Category Offers Plenty of Oppurtunity.” Footwear Insight September/October 2011: 22. Print.
- http://en.wikipedia.org/wiki/Nike_Free
Originally appeared at http://www.runnersworld.com/article/0,7120,s6-238-267–13104-0,00.html
By Ed Eyestone
Image by Emiliano Ponzi
From the May 2009 issue of Runner’s World
Ron Hill, the British Olympic marathoner, has run every day since December 1964. That streak includes running the day after a car crash in which he broke his sternum. I’m all for consistency, but that seems to cross the line into compulsivity.
In college I took one day off every week. I liked the end and beginning it created for each week. NCAA champs and Olympians have been made that way. Yet some were incredulous that any day could be squandered on rest.
Years of research disprove the notion that a day off wrecks fitness; in fact, the opposite is true. Little detraining—the loss of fitness and performance that occurs when you stop working out—happens until you take off more than two weeks. When it follows difficult bouts of work, rest lets your body adapt to the work and improve. A day off every seven to 14 days restocks glycogen stores, builds strength, and reduces fatigue. Without recovery, adaptation may occur short-term, but ultimately it will fail. And since most injuries come from overuse, a day of cross-training, rest, or easy miles can prevent three-or four-week forced breaks caused by, say, ITB syndrome.
I worked my butt off for six days to enjoy logging a zero on the seventh. I caught up on sleep and nursed soreness with massage and light stretching. The day was as crucial to training as a long run. I could push through hard workouts knowing rest was ahead. I started the new week physically and mentally restored—ready for whatever masochism awaited.
That said, I can appreciate how some find it hard to let the running shoes sit. On his rest day, German Silva, who won the 1994 and ’95 NYC Marathons, ran an easy three miles, keeping his heart rate below 60 percent of max. These jogs may not boost VO2 max, but they loosen up the muscles to fend off sluggishness.
So is a little running on a rest day okay for mere mortals? It can be. As long as you keep the volume and intensity very light, you can still get the recovery benefits. (The same goes for cross-training on a rest day: Keep it relaxed.)
Light recovery runs shouldn’t be confused with base miles you log between hard workouts. Base miles—the staple of training—strengthen muscles, build endurance, and burn fat. The key is to keep the pace conservative. Use the chart below as a guide. Then get back to work.
Less Is More
Rest days and easy days reward runners with different benefits
REST DAY
How It Helps:
Prevents overuse injuries
Restores glycogen stores
Prevents mental burnout
How Often: Once a week
How Easy: Off completely or 20 to 30 minutes (or 2 to 4 easy miles) below 60% of max heart rate
EASY DAY
How It Helps:
Builds base
Improves endurance
Increases blood volume
How Often: 80 to 85% of total weekly mileage
How Easy: 70 to 75% of max heart rate or conversational pace at comfortable to moderate effort
Popular Seiko Running Metronome
People often mention cadence when discussing proper running technique. What exactly does it mean?
Cadence defines the amount of steps runners take over a period of one minute. When evaluating running form, it is crucial to examine the patient’s cadence. In studying runners who are faster and more efficient, researchers have determined that these runners have one common denominator: their feet strike the ground at a minimum of 180 times per minute.1,2 Some of the more elite runners may reach a cadence of 200 or greater. However, when runner patients are initially learning proper form, I recommend striving for 180.
Runners can determine their cadence by timing themselves for one minute and counting the number of times their right or left foot makes contact with the ground. They should repeat this two to three times to find an average.
The next step to understanding what a faster cadence feels like is by running in place. Runner patients may purchase a running metronome with a clip to attach to their waist. It is a great tool to use while running. Another simple option for runners is downloading a metronome app on their smart phone. Standing with their feet shoulder-width apart, runners can start the metronome and begin to run in place, trying to match each footstep with the beat.
I usually recommend beginning with a cadence of 180 before going at a higher rate. A runner’s form can break down if he or she has not yet adapted to the proper running form. The best way for runner patients to achieve a faster cadence is taking the metronome with them on a run and periodically turning it on for two to three minutes. Runners may initially think they are maintaining their 180 steps at first but this can be deceiving. It is important for runners to continue training with their metronome until they are staying up with the beat each time they resume using the tool.
It is also important to let runners know that pace is irrelevant with cadence. Runners can achieve a cadence of 180 whether they run a six-minute mile or 10-minute mile. Improving their cadence will help them run faster and more efficiently.
Can Small Changes In Cadence Help Reduce Injury Recovery Time?
Cadence becomes very significant from a clinical perspective for any podiatrist who treats runners, especially when dealing with a chronic injury that is not resolving. Often, it is the runner’s form that is suffering, creating an overuse phenomena leading to injury. By evaluating a runner’s form and, in this case, the cadence, we can sometimes make what may seem to be a small change and actually have a large impact on the recovery from an injury. Developing a faster cadence leads to less time spent in the vertical plane, which over the course of time can significantly reduce impact forces.
In my practice, we have teamed up with a physical therapy clinic. The clinic staff performs a gait analysis on my patients and then discusses the findings with me. We even have the ability to e-mail videos of runners’ form to discuss the cases in greater detail. With the advancement of mobile phones, I even have runners send their own videos to review their gait in efforts to find any abnormality that could be leading to injury.
Many times, it is the gross examination of a runner’s form and cadence that is actually more important in addressing an injury than small, insignificant readings from a force plate analysis, which sometimes takes up more of our diagnostic focus than it should.
Oringally appeared in online at The Podiatry Today Blog by Dr. Nick Campitelli at http://www.podiatrytoday.com/blogged/how-running-cadence-can-be-clue-injury-prevention
References
1. Chapman RF, Laymon AS, Wilhite DP, McKenzie JM, Tanner DA, Stager JM. Ground contact time as an indicator of metabolic cost in elite distance runners. Med Sci Sports Exerc. 2012; 44(5):917-25
2. Daniels J. Daniels’ Running Formula. Human Kinetics, Champaign, IL, 2005.
3. Available at http://sciencebasedrunning.com/2011/07/the-basics-cadence/ . Published July 5, 2011. Accessed July 16, 2012.
Plantar fasciitis has become an epidemic in our society not only amongst runners, but even more so to the average person who may not even exercise. Over the last 30 years we have been able obtain a better understanding for the condition and discovered that, contrary to the belief of many, heel spurs are not the cause of heel pain. The pain is due to an inflammation of the plantar fascia- a band of tissue that supports the arch, originating on the heel bone and extending out to the toes. Chronic overuse of the foot can lead to inflammation of this structure, very similar to the way tennis elbow effects the tendons of the forearm.
So now that we understand the condition better, how do we fix it? Well, it’s not exactly that simple. Most of the time we can resolve the problem with stretching exercises and anti-inflammatories such as ibuprofen and ice. However, some patients can go on to have recurrent episodes that may do not resolve for years. These cases are typically due to biomechanical factors usually directly related to shoe gear.
In this particular case, the patient was a 50 year old male who works in remodeling and is required to wear steel toe work boots. He had suffered from plantar fasciitis for over 3 years and was able to control the situation with cortisone injections periodically but was never able to fully overcome the pain. He did notice his pain would improve when he was out of his work boots and either barefoot or in a more comfortable shoe but was unable to form any correlation other then his boots were making his condition worse. He had spent hundreds of dollars on different work boots and currently was wearing the popular Red Wing Shoes steel toe boots.
We discussed with him the principals of why a heel was detrimental in a shoe and had advised for him to try cutting a heel off of a pair of work boots that he had to see if this changed his symptoms. An injection was not an option at this point as he had already received the recommended limit of three in the past year.
He was able to remove the heel from his boot without ruining the sole and began wearing it gradually each day for an hour and then increasing each week.
After six weeks of this routine he had improved considerably and was 80% better. At his last visit he had felt the best he had in the past three years and really attributes this to the change he has made to his boots.
How can this be explained biomechanically? It’s actually pretty simple- our feet were designed to function best with nothing interfering with it’s normal motions especially between the sole of the foot and the ground. There is no scientific or clinical basis to put a heel under the foot that is non pathologic (no deformity). This is really hard to swallow as the majority of shoes designed have a heel. Even 90% of running shoes sold today have a large cushioned heel (this is actually a decrease since minimalist shoes were introduced and have now gained a 12% share in the market.)
This philosophy is now becoming increasingly more common in running shoes as we have seen the category of zero-drop shoes emerge (shoes creates with no height difference between the forefoot and the rearfoot – no heel . With the large interest seen in barefoot running and running in minimalist shoes we hopefully will begin to see a decrease in plantar fasciitis as runners forms will change and their feet inadvertently will become stronger.
http://www.bbc.co.uk/news/health-18863293
Consumers could be wasting their money on sports drinks, protein shakes and high-end trainers, according to a new joint investigation by BBC Panorama and the British Medical Journal.
The investigation into the performance-enhancing claims of some popular sports products found “a striking lack of evidence” to back them up.
A team at Oxford University examined 431 claims in 104 sport product adverts and found a “worrying” lack of high-quality research, calling for better studies to help inform consumers.
Dr Carl Heneghan of the Oxford University Centre for Evidence-Based Medicine led the independent research into the claims made by the makers of sports drinks, protein shakes and trainers.
In the case of Lucozade Sport, the UK’s best-selling sports drink, their advert says it is “an isotonic performance fuel to take you faster, stronger, for longer”.
‘Minuscule effect’
Dr Heneghan and his team asked manufacturer GlaxoSmithKline (GSK) for details of the science behind their claims and were given what he said scientists call a “data dump” – 40 years’ worth of Lucozade sports research which included 176 studies.
Dr Heneghan said the mountain of data included 101 trials that the Oxford team were able to examine before concluding: “In this case, the quality of the evidence is poor, the size of the effect is often minuscule and it certainly doesn’t apply to the population at large who are buying these products.
“Basically, when you look at the evidence in the general population, it does not say that exercise is improved [or that] performance is improved by carbohydrate drinks.”
In response, GlaxoSmithKline said they disagreed with the Oxford team’s conclusions:
“Over 40 years of research experience and 85 peer-reviewed studies have supported the development of Lucozade Sport and all our claims are based on scientific evidence that have been reviewed and substantiated by the European Food Safety Authority.”
GSK is also the manufacturer of the Maxinutrition range of sports supplements, which is endorsed by some of Britain’s top athletes, including the Olympic triathalon team and the Rugby Football Union.
Some of GSK’s supplements in the Maxinutrition range contain branch chain amino acids which are found in muscle protein. The company says these amino acids “help hard-training athletes recover faster after intense exercise”. The supplements sell for as much as £34 a tub.
‘Expensive milk’
But the Oxford research team and the British Medical Journal said the science does not back up that claim.
Dr Heneghan said: “The evidence does not stack up and the quality of the evidence does not allow us to say these do improve in performance or recovery and should be used as a product widely.”
Nutrition expert Professor Mike Lean of the University of Glasgow described what little evidence there is that certain amino acids, which form part of proteins, may improve muscle strength as “absolutely fringe evidence and I think that that is almost totally irrelevant, even at the top level of athletics”.
Prof Lean said the market for supplements is “yet another fashion accessory for exercise… and a rather expensive way of getting a bit of milk.”
GSK said in response: “We stand by the evidence that branch chain amino acids can enhance performance or recovery.”
But the company said it accepted recently revised rules from the European Food Safety Authority about what claims manufacturers can make about their sports products and supplements and said it will “revise our label accordingly while we gather further evidence required to substantiate the claims we believe can be made”.
In the case of trainers, the Oxford team examined the claims made by Puma that their shoes – endorsed by Olympic champion Usain Bolt – are “designed to… minimise injury, optimise comfort and maximise speed”.
Dr Heneghan said his team could find no evidence to back up the company’s claims and Puma declined to provide his research team with any studies to prove that their shoes can deliver on those claims.
Dr Carl Henegan, University of Oxford, says there is little evidence some expensive sports products work
“That should be really underpinned by good quality evidence… I cannot quite understand how you get from the evidence to that claim. If you can’t find research for it, how can you then make that claim?”
Puma declined to reply to the BBC about the Oxford team’s findings.
Professor Benno Nigg of the University of Calgary in Canada, has been studying the biomechanics of running for more than 40 years.
He said the conventional thinking was that cushioning and control were the key health benefits of running shoes – but that idea has been proven wrong by recent studies that showed no difference in injury rates if runners were prescribed structured shoes meant to control how their foot lands as they run.
“The most important predictors for injuries are distance, recovery time, intensity and those type of things… the shoes come very, very later as minor contributors.”
Prof Nigg’s advice to runners is to find something that fits.
“If you can find a shoe where you just enjoy that activity and you are comfortable, that’s all you need.”
In our society it is generally accepted that most people would rather sit down in a chair then to stand given the opportunity. Whether we are watching TV, reading, eating, or sitting at our desk at work, most of us would be in a chair. Our ancestors most likely didn’t spend as much time in a chair as today’s generation. The question becomes, “is our body designed for so much sitting, and could it be detrimental to our health?”
Below is a collection of evidence that supports idea that there is a increase in health related issues that is directly proportional to the time that we spend sitting. And for those of us out there who say “I wish I could stand more, but my job requires me to be at a desk for 8-10 hours a day,” meet Lee. He has a different approach. His job requires him to spend 100% time at a desk in front of a computer. A year ago, Lee decided that he was not going to sit all day after realizing it probably isn’t good for his health. He now spends four hours of his work day standing, and the other four hours sitting. Interestingly enough, the four hours spent standing Lee is barefoot. The other fascinating aspect to this story is that this is not his only form of exercise. He competes in triathlons does many of his runs in the morning before going to work. His PR for a 5K is 18:53 (6:23 pace) – not bad for someone that is “on his feet all day.”
Pictured is the desk Lee built himself to sit atop his original desk to allow him to stand while working. It can easily be removed to have the computer sit back on the lower desk.
“John” is a 44 year old male who presented to my office with a year long history of Achilles tendonitis. He had been evaluated and treated by a previous orthopedic surgeon with the use of custom orthotics and stretching exercises. His pain had never resolved. He is novice runner averaging about 10 to 15 miles a week and the pain was more associated with his running. He would improve if he took a break from running, but as soon as he returned the achilles became inflamed and painful again.
John was frustrated because he was wearing the “best” shoes he could find and changed them every 3 months and was wearing his custom orthotics. The pain would not resolve and was worsening over the course of a year.
Upon evaluating John, he was unsure of his “foot strike” but really thought he was a heel striker because he focused on landing on his heel and rolling lateral before toe off as he had seen described years ago in “Runner’s World.” He concentrated on doing this more when his pain was worse.
I then advised that most likely his pain is secondary to his form, and was really irrelevant of his shoe gear. His orthotics were also very unnecessary given his normal arch and absence of a osseous deformity.
My advice was to have a gait analysis performed by my partnering running institution – The PT Center of Akron. There he was evaluated where he was asked to run barefoot on a treadmill as well as with his traditional running shoes. It was determined that he was a heel striker and was also abducting his right foot (the non injured side.)
After 6 weeks of working changing his foot strike, increasing his cadence, and strengthening his lower extremity musculature, John is now 90% better and is running 10 miles a week. He is going to run a 4 mile race on Independence Day with a goal of 8:00 miles.
John continues to run in his traditional running shoes but is considering a switch to a more minimal shoe given what he has experienced by changing his form thus far.
This is one of the many runners we have helped by focusing on form, as opposed to shoe gear or orthotics. We have relied so much on shoes in the past that we sometimes forget about our form when it comes to running. If we let our feet function as they were designed, the rest of the body can also function properly thus minimizing injury.
You may have heard of runners following Hal Higdon training programs, but what about Bart Yasso? Yasso joined Runner’s World in 1987 to develop the groundbreaking Runner’s World Race Sponsorship Program, creating a vehicle for Runner’s World to work with over 7,000 races representing 4 million runners per year. Inducted into the Running USA Hall of Champions.
Yasso also invented the Yasso 800s, a marathon-training schedule used by thousands around the world. He is one of the few people to have completed races on all seven continents from the Antarctica marathon to the Mt. Kilimanjaro marathon. In 1987, Yasso won the U.S. National Biathlon Long Course Championship and won the Smoky Mountain Marathon in 1998. He has also completed the Ironman five times and the Badwater 146 through Death Valley. He has also cycled, unsupported and by himself, across the country twice.
So let’s discuss what Bart has introduced and the Yasso 800’s. By conditioning yourself to the point where you can run ten 800 meter repeats (twice around the standard 400m track) with appropriate rests in between (3 minutes of jogging) the time it takes you to complete each 800 will correlate to your marathon time. For example, if the average time it takes you for each 800 is 3 minutes and 45 seconds, then your predicted marathon time would be 3 hours and 45 minutes. There really has been no scientific basis for this and it has not been explained physiologically. It has been described as being a great training coincidence.
Does this work? Well it has been discussed considerably amongst running coaches, trainers, and runners themselves and has mixed results. Some are a able to run their 800s on average faster then they can actually complete the marathon, while others say its a really close predictor. Regardless, it is a great training tool which still needs to be complemented with a proper marathon training program.
My blog for Podiatry Today.
http://www.podiatrytoday.com/blogged/how-shoe-choices-children-can-affect-foot-development
“I only buy the best shoes I can find.”
“I paid $150 for these!”
“All of the nurses and doctors wear this brand.”
“I change my shoes every three months.”
“I consulted with my local running shoe store before buying these.”
“I know I have the right shoe for my arch.”
I am sure many of you have heard these same comments and probably continually do on a daily basis. So what is the best shoe? Should this even be a question? In our society, we too often place our focus on finding a quick fix. In regards to foot injuries, that quick fix happens to be shoes. In reality, it might not actually be the solution.
Rather than beginning this discussion with what adults wear, let us take a look at what the literature advises on footwear for children. The American Academy of Pediatrics does not advise placing children into shoes until the environment necessitates it.1 When you review the pediatric orthopedic literature on shoe gear, it is also clear that children should be wearing shoes that are flexible and allow the foot to bend and move as though the child is barefoot.2-6 In his 1991 article in Pediatrics, Lynn Staheli, MD, makes the following comments.7
1. Optimum foot development occurs in the barefoot environment.
2. The primary role of shoes is to protect the foot from injury and infection.
3. Stiff and compressive footwear may cause deformity, weakness and loss of mobility.
4. The term “corrective shoes” is a misnomer.
5. Shock absorption, load distribution and elevation are valid indications for shoe modifications.
6. Base shoe selection for children on the barefoot model.
7. Physicians should avoid and discourage the commercialization and “media”-ization of footwear. Merchandising of the “corrective shoe” is harmful to the child, expensive for the family and a discredit to the medical profession.
Rao and Joseph demonstrated a higher prevalence of flat feet among children who wore shoes in comparison with those who did not.2 They found that closed toe shoes inhibited the development of the arch of the foot more than slippers or sandals. Rose advises not to address a flexible flatfoot in a child even with the use of custom orthotics, stating that treatment is not influential in the course of the flatfoot as the child ages.3
It becomes apparent even when looking at a child’s foot that flatfoot deformities are more of a variant than a true pathology.
The question remains as to what truly happens to an adult’s foot if he or she continues to wear non-supportive shoes through childhood and into adolescence. Will the adult foot maintain the wider forefoot and more evenly spaced digits from childhood?
References
1. Hoekelman RA, Chianese, MJ. Presenting Signs and Symptoms. In: McInerny TK, Adam HM, Campbell DE (eds.) American Academy of Pediatrics Textbook of Pediatric Care, 5th edition, American Academy of Pediatrics, Elk Grove Village, IL, 2009, p. 1528.
2. Rao UB, Joseph B. The influence of footwear on the prevalence of flat foot. A survey of 2300 children. J Bone Joint Surg Br 1992; 74(4):525-7.
3. Rose REC. Flat feet in children: when should they be treated? Internet J Orthopedic Surg. 2007; 6(1). Available at http://www.ispub.com/journal/the-internet-journal-of-orthopedic-surgery/… . Published 2007. Accessed June 18, 2012.
4. Walther M, Herold D, Sinderhauf A, Morrison R. Children sport shoes–a systematic review of current literature. Foot Ankle Surg. 2008; 14(4):180-9.
5. Wegener C, Hunt AE, Vanwanseele B, Burns J, Smith RM. Effect of children’s shoes on gait: a systematic review and meta-analysis. J Foot Ankle Res. 2011 Jan; 4:3.
6. Wolf S, Simon J, Patikas D, Schuster W, Armbrust P, Döderlein L. Foot motion in children shoes: a comparison of barefoot walking with shod walking in conventional and flexible shoes. Gait Posture. 2008; 27(1):51-9.
7. Staheli LT. Shoes for children: a review. Pediatrics. 1991; 88(2):371-5.
For those unaware, Adidas has now been named in a lawsuit regarding their version of the “toe shoes” called the adiPure Trainer shoes. Joseph Rocco said the $90 pair of adiPure shoes he purchased did not deliver the increased training efficiency and decreased risk of injury promised in advertisements. He claims the shoes actually increase the risk for bruising and foot damage, due to their decreased padding and other structural differences from more traditional running shoes. Rocco said he and other customers were never warned about the potential hazards and that, as a result, he suffered compound fractures after training in the shoes.
Isn’t this common sense? Or am I missing something here? For millions of years, people have functioned without shoes. Why are people now deciding to sue the manufactures if they do not see a “benefit” from the shoes. Are shoes really designed to enhance performance? If that were the case shouldn’t we have wheels with precision die cast bearings that would allow us to move extremely fast with less demand on the body? After all, following the trend it seems that the less we use our body, then the less likely we are to get injured, right?
Since March, this is now the second suit filed against a shoe company claiming that the shoes did not provide the desired health benefit and that the consumer became injured. Vibram was the first in the line of minimalist shoes to be named in a suit when Valerie Bezdek accused Vibram of inflating claims about the health benefits of barefoot running to market FiveFingers and charge a price premium over other brands.
Whatever happened to learning proper form, strengthening your foot musculature, and not blaming a shoe for failed performance. If shoes were meant to prevent injuries, why do we see plantar fasciitis, stress fractures, and numerous other foot pathologies exist in such large numbers in those wearing traditional running shoes? There are over 1 million physician visits per year with a diagnosis of plantar fasciitis. I challenge anyone to present a comparison of injuries in those wearing traditional running shoes to those wearing minimalist shoes.
If someone purchases a pair of gloves and strikes their finger while hammering a nail, are they entitled to sue the manufacturer of the glove, or should they learn how to use the hammer? Maybe Mr. Rocco and Ms. Bezdek should learn how to run first, before blaming the shoe companies. I would be more the happy to help educate them.
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