I subscribe to the Pedorthic Newswire newsletter. It is useful to keep me in the know about trends in the footwear industry from a pedorthist’s perspective. Here’s my description about Pedorthist in Fixing Your Feet:
Pedorthists work with the design, manufacture, fit, and modification of shoes, boots, and other footwear. Pedorthists are board certified (C.Ped) to provide prescription footwear and related devices. They will evaluate, fit, and modify all types of footwear. A C. Ped. can help find a shoe built on a last (the form over which a shoe is constructed) that best matches a person’s feet, and then construct a custom orthotic that meets his or her particular biomechanical needs and interfaces with the shoe in a way that improves its fit and performance.
In the June 1, 2011, issue of the Pedorthic Newswire, there were six answers to a question posed by a pedorthist. Here’s the question.
Question: I am seeing a lot of patients who are runners, wearing shoes like the Nike Free and New Balance Minumus. For many of these people, these shoes are completely inappropriate and actually causing problems, yet they insist on wearing them. Is anyone else encountering this and how are you handling it?
Now for an explanation about the answers. The first five are from pedorthists. They may or may not be experienced in working with athletes. But they know footwear and physical problems caused by wrong or bad footwear.
Response #1: We have also been seeing a great number of these athletes, as well as those wearing toning footwear that has been well marketed to the populous without consideration of the individual’s biomechanical needs. Video gait analysis has often been the answer. A talking head is quickly muted, and often overpowered, by marketing genius – however the visual of a flexible pes planus (flat feet) with huge torque through propulsion (and the resultant deformation of the foot and ankle in the patient’s eyes) is often the proof one needs to sway their opinion. For the blue Kool-aid runner who insists on wearing minimalist footwear in spite of their biomechanical challenges, assisting them with their training regime, or referring them on to someone who can, may be beneficial. Limiting their use to shorter runs could be suggested, and will keep them in the cool crowd.
Response #2: I would suggest telling your patients to try a pair of the Five Finger shoes or go barefoot when running. This exercises the feet and allows a more natural running gait. We have seen in our practice that most running shoes, including the Nike Frees, give too much support and cause many tendonitis and fasciitis problems. If your runners usually run 6 or 7 days a week, have them run barefoot about 5 days and wear shoes only once a week for their long run.
Response #3: I like to take some history first. Usually, if we are seeing them, it’s because they are symptomatic in some way. The best approach is not to “attack” the shoe choice right away. Ask about the type of symptoms, the timeline, and what shoes they wore before and during their symptoms. As we know, runners can be some of the most challenging patients as far as treating them “between the ears.”
Some runners will listen, while others will kill themselves with a shoe if some expert, book or coach told them they were the best shoe for them. No shoe or style is a silver bullet for everyone. Unfortunately, like unstable toning shoes, minimal shoes are being presented as a great shoe for a large number of people. I use the eyeglass analogy. If I passed out 100 pairs of 1.75 corrective reading glasses to random people, I would get similar results. A certain percentage would have great results. Others would have marginal results. There would also be a given percentage that would have poor to awful results.
The good thing about eyecare is they have a standardized system of measuring and fabricating that doesn’t exist in our field. Some runners have the flexibility and biomechanics that allow them to adapt to minimal shoes. I may be over-simplifying it, but I chalk that up more to how they picked their parents and their DNA. On the other hand, some runners lack the ability to adapt to those shoes and that style of running. It’s also possible that some of the runners reporting amazing results could have simply been “over-shod.” Not bashing anyone, but about 90% of the runners I see who had an expert evaluate them, are in moderate to heavy pronation control shoes.
My experience with symptomatic runners shows that many of them should actually be in a neutral shoe. Perhaps these minimal shoes are nothing more than getting them closer (by default) to their actual prescription? If the runner is clearly doing harm with a minimal shoe, I ask them in a nice way why they are using them and what they are trying to achieve. Some responses make sense, but often it’s not a very valid reason, especially if it could be contributing to their symptoms. Again, runners can be quirky, so I rarely tell them something they are doing is terrible. If they are smart, they will put 2 and 2 together and make the right choice.
You can also wean a runner on or off those shoes (if they aren’t sure about them, or they are having poor results). One option is to suggest a traditional neutral cushion shoe instead. Some runners become symptomatic in a pronation control shoe with 250 miles on it. Imagine what can happen going from that to a minimal shoe, and one can see how some runners have awful results using these shoes. For the ones who are stubborn, I don’t lose breath arguing or trying to prove how smart I am. You will gain nothing by engaging in a circular debate with them. Wish them luck, and tell them to feel free to contact you if they develop any problems.
Response #4: I wonder what you mean by “inappropriate,” and what problems they are causing. I think the running shoe manufacturers have injured an entire generation of runners by claiming cushioned shoes with elevated heels will propel you further and faster. My personal experience with minimal running shoes is that there is far less internal rotation on the tibia and excessive pronation when you reduce the heel height and softness of the shoe. The acceleration of the foot moving to foot flat caused by heavy heel striking is likely the cause. I agree with Christopher McDougal (Born to Run fame) that the shoe manufacturers are to blame for most of the injuries in the sport. BTW, I do use orthotics in my minimal running shoes.
Response #5: I have been in the footwear industry for close to 30 years, and have seen the “barefoot” versus running shoe debate raised several times. Back during the beginning of the first running boon in the 1970s, only skinny ectomorophic types like myself, too small for football, were destined to be runners. The were plenty of plimsoll shoes to provide the protection needed for our sport of running. The 1970s running boom inspired by Dr. Kenneth Cooper, aerobic fitness studies, and the international success of American distance runners such as Frank Shorter and Jeff Galloway, drew “less gifted” participants into the sport of running. Back then, we egotistical runners referred to them as joggers. However, there was a need to develop running shoes to accommodate to protective needs of the rapidly diversifying running population. The choice materiea during those days was sheet stock EVA. It was light weight, and provided a blend of cushioning but rapid compression under repetitive loads. The only reason that the 24mm heel to 12mm forefoot ratio was deemed optimal was to alleviate Achilles tendinitis, and knowledge that the material compressed close to 50% under impact loads typically experienced during foot strike during running.
The current minimalist running craze has me equally concerned. While I do advocate some barefoot running to help strengthen and “awaken” the intrinsic musculature of the foot and lower leg, minimalistic footwear only addresses about 10% of the running population. Today’s average runner maybe more athletically gifted, but there are also mesomorphic types who have participated in other sports and are entering the sport for the first time in their 20s and 30s. Minimal footwear does not offer sufficient protection for average larger framed runners. In our Lab we have found that running barefoot does effect footstrike by increasing the angle of plantarflexion at the ankle joint, however there is no evidence that changing footstrike pattern will reduce injury. In fact, we are hearing of more metatarsal stress fractures from runners attempting to adapt to minimalist footwear. Minimalistic footwear has always existed; we called them racing flats. How many average runners can successfully train in racing flats without experiencing injury? A strong voice from the foot care and Sports Medicine professions is needed to tame this fad. Run Healthy!
Response #6: The minimalist footwear movement has traction, and is not going away anytime soon. Many athletes, runners especially, are eager to try these new shoes in the hope it will improve their race times, or simply help them “feel” the trail. For some of these athletes, the shoes work. For others, they cause problems. Most of the time, it is because they buy the new minimalist shoes and try to run the same miles they ran in their older, heavier, and more supportive shoes. Occasionally, there are people who buy the shoes because they want to start running. For all these folks, reducing mileage and starting slow is the best advice you can give. Almost like starting over. You’re right, they see others doing it and read about the movement everywhere, and so of course it will be OK for them. And they are not going to stop.
Many shoe companies are adding a minimalist shoe(s) to their line. New companies are starting up with footwear that may be fine for walking – but not for running. Yet runners see these new shoes and figure less is better so they can run naturally and have a better feel for the earth. Again, reducing mileage and starting slow is the best advice, and to be attentive for possible injuries. And of course, educate them on the warning signs of possible injuries. If you have the opportunity to do a gait analysis, it would be helpful. Last summer I provided foot care at a six-day stage race where a runner ran 115 trail miles in the Colorado Rockies in Vibram Five Fingers. He did fine because he had a high base mileage as conditioning. His feet were in better shape at the end than many runners who wore “normal’ supportive and cushioned shoes.
My response was #6. Could you tell? What are your thoughts?