Toe Spring And Plantar Fasciitis

Ever wonder why so many people other than runners are getting plantar fasciitis? It may be because of the amount of 'toe spring' in your shoes.

You may have already noticed this in your running (or other) shoes, most of them seem to have 'toe spring'. Toe spring is how much the front of the shoe is curved upwards. This curve allows your foot to roll off the front of your foot more easily compared to wearing flatter soled shoes.

Hence, the toe spring allow your foot muscles to work less hard when you are walking or running. The more toe spring in the shoe, the less work your feet have to do.

However, this may lead to weaker foot muscles according to research (Sichting et al, 2020).Weaker intrinsic foot muscles may increase your chances of sustaining injuries like plantar fasciitis.

In the research which includes famed Harvard evolutionary biologist / barefoot running researcher, Daniel Lieberman, had subjects walk on a specially designed treadmill that had force plates and infrared cameras to measure how much power was put into each step.

The subjects walked barefoot in four different pairs of custom made sandals. The sandals had varying angles of toe spring from 10 to 40 degrees. These ranges of curvatures were designed to be similar to modern footwear.

Sandals were chosen as they allowed the researchers to see the exact motion of the subjects' feet as they walked. The different degrees of toe spring can be filmed to see how they affected their gait with special attention paid to the metatarsophalangeal (MTP) joints at the base of their toes. This is where the toe bones join to the foot bones.

The results showed that the more the shoes curved up front, the less propulsive force was generated with their MTP joints. This means that your intrinsic foot muscles are working less to maintain stability when you move making walking and running easier. However, it also decondition your foot muscles over time, making them weaker and not able to protect other structures in your foot.

Weaker intrinsic foot muscles make one more susceptible to conditions like plantar fasciitis as people rely on their plantar fascia to do what the intrinsic muscles normally do. This may also explain why people get injured if they transition too quickly minimalist type barefoot style running shoes.

Many of my patients who do not run with plantar fasciitis have been told to wear more 'supportive' and comfortable shoes while outside or even at home. This may be worse as their intrinsic foot muscles continue to weaken.

This is why shoes with more toe spring are popular because they are more comfortable and prevent your feet from tiring. This is great in a race and it may be why most racing shoes have a lot of toe spring (see picture below).

More research needs to be done with toe spring and foot injuries as other elements of footwear like stiffer soles and amount of cushioning can impact how our intrinsic foot muscles work.

So what should a runner do? Some physiotherapists and podiatrists often suggest doing intrinsic foot exercises like towel scrunching or pulling your toes toward your heel.

I suggest going barefoot more often. Either at the beach, or when you're at the playground with your kids. In Singapore we are generally barefoot while we're at home. That's better than wearing shoes with lots of toe spring at home. 

While training, look for running shoes with little or no toe spring when you train. 

For my patients who have plantar fasciitis, I tell them to wear flat slippers like Havaianas to minimize the effect of toe spring and for their intrinsic foot muscles to get stronger. 

That is totally different from what some other physiotherapists or podiatrists may suggest. Of course, I also treat plantar fasciitis differently from them.

Reference

Sichting F, Holowka NB, Hansen OB and Lieberman DE (2020). Effect Of The Upward Curvature Of Toe Springs On Walking Humans. Sci Reports 10, 14643. DOI: 10.1038/s441598-020-71247-9.

Asics Metaracer Tokyo - a racing shoe with lots of toe spring

Luna Mono Running Sandals Review

I've had the Luna Mono Mgt running sandals for a while now and feel ready to write about them after my most recent run in the rain. Despite being wet, the soles were truly non slip, I was truly impressed as I thought they'll be slippery but they were not at all.

Like I wrote before when I first received it, they were nice and soft to wear, almost no breaking in required compared to my other running sandals, the Earth runners huraches. They were also super light, great to bring them while traveling so they can double up as your running sandals.

With normal walking, I didn't mind the strap between my first web space (between big and second toe), but during the runs, I've had some minor discomfort and upon using normal or toe socks they went away.

Normal socks instead of toe socks

I found the "over the top" ankle strap very useful as it helped tighten the sandal to prevent my heel from slipping out (my right foot is slightly smaller than my left so I need to tighten the right sandal more).

I've even had my own version of running mini intervals with them. 3-4 times a week when I bring my two boys to the playground near our place I'll end up playing "big bad wolf" with most of the kids at the playground. I have to run hard to chase them and I must say the Lunas stay on my feet much better than my Havaianas slippers.

My calfs were a tiny bit sore the very first time I used them probably due to the fact they were new. I didn't have a problem with that thereafter.

The Luna Mono's have a fair ground feel and feel good to walk and run in. And they definitely don't give you black toenails. Thanks to Fred from Run Minimal  for the sandals.

Are There Any Benefits In Running With Zero Drop Shoes?

My wife's zero drop running shoes

Although you don't see it as much now, the minimalist type running shoes were the rage all few seasons ago. These minimalist type (and not the barefoot type) usually have a relatively low heel to toe drop. Meaning the height in the midsole and the outsole at the back of the shoe is almost level and/or no difference in height.

One proposed benefit of zero drop running shoes is that it may reduce injury. Shoes with a large drop encourage severe heel striking which can contribute to knee injuries. With zero drop shoes, it may also allow your feet to land as if you were not wearing shoes which helps to distribute impact forces.

Shoes with a high drop may also tilt you forward too much and contribute to alignment and compensatory discrepancies.

If you visit the running section of most running stores now, most midsoles of current running shoes are almost back to before when they were much thicker. But many manufacturers have retained the zero drop while offering plenty of cushioning like the Hokas and Altras.

A recent study however found that a shoe's heel to toe drop may not have have anything to do with running injuries.

The researchers studied 533 non elite runners wearing running shoes with 0, 6 or 10 millimetres (mm) drop for six months. The running shoes were 2l mm in the heel and forefoot, 21 mm in heel and 15 mm in forefoot and 24 mm in heel and 14 mm in forefoot respectively. The shoes were otherwise similar.

25 percent of the runners reported being injured during the six month study period. An injury was defined as leg or lower back pain that resulted from running and prevented planned running for at least one day.

The main finding of the study was that injury rates among the three groups were similar, regardless whether their shoes had a heel to toe drop of 0, 6 or 10 mm.

However, among the runners who ran more frequently, those in the 0 or 6 mm drop shoes had a higher injury rate than the frequent runners with a 10 mm drop.

The researchers suggested that that this may be due to the runners transitioning to fast from their regular running shoes to zero drop shoes leading to increased injury rates as 78 percent of the runners recruited in the study hadn't run in zero drop shoes before.

I remember when I was racing cross country races as a kid we used to train in heavier cushioning shoes and then switched to racing flats for the race. It was very common to have sore calves after the first few races of the season as I've not done enough running in the racing shoes (which had lower drop than the training shoes). Yes, racing flats back then were very similar to the zero drop shoes now.

It was more apparent (sore calves) switching to racing spikes for the track training and track meets when cross country season ended and I raced in track events.

As I always tell my patients, their running technique is much more important than their running shoes. Be sure to rotate your running shoes to minimise injuries too.

Reference

Malisoux L, Chambon N et al (2016). Influence Of The Heel-to-Toe Drop Of Standard Cushioned Running Shoes On Injury Risk In Leisure-time Runners. A Randomized Controlled Trial With 6-month Follow-up. AJSM. 44(11): 2933-2940. DOI: 10.1177/0363546516654690.

Now, this is what I'll call a racing flat

Earth Runners Huraches/ Running Sandals Review

My Earth runners huraches

More than a year ago Mike Dally, founder of Earth Runners contacted me and asked if I was keen to review a pair of his earth sandals. I wrote back and said that I would be most happy to try a pair and mentioned that I live in Singapore.

Mike simply wrote back and asked for my size and mailing address. I requested for the Alpha X-11 mm which was a bit thicker and were more moldable. Mike added he was sending me the conductive leather laces.

The sandals were "zero drop" (same thickness between heel and the forefoot). There was a strap between the big and second toe and buckle on the outside the secure the sandal.

What was interesting was that I noticed there was a copper grounding insert flushed with the Vibram outsole. I later read that they were there to offer electrical conductivity  (or earthing). This is to offer the primal experience of walking/ running grounded to the earth. You can read more about the concept of earthing here. The copper inserts did not bother me at all while walking or running.

Copper inserts

I've waited a long time to write this as I wanted to wear the sandals in a bit before commenting. Mike Dally told me to take my time as most of the reviewers feedback was the longer they'd worn the sandals the more comfy they feel.

I first wore them mostly at home for up to a couple of hours at a time. I found that the leather straps (even though they were very soft) tend to cut into my first web space between my big and second toe. Because of this, I felt slightly more discomfort over the base of the second toe. Otherwise I had no issues at all with walking. The buckle at the side tightened without any difficulty at all.

I've began to wear them more recently as my older boy has been wanting to ride his bicycle. He can ride well but is afraid to stop as his feet can't touch the ground yet.

Lending a helping hand

So almost every single morning he's been asking to ride so I just wear my earth sandals with normal ankle socks and run alongside him steadying him when the need arises.

How does the sandal feel while running? If you've run in minimalist shoes, then you'll understand when I say they have a fair ground feel. They were nice to run in after you've broken them in and gotten used to them. They offer more than ample protection for the running that I do. If you have black toenails like me, then they will be very much appreciated since there's nothing for you to jam your toes against.

For the fashion conscious, hey look real cool with its raw genuine hurache appearance and you can wear them pretty much everywhere else.

Thanks Mike for a great pair of running sandals.

Huraches/ Running Sandals From Earth Runners

Here's what arrived in the mail for me today? Yes, A pair of running sandals from Earth Runners.

Otherwise known as huraches. Used to have a pair from Nike years ago, although those were really running shoes called Nike Air Huraches and not sandals like the pair I got today. The Tarahumara Indians will probably wear something similar to this.

Used to have a pair like this

Well, let me do a few runs in them and I'll tell you how they feel, stay tuned.

Another look at my Earth Runners

What Happens On Your First Run In Minimalist Running Shoes

Nike Free 3.0 (left) and 4.0 (right)

Runners hate getting injured since they usually can't run while nursing an injury. To minimise injury, you can vary the impact forces by running on different surfaces, running at different speeds and running on different terrain. I wrote previously that rotating your running shoes can help prevent injury as it loads bones and soft tissue differently.

Vibrams have been taken to task for advertising that wearing their shoes can help you change your running gait and thus prevent injuries.

Now I have good news for runners wanting to try minimalist running shoes. Another study has shown that switching from conventional running shoes to Nike Frees does not change your running gait, which is great for those of you thinking of transitioning to minimalist running shoes provided your running technique is correct.

Researchers had runners who were used to running in conventional running shoes do three 10 minute runs. First 10 minutes in their normal shoes, then in Nike Free 3.0, and in their normal shoes again.

The researchers expected the runners would change their gait while running in the Nike Frees as they were unfamiliar with the shoes. (This is thought to increase injury risk as you need to get used to a different shoe).

The researchers were surprised to report that in trained runners, there was no change in lower limb variability while wearing minimalist shoes for the first time. It was similar when the runners switched back to their regular shoes.

My own personal take on this? As written previously, the Nike Free's are probably on the conservative end of minimalist running shoes (as compared to say Vibrams) and provide cushioning close to traditional running shoes. It may be different for minimalist shoes that are more minimalist.

Now while I'm writing on Nike Free's, remember I received 3 pairs of Nike Free's earlier this year? Well, I guess it's not too late for me to write a little on how the shoes feel since I've logged some decent miles in them.

Since late May this year I've been working a couple of half days at Physio Solutions. I usually try to run home after I'm done seeing patients there.

Well, I worked there 3 half days this week, which means I ran home 3x this week!! When I first started running home, I ran mostly in my 3.0's. Now I prefer the 4.0, mainly because the 3.0 seems to run a bit on the short length wise. Probably half a size smaller. My suspicions were confirmed when I put my 3.0's and 4.0's together. Though both were listed as size 7, the 3.0's were a tiny bit smaller.

Slight difference in length even though both same size

Width wise the 3.0's were pretty snug. Again I found it easier to put on and take off the 4.0's compared to the 3.0's. The 3.0's had a more "sock-like" feel compared to the 4.0's. Both have very soft midsoles. I sometimes try to cough deliberately when I'm running to pass someone as quite a few people who don't hear me have been startled when I run pass them.

As for my 5.0's,I've not run in them yet, just worn them for walking around.

Reference

Frank NS et al (2013). Lower Limb Kinematic Variability Associated With Minimal Footwear During Running. Footwear Sci. 5(3): 171-177.  DOI: 10.1080/1942480.2013.797505.

*Thanks to Andrew Kwong again for my 3 pair's of Nike Free's, to Andrea Goh for bringing them and Ernest Rodrigues and Duane Wee for previous Nike Free's.

My previous 5.0 all worn

The "pull-tab" makes it easier to wear

Running Injuries Linked To Your Footstrike

Photo by Jordan Shakeshaft from flickr

I wrote earlier that the minimalist/ barefoot inspired type running shoes sales were declining, however researchers seem to be very keen on finding how they affect running still. To put it simply, researchers are very interested to find out if barefoot running, minimalist shoes or how you land (forefoot, mid or rear) can reduce injuries.

A group of South African researchers specifically studied how barefoot running (or forefoot striking) affects five common running injuries.

Bear in mind that many researchers and runners alike tend to assume "barefoot running" and running with forefoot/ midfoot strike as similar although some studies have shown differences.

Well, here are the main points on the five common running injuries. Regarding shin splints/ tibial stress fractures injuries are decreased by barefoot running although runners have to be extra careful with transition time from their previous more cushioned shoes.

Increased incidences of metatarsal (or your foot) stress fractures with barefoot running. I've seen some of our patients with metatarsal fractures after switching to Vibram Five Fingers.

As I've written earlier before, good news if you have knee pain as it may be reduced by barefoot running, but not so good news if you have Achilles tendon injuries as it may be increased with barefoot running.

For those of you with plantar fasciitis, barefoot running can reduce this if you gradually and correctly transition from your cushioned running shoes.

Well, as you can see, nothing is foolproof yet with barefoot running. What the researchers were sure was that bad training practices like training too much too soon, running too fast and hard are the major causes of running injuries. And my favourite, they mentioned that good (i.e. correct) running technique may be more important than shoe selection.

Reference
Tam N, Wilson JLA, Noakes TD and Tucker R. (2013). Barefoot Running: An Evaluation Of Current Hypothesis, Future Research And Clinical Applications. BJSM. doi:10.1136/bjsports-2013-092404.

Minimalist Running Shoe Fad Over? Or Not Quite...

Minimalist running shoes from Runnersworld.com

Headlines for the running community that you runners may want to know. Despite running shoes sales growing 8 % for the first quarter of 2013, sales of minimalist shoes declined more than 10 % during the same period.

This is in contrast to past few years' quarterly reports where the minimalist shoe category had the highest growth while sales in the motion control and stability segment stagnated or fell.

What drove sales of running shoes this past quarter surprisingly was motion control and stability shoes which grew > 25 % and 10 % respectively. A real reversal of sorts it seems.

An running shoe industry observer even commented that the "minimalist shoe fad is pretty much over."

So, do we take the report as the headlines suggest? That there are decreasing number of runners buying and wearing minimalist running shoes and perhaps even reverting back to the more chunky counterparts?

Well, my personal take on this is, hold your horses. A line from the running report said that "Lightweight, which remains the largest sub category, grew in the low teens." This minimalist (or barefoot) trend has definitely influenced and even resulted in running shoes becoming lighter across the board. Other design elements like low or zero drop midsoles, wide toeboxes etc have been transferred to other shoe categories. The whole running shoe market has shifted toward lighter, simpler shoes to give you, the runner a much wider choice than before.

If you recall, it wasn't that long ago when you went to a running shoe store and your options were pretty much limited to relatively heavy and chunky (> 12mm drop) shoes from brands that was classified as neutral, stability or motion control. Those days are long gone (although many medical professionals here in Singapore who have not kept in touch still insist on those categories) and the market has shifted and studies have shown that the previous model of fitting shoes were not effective.

Probably the most important issue now is how to choose your running shoes given the wide variety you now have.

By the way, I just got a minimalist/ barefoot running inspired shoe for my wife. She loves her new running shoes. A clue that "the fad" is not quite dead yet perhaps?

A pair of Merrell's for my wife

Those of you who work in the Singapore running shoe retail stores may have the latest trends probably, some comments here would be appreciated.

 * Footnote - Nike Free running shoes were not included in the minimalist shoe category as SportsOneSource (the company doing the statistics, SportsOneSource) felt that a lot of people buying Nike Free shoes are not real runners.

* Some numbers for those of you keen on statistics, most of the core running brands all had strong sales increases. Brooks and Mizuno improved about 40 %, Asics about 25 %, Saucony in the low teens and Nike in the high teens.  Under Armour running (not common here in Singapore) doubled for the year so far.

 To buck the trend, both Adidas and Reebok declined sharply in their share of running shoe sales.

How Different Footwear Affects Adolescent Runners Performance

Iman Fandi

Have a look at how a group of researchers found that different footwear can significantly alter young runners foot strike and diminish running performance.

I posted it in our other blog. Please have a look here.

Please also see here.

*Picture (of Iman Fandi at 2013 National Schools Track and Field meet)  by richseow in Flickr.com.

Comparing Running Barefoot Versus Nike Free, Lunaracer And Own Running Shoes

Nike Free 3.0

This recently published article in the British Journal of Sports Medicine caught my eye as it compared highly trained runners running in four conditions namely, barefoot, running in a Nike Free 3.0, Nike Lunaracer 2 and their own running shoe. Well, good news if you have knee pain, but not so good news if you have ankle, foot, Achilles or calf pain.

22 highly trained, high-level runners (average 10km time of 33 mins) were chosen by the researchers. Each were given a pair each of Nike Free 3.0, Nike Lunaracer 2 and they had 10 days to run in them and barefoot to get used to them. In addition they also ran in their regular running shoes (on average 125-140 g heavier than the 2 Nike shoes given).

The runners were filmed and their running gait measured using 8 force plates. After a warm up, they did 10 running trials in each of the four conditions (running barefoot, Free, Lunaracer, own running shoe). Their average speed was fast, at 4.48 m/s (or 6 min miles).

And the results? Well, the study showed that running barefoot ia a lot different than running in shoes, but the different shoes did not differ much.

One real difference though was that the runners tended to have a shorter, quicker stride in the Nike Frees and Lunaracers compared to their own regular shoes (average cadence of 183.9 steps/ min versus 181.3).

Key differences between barefoot running versus running in shoes were numerous. Barefoot running elicited a shorter stride length than all shod conditions. There was also higher cadence than all shod conditions (average 187.7 steps/ min). Flatter foot placement at contact and greater ankle plantarflexion at toe off were also observed.

There were also less work done at the knee (24% less when barefoot compared to own running shoe). There was greater joint movements and more work done at the ankle though.

The authors summarized by adding that knee and ankle mechanics were different when running barefoot compared to all shod conditions, including minimalist shoes. Meaning that the minimalist shoe cannot entirely replicate the mechanics of running barefoot.

What does this all mean for you, the runner? Well, this article confirms that running barefoot mechanics are different compared to running in a well cushioned shoe. Running barefoot tends to reduce work done in your knees, but increase work done in your ankles.This means that barefoot running will help those with knee pain but may stress your foot, calf, Achilles and ankle more. So good for those with knee pain but not so great for those with ankle, calf, foot, Achilles pain.

The researchers also acknowledged that the Nike Free may not be really considered a minimalist shoe (given its elevated heel and cushioning available). Wearing a more "minimalist" shoe like the Vibram Five Fingers may be closer at replicating barefoot running although even ultra minimal running shoes will not be be a perfect replication to running without footwear.

Lesson here is that wearing minimalist shoes may not instantly replicate barefoot running. I personally feel your running form is more important. Please also see this and this.

Email me if you want a copy of the article.

Reference

Bonacci A, Saunders PU et al (2013). Running In A Minimalist And Lightweight Shoe Ia Not The Same As Running Barefoot: A Biomechanical Study. BJSM. 47: p 387-392.

*Picture from Nike.com

Heel Striking Even While Running Barefoot

If you have been running barefoot or in minimalist/ barefoot type running shoes and still landing on your heels (meaning you have not quite mastered the technique yet), take heart. Here is some evidence published early this year to show that not all people who grew up barefoot will run landing mostly on a forefoot strike pattern. So if you've been wearing shoes your whole life, you're gonna really have to master the technique.

Prominent barefoot running researcher Daniel Liberman published a key article three years ago showing a high percentage of forefoot strike in Kenyan runners who have grown up not wearing shoes, leading to conclusions that humans had evolved to be forefoot/ midfoot runners and not rearfoot strike runners. (Have a look here.).

This recent paper analysed another group of non running habitually barefoot Daasanach Kenyans and concluded the exact opposite of Liberman's research paper. Their study showed that 72% this particular tribe of Kenyans landed on their rearfoot while running at a self selected, comfortable pace. While running faster, the  Kenyans (who are not known runners) in this study tend to land on their midfoot or forefoot. However at slower speeds (of 9:00 - 13:24 min per mile), 83% landed on their rear foot. At speeds fater than 5:21 min, rear foot landing was 43%.

Subjects in Hatela study

In contrast, Liberman's group of Kalenjin Kenyans (where many elite runners come from) were running at under 5:00 min/ mile pace, while his American subjects average 6:52 min pace. Liberman's Kenyan runners average almost 20 km of running a day while this study's subject's hardly even ran at all.

One similar finding to the Liberman study was that a forefoot strike reduces impact loading.

This study concluded that many other factors like training level, running surfaces, running distance and frequency can influence preferred running style. They added that running speed is important as from an evolutionary perspective, we need to know how fast the cavemen ran to get food. Did they ran relatively long and slow or did they have to sprint and chase their prey while hunting.

References

Hatela KG, Dingwall HL et al (2013).Variation in Foot Strike Patterns during Running among Habitually Barefoot Populations. PLoS ONE 8(1): e52548. doi:10.1371/ journal.pone.0052548

Liberman DE, Venkadesan M et al. (2010). Foot Strike Patterns and Collision Forces in Habitually Barefoot versus Shod Runners. Nature. 463:531-535.

*Picture from Flickr

Best Shoes For Your Kids

My little one running in his Havaianas

I have many patients who are parents and they always ask what shoes should their little ones be wearing. Well, being a parent myself, let me try to provide an evidenced-based view for this.

Prominent gait and running researchers Daniel Liberman & Irene Davis have provided lots of evidence on how we run barefoot, with shoes and how footwear can affect it. Their research is even more relevant for young kids and youths since this is the time when their movement patterns and neuromuscular pathways are being formed.

In a study published way back in 1991, the author concluded that shoe selection for children should be based on the barefoot model as optimum foot development occurs in the barefoot environment. If their shoes are too stiff & compressive, deformity, weakness and loss of mobility could result (Staheli, 1991).

A systematic review published last year concluded that with shoes, children tend to walk faster by taking longer steps increasing tibialis anterior muscle activity resulting in greater knee & ankle motion. Shoes reduce their swing phase leg speed, reduce the child's foot motion and increase the support phase during gait cycle, encouraging a rear-foor strike pattern (Wagener et al, 2011).

For those of you who are trying to run in minimalist shoes/ barefoot running style shoes, this is exactly why you have a hard time switching, your neural pathways have been programmed to run such that you land on your heels. As I have written before, the shoes are not important, your running technique is.

Based on the above mentioned studies, the best shoes for our children are no shoes or those that are closest to no shoes, so they don't change the shape of the foot nor alters how the child's feet works.

So all you parents reading this don't fret if your child runs around sans shoes.

References

Staheli LT (1991). Shoes For Children: A Review. Pediatrics 88:2 371-375.

Wagener C,  Hunt AE et al (2011). Effect Of Children's Shoes on Gait: A Systematic Review & Meta-Analysis. J Foot & Ankle Research 4:3 doi: 10.1186/1757-1146-4-3.

*Picture of my little one running by iPhone 3GS.

More On Running Barefoot

The above photos show runners wearing Vibram Five Fingers (VFF) but still landing on their heels. Now the VFF's were made popular by Christopher McDougall (who was interviewed by Jeanette Wang in yesterday's Straits Times article in the previous post) in his book Born To Run.

Well, no point running in VFF's if you still land on your heels as that is what causes most running injuries. Most if not all of us have spent years wearing shoes that have caused our legs and feet to be supported by the presence of a heel so most runners now land on their heels.

Now don't get me wrong, I'm not against anyone wearing the VFF. Like I written before in a previous  post it's not the shoes you wear to run, its how you run more that is more important. That means if you master the technique, you can literally run in any shoes you want.

We had many calls and emails asking about running barefoot after yesterday's article even though Sports Solutions was not quoted in the article. I even had a student contact me on my views regarding running barefoot running for her research project.

I firmly believe that what is currently suggested by most health care professionals on the basis of pronation control and cushioning is flawed.

This is what I feel regarding choosing your running shoes. Most people can run in just about any shoe (if they run correctly) as long as they take things slowly and listen to their OWN body. Problems arise when they attempt to do too much too soon in a new pair of (minimalist) shoes.

As for running barefoot, don't go and try more than 2km or else everything may hurt since you are now loading your muscles and joints (that have been so used to shoes) much more. Gradually build up your distance and it should be fine.

Do Your Running Shoes Prevent Injuries?

How do you choose your running shoes? I've been asked that question many times over. I've even compiled a shoe list regularly over the years since the 90's and yes many other physios, health professionals etc have conveniently/ blantantly taken out my name and passed the list off as their own (picture below).

One of my often copied shoe lis

For years, podiatrists, coaches and shoe salesmen etc have looked at your foot type (to see if you have a normal, low or high arches) and then recommended that you have stability, motion control and cushioned shoes respectively. The rationale being that if you had high arches, you did not pronate enough and needed softer, well cushioned shoes while if you had low arches, you tend to overpronate and needed sturdy motion control shoes to control that overpronation. Runners with normal arches needed neutral shoes and were prescribed stability shoes. This method was deeply rooted in athletic circles and widely accepted.

The above mentioned method was exactly what the US military did in terms in handing out shoes to their recruits as injuries were rampant during basic military training. Military authorities hoped that injury rates will drop by ensuring their recruits were fitted with the correct shoes according to their foot type.In order to determine whether fitting correct shoes help in lowering injury rates, military researchers found no scientific literature in support of what they were doing and decided to do their own research.

And you know what, they found almost no correlation at all between wearing proper running shoes and avoiding injuries (this is published in the American Journal of Sports Medicine recently). Injury rates were actually highest amongst soldiers who had received shoes fitted according to their foot types. Wearing the so called "correct" shoes for their type of feet had actually increased the recruits' chances of getting injured.

If you have been following our blog, you would have read that Sports Solutions first wrote about this last year when researchers in another published article in the British Journal of Sports Medicine concluded that sports medicine specialists should stop recommending running shoes based on a person's foot type as there was no evidence supporting it. Please have a look at one of our our more popular post last year. 

And just in case you decided that published studies on military recruits were of a lower quality, another study done on experienced runners was published more recently in support of the military subjects paper. In this study, 81 runners were classified according to their foot postures (a more detailed measure of foot type than just arch shape). Runners in each category were then randomly assigned one of 3 footwear conditions, neutral (Nike Pegasus), stability (Nike Structure Triax) and motion control (Nike Nucleus).

All the women embarked on a 13 week half marathon training program. How did they fare? Nearly a third of the women had to miss some training days because of pain, with a majority of the injured runners wearing (yes you guessed correctly) shoes specifically designed for their foot postures. What's more, also of note was that motion control shoes were the shoes across the board that "caused" the most injuries.

Now in theory, overpronators should benefit from motion control shoes to limit their overpronation. However, these runners who overpronated actually complained of pain and missed training after wearing them as did a number of runners with normal feet and every single underpronating (or high arched) runner randomly assigned to a pair of motion control shoes.

This is despite that fact that motion control shoes do limit over pronation as numerous biomechanical studies of runners running on treadmills have repeatedly proved that runners who wear motion control shoes have significantly reduced pronation.

There you go, not quite what you may expect I imagine. Please email this to your friends who are planning to invest in new running shoes.

I have all 3 articles, email me if you want a copy.

References

Knapik JJ, Trone DW, Swedler DI et al (2010). Injury Reduction Effectiveness Of Assigning Running Shoes Based On Plantar Shape In Marine Corps Basic Training. AJSM published online before print June 24, 2010.

Richards CE, Magnin, PJ and Callister R (2009). Is Your Prescription Of Distance Running Shoes Evidenced Based. BJSM. 43(3) : 159-162.

Ryan MB, Valiant GA, McDonald K et al (2011). The Effect Of Footwear Stability Levels On Pain Outcomes In Women Runners: A Randomised Control Trial. BJSM. 45:715-721. DOI:10.1136/bjsm.2009.069849.

Barefoot Running Versus Running In Shoes

Here's the latest and hottest debate in online running forums this past week after this article was published last week in the Nature journal (reference below). The article reviewed landing patterns while running barefoot or with running shoes and which produced more forces. You know what, the barefoot debate is about to get hotter.

The scientists studied 5 different groups of runners and had them run barefoot and in shoes while measuring their foot strike patterns, (whether the runner landed on their heels, midfoot or forefoot) impact forces, loading rate and joint angles .

What did they find? The runners who ran barefoot landed more towards the fore and mid foot. Nothing new here as many previous studies showed this already. They also found that while running barefoot the runners had a reduction in loading rate and peak impact forces (3 times lower in fact).

We know in theory that with higher impact forces means greater injury risk and this paper's findings may suggest that people who run barefoot (or at least in minimalist shoes) may have a higher chance of avoiding injury.

I guess the media will probably have a field day over this and suggest that running shoes have caused all your injuries and that you should throw away your running shoes and start to run barefoot.

Now before you all go out and chuck your running shoes away, please bear this in mind. If you haven't at all been running barefoot or even in minimalist shoes and you go try and run say even 5km barefoot I bet you'll be sore and probably even get injured the next day. Why? Well, you are now loading your muscles and joints (that have been used to shoes) that are definitely not used to this sort of loading. Even the authors suggested that there needs to be more controlled studies on whether runners who run barefoot have reduced injury rates.

So the question remains on whether barefoot running reduces injury rates or help you run faster. Well, what we do know from this latest study is that barefoot running may protect you, your feet and lower limbs from some of the impact related injuries experienced by a high percentage of runners. If you want to try it, please do so progressively.

If you enjoyed this please also see this and this and please pass this information on. Please email me if you want the articles referenced below.

References

Jungers W (2010). Biomechanics: Barefoot Running Strikes Back. Nature. 463: 433-434.

Liberman DE, Venkadesan M et al. (2010). Foot Strike Patterns and Collision Forces in Habitually Barefoot versus Shod Runners. Nature. 463: 531-535.

*Picture from Nature cover