Just Back from the Salt Lake City Functional Foot Course!

Great job everyone at this past weekend’s Functional Foot course in SLC! Dan and I enjoyed sharing with you all and look forward to sharing more on thefunctionalfoot.com!
Keep learning and growing! The Functional Foot course will go to Phoenix next on April 27 & 28. Take care! Have a blessed Easter!


Barefoot running…Really? Or Really!

Let me first begin by stating some bias points: 1) I have been a recreational runner for 25+ years; 2) I wear running shoes; and 3) I wear orthotics.  In the past 6-months though I have made a very happy transition to “minimalist” running shoes (New Balance Minimus to be specific).  Why did I make this transition?  Morbid curiosity I suppose, spurred mainly by reading McDougal’s book Born to Run.  With that said, I am not a proponent or opponent to barefoot running…I am a proponent of minimalist running footwear.

Now some facts:

  1. McDougal’s book, contrary to so many reports on the internet, is NOT a book about barefoot running…it is a book about ultra distance running and the fact that the human species is actually quite well designed for distance running.  It is a book about individuals running tremendous distances. It is a book about a group of runners from Mexico who run in nothing more than primitive sandals on their feet (not barefoot) – basically they run in “minimalist” shoes.
  2. Barefoot (BF) runners are NOT setting world record times in distance
  3. BF running IS more efficient than shod running (running with shoes), but this efficiency has not translated into improved performance
  4. BF runners run with “different”(note the word “different” and not “better”) biomechanics than shod runners, which include the following:
    1. Decreased stride length
    2. Higher cadence (higher stride frequency)
    3. Primarily landing on the mid or forefoot, rather than the heel
    4. Reduced “impact” force, but same overall average ground reaction force as shod runners (see image below).
    5. BF running (and midfoot running in shoes) requires greater need for ankle range of motion, compared with shod runners
    6. BF running requires greater effort of the ankle plantar flexors (gastrocnemius, soleus, etc.), compared with shod runners
    7. BF running results in greater load to the forefoot, compared with shod runners

    From Lieberman et al 2008:  Note, the maximum GRF remains the same whether barefoot running with a heel strike, shoe running with a heel strike, or barefoot running with midfoot strike. Is the impact transient (first spike) the issue?

  5. These biomechanical differences (4a-g) have not been associated with increase or decrease injury risk. The ONLY factors associated with injury risk in runners are “pre-existing” injuries, weekly mileage, age, and training errors (and possible relationships to “foot type”).
  6. Of these biomechanical differences, it is quite interesting that “elite” shod runners tend to run with similar biomechanics as barefoot runners – this suggests that the body adapts its running to be most effective, regardless of footwear.  Nearly 40% of “elite” shod runners use a forefoot landing style with high stride frequency and decreased stride length (less stance and float time).  This running form is seen in shod runners.
  7. BUT, with all the amazing “improvements” to the modern running shoe, the injury prevalence in runners has NOT diminished (35-70%) in the past 40 years.
  8. BF running has NOT been proven to reduce injury risk; in fact anecdotal evidence from sports medicine folks report an increase in Achilles tendon pathology, calf strain, and midfoot related injuries in barefoot runners.  However, anecdotally, many runners report less injury when switching to barefoot running – as evidenced by a new study by Goss and Gross (2012) – I’ll write more on that “self-report” study another time.  But, in a paper they wrote in a prior study, they suspect forefoot landing might place the runner at greater injury risk to the ankle muscles and the forefoot.

    Goss and Gross 2012

Two last points:

  1. BF running “might” increase foot muscle strength, but there is no evidence that this is of any use for injury prevention
  2. Modern running shoes, contrary to the internet, are not “bad” for runners, but in the same light they have not proven to be helpful in preventing injuries. There is no evidence in either case.  Modern running shoes are confining, restrictive, and expensive, but, the new Minimalist shoes are also expensive (my own pair of NB Minimus retail for over $100).

So, where do these facts leave us? There is no evidence to support barefoot running claims as less injurious to the runner; there is no evidence to support internet claims that running shoes are harmful. And, well, in modern society, finding a surface to run barefoot safely (glass, debris, hot pavement, cold pavement, etc.) is increasingly challenging. Hence the advantage of the minimalist running shoe.

Are minimalist running shoes better than the typical modern day running shoe? I don’t know because we don’t have any research evidence to support these claims. Are they lighter – yes. Do they force the runner to run more like a barefoot runner (or like an elite runner) – yes. Is this a good thing? I don’t know. But it seems logical that for those individuals who would like to run barefoot, but fear injuries to the bottom of the foot, the minimalist shoe is a viable option.

It also seems logical that for the runner without any inherent biomechanical issues, the minimalist shoe is a viable option that will allow this runner to achieve a more efficient running form.

It is possible too that for the biomechanically challenged foot (read abnormal pronator), that the minimalist shoe might be a viable option, reducing demand to the rearfoot (subtalar joint) and placing greater demand on the forefoot. However, the biomechanically challenged foot (read hallux valgus, hallux rigidus) might be better advised to continue using a standard, modern running shoe.

Do you, or do you know a runner, wishing to go au natural?  Or, at least transition to a minimalist shoe?  If so, here is some “transition” advice:

  1. Running barefoot or with minimalist shoe requires the runner to land on the forefoot or ball of the foot. This does not happen naturally and requires some “break” in time – some training and adaptation time.  Just like with any new exercise (read “stress”) the body needs time to adapt.
    1. Begin with shorter runs
    2. Alternate days between minimalist and standard running shoe until comfortable form feels natural – this may take up to 3-months (according to research)
    3. Find a gentle hill and train running/walking uphill.  Uphill requires forefoot loading and places greater stress on the calf muscles – those muscles needed for forefoot running.  Treat this as a dosage exercise, like any other strength/conditioning program…perhaps a few sets 2-3 days/week.
  2. Be prepared to shorten your stride
  3. and quicken your cadence
  4. and land more softly when running in minimalist shoes

Until we have sufficient research to support/refute all the internet claims, proceed with caution when making the switch from a standard running shoe to a minimalist running shoe, or even to BF running.  And since we have sufficient research to support the benefits of running, Just Do…oh wait, I am not about to support that slogan…Just get out and run!

Dan | Follow me on Twitter at https://twitter.com/danielcip3


Welcome to The Functional Foot Blog!

From Dan:
Welcome to The Functional Foot. Chad and I are very excited about our new course and the opportunity to share and learn from all of you. For this first “blog” we would like to give a shout out to those who have inspired us in developing The Functional Foot. A huge thank you to Gary Gray and the Gray Institute (http://www.grayinstitute.com/). As a pioneer in the notion of “functional thinking” Gary inspired Chad and I to ask basic questions about movement and consider the myriad of dynamic contributions of the foot to the entire lower extremity. Gary developed what we believe to be the first functional foot seminar “When the foot hits the ground everything changes” back in the late 1980’s. Even at that time, Gary’s footprint left an indelible mark on our path to functional thinking. I am personally indebted to Gary as he took me under his wing when I was a newly developing clinician – gently nudging me to think more practically and to truly appreciate the role of common sense in clinical decision making. I would also like to thank Don Neumann (http://marquette.edu/health-sciences/continuing-ed-grossupper.shtml) for helping me to better understand the function at the hip. Don, like Gary, is an amazing and visual teacher, and his lectures on hip muscle and hip joint function are a must see by every orthopaedic rehabilitation specialist. So, between Gary and Don, I almost understand the relationship between foot function and hip function, with the knee being caught in the middle.

From Chad:
I also welcome you to The Functional Foot! Like Dan, I am thrilled to be a part of this new concept in on-going professional education and development. Our hope is that the participants of The Functional Foot courses will join our network of professionals in continual “on-line” learning opportunities with our “Blog” and “Forum” areas of the website. We look forward to collaborating with you in order to develop your skills, problem solve, inspire, and encourage one another in our practices. We hope that these opportunities will help you (our participants) retain what you learn at our course(s) and be able to more effectively implement your skills with patients in a day-to-day real life world. We would be remiss if we did not recognize our families for their support of this endeavor! Melissa and Jackie, thank you for your help, support, and tireless patience with Dan and I taking pictures of your feet!

From Chad and Dan:
The main point of “The Functional Foot” is to create a collaboration between practicing clinicians (PT’s, PTA’s, AT’s, OT’s, etc.), educators, and other individuals involved in health and wellness promotion for the essential purpose of making us all better at what we do – that of helping our patients and clients. The Functional Foot, as an attendance based seminar, provides hands-on training for examination of and intervention for the lower extremity, with a focus on the foot. The Functional Foot, as a Discussion Board resource, provides an opportunity for participants to interact in discussions relative to treatment ideas, new examination approaches, findings in the research literature, and enhancing an “evidence-based” approach to clinical decision making. And the Functional Foot, as a “blog”, is an opportunity for individuals to contribute insights and challenges to all members – yes, you will be invited to blog with us…and have fun sharing. Our blogs will primarily consist of clinical practice observations, techniques, new ways to manage complex lower extremity problems, and information on new tools to help you and your patients in the clinic. We will also discuss the use of current research to assist us with decision making, beginning with articles on how to efficiently read a research article, critique it for its methods, without getting all hung up on those messy statistics. Chad and I believe that readers place too much emphasis on the “stats” and not enough on the “where did the data actually come from and can I value that data?”

Chad and Dan