Thursday, December 3, 2009

Ambling Barefoot

Barefoot running has been around for awhile, but did not hit the national radar screen until the best selling book Born to Run by Christopher McDougall put a new face upon barefoot running interest. You know things are reaching a critical mass on this issue when non-runners start to bring articles about this to me in my office. Minimalist equipment, such as the Nike Free, Tera Plana, and more recently the Vibram Five Fingers (a glove for the feet) are gaining fans and market share.

This past week I received the following position statement from my National Professional Society:

APMA Position Statement on Barefoot Running

It is a very non committal statement leaning against unshod running. Some of the academy members were more critical: "Most of my patients aren't world class runners," adds foot doctor Stephen Pribut, DPM of the Academy of Podiatric Sports Medicine. "It wouldn't make sense for them to risk getting twigs and glass in their feet. And I think some soft surfaces increase plantar fascia and Achilles problems. Of course, what doesn't kill you might make you stronger."

Running surface conditions that are too soft can pose a risk to the shod as well as the unshod runner. Barefoot running can benefit the weekend warrior as well as the world class runner because I know of no class of abilities who doesn't want to have a smaller number of injuries. I only hope Dr. Pribut was quoted out of context. I see less plantar fascia and Achilles problems when bare feet meet the turf.

My first experience with barefoot running was at an AAU developmental track meet in Paramus, NJ. I was speaking with World Class marathoner Tom Fleming. My shin was stiff after winning a 3 mile race and he suggested that I warm down barefoot on the grass. I did so, but for some reason, never incorporated this maneuver into my routine. Now fast forward about 35 years. I am invited to participate in a semi-private thread by National Distance Running hall of famer Patti Catalano Dillon. I am there no more than a week and the barefoot running questions from Camille Herron get put to the foot doctor. I didn't have many answers so I did what any objective inquisitive runner/physician would do. I experienced it. Four years later, it has become an important tool in my running bag of tricks.

For the record, here is how I do it. I do not run barefoot on the extremes of surfaces, no roads and no beaches. I just gradually build up the barefoot miles to about half of my run. I find the best place in the urban/suburban environment is on AstroTurf. The consistency is perfect for running. The fields are swept of objects often with a "Zamboni" type contraption. Ironic, isn't it? The best place this lover of scenic trails runs to amble au natural is on an artificial surface.

There are some very compelling arguments for going shoeless, or at least wearing the least amount of shoe possible.

You may develop a more natural a fluid of gait. Sometimes I am so fluid, running takes on a Zen like enjoyment. This can only be proven in a subjective fashion by actually trying some unshod running.

It is the belief of this author that the biomechanics of running is cleaner. There is less errant eccentric and postural muscle firing during the gait cycle. Tendons have in excess of 90 percent energy return. Mid soles of running shoes have considerably less energy return so they impair rather than enhance function. Aging of the shoe materials causes even more loss of support and energy return.

So my national society feels there is a dearth of studies, abstracts, and reviews
available on shod versus unshod. It took me all of one hour to find a bunch. Here are some highlights:

Wearers of expensive running shoes that were promoted as correcting pronation or providing more cushioning experienced a greater prevalence of these running-related injuries than wearers of less expensive shoes (Robbins and Gouw, 1991). In another study, expensive athletic shoes accounted for more than twice as many injuries as cheaper shoes, a fact that prompted Robbins and Waked (1997) to suggest that deceptive advertising of athletic footwear (e.g., "cushioning impact") may represent a public health hazard. Anthony (1987) reported that running shoes should be considered protective devices (from dangerous or painful objects) rather than corrective devices, as their capacity for shock absorption and control of over-pronation is limited.

Michael Warburton: Running barefoot is associated with a substantially lower prevalence of acute injuries of the ankle and chronic injuries of the lower leg in developing countries, but well-designed studies of the effects of barefoot and shod running on injury are lacking. Laboratory studies show that the energy cost of running is reduced by about 4% when the feet are no shod. In spite of these apparent benefits, barefoot running is rare in competition, and there are no published controlled trials of the effects of running barefoot on simulated or real competitive performance.

When you run barefoot, your body precisely engages your vision, your brain, the soles of your feet, and all the muscles, bones, tendons, and supporting structures of your feet and legs. They leap to red alert, and give you a high degree of protection from the varied pressures and forces of running.

On the other hand, when you run in socks, shoes, inserts, mid soles and out soles, your body's proprioceptive system loses a lot of input. "This has been called 'the perceptual illusion' of running shoes," says Warburton. "With shoes, your body switches off to a degree, and your reaction time decreases."

So what are the risks? There is obviously less protection of the running bare foot. Ironically, my only pedal puncture wound ever sustained happened while running with running shoes on my feet.

So my society wants something conclusive? You cannot do a double blind study on something like this so results will always have some level of bias.

Abebe Bikila famously won the Olympic Marathon after discarding the shoes given to him before the race by a show company. Most Ethiopians I have treated have a "boxy" shaped foot. I am sure that the shoe company made he gaffe of giving him a shoe made on a traditional last for a western foot. The misfit was resulting in discomfort so Bikila went back to the known quantity or running barefoot like he had trained in his homeland.

Running barefoot is a healthy alternative to running shod. The educated runner will encounter minimal risks and great benefits. The funny thing is that if shoes met the individual needs of the runner in a better fashion, this whole shod versus unshod discussion would become a moot point. However, that is a whole other rant for another day.

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