Shortly after I started running regularly back in 2007 I was “diagnosed” as suffering from serious over-pronation. My visit to the sports medicine doctor had been prompted by significant, painful plantar fasciitis, runner’s knee, IT band pain and an occasional soreness in my hip–all classic running maladies. I had also long suffered from painful foot cramps in which my arch would tighten and my big toe would splay awkwardly and painfully inwards. The doctor sent me to a running store for motion-control shoes and to a physical therapist. I was instructed to stretch more, take several days off between runs and ice my knees afterwards. (I never bothered with the recommended orthotics or night boots)
For the next couple years, I believed this to be normal. But having since switched to a more natural stride, forefoot landings and minimal footwear, every single one of those problems is gone.
Summer of 2009, I bought a pair of Nike Free 5.0s (precursor to the Nike Free Run+) to wear as everyday shoes, having fully swallowed Nike’s marketing video:
Stronger feet? That couldn’t hurt.
At first I was indifferent. While I liked how they looked and felt, I wasn’t sure the Nike Frees were anything more than expensive Crocs. But after a few weeks, I noticed my feet were cramping less and rarely hurt in the mornings.
Still, I never tried running in them. I was too invested in my diagnosis and convinced my foot and knee pain would be even worse without my doctor-prescribed, running-store-recommended, $130 motion-control running shoes. I mean, the store analyzed video of me on a treadmill, was that all BS?
After reading Born to Run in Spring of 2010, I finally felt brave enough to try a short run in the Nikes. “Short” turned into a very pleasant 10k. The next day the tops of my feet and the muscles running up the outside of my shins were sore. (Turned out those are a single muscle group, the Extensor digitorum longus.) But sore isn’t pain, and my knees didn’t hurt. A few days later I went out again in my Asics–for what would be the last time.
My original plan had been to alternate between shoes, but that last 8 mile Asics run left my knees hurting for days. I also noticed I was hearing my footfalls through my earbuds. My landings in the Frees were much gentler and nearly silent.
One more run in the Frees and I knew I was done with the Kayanos. The next night I ran 15 miles, my longest run up to that point (by half), and felt absolutely fantastic afterwards–and only mildly sore the next day. All my previous attempts at running anywhere close to 10 miles had ended with IT band tightness, limping and days of residual knee pain.
Something was working, and it was not all in my head.
“I realized there was no way in hell that this barefoot running was ever going to become a fad or a hit in the United States unless there was a product… We are so trained, we purchase a solution. We’ve got to have a purchasable solution.”
He’s right, we’re conditioned to believe in the power of products. While I do blame my old motion-control clunkers for inhibiting my form and contributing to knee pain, my success with the Nike Frees was because the shoes got out of my way and let me run more naturally. They helped by not helping.
The Nike Free is a revolutionary product, and a gateway shoe to no shoes at all. After a few months and several hundred miles run in Nike Free 5.0s, including my first ever half-marathon, I stepped down to the flatter, more minimal Nike Free 3.0 and started to mix in some near-barefoot runs in Vibram FiveFingers.
Learning to run near-barefoot was a slow process of rebuilding long-forgotten muscles. For fully 6 months, my calves would be rigid knots for days after a few miles in the FiveFingers. Having spent most of my life in shoes, the muscles and tendons in my feet and lower legs needed quite a bit of time to stretch out and build back up.
While in the middle of this transition, it’s comforting to remember that muscle soreness gets replaced by strength. My aching calves were a promise that someday soon my legs would be even stronger. The encouragement of finding an entire unused muscle group was incentive to keep at it.
With the Nike Free, I became aware of how important shoe flexibility is to foot health. Whenever people asked me about them I’d take one off and curl it up to show how flexible it was. (I did realize how silly this looked) But running in VFFs showed me that a totally-flat, zero-drop heel is every bit as important as sole flexibility, maybe even more so. I’ve since become obsessed with wearing the flattest, most flexible footwear I can find.
Going all the way: Running barefoot
Towards the end of Summer in 2010 I finally took the last step and lost the shoes completely.
It’s difficult to explain how wonderful running barefoot felt, like trying to describe a completely new color or flavor. The quantity of sensory feedback is astonishing and the permanent silly grin can’t be helped. There really is a profound, near-spiritual experience of both human freedom and connection to the Earth.
The promise of extra leg strength proved out. Once my legs adjusted I found myself running further and slightly faster without significant fatigue. My form also improved, the VFFs were masking a lot of skidding and over-reliance on my toes which was immediately apparently–and corrected–barefoot. Despite one significant shoe-related setback (I did too much), I’ve been amazed at how durable and adaptable our feet are. Only two barefoot runs had to be cut short, both of those were because previous, shoe-caused blisters failed and needed covering.
I used to think all that needed to run was a decent pair of shoes. But all I really ever needed was to go outside and just start running.
Stress fractures are ridiculously common among runners, but this post will specifically address the apparent rash of metatarsal stress fractures afflicting minimalist and VFF runners, including myself.
First off, the term “barefoot” needs to be clarified. In every case I’ve found the runner wasn’t actually barefoot. We were all running in minimal shoes: Vibram FiveFingers, Nike Frees or something similar.
I noticed several consistencies among runners’ accounts of their injuries:
Running in Vibram FiveFingers or other minimalist shoes, not barefoot.
Running faster than normal (races, speed work, or just having too much fun)
Mostly older than 35 years old (past the age of peak bone mass)
Injury occurs months after transitioning to minimalist or barefoot running
So here’s my theory:
The majority of stress fractures affecting minimalist runners are not impact-related, but rather result from overloading weak metatarsals with increased toe push-off. These injuries arise several weeks or months after switching to natural running because the runner’s muscles strengthened faster than their bones.
Metatarsals are most susceptible to injury because they’ve been immobilized and weakened by conventional shoes. The second metatarsal, being the longest, endures the most stress.
Skin protection offered by VFFs and minimal shoes likely increases the risk of injury, friction on bare toes would have limited activity before the bones could have been hurt.
As I’ve been researching this, I’ve found a lot of stories similar to my own:
So I got my foot x-rayed and my recent suspicions proved true. Apparently in mid-December I suffered a stress fracture of the second metatarsal on my right foot. It was healing well, but needed more time and was re-aggravated during the Manhattan Half Marathon on January 22nd.
Doubtlessly, I’m going to be dealing with a lot of “this is why you shouldn’t run barefoot” comments, so this will be something of a pre-emptive refutation.
Is barefoot running a failure? No.
As described in Essentials of Surgical Specialties, “Stress fractures are the classic overuse injury.” Stress fractures were originally identified in the feet of army recruits resulting from long marches (while wearing boots). Wikipedia’s March Fracture entry precisely described my injury: “mostly occurs in the second metatarsal of the right foot.” Yep. My exact fracture is on the bone’s shaft, towards the base (proximal, meaning towards the body).
The American Academy of Family Physicians Common Stress Fractures page describes this injury as “among the most common sports injuries” with “track and field sports” acounting for 50% of stress fractures in men and 64% in women. One quarter of all stress fractures affect the metatarsal bones of the feet. Runners are exceptionally well represented among stress fracture sufferers.
Yes, there are apparently a number of Vibram FiveFingers runners who’ve suffered stress fractures. But clearly, shod runners get them too. The clinical literature notes that changing equipment can lead to stress fractures, but much more blame is assigned to increased amount and intensity of excercise.
Barefoot and minimalist runners are running more because it just feels great. When I switched to minimal shoes my running distances more than tripled, I was having a blast and my knees, hips, feet and back didn’t hurt. I know I’m not alone in blowing past my previous physiological limitations.
My skeleton seems to be in pretty good shape, with the distinct exception of my feet. Having spent most of my life in stiff, over-cushioned and inflexible shoes, the bones in my feet are doubtlessly weaker than they might have been.
This leads to what is probably the most difficult question:
Am I simply too old to recover from a lifetime of shoe-weakened feet?
I’m inclined to say no.
Ten months might have been long enough to build up the muscles and tendons in my feet and legs, but seemingly wasn’t nearly long enough to make up for 39 years of under-use and weakness in my foot bones.
The ‘fatigue theory’ suggests that during repeated efforts (as in running), the muscles become unable to support the skeleton during impact as the foot strikes the ground. Instead of the muscles absorbing the shock, the load is transferred to the bone. As the loading surpasses the capacity of the bone to adapt, a fracture develops.
If my extensor muscles were exhausted by trying to flex against the restrictive toes in the Bikila, then it’s completely possible that fatigue could have contributed to this injury.
Additionally, the VFF Bikila muffles ground feel much more than thinner-soled VFFs or Soft Star RunAmocs. Reducing feedback from the ground can result in harder foot-strikes.
Ultimately though, this happened after my third (non-consecutive) 100+ mile month–which is a lot for me. That last month also coincided with colder weather and increased use of the Bikilas–often with socks, further reducing ground feedback.
I’m off the roads for a few weeks but I’m not planning on sitting still. First off, I’m going to learn to swim better.
This is also a great opportunity to fulfill the volunteer requirement for NYRR’s 9+1 guaranteed entry to the 2012 NY Marathon. I can’t run, but I can still help.
Accepting my potentially not-yet-sufficient bones, it’s possible that the reduced ground feedback of cold weather running presents a hazard for me. I may just need to accept that when I can’t feel the ground my feet still need a bit of padding to make up for weakness in my bones. Whether that will prove a tradeoff for pain everywhere else remains to be seen.
I’m not sure what to do about races. They’re ridiculously fun and while I’m not “racing” racing, I do tend to run much faster during races than I would normally. Maybe I need to wear a more forgiving shoe, or just train better.
I’m not about to stop running or give up running barefoot. The first thing I did after the doctor confirmed the white fuzzy spot in the x-ray (bone callus, a sign of healing) was to mark a date in my calendar. Unless there’s some clinically compelling reason not to, on the first Saturday in March, I’m going running.
The indictment of contemporary running shoes in Born to Run is contributing to a radical transformation of the running world and athletic shoe industry. Chris McDougall’s book deserves credit for bringing barefoot running out of the shadows and into the mainstream, but challenging the conventional wisdom about athletic shoes is not a new idea.
The Foot Strike paper focuses primarily on impact force generated by different foot-strikes, and also measures the incidence of various landings in several small sample running populations. These strike-plate graphs showing barefoot vs. heel-strike landings from the Barefoot Professor video clearly show the different impact forces and were very helpful in adjusting my own form:
Back in 2001, physiotherapist Michael Warburton published a research paper titled Barefoot Running. His introductory paragraph lays out the entire case against shoes:
Well-known international athletes have successfully competed barefoot, most notably Zola Budd-Pieterse from South Africa and the late Abebe Bikila from Ethiopia. Running in bare feet in long distance events is evidently not a barrier to performance at the highest levels. Indeed, in this review I will show that wearing running shoes probably reduces performance and increases the risk of injury.
Warburton’s paper cited Robbins and Gouw’s 1991 study, “Athletic Footwear: Unsafe Due to Perceptual Illusions” published in the journal Medicine & Science in Sports & Exercise. This frequently referenced study appears to be among the first to clinically link the hyper-sensitive densely-packed nerve-endings in our feet with our body’s ability to properly accommodate impact stresses. The abstract goes so far as to close with this:
“…it might be more appropriate to classify athletic footwear as ‘safety hazards’ rather than ‘protective devices'”
Dr. Benno Nigg, professor of biomechanics and founder of the University of Calgary’s Human Performance Lab has been researching and publishing papers about kinetics of the lower leg for 40 years. (The man is a science-publishing machine.) Dr. Nigg published a number of papers starting in 2000 which examine plantar sensory input, impact forces and kinematics related to running barefoot and in shoes. Unfortunately, the papers I most wanted to read were only freely available as abstracts.
Dr. Nigg’s work on muscle tuning has proposed a connection between the reaction of nerves in our feet and muscle pre-activation, to reduce impact force and “soft-tissue vibration” while traversing various surfaces. This 2008 Science of Sport article discusses the detrimental biomechanical effect of motion control shoes and orthotics based on Dr. Nigg’s theories.
An example of [muscle tuning] can be seen with barefoot running, the diminished proprioception (sensory feedback) of wearing a shoe negates the cushioning of the shoe. Studies using minimal shoes/barefoot have shown that the body seems to adapt the impact forces/landing based on feedback and feedforward data. When running or landing from a jump, the body takes in all the sensory info, plus prior experiences, and adjusts to protect itself/land optimally.
Years prior to Dr. Lieberman’s research, Dr. Nigg’s studies or Warburton’s paper, in the mid-1980s at the latest, Olympic runner Gordon Pirie’s book “Running Fast and Injury Free” unflinchingly blamed “overstuffed, wedge-heeled” running shoes for the high rate of running injuries.
Pirie described cushioned running shoes as “orthopedic running boots.”
“The human foot is the result of millions of years of evolution.” to again quote Mr. Pirie. One quarter of the bones in our bodies are in our feet, that level of complexity doesn’t happen without a reason. Running shoes as we’ve come to know them have only existed for a few decades. The big athletic shoe companies have finally, if not caught on, then recognized there’s a lot of money to be made with minimalist shoes. Either way, our feet win.
I’ve been reluctant to post this because there’s a weird sort of stigma among barefoot and near-barefoot runners that injuries should be a thing of the past. For the most part, that’s been completely true for me, but something is going on with my feet and I felt it was important to write about.
The pain is focused on the Extensor Digitorum Longus and Extensor Hallucis Longus on top of my feet, mostly behind the smaller toes, but with some sensitivity over the joint between the first metatarsal and first cuneiform bones. These muscles and tendons are responsible for lifting the toes–which is why I’ve become suspicious of the Bikilas, but more on that in a bit. There is no discoloration or swelling. Pain is most noticeable during the toe-off phase of walking, running mostly feels fine. It is very difficult to raise up on the toes of one foot at a time.
As seems to be tradition with running injuries, I’ve been spending a lot of time theorizing about what could be the cause.
In November, following my post about bad running form, I ran about 65 miles completely barefoot (and LOVED it). I spent a good amount of that time on Barefoot Ken Bob’s advice about lifting the entire foot, especially my toes. But December has been too cold for bare feet with only a few days above freezing, so I’ve been running in the Bikilas which are warmer than my open-top VFF Sprints.
I ran three races in December. The first two were MUCH faster than I normally run. By the third race, my feet were still sore from the previous week and I just wanted to finish without limping. Despite my growing suspicions, all three races were run in Bikilas.
What’s wrong with the Vibram FiveFingers Bikila
One of my first reactions to the VFF Bikilas was that the toes felt stiff. In this video, I demonstrate the differences in toe-flexibility between VFF Sprints and VFF Bikilas.
Toe dorsiflexion is severely limited with the VFF Bikilas. I suspect that trying to lift my toes against the stiffness of the Bikilas either pulled or strained my extensor muscles or caused some tendonitis where they attach.
I’d also considered the possibility of simple overuse or the switch to heavier winter shoes, but I’ve become convinced that the toe-stiffness of the VFF Bikilas is the culprit here. I’m taking some time off to heal, but I’m not planning on running in the Bikilas again for a while. When I do, I’ll be paying very close attention to how my feel are feeling.
The New York Marathon is this weekend, and barefoot running is this year’s “story of interest.”
Neil sent me David Willey’s HuffPo article “Barefoot Running: The Exercise Craze That’s Hit the Streets.” Mr. Willey is treading a very fine line. As Editor-In-Chief of Runner’s World magazine, he is intimately tied to the athletic shoe industry. A tsunami of minimalist shoes will arrive in spring 2011, but however popular the idea of barefooting becomes, Runner’s World would be slitting their throats if they advised their readers to stop buying shoes.
I’m glad to see him exploring minimalist/barefoot running, but I think he misunderstood some key ideas. He claims barefooters insist “the human foot supplies all the cushioning and shock absorption any runner needs.” This isn’t really true. The human foot is a spectacular mechanism, one that we’ve neglected and failed to appreciate for too long. Bare feet force us to land more softly and soft landings don’t require cushioning. Also, the idea of “shock absorption” is counter to running efficiently. Ideally, the muscles and tendons of our feet and legs don’t absorb shock so much as redirect impact forces into the next stride, Ken Meierke calls this elastic recoil “free speed”. Flat heels increase the peripheral heart effect of the soleus muscle on the deep veins in our calves.
Chris McDougall’s NYTimes article “Born to Run the Marathon?” talks about how he “got over himself” and decided to run the Marathon this year.
One of Chris’s persistent themes is how running can bring out the best in people, something I’ve personally found to be true. Runners tend to be fantastically optimistic people. Maybe that grows from realizing accomplishments that first seemed impossible, or perhaps it’s a shared strength found when humans move together. Chris included the incredible story of Derartu Tulu and Paula Radcliffe in the 2009 NYC Marathon, as well as one of my favorite bits of Native American lore:
The Hopi believed running was a form of prayer; before setting off on a long run from Arizona to the Pacific, they’d offer their effort on behalf of loved ones in need of help. “I’m offering my strength to them,” the runner would murmur to their god, the Great Mystery, “and in return I ask for some of yours.”
The comments on these articles have become predictable, though with more defenders than before. Several people rehash the dogma that our feet are weak, or that people are not designed to run. Others makes comments about the ground being gross, dangerous or “harder than the soft earth humans were meant for.” Then there’s always a physical therapist or podiatrist telling about injured patients.
I went to physical therapy before switching to minimal shoes. My knees were a mess, my feet hurt, my hip hurt and my back hurt. After running in my prescribed motion-control shoes I’d stretch and ice my knees, then wait 2-3 days before trying to run again. I thought that was normal. Now, I can run near-barefoot or barefoot every day without pain. The sports medicine doctors and physical therapists never once asked to see me run.
So many people are convinced of human mediocrity despite everything we’ve done.