I agree there is no one “fix-all” shoe or philosophy for running injuries. My approach to treating running injuries goes way beyond shoes. In fact, I like to make the comment that the shoe makes about as much difference in your running as the shirt on your back. With that said, I have a lot of favorite shirts and favorite shoes! The point is our society has placed way too much emphasis on shoes and what we put on our feet over the past 40 or so years that we have neglected the concept that our feet can function fine without shoes. I’m fortunate enough to have had the opportunity to experience both sides of this argument or discussion. I wore orthotics for over 10 years of my running career and have placed many of my patients and runners into them. When I discovered that form was the result of my chronic sesamoid pain of 10 years, I stopped focusing on what I placed on my feet. I’m not saying shoes and inserts don’t play a role in the treatment of an injury, because they can – temporarily. What many of us thought to be an underlying biomechanical deformity as being the cause of the injury is not as significant as we think. When you review much of the literature that exists on foot biomechanics, especially from Merton Root, you see that it was only study of foot biomechanics and position amongst individuals. There was no direct relationship made to deformity being a cause of injury or pathology to the extent that we place emphasis on it today. Does a flat foot exist? It does in variances. Variances that most likely need treated in less then a small fraction of our population. Foot deformities that we tend to blame on running injuries are nothing more then variances. If we were to stop focusing on shoes and biomechanical variances and just let the body work the way it was intended it, more progress would be made. Don’t get me wrong, there are biomechanical deformities in the foot that do create problems, but not to the extent we see them in practice. I like to make the statement that if a 10 year old looks at someone’s foot and says “man look at that persons foot” then it’s probably deformed to the extent it needs external support or even surgical correction. By measuring someone’s subtalar joint and comparing it to a neutral position and relaxed calcaneal stance position we accomplish nothing more then a measurement that will vary greatly amongst different practitioners. Remember, I have measured many angles and positions in the foot and lower extremity through my training and practice to come to this realization. I have placed many patients into orthotics to treat these “deformities” to see that it is nothing more then a shotgun approach. I have collected pictures of the feet and bags of shoes and devices these patients have tried over months to years that have solved nothing.
Something else to consider. The work of Root and most biomechanical colleagues has somehow evolved over to treating running injuries when it was initially described for walking. So when they described excessive pronation and referred to measurements and numbers, it referred to heel striking. The question has arisen lately as should we be striking with our heels when we run. If you refer to some of my previous blog posts you will see videos of the elite marathoners and distance runners midfoot striking. When you bring this into the discussion you have to look at video. Pictures mean absolutely nothing. What may appear to be a heel strike in a picture can instantly convert to a midfoot landing in real time as well as the fact that if they are wearing a higher drop shoe the midfoot will be striking first but it looks as if the heel is. There have also been some studies published recently on foot strike positioning claiming that this is the preferred way to land as a result of the high number of runners landing this way. The problem with this is that you have to consider the shoes these individuals are in. The shoe will influence strike position and if there is a lot of cushion and a higher heel, then most likely this runner will have adapted a heel strike as a result of the shoe. The studies aren’t necessarily flawed, only the claims and inferences are. I like to say that a shoe should allow us to run, not enable us to run. If you can’t take your shoes off and run 100 ft. barefoot without pain, then you’re probably running incorrectly as a result of shoe influence.
I have helped more patients with plantar fasciitis by having them remove all their inserts and structured cushioned shoes, and work on natural foot functioning and strengthening. The physical therapists have figured this out long before most of us podiatrists. If we just strengthen the foot intrinsic and extrinsic muscles, we create a stronger base of support and eventually the “overuse” syndromes fix themselves. As I have been pondering over my response for this, I saw a patient in my office who suffered from chronic foot pain and plantar fasciitis that I had seen last December. Back then I spent a long time discussing with her foot function and strengthening and to stop relying on her expensive orthotics and shoes. She listened but didn’t follow through with this because her previous physicians and friends had all said, you need an insert and a “good” shoe. A year later she has his returned to me having spent even more money on custom inserts and shoes to have her pain remain and now transformed into other areas. She has proven to herself controlling any motion to her foot with the inserts and supportive shoes has accomplished nothing. Now of course we aren’t discussing any of her deformities or foot angles etc, but my point is they don’t matter. I have helped patients with all aspects and variants of deformities by not relying on inserts or shoes to alleviate their pain. Consider that when someone who is in their 40’s or 50’s and presents with foot pain is told they have a deformity that needs supported, they can simply respond with a valid point of having lived pain free with this same foot so why all of a sudden does it need supported? Yes it could have “changed” over time but very unlikely. Especially when you have X-rays demonstrating no severe arthritis or loss of joint space.
Do minimalist shoes create injuries? Absolutely not. Running creates injuries. Shoes do not protect you from these injuries.
So yes, I may be an advocate of minimalist shoes but I think it would be better worded as – “I’m an advocate of letting the foot function the way it was intended to, and not letting a shoe interfere with it”.