A new study accepted for publication in Arthritis & Rheumatism has demonstrated reduction in the force through the knee joints as well as pain when the patients were either barefoot or wearing minimalist shoes which closely mimics the gait of someone walking barefoot. This article is greatly needed in the world of orthopedics where the majority of surgeons are still prescribing foot orthotics to treat many of the lower extremity injuries that do not warrant surgery. Despite the fact that literature does not support the use of foot orthotics for conditions such as plantar fasciitis, shin splints, knee pain, IT band syndrome, piriformis syndrome, and many other running injuries, our society still sees an overwhelming number of physicians and health care providers implementing them.
Why orthotics are over utilized is a tough question to answer. For years they were prescribed to prevent excessive pronation which was thought to be a biomechanical fault in individuals leading to injuries. This continues to be an indication for use, although excessive pronation is not as detrimental as we once thought. Many times it becomes nothing more then convenience for a physician to prescribe an orthotic for a patient with unexplained foot pain with no real clinical explanation. In my practice, these patients tend to show up with bags of shoes and orthotics with continued pain.
This recent article acknowledges that recent studies have demonstrated both barefoot walking as well as walking in a minimalist shoe is associated with reductions in knee loading compared to conventional footwear. The primary focus of this article was to demonstrate a reduction force to the medial knee as well as decreased in symptoms knee OA over a longer period of time which in this case was 6 months. Scientifically the study looked at peak external knee adduction moment and adduction angular impulse. Both parameters reflect the extent of medial compartment knee loading during walking. The results demonstrated a 19% reduction if the force to the medial knee as well as a reduction in pain by 36%.
In my opinion this is extremely significant because this is a relatively long term study combined with previous research that demonstrates decreased force to the knee joints as well as pain as a result of functioning in less of a shoe. So we see here the medical literature since at least 2006 has been evaluating the body’s (specifically the knee) response to functioning barefoot, in minimalist shoes, and traditional shoe gear. It will take time to see the effects of these as well as future studies to make there way to actual medical practices, especially the orthopedic and podiatric specialties that focus more on surgical therapy then “running form” and “technique”. Remember that for the past 40 or so years these specialities have believed in and recommended countless amounts of orthotic devices to their patients as well as taught this philosophy to students and residents. Industries have evolved where the primary focus is manufacturing foot orthotics that are custom made for the patients feet. It has become common place for specialty shoe stores to recommend over the counter inserts as an adjunct to the traditional running shoe being sold to their customers. Our society has accepted that we need to “support” our feet and arches. As you can imagine it is going to be very difficult, as well as timely, to see such a drastic change occur to where we will see the standard of care move from supportive running shoes and orthotic devices to more minimalist style footwear. The change is beginning to occur though as evident by the focus of current research as well as the evolution of more minimalist shoe gear. Over the past several years heel height has decreased from an average of 12mm to 8mm. More then likely, the change is going to occur in the running and shoe industry first before it makes its way to the medical community. Why? We have already seen this happen with today’s current standard of care. The paradigm for recommending shoe-gear that physicians follow today evolved from the shoe industry.