Two year long case study demonstrating an increase in arch height from running in minimalist shoes.
Article by Dr. Nicholas Campitelli (Click to access Dr. Campitelli’s Office website)
The debate is ongoing as to the use of minimalist shoes and running barefoot. Few studies have been done and there are so many variables to control which makes these existing studies practically irrelevant. To see the true effects of what happens to our foot by removing the external support from a traditional motion control running shoe, it takes time. Years actually. I would like to share an example of a runner who had abandoned her rigid orthotics and motion control ASICS running shoes and began wearing minimalist shoes. The New Balance Minimus with a zero drop to be exact.
She was 34 two and a half years ago and had flexible flat feet, a valgus position of the calcaneus ( the heel bone angles inward when observing from behind), and a valgus knee deformity (knock knees). Her symptoms consisted of knee pain as well as frequent lower back pain. She was wearing custom rigid orthotics which were implemented to realign her arch and heel bone. We had her follow my transition protocol of removing the orthotics for the first part of a run and then replacing them for the remainder. As an example, for a three mile run the orthotics would be removed for a half mile then placed back in for the remaining 2.5 miles. This was gradually increased each week until she was able to comfortably run without them. The same was done for the motion control shoes but in a slower manner. I advise using the 10% rule. Each week mileage is increased wearing the minimalist shoe by 10%. Again, the new shoe is worn first and the run is completed in the traditional shoe. This can sometimes take up to 6-8 weeks or more depending on the level of running a person is doing before the complete transition is made. Many times I tell the patient it takes 3 months to safely transition. Remember, three months can be a blink of an eye in the whole scheme of things as many patients present to me with years of pain.
Of course what I am about to share is anecdotal. I realize that. However, this is a two year example of the changes that can occur to an adults foot that results from strengthening the postural muscles of the foot, specifically the abdcutor hallucis muscle. This is not the direct result of simply wearing a minimalist shoe. This is the result of what happens when you stress the foot and let it work the way it was intended to and become stronger. It has not relied on external support and adapted to the stresses placed upon it. The studies that are currently being published share weeks or sometimes a few months of results. This is a 2 year example. My colleagues and I are also submitting for publication a 6 month study that will show objective results of a similar finding. Let’s see what happens to the foot when you do not rely on orthotics and motion control shoes.
PLEASE DO NOTE THE INDIVIDUAL IN THESE PHOTOS WAS INSTRUCTED TO BEAR FULL WEIGHT TO THE FOOT AND ALLOW THE ARCH TO REST IN A RELAXED POSITION.
Side View
A side view of the foot demonstrates a mild increase in the height of the medial longitudinal arch. It is not possible for me to measure the hight change as the images were not taken from a set distance but one can see the increase in curvature of the arch.
To demonstrate the change, this color fill was added to shoe the increased curvature or height of the medial longitudinal arch.
Heel Alignment
The below pictures shows the improvement in the alignment if the heel bone known as the calcaneous. You can see in 2012 the calcaneous was more everted or slanted inward as a result of a weak abductor hallucis muscle which leads to a collapse of the medial longitudinal arch. In 2014 the calcaneous is now more rectus or vertically orientated. This is a result of a stronger abductor hallucis muscle pulling and shortening between the great toe and heel bone which improves the arch and straightens the heel or calcaneous bone.
“Outward Toes”
Next is an example of what clinicians refer to as the “too many toes sign”. When viewing the foot again from a posterior or “behind” view we can see in 2012 there were more toes visible on the outside of the foot demonstrating a weak or collapsing arch. In the 2014 image you can see the lateral or outside column of the foot has realigned and the toes are no longer visible.
The Arch
Finally we examine the medial longtitudinal arch. This is the arch of the foot that most people refer to when they say they have a “flat foot“. To simplify, the arch height will be absent or pressed against the floor with a flat foot or in someone with weak foot musculature. Here we can see in 2012 there was very little if any arch height present on the inside of the foot. After 2 and a half years of strengthening the foot and lower extremity musculature in 2014 there is now an increase in arch height.
In summary, this is anecdotal, but these are the changes we are seeing in runners who have transitioned to less of a shoe. These results were seen and described by many in the barefoot running community and now we are exponentially increasing numbers as runners are switching to minimalist type shoes. This is just one documented example of many with photographic evidence that I have seen in my practice. Why is this so significant? Because this is proof that running in a minimalist shoe can strengthen intrinsic foot musculature which can then change the shape of the foot and arch over time. I hope to soon have more similar objective results published!!
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About The Author
Dr. Nick Campitelli
Dr. Campitelli is a podiatrist in Akron, OH specializing in foot and ankle surgery with an interest and enthusiasm for running as well as helping runners with injuries. For the past several years he has been treating running injuries in patients by fixing their form and transitioning them to minimalist shoes. Having treated runners with all types of injuries through conservative measures with orthotics and shoe gear changes to reconstructive foot and ankle surgery, Dr. Campitelli has brought what works best and is most current to his practice as well as the Akron and Cleveland running communities.
I wish I had before photos to show people how much the structure of my feet improved by going barefoot and wearing minimalist shoes like the New Balance Minimus. It is nothing short of remarkable. Fortunately, after decades of intervention for feet with weak intrinsic muscles in the form of arch supports and orthotics that did more than doing nothing to address the underlying issue in many cases exacerbated it, we are now seeing sound thinking prevail as expressed in a recently published papers, ‘The foot core system; a new paradigm for understanding intrinsic foot muscle function’ – Br. J of Sports Medicine dii: 10:1126/bjsports-2013-092690.
I can’t think of any application where the universal mentality that ‘supporting the foot is necessary for a strong foundation’ is causing more adverse effects than in ski boots where the forces in a turn can reach several Gs. In such a situation the foot is preventing from acquiring the intrinsic tension need to oppose the external forces and potentiate the neural processes associated with balance.
Thanks for the comment! Very true!
Hi, I wonder if there has been done any studies on the effect of transverse arch problems? Manny people suffer from Morton’s foot. An impinged nerve is extremely painfull and without anything under the proximal heads of the metatarsals and nerve..I can only imagine the effect.. Manny doc’s speaks of a to short first “ray”/os hallucis as one of the causes to Morton’s foot/swelling of the nerve. (It affects the biomecanics) Maybe a gradual habituation would work, but I still wanna se more effort and research put down to this type of disabling foot problem.
1 comment to the pictures; it would be better to show a pic from the back and down to the feets. It would give a better and more functional picture. ( what we also clearly can see, is that the Tallus has moved to a better alignment, this I think is as much important as looking at the calcaneus in a functional perspective )
This is fantastic! A picture is worth 1000 words & this proves what I’ve believed all along. I also run in NB Minimus, zero drop & have had all injuries & pain subside since the switch. Thanks for sharing!
You’re welcome Sheila!! Thanks for reading!
No, a picture is not worth a 1000 words when you’re talking about health. A study is worth 10^100 words/pictures (though it is still not the final judge on reality, it is still much closer to it then personal experience).
I’d recommend, if you believe this is an actual effect of barefoot running/minimalist shoes, for you to send an email to its major brands/associations, telling them about it. If they have learned anything from the court of law, they will find an imparcial lab to run controlled studies on the health benefits of the minimalism shoes/no shoes.
To conclude up, I’ll just give emphasis to the fact that the court did not rule that there were no health benefits, it ruled that there was no scientific proof of it and, therefore, that any claim to that effect is not valid.
Have a good day.
Well said!
This is a really great information. Thank you! I wonder if incorporating 100-up exercises as designed by Walter George would be helpful?
it also depends on how you are running , heel, midfoot , front ….
barefoot running is an excellent way to help build proper running mechanics , if you are competing for long distance events , barefoot running can be detrimental to your running mechanics .
it depends on your ligaments , tendons and muscles of the foot strength
I’d like to see more research separating out zero drop and minimalist. I think the zero drop and forefoot running is the cause of better foot posture, rather than minimalist
In my experience switching from the minimus to terra kigers, now Topo MT-2’s and Altra lone peaks. i think the drop and shoe structure has more to do with it than the “minimalist” part. That’s my personal experience. A shoe that allows your foot to do what your foot would do if you aren’t wearing a shoe is the idea scenario, if you’re logging high miles the minimus wasn’t great for me, whereas the altra, topo and terra kiger were a little more cushioned but allowed me to strike forward more easily and maintain that non-heel striking stride that contributes to the affect described here
Is she fitter and faster? Because thats all that really matters…
B.A – If your goal is to be fitter and faster, there are many means to that end. However if your goal is to optimize your function and biomechanics- being fitter and faster is irrelevant. Thanks for the article Dr. Nick. I myself have seen many people improve their foot function by changing their footwear choices. Maybe it is all coincidental that my clients who work on rebalancing their muscles, changing their footwear and lessening their dependance on shoes have less pain overall and many are no longer in chronic pain.
Thanks Lauren!!
I find this really hopeful!! I am not a runner (have morton’s neuroma in left foot) and wear orthotics. My feet/ankles look almost identical to the woman’s in the photo. I’m 53. They said it was overpronation and gave me orthotics. Is it possible to strengthen the feet somehow (even if it’s painful to walk in bare feet)? I would love to kiss this condition goodbye! Thank you.
*calcaneus
I’m still not convinced, I’m NO runner in the truest sense. I weight 260 lbs and over weight but trying. I’m running reguarly on the treadmills at the Y and i’m not thinking minimalist shoes are for me…..I await your reply, I just don’t see me losing the cushion to lessen the striking force. These minimalist shoes may be for the elitest running crowd but certainly not for everyone, unless you have research to suggest otherwise for someone obese.
I’m 44 years old and I’d hardly run at all since school, but then took up running in zero drop shoes about 7 years ago. The elitist tag amuses me no end, as I was certainly no athlete when I started (a history of knee pain – now gone). – also, it’s the natural way to run, so I don’t see how that should equate with elite athletes specifically.
You sound like you’re convinced against minimalist running so I’m probably wasting my words, but it’s very much more about the running form than what your feet are doing specifically. If you can ease yourself into it, but running on grass, or the beach for the first few months, and just do 2-300m at a time then you will see results.
@Toby, the elitest tag, i’m glad you are amused but it simply was to demonstrate that i’m NO runner. I’ll try anything once but at the tune of a hundred dollars for new running shoes i’m not so certain. There are hundreds if not thousands of articles directing me to traditional shoes but alas this is my first that suggests minimalist shoes….i’m certain you can understand my reservations, and by the way…you are not wasting your words.
Don’t focus on shoes. Focus on form and training patterns. Find a shoe that then let’s you run. If you can’t run 100 yards barefoot then your form and foot strike patterns are probably negatively effected by years of traditional running shoes which changed your gait. To say you need a supportive shoe to run is not valid. It will take time to switch but all the while worth it. If your not injured then your form is probably fine and has not been impacted by your footwear. Bottom line, our society places way too much emphasis on supporting our arches and wearing “good shoes”. It’s not needed.
Eric, since you asked for more credible sources check out these Harvard pages which explain stuff about biomechanics with relation to running with or without shoes: http://www.barefootrunning.fas.harvard.edu/ . You will see in the slow motion videos including force graphs, that it doesn’t matter if you are wearing shoes with damping and support or not. In fact, because you miss a lot of feedback, flexibility and stability with conventional shoes, you are much more likely to run using a wrong and damaging technique. Plus you will make your feet weaker since they are too restricted to be used.
Try running barefoot, it doesn’t cost you a thing (start slow and short!). Feet, in contrast to shoes, only become stronger and better with time (muscles, bones as well as a thicker sole). Pretty good for a free investment :-).
I would only note that the website you linked to is directly funded by Vibram, so of course they are promoting the barefoot concept: “FUNDING DISCLAIMER: Research presented on this site was funded by Harvard University and, in part, by Vibram USA®.”
While I agree that running barefoot can be beneficial to runners, I think that some caution, or at least clarification, is important.
Hi Eric,
Just to clarify, I’m approx 300lbs, and I would say the only reason I can run is because of barefoot running. Don’t get me wrong it took months before I could do it, without significant aches and pains. But just because it doesn’t hurt when you are running with running shoes doesn’t mean you aren’t damaging yourself. This is analogous to why helmets in American football cause brain damage in the the athletes. Which is to say we are designed with sensors on the outside not on the inside, so just because it doesn’t hurt to hit your head against a wall wearing a football Helmut doesn’t mean you aren’t injuring your brain. its similar with running shoes. Just because you don’t fell pain when you land with a locked knee on your heel in your stride doesn’t mean you aren’t damaging your patella or more generally your knee.
Now there are side effects my feet have changes shape my calves have become enromious and the tendons in my ankles are large.
But for me I had to do a lot of training to strengthen my feet and calves to deal with the strain. Effectively you need to be able to load each leg more specifically each calve with 2-4 times your total body weight, depending on the speed you want to run with. so for me I worked towards feeling reasonably comfortable with a 1000lb load weight per leg.
Sure it was a lot of work getting to the point where I could run comfortably barefoot but it was so worth it. running in shoes feels like work, once you have the legs running barefoot feels more like flying. Like I say a lot of work but definitely worth it.
Minimalist fixed my hate of running and forced me to run with non heal strike tequnique, I had real bad plantar fax cutis and terrible heal pain. 1 1/2 years ago I was buying the recommended shoes, I have transitioned into minimums and love them, look for zero drop and a wide toe box, I thought I had wide feet but I don’t I had wide toes and nothing is better for my feet than free toes. They say in yoga, use your yoga feet
I started running in minimalist shoes 2 to 3 years ago. I didn’t ease into it – I just beat my feet up for a few months and conditioned. Now, I can run 3 to 5 miles in sub 9 minute miles on the street and 7:33 miles on dirt and trails. Oh yeah, and I am 6ft 2in and 230 lbs. So, if you think minimalist shoes aren’t for you due to padding and cushioning, you’re wrong – you’r body isn’t meant to compensate for the drop created by traditional running shoes. Not to mention, the materials the soles are made of often promote a false representation of physical capabilities due to the energy recycle as the sole pushed off the ground and the drop inclines your forward. I thought I would switch to Asics for street running so that I would be able to lessen the impact on my knees. Wrong – nearly immediately developed patellar tendonitis. Rather than relying on the shoe to lesson the impact on your joints, rely on your form. Once I focused on form I became incredibly efficient and the impact on my joints decreased ridiculously – not the impact hits my muscles.
Eric, I understand where you are coming from. Dr. Nick made a good point to focus on form and less on footwear. However, wearing a shoe with a huge heel-toe drop will make it harder to have proper form. There is a zero-drop shoe company called Altra that makes shoes that are minimalist in that they are zero drop and have a wider forefoot, but are cushioned quite a bit, some models have as much cushioning as traditional running shoes. So they’ll help you foster proper mechanics without excessive impact when running on roads or treadmills. You might want to look into them.
So true Jon. Glad you see this as well. It’s not the shoe directly but his he shoe can interfere with someone’s running form. Yes, Altra makes a great running shoe. And the people have spoken. Altra is now the 8th largest running shoe company and has passed Adidas. Not bat for a 3 year old company.
Don’t think that more cushioning will make the landing softer, though. When measuring forces of gymnasts landing on a mat, they would land harder with a thicker mat. So give a shoe more cushioning and you will try and land harder because your feet will want to have stability. It will also reduce feedback. So more cushioning will basically introduce a larger amount of handicap when trying to run a proper, injury-free form.
I was in a similar situation when I started wearing minimalist shoes (Merrell Trail Gloves for $80 on Amazon). I was ~210 pounds (only 5’6″), not at ALL a runner. I’m still not very fit (can’t run more than half a mile without stopping), but I love the zero-drop Merrells and would wear them all the time if I could (unfortunately need traditional dress shoes at work).
At any rate, I’m down to 162 pounds and feeling great overall. That’s obviously not because of the footwear (I’ve made a lot of changes to my eating and exercising habits), but they are working out great for me despite the fact that I’m not an “elite” athlete.
Also, minimalist footwear such as the New Balance go on sale pretty frequently at Joe’s New Balance Outlet. They can easily be had for less than $50. I watch for sales to be posted on the community deals site Slickdeals.net.
I’m 30-year-old overweight female, 5’6″ and weighing 260 lbs. I had a severe flat foot diagnosis before I purchased my first Vibram Fivefingers in 2011. Today, three years later, I have normal arcs in my feet according to my physician, and no crippling pain in my ankles, knees or lower back that I had with normal shoes, _despite_ the fact that I’ve been overweight all the times. I couldn’t run with normal shoes, but Vibrams combined with forefoot striking, I can easily run two miles or more without stopping, despite the weight 😉
Can you give some details regarding any specific strengthening that you did for the intrinsic foot muscles or was this purely the result of the footwear change when running?
Also, do you have any experience of the same presentation with the addition of hallux valgus (with pain)? And reccomendations re footwear or potential for foot posture modification in high impact training?
Most ludicrous article, baseless and tactless article I have ever seen. This doesn’t even quantify as research by your complete lack of having a control group vs study group? What were your exclusion criteria. Utter and complete rubbish. Provide a relevant article for publication , such as having more than one person in the study. Waste of my time!
He states that it is anecdotal. You don’t have to have a control group for it to be research. Anecdotal evidence is at the bottom of the research totem pole but it is still evidence. He shouldn’t have used the word proof, but papers are published all the time that are single studies based on one patient. That is often how other, larger studies get started.
Case studies are legitimate research, also, which is why they are published in medical journals, and he clearly states that this is a case study in the above article.
Thank you. In regards to anecdotal data. The world is our subject and the internet has allowed our access to the subjects in ways we never imagined. It’s changed the way we can gather data and find examples.
Wow. Just wow.
How can anyone think that “before and after” pictures constitute “evidence” in 2014?
Don’t want to be coming at you all technical and stuff, but if someone stands with their feet more adducted then all the “changes” seen here can be replicated. Presto, its a miracle. External rotation moments in the leg against a foot held on the ground by friction create supination moment at the stj.
Might I humbly suggest that a study which uses somewhat more sophisticated measurement techniques like MRI scanners, EMG data, or even a tool like the arch rigidity index might be less prone to wishful thinking and optimistic interpretation?
I’m not sure we can draw any conclusions from these photos as they are clearly not taken from the same angle. Very misleading.
Am I the only one who cringes when a person uses the word ‘proof’ when they mean ‘evidence’?
‘Proof’ is for mathematics and logic, or at least science working in the deductive mode. When you’re arguing for a theory on the basis of empirical observation, the operative word is ‘evidence’. To fail to appreciate the difference is to demonstrate that you don’t really understand how science is done.
Semantics
No, rather an important difference actually.
And even calling this evidence is being slightly generous. It is, as was rightly stated, an anecdote. It’s a shame that after recognising this the author went on to call this anecdote proof.
Thank you to Micgael, Robert and Jeff for being the voice of reason – I was getting close to throwing in the towel on this crap – I have been practicing Podiatric Medicine for almost 20 years and I am so sick of hearing
” but my therapist told me I don’t need orthotics if I strengthen my intrinsic foot muscles ”
Lack of foot structure has more to do with ligaments and bone structure than muscle function, this is the first that I have heard about the abductor hallucis supporting the arch. I’m pretty sure that has a lot more to do with the long and short plantar ligaments – however I clearly do not have the state of the art research skills that this author does.
Stop trying to lump all foot conditions and foot orthotics together – properly designed and applied foot orthoses improve foot and lower extremity alignment and mechanics, POINT FINAL, even and especially in SKI BOOTS, David MacPhail!!
Gord, here’s a suggestion. When you are aligning the lower extremities pay close attention to where CoP ends up in relation Snow Reaction force underfoot at the inside edge of the outside ski. If there is an offset between the two forces there will be an unbalanced moment of force across the STJ and through torque conversion a corresponding unbalanced vertical axial moment of force acting on the tibia at the knee joint against a well stabilized femur. All you need is an instantaneous peak force, say from a slipping ski catching on an ice formation, and guess what could happen? I’d love to see your alignment protocol.
David.
You are perhaps, somewhat overstating overstating the case there. The Cop will move constantly and more importantly the vector of force moves constantly. Realistically there is always an “unbalanced moment of for force” across the sub Talar axis in dynamic function if you consider grf in isolation. The trick is to ensure that the moments required of the tensile structures to to balance the grf moments remain within the elastic zone of their load deformation curves. That’s achievable.
David thanks for your comment, I’m glad you’ve come out to play – it has been years since I first heard of you and your “interesting” theories.
Your response to my comment seems well rehearsed and in fact I’m pretty sure it is cut and pasted from elsewhere as you stated the same thing WORD for WORD in a response on your own blog to a Chiropractor and Ski instructor named Stu.
I have no interest in Jousting with you here on a comments forum but would love to some time have the opportunity to speak in person – for, I’m sure we could entertain ourselves with witty banter over beers for many days.
I believe that when it comes to ski boots that we actually share many of the same Philosophies regarding kinetic chain freedom, however when it comes to what you call “arch supports” in conjunction with orthotics
( a term that I find embarrassing and illuminates a gross misunderstanding of foot function when used in serious biomechanical discussions ) – I prefer to use the term plantar biomechanical interventions or at least foot orthoses / orthosis. I surely hope that you were not implying that foot orthoses in ski boots can be DIRECTLY linked as the causative factor in ACL injuries while skiing??
Anyhoo – I digress, I look forward to reading up on all of your blog posts shortly to get a fuller understanding of where you are coming from.
BTW – what ever happened to the ski boot you were developing with Pod and Head / Tyrolia
( ? my facts may be foggy ) – I heard much about it from several insiders in the late 90’s and then – poof the Tyrolia “fischer price” boot emerged instead.
Cheers – look forward to perhaps meeting the next time I’m in Whistler.
Robert,
Journal of The Royal Society Interface
rsif.royalsocietypublishing.org
Published 29 January 2014 doi: 1100..11009988//rrssiiff..22001133..11118888
J. R. Soc. Interface 6 April 2014 vol. 11 no. 93 20131188
Intrinsic foot muscles have the capacity
to control deformation of the
longitudinal arch
Luke A. Kelly1,2, Andrew G. Cresswell1, Sebastien Racinais1,2,
Rodney Whiteley2 and Glen Lichtwark1⇑
I am a 52 yr. old male and I have been running since I was 12. I have battled plantar fascitis on and off for years. I wear super feet in all my shoes. I started doing CrossFit about a year ago and I tried to switch to a zero drop shoe (Reebok Nano) but I keep getting injuries. Mostly plantar problems but also Achilles injuries as well as others. Are these shoes good for CrossFit? Or am I just to old and beat up to make this switch I have run in Saucony Triumphs for years.
If you keep getting injuries, you’re doing something wrong. Being 52 probably doesn’t mean you can’t change to a different style of running but does mean your body will take longer to adapt, especially if you you have a history of injuries to TA and PF. Perhaps a longer, gentler transition period…
Do what’s comfortable.
I’m glad I was turned on to this blog. As a Podiatrist, I utilize orthotics daily as a means of reducing forces that contribute to painful conditions in my patients. Many patients, especially factory workers, need an orthotic to support their foot, decrease strain of plantar fascia and tibialis posterior, reduce stress on the sinus tarsi, and off-load metatarsals.
That being said, I believe that there is a population of active individuals who may have the potential to reduce their need for orthotics, and bulky running shoes. I think, as Dr. Nick outlined, the transition has to be gradual, considering various factors such as length of runs, running surfaces, and running cadence. There is no substitute for good form.
I have myself transitioned gradually away from motion control shoes and custom orthotics to a minimalist shoe (Merrill), for some of my activities. I did not go directly into zero drop, I started with Nike Free, but for me, that was a huge leap.
Has my calcaneal stance position improved, do I have more of an arch than I did? I don’t know, don’t think so. For static standing, or for longer runs, I still need more support to prevent foot pain.
I am interested to know opinions on Chi running, and especially the Galloway method. I have been recommending this to my patients, as I believe one way to prevent foot pain when running is to eliminate the slow, labored jogging and substitute a faster cadence, with a longer stride combined with interposed walking.
Thanks, look forward to following along, and learning a bit.
What about those of us with overly high arches with minimal pronation? I’m having a time of it deciding on more of a minimal with orthotics or a more stable shoe without. Minimal shoes alone don’t feel good. I also teach yoga so am barefoot a good deal of the time.
I have just switched to invo8s bare xf trainers for cross training and strength training, I have the opposite problem to the lady above, in that I have high arches. As I danced for years, always in bare feet, I am preferring my new trainers a lot, and really do feel the difference, but Do you know if there is any research on this? Im not a runner, but don’t want barefoot and the lack of support to worsen my ankles – I presume her improvements are a result of better posture and running position etc.
These pictures can be taken quite easily by positioning the foot differently. What about for those who DO NOT run? What about the evidence that bare foot running technique can actually injure u further if you have excessive pronation or supination?
…and of course – what about arch supports that are flexible and trigger more of a neurological response than a ‘dumb’ stiff/rigid support making the foot ‘lazy’ without engaging intrinsic or extrinsic muscles?
Nature for the foot to be natural needs to be grass, turf, sand , etc…..NOT CONCRETE.
Let’s not all be sold on gimmick and remember to do things case by case.
Well said Bob….. I fully agree. Faaar too often people apply a one solution fits all approach to the human body in general. Bravo!
I remember being yell at as a child, to put my shoes on… Never did and still do not….. My Hubby yells at me to put shoes on… So now I can show him this article, and say Ha it’s good for you, why don’t you take your shoes off!!!! Thank you…. I am a runner too…. But my Issues are with my knees….. But I know a few people who can benefit from this article…. 🙂
Will minimalist shoes help for severe Morton neuroma? At the moment I have wide sauconys with special inners…
The only reason for inserts is to splay the metatarsal bones apart. So if there is no neuroma pad, the inserts are not needed. The Altra running shoe is a great wide shoe that helps. Thanks!!
Dr. Nick
Regarding Neuromas – this is what I learned about them and implemented as a perminant solution along with barefoot and minimalist Huerachy sandals. https://hsd.infusionsoft.com/go/offer/elenier/
Minimalist shoes are controversial but I can’t argue with my personal results: better time, shorter recovery and no more dead toenails. Everybody focuses on the lack of cushioning, but the problem is that the cushioning encourage poor form.
I tried to transition to more minimalist shoes and ended up in PT for knee, foot and hip pain/problems. My initial transition was from the most supportive Asics to less supportive….didn’t think of trying to divide my runs up. My PT recommended Super Feet and a very supportive running shoe. I still wear my nanos for most crossfit activities and lifting (or just take my shoes off). I switch to supportive running shoes for running. I used to have aching pain after any kind of jumping (box jumps, speed rope…even wall balls), which would subside after 5 mins or so. Haven’t had that in a while now. I roll my feet on a lacrosse ball and do yoga now also. Not sure I will ever risk running in nanos, though!
Enough already with selling “miracle” minimalist shoes and books extolling their virtues. The barefoot revolution is dead and gone. How many dusty pairs of barely used VFF’s sit in closets?
I don’t wear running shoes all day. As a matter of fact, I wear running shoes about 1/24th of each day. My foot shape is probably not going to change if I wear business oxfords, with chunky heels for 9 hours a day and minimalist shoes for 1 hour. At least you correctly stated your study is anecdotal rather than scientific fact.
You should not be wearing business oxfords with chunky heels for nine hours a day.
What most people in the footwear industry do not seem to realize is that the days of making claims based on thin air are fast disappearing. This includes sellers of insoles who are making questionable claims pertaining to the ability of their products to improve foot function. The basic mechanism of human locomotion is alternating single limbs support. The process involves establishing a dynamically balanced base of support on one limb from which to move to establish a dynamically balanced base of support on the other limb. ‘Dynamically balanced’ in this context implies simultaneous neuromuscular mediated balance of the moments of force in all 3 degrees of freedom in the lower limb, something that always happens in barefoot unless a person has pathologies so serious they are bedridden in which case the issue is moot. If footwear diminishes this process then it can be argued that it has a negative impact on balance and acceleration. Today’s technologies are fast making it possible to not only monitor the affect of footwear and insoles on processes of balance and acceleration in real time in real life circumstances but also determine what the subject had for breakfast 3 days ago and whether he or she suffers from indigestion. Here are a few examples of what to expect.
Vibram FiveFingers Barefoot Running Shoes Class Action Lawsuit
http://www.topclassactions.com/lawsuit-settlements/lawsuit-news/2171-vibram-fivefingers-barefoot-running-shoes-class-action-lawsuit/
Skechers Class Action Lawsuit Shape-Ups – Business Insider
http://www.businessinsider.com/skechers-class-action-lawsuit-shape-ups-2013-5
Reebok pays $25 million to settle EasyTone lawsuit | GlobalPost
http://www.globalpost.com/dispatch/news/regions/americas/united-states/110928/reebok-settles-easytone-lawsuit-ftc
David,
I would love to agree with you. I’d love to live in a world where making claims based on thin air are disappearing. Sadly however, reading this thread in general, and your posts in particular give me little hope of that. Claims like the abductor hallucis strengthening the arch (Dr Campitelli), and your slightly hilarious claim that the forces in the foot are always balanced when running barefoot (a clue, the forces across the sub talar axis are always balanced, period) give me no hope that your prediction of questionable claims are destined to disappear any time soon.
It never ceases to amaze me when people deplore the lack of evidence or support for something (generally incorrectly) then proceed to make extravagant claims which have far less support, such as the claim that barefoot running strengthens the intrinsic muscles of the foot more than shod running. Presumably we are to accept that hypothesis without question or evidence? Because that hypothesis HAS been tested, a few times, and that is certainly not what they found.
Here http://www.ncbi.nlm.nih.gov/pubmed/20880486?dopt=Abstract
or here http://www.ncbi.nlm.nih.gov/pubmed/22715143?dopt=Abstract
or here http://www.abstractsonline.com/Plan/ViewAbstract.aspx?sKey=cbfac0c5-f6e7-4803-8d01-2074170029ab&cKey=3c13a950-7dcc-4c9b-ba27-5dd89d5a5881&mKey={FCDB1C1C-280A-4DF1-95F8-2DAA9AB6A8BE}
I could go on but you get the point.
Robert, the fact that you omitted the word ‘dynamic’ from balance is telling. Do you think postural responses are mediated by levitation? At the very least I get a good laugh from some of the absurd claims made for custom insoles and orthotics. There is real benefit for me because laughter really is the best form of medicine.
Give this man a medal. NOW
I’ve been wearing Five Finger shoes full time now for almost 3 years. Normal shoes just feel weird at this stage.
Out of curiosity….did she loose weight over the two year?. I have personally seen a change in “foot posture” in those who have lost a significant amount of weight. I would also love to see pictures with knee and hip angles. Because your foot posture can “go up the chain” and affect everything above. Great article!
Any insight on how minimalist shoes could help with bunions if the arch, outward toes and the heel position are corrected?
No evidence that it would. We know that insoles can affect a change in foot posture and we know that insoles don’t affect the development of Juvenile hallux valgus.
Orthoses in relation to Bunions or as its known HAV (Hallax AbductoVaglus deformity) orthoses work by slowing down the condition, not correcting the condition, surgical correction by a podiatric or orthopaedic surgeon is the only way to correct and the deformity
Nick, I have been having pain for over a year that has worsened the past few months behind my medial malleolus and feel confident after getting help from my athletic trainer that it is an issue of a tight tibialis posterior. I run 70-80 miles/week and at times rely on a calf sleeve and a 1/8” medial heel wedge just to make it through my runs. I also find relief by running on the right side of the road where it curves down, which shortens that tendon and decreases the pull I feel on it. My arches are just a little higher than normal. I’ve recently started arch strengthening exercises at my AT’s suggestion. You’d think though, with a normal-high arch I wouldn’t need arch strengthening. So I am a little confused. I am contemplating making the transition to zero-drop footwear after my collegiate eligibility runs out this summer. Does it sound like someone like me could benefit from the foot strengthening minimalist or zero drop footwear would bring?
The problem is most runners just run. For a runner who just runs…I think strengthening the muscles in the foot is appropriate and will solve a lot of problems…as in this case study. But for a runner who cross trains and includes the appropriate strength training regimen into their program, I think the right shoe or orthotics can make a huge difference. I have anecdotal evidence that orthotics have allowed people to continue running for years when they might not have otherwise been able to. I have a client that fits that description and my orthotics have helped me tremendously. But like I said, we are both physically strong and have a very diverse training program compared to most runners who are very one dimensional in their training. That, I think, is the real issue.
And I definitely do not believe that barefoot or minimalist shoe running is the cureall for ailments related to running. It just brings on a different set of injuries. If it’s not broke, don’t fix it. It’s whatever works for you.
David
Well, we have that in common. For a real hoot, I recommend you look to the work of Dr Rothbart, who claims his insoles cure everything from infertility to droopy eyelids. That, however, is neither here nor there. I can’t help noticing that your response to the issue at hand (whether barefoot running increases arch height by strengthening intrinsic musculature) is to to question claims made by other people about other things.
Since you, like I, demand good evidence for strong claims, whats your evidence that
A: Barefoot running strengthens intrinsic muscles and
B: strengthening intrinsic muscles changes foot posture.
I’ve provided evidence, research based evidence, to the contrary. Whats your evidence that it does? Do you have any besides opinion?
Robert, I am not convinced that bare foot running per se will strengthen intrinsic foot muscles. I preferr a structured approach that uses exercises like the short foot in conjunction with monitoring of progress with quantifiable metrics. Here’s a link to a very interesting paper. Note that the study found that the foot will continue to gain strength up to 150% of body weight.
Journal of The Royal Society Interface
rsif.royalsocietypublishing.org
Published 29 January 2014 doi: 1100..11009988//rrssiiff..22001133..11118888
J. R. Soc. Interface 6 April 2014 vol. 11 no. 93 20131188
Intrinsic foot muscles have the capacity
to control deformation of the
longitudinal arch
Luke A. Kelly1,2, Andrew G. Cresswell1, Sebastien Racinais1,2,
Rodney Whiteley2 and Glen Lichtwark1⇑
I wish that had been my experience, unfortunately I had the opposite experience. I transitioned slowly over the course of a year (walking first then short runs). I walked and ran barefoot a lot as a child so didn’t think I’d have any issues.
After about a year I started to get pain on the ball of my foot and it got worse over time till I couldn’t walk without pain. I noticed I’d developed a callous on the ball of both feet and that my feet looked flatter. Indeed when I went to the podiatrist he told me the second and third metatarsals on both feet had dropped and the pain was caused by the landing force of my footstrike on the heads of both metatarsals.
I’ve been running in shoes again for a few years now and it’s taken this long for the damage to be undone.
Robert,
Really enjoyed your contribution to this post. Like you, I could not see the value in level 6 anecdotal evidence. In saying this, as a marketing tool and article like this holds much more value as it is far more palatable to the consumer than a well structured systematic review.
I was horrified to think that anyone would suggest that a hypermobile pes planus foot with a valgus rear foot would be sent to barefoot run. I was also disappointed to see a self proclaimed professional talking about abductor hallicus as the be all and end all for arch support!
Nick, I understand your article was presented with good intention, but are you creating more problems than you’re solving with this sort of literature?
Thank you, Dr. Nick. The willPower Method® is a barefoot exercise program in which we train the full body while barefoot. We practice foot specific exercises, and then apply them during full-body movement. I’ve been developing this program for 14 years. It’s spectacular to have some evidence based research that validates all that we do. As always, Dr. Nick… you ROCK.
Wow Stacey, you are preaching to the choir. I am going to check out your web site. I am trying to get someone interested in developing a program like yours for sports like skiing and skating for the science based footwear technology I spent 35 years developing.
Great case study. It’s not often you see flexible valgus feet especially after wearing orthotics for years. Not only changing the shoes and following the 10% rule, I’m curious if she changed her stride, or took on a more minimalist or pose method stride as she transitioned shoes. Also did she do any rehab like short foot or foot dialing to train the arches during the hours while she was not wearing these shoes. Was any rehab integrated to prevent overuse injuries? Thanks for sharing this case observation!
I have had a similar experience to your subject, however coming at the arch problem from the opposite direction.send a song child I have been in custom built orthotics to support a very high arch,however this left my feet unable to go even half a mile without arch supports and supporting shoes. Barefoot or sandals we’re completely out for most of my life. At 42 years old I decided maybe I could change things, it has taken me quite a few years to migrate away from all of the intrusive shoes and supports however today I am able to run 7 to 10 miles in non supporting relatively minimalist shoes and I almost never use orthotics anymore.
Insightful and hopeful research. Have you researched only the runners? It would be interesting (and possibly easier from the implementation perspective) to study a transition to a minimalist shoe among non-runners. I understand that the results are contingent on physical activity, so simply wearing minimalist shoes will probably not be as successful. What about walking, exercising in a gym, etc. Would be great to hear your thoughts on that.
Hi Dr. Nick, this is potential revelatory to me. I am 26 and have a chronic bunion (think a 50 year old’s). I had custom insoles made 9 months ago; have been wearing them with Asics shoes and doing regular intensive exercise (jumps, wall climbs, heavy conditioning and flow). The bunions have worsened rapidly and I am at my wit’s end. Your case study didn’t have bunions but is it something you might recommend too? (i.e. the slow transition to something like the New Balance minimus) Or are bunions different from that which your case study had corrected? Thanks very much!
Just wonder what you all, if you are familiar to them, think of the Masai Barefoot Technology/MBT shoes? I wore this kind of shoes at least 8 hrs a day at work for a couple of months, most likely being the cause for PF requiring the use of sports tape for any barefoot exercise (I train taekwon-do). After changing back to “normal” footwear the PF gradually disappeared without any PT or other intervention. Your thoughts?
Kristin – MBT shoes are a completely different animal than the zero drop shoes that Dr.Nick and others are referring to. The MBT has a very soft heel and aggressive toe rocker which effectively makes a negative heel”.
Your heel sits lower than your forefoot essentially. The standard shoe that most people wear other than the typical “sneaker” usually have some sort of elevation at the heel. The zero drop running shoes here have just that – zero drop in height from heel to forefoot.
If one does not have an extremely flexible calf muscle group or better than normal ankle dorsiflexion ( toes moving towards the shin ) it is extremely likely that they will get PF, in fact if the ankle is limited or calves are tight I would be so bold as to say one would be guaranteed to get PF, Shin splints and or Achillies tendinitis, possibly a combination of the three.
Hope this answers your question.
G!
This would apply to any “negative heel” style / type shoe including shape ups etc
I was around when the Earth Shoe was promoted. My recollection is that the marketing pitch went something like, A Danish woman walking in wet sand one day was thinking how good it felt. Then she had an epiphany (as in $$$$$$$); humans were deigned to walk with a negative heel! That explained why walking on wet sand felt better than walking on concrete. The solution? The negative heel Earth shoe.” I got sucked in and bought a pair. Worse, I wore them. I developed such terrible inflammation under my calcaneus that I had to walk with my heels off the ground for about a year. As I recall it took years to completely clear up.
Earth shoes saved my feet. Professional double bassist on my feet all day. Got plantar fasciitis in grad school, wore earth shoes, went away. Shoes were the only thing I changed in my habits.
This could have been a picture of my feet. Been doing the minimalist walking and running for 1,5 years. After three months, I stopped my monthly visit to the chiropractor. I have discovered many other benefits, but ending 20 years of back pain, must be the top scorer.
Oh, my toes are starting to spread also.
Weak feet is the issue here. So a question to all sceptic readers. What other part of your weak body, would you wrap in the same way as with a stiff unflexible heal drop shoe?
Non, is my answer. Unless it was a broken bone!!!
I would like to know if this would work on someone who was born flat footed as I was? It hurts me to wear any type of arch support and as I get older it’s starting to take a tole on my knees and back. I’m not a runner and don’t like to run either. My excersize is karate, course we have to go bare footed.
I’m not so sure this is for everyone, either. I have feet and ankles almost identical to the first photo. I didn’t have orthotics until about a year ago, and that was only because my feet got worse and worse until I started physically bruising – and that’s on top of the other sorts of crazy leg/hip/body pain that comes with flat feet. I am very much a lover of bare feet. When I get home the socks come off instantly. My favourite thing is cheap sandals in the summer; if not I’m walking in the grass shoe-less.
How is it that over time being so barefoot has made it worse, when you say it should make it better? Or are you strictly talking about running? Because I feel that running outside, on a treadmill, wherever, barefoot, is a dangerous idea. Germs, sharp objects, the works. Even socks can’t escape those things. I feel like those things far outweigh any potential benefits of the naked (feet) running itself.
On top of that, just because this worked for one person does not mean it will work for every person. I really don’t see it working for me, for example. I’ve been running for about 6 years, and only since I’ve gotten orthotics have the pains stopped and my feet have actually gotten better on their own. I still stand funny without them, but not as awful as I had a year ago. I can see a difference. They do not over-correct, and I do not rely on them for just living in my house. But I do rely on them for outdoor walking and running, if I want not to have sore feet… like I had all my life.
I’m not bashing the bare-foot running, but I am questioning it.
Oh, and I do apologize. I should have made this apparent. I do recognize that the article is about minimalist shoes, and not really bare-foot running. However I have run in minimalist shoes and it caused me nothing but issues, and after a few months I threw them out and got orthotics.
There is just to many factors regarding how your foot will react. If you wear minimalistic shoes on asphalt you will weaken your knees.
The best thing to do is just running in the forest or grass regardless what running shoes are you wearing.
Actually Mike your knees will become stronger in response to the stress placed upon them. The surface is irrelevant. A change in surface is far more detrimental then the surface itself. For example if you ran all summer on asphalt and then do a 10 mile run on a grass or softer surface I would hypothesize an overuse injury from the change. The body has to adapt to the softer surface and needs to over time. To make a statement that your knees will weaken is illogical. It’s unfortunate that people are still telling this and being told this. Something to consider is that elite marathon runners are racing 26.2 miles on asphalt in minimalist shoes with no knee issues. I’m generalizing of course but it’s pretty much understood that asphalt in itself is not bad for the knees. That’s an old discussion that doesn’t come up anymore. Thanks for reading!! Love the comments!
Do you have any prove of this statement of yours? To how many runners did they made x-ray/MRI of the knee. Comparing groups of runners on the asphalt, and soft grounds. It would be great to read this kind of studies.
And one more thing, using minimalistic running shoes will brush your hips. The shoes are supposed to minimize the pressure not to increase it. The shoes which do not decompress force, can create HIP ARTHROSCOPY.
Those studies are rubbish.
I have flat feet (they look exactly like the ‘before’ pictures), knee pain, and lower back pain. I already wear reebok nanos when I workout. I don’t run that much, mostly just strength training. Any advice?? Thank you!!
Go to your physician. Make MRI, X-ray. Get professional advice. Have had the same issues. Doctors found spinal stenosis. I will go to operation of my back.
Back bone is linked to all parts of the body, and if the nerve(s) is pinched, It can hurt your legs like hell.
I do not think new shoes will solve your problems.
Mike, thanks for the response. I have been to my doctor numberous times and have had X-rays and a lower back MRI. They didn’t find anything. My doctor told me to refrain from exercising. Which is totally worthless advice in my opinion.. When I’m not being active and exercising is when my back pain is the worst.
It makes total sense to me that my flat feet are connected to my knee and lower back pain. I’m not saying new shoes will solve my problems but I do think that if I could find a way to “correct” my flat feet that it would make a difference.
Jessica, unfortunately, there are dozens of reasons you can have knee and lower back pain, but the fact that you have very flat feet almost definitely has something to do with it. I run, rock climb, and practice crossfit and I used to have terribly flat feet but have strengthened them with posture, proper lifting mechanics and minimalist running and have had good results. Let me know what kind of strength training you do, I might be able to point you toward some good resources.
Yes I do crossfit.
Jessica, a really good resource is MobilityWOD. A very important aspect of crossfit (or any other type of exercise) is mobility and proper form. Something that really helped my arches was the cue of “screw your feet into the floor”, or “knees out” or “Externally rotate the hips” when you do anything – squat, overhead press, deadlift, kettlebell work, etc. When you externally rotate your hips it sets up the foot in a good position and helps keep your arches up, among other things.
MobilityWOD has a number of good videos explaining fixes for many problems, including flat feet. They also work through a number of mobility problems that may be exacerbating or contributing to flat feet including ankle, knee and hip restrictions, as well as soft tissue tightness. If you check it out, when you go to the episode archive, don’t use the filter functions at the top as they only sort the pro episodes. Use the search tool at the top or search the later pages in the episode section and you’ll find some really great stuff. You can find MWOD videos on youtube as well. If you want I can find some of the better videos and link them here but I can’t until Monday as I am working these next few days (long hours, at a hospital).
Also, try talking to your Crossfit coach or even some of the more experienced crossfitters, some might already be pretty knowledgable in some basic mobility techniques to help.
As far as your back goes, it may be related to your flat feet. I have back problems as well (incl. herniated discs) and I found that mobility work on my psoas helped a lot. The psoas (along with the iliacus) is a pretty big muscle running from your lumbar spine, in front of the hips, and attaching to the top of the femur. It is an oft forgotten muscle and is pretty tight in most people and is thought to be an important, yet overlooked component to back pain. MWOD has some information on working the psoas as well.
And the disclaimer: none of this is real medical advice, not intended to treat any conditions, etc. Good luck!
Thanks for all the info Jonathan. I have seen that website before but I will explore it some more. My coaches are very good about mobility. And they have taught me all the things you’ve mentioned. I need to work on going in more often and practicing all of this more. And also being better about doing mobility work everyday from home. I’m just wondering if I should be doing something different with my shoes. Like getting orthotics and then transitioning back to my minimalist shoes..
What type if shoes do you function in when not working out? I see a lot of professionals who wear Dansko shoes which are clogs with a heel and they frequently have lower back pain as a result of the shoes altering the ankle position and the back has to commonest for it.
I mostly wear flats or flip flops. Occasionally high heels when I go out but not that often because they usually hurt.
I have a lot of concerns about this anecdotal “study” This is not a “study” at all it’s a piece of podiatric trickery double talk Photoshoped falsehoods about a person with back pain that is now gone 2 years later. That was her only complaint as far as I could see. The flat foot part were concerns of her podiatrist, not hers. And they want to give credit to her new found arches to ditching her shoes! Did you have a sore back 2 ears ago? Yea me too. So did 80% of America. The photos are tricks. The angle of the camera can make the “two many toes sign” appear better or worse. The calcaneus lines drawn are not consistent with before and after pics. Why do so many people spend so much time and energy trying to fix something that is not broken? Money that’s why. The master engineer that designed or helped evolve our feet did not intend for us to be forefoot first strikers. It’s just the opposite of what we were designed to do anatomically. Our rock hard calcaneus and wonderful biomechanic movements to absorb energy when placing one front in front of the other is the true normal gait. The rest is selling shoes and arch supports. I do recognize the value of well made non-rigid custom inserts to address some foot pathologies, but wearing arches will not make a person develop arches, just like ditching shoes will not make one develop arches. Shoes are to protect us from the environment, they should be comfortable. If the runner runs on hard surfaces they are helpful to absorb impact forces. That’s about all shoes really do for us, the rest is determined by our inherited foot anatomy
Wow.
Just wow. Reading all the negative comments about so-called “anecdotal evidence” that is then summarily dismissed just makes me shake my head. I have been wearing minimalist shoes for several years now and the only evidence *I* need is that my ankle, knee and back problems have disappeared, my feet have actually become SHORTER because the arch re-developed and consequently I feel much better overall.
But your answer, Steve, just takes the cake. One look at the anatomy of the foot should tell you that the heel is NOT made to “absorb” impacts. On the contrary: The impact travels through the posterior chain all the way up to the skull. Some people already linked the Harvard barefoot study. If even THIS does not tell you your claims are completely wrong, it should tell you something about yourself.
Just take a look at barefoot runners in Africa or anywhere else in the world, for that matter. The impact from running is absorbed by the Achilles tendon, the muscles of the thigh and the hip. NOT the heel.
Accusing people of doctoring photos is also telling. It just goes to show that you are of the “It can’t be because it must not be” school. do you have any stakes in firms that produce clunky running shoes or something? Sheesh.
Thank you!
well said
I have a lot of concerns about the mistaken belief that statistical models are science. Just because medical “science” beliefs that it understands these things doesn’t make it so.
From what I can see most of it seems to be based on unproven wise tails.
My favorite unproven medical fallacies are, eating regularly is healthy for you, closely followed by salt being unhealthy and stress being dangerous.
From what I’ve read in this field the nicest thing I can say is that a lot of it reads like the application of mechanical wearing of mechanical systems to biomechanical ones. Which is unjustified, as biomechanical system are dynamic which is to say adapt to conditions. So where as stressing a mechanical system won’t strengthen it stressing a biomechanical one may.
For me my interest in barefoot running was more about increasing bone density and joint stability in my feet than increasing muscle strength. Its one of the reason I used to go on short runs bare foot with 40kg backpack. Because as I’m sure you know in biomecahnical systems even though prolonged periods stress can be debilitating short periods of stress can be invigorating.
Interesting to see the improved integrity of the Achilles in regards to size and pallor. It looks visibly larger and more vascular in the recent pics.
I have been saying this for years finally someone put some, albeit anectdotal, quantitative evedence to the point. I too have experienced the same type of relief from transitioning to minimalist style shoes ~ 6 years ago i started running again i had been an athlete in high school and college and suffered from all kinds of running related ailments causing me to leave my sport. When i began running again the same problems began again. So started trying new running forms and more importantly new shoes went cold turkey with traditional shoes, while not a great idea, it worked for me. A year later my arch had raised, my comfortable shoe size had gone down a size and a half and i was loving life! Feet feeling good running not causing problems! live for minamlism!
Thanks Chris!
Not enough credence is afforded to so called “anecdotal evidence” as if it’s some inferior form of analysis. It’s the only form of analysis as far as I am concerned because it comes directly from practical, real life occurrances. You measured results from real data and have actual results from a real case, so no further qualification is required IMO.
Thanks Larry!!
Hi,
I have extremely flat arches on both feet and suffer excruciating pain of I run without my orthotics and often pick up injuries as a result. I would love to ‘ve able to run in minimalist trainers, do you have any advice as to how I can overcome the pain element?
Many Thanks
Irfan
Tough to answer as here can be many variables involved. My advise would be to look at you training patterns. Run slower and really focus on your form. Get over the pain before you begin running again. If your getting pain every time you run, the it’s the WAY You’re running. Check out http://www.goodformrunning.com
Thanks!
Hi, I just wanted to thank you for the article.
I’m severely flatfooted, with overflexible ankles too, and suffer from shin splints every time I’ve ever tried to take up running for coming on 10 years now, regardless of how gradually I get into it.
I’ve tried minimalist running, and although running felt much more comfortable during the exercise, I did still develop shin splints afterwards. I’m now dealing with a physio, and a chiropodist, both of whom insisted I stop wearing those shoes, despite the issue being no worse while wearing them.
After reading this, I’m much more inclined to just keep to the strengthening exercises given to me for building up the arch, and continuing with minimalist running once I’m able to run 3 miles again, using the transition approach from my current arch supports.
Thanks again.
Well..seems great but i’ve tried this and the only think I’ve get it is periostite. It’s a leg inflammation and so I can’t run anymore because of that.it is now 2 years that I have that.
So yes maybe I can be good for foot but not for the rest of your body..
My feet kill me. I have been using nike free for a couple of years and they seem to help except for my second toe and the tops of my feet. My second toe is longer than my big toe and they are so tender after I run or walk. I’ve lost the toe nails several times. The tops of my feet close to the ankle hurt so much I look like I’m 101 when I walk. Especially first thing in the morning. The first 10 minutes or so of my run/walk is painful, but then it improves (except for my toes).
Do we know if the subject did any strenght and conditioning exercise during those two years, i.e. something that would have for example improved her gluteus mediums strenght such as squats? Any evidence on her knee alignment in functional movements prior vs post to running barefoot? We cannot exclude a possibility that regular running could have had an effect on her ankles alignment regardless of what shoes she was wearing. The more some of my patients run, the stronger they get and achieve better lower limb control in landing, which improves their ankle and knee alignment.
This is a really interesting subject! I’m curious about your note mid-post that she had “knock knees.” Were they really curved femurs, or just internally rotated? Did you take a look at her hip joints to see if hip instability might have been the source of her pronation?
WOW! Those pictures are incredible! I knew there were loads of benefits to wearing minimalist shoes (I wear them constantly – I wear Merell Pace Gloves for work and Vibram Five fingers outside of work), and I knew that minimalist footwear (Vibram Five Fingers) helped correct my husbands flat feet, but we never took any pictures. These are just amazing!
Dr. Nick, Thank you for sharing these results. You and Dr. Nirenberg have inspired me to share my own results. I hope you will check out my blog post reviewing the changes we’ve seen in feet by simply ditching the shoes. The growing body of anecdotal evidence is becoming increasingly convincing. 🙂
Thank you so much Dan!! Would love to read your book!
What if you have strained/sprained ankles?
I have horrible feet, knees, and hips. I am 34 and overweight, even though I try to work out from time to time. I am interested in changing the structure of my feet. I work at a Chiropractor and he constantly tells me I need orthotics but I’ve been hesitant since I don’t want to support my feet, I want to fix them. I would like to know besides running (I can run 3 miles very slowly) are their exercises I can do? Also, lots of people here talk about “form.” How do you go about fixing your form? I have various running shoe stores in my area, but the people that work there all want to sell me the most built up asics, and I don’t want to move to that point yet. I would rather spend a few years trying to fix the problem than giving in. I wish I had known this when I was younger!
Good running form tips can be found here, also check out the video’s there: http://www.goodformrunning.com/ . You can slowly start training your feet by running barefoot using the form tips you see on the previous site, or order minimalistic shoes with a thin flexible sole, no damping and no raised heel. Start slow, build up slow and if you feel pain somewhere let it heal first then adjust your form or build up less fast. Walk barefoot whenever you can, it will all help. Good luck!
Emile,
Thank you very much for your response! I’ve already looked at that site and am getting a bit pumped. I live in the city, so I will have to go for a minimalist shoe. Funny thing is, I am also an archer, and practice Olympic Recurve (where form is everything), and they told me ages ago to go barefoot or minimalist shoe. I shoot barefoot as much as I can. I think this will all tie in together. My sister is also a runner thanks to C25K, but I think I need to focus more on form since she is 10 years younger than me, but maybe we can help each other. I appreciate the feedback.
And to those who are arguing about this being a “study” or “evidence” I think the important thing to remember here is that the big shoe companies probably fund a lot of research. So, maybe go easy on people who have to rely on their own experiences. I’m not saying one is better than the other, but you know what they say, “if the shoe fits…” I am going to personally try to “fix” my feet while I am still able, and who knows, maybe running will actually have more benefits than just helping me to stop over pronate? Like longevity, weight loss, better well-being, etc. Who knows such things?!
PA, if you’d like more science besides this one case study I can recommend the book “Tread Lightly”. A lot of scientific insight into running, evolution and shoes. Available as kindle: http://www.amazon.com/Tread-Lightly-Peter-Larson-ebook/dp/B00885RHR8/ref=sr_1_1?s=digital-text&ie=UTF8&qid=1398260509&sr=1-1&keywords=tread+lightly .
I also live in an urban area and run barefoot whenever I can. I travel a lot and have ran through a lot of cities worldwide, no problems at all.
I think it is really important that people understand the going barefoot alone will not be the cure to their foot issues. It is just one thing that people should do more of to get their feet stronger and it is really important that Dr. Nick is highlighting this important step. However more important than JUST going barefoot or running barefoot is to do exercises that stretch and strengthen the foot and leg muscles. If all someone does is go barefoot, that is not enough AT ALL to remedy the fact that all of their shoe wearing has created a foot that has muscles that are weak and tight and imbalanced. The imbalance of the foot musculature is one that can take quite a bit of work to remedy but with daily diligence it is completely possible. Most of my clients suffer from severe foot issues and they all work on exercises DAILY that both stretch and strengthen their feet. They all have seen remarkable improvements in their whole body as a result. The move to being barefoot is a really gradual one that we assess every few months to see what the improvement in the muscles are. There are about 4-5 exercises that I have sent o drastically improve the function of the foot. If Dr.Nick is okay for me to post the link to the video, I will do that. Otherwise, I am sure if you contact Dr. Nick, myself or another foot specialist, they will guide you to the right direction of exercises to strengthen your foot.
Could you please send me the video? Thanks!
My youtube channel is https://www.youtube.com/channel/UCzHFM22VxtAt4Nq2j0z5z2g. I have a bunch of informational videos (especially my latest one on shoes) with stretches as well as a Sweet Foot Flow. If you are not into yoga just skip over the yoga in this video and JUST do the foot stretches- they are very effective. In the coming months, I will be posting many more videos with additional stretches. Be well.
see my youtube video for foot strengthening exercises -https://www.youtube.com/watch?v=DZ4ikkbQ2RE
also follow Dr. Emily Splichal -http://evidencebasedfitnessacademy.com/faculty.html
Amen Lauren!!
The photo of the before is how my feel look now. I am having a difficult time walking let alone running. Will these barefoot, or minimalist shoes help me also? I have torn ligaments on the medial side, and stressed ligaments on the lateral side. I walk with the aid of orhtotics, and nothing has really improved!
It’s hard to say. One thing I can tell you is orthotics do not do much in regards to controlling the subtalar joint and preventing an ankle sprain. If you truly need to have the subtalar joint controlled, then an ankle foot orthoses or fusion of the joint would be indicted. Orthotics are more of a shotgun approach to a problem. I would think its safe to try functioning without them gradually each day by taking them out for 30 minutes in the morning then put back in for the rest of the day. Increase 30 minutes each week. You’ll know in a matter if a few weeks if it’s making a difference. You have to let the body adapt. Also, keep constant with shoe gear. The body doesn’t like change and will need to adapt every time you change a variable.
I believe those feet are improved from one 2012 to 2014, however if you look at the angles the pictures were taken from (the horizon) this goes some way to make the improvement seem enhanced. The camera should’ve been laid flat on the floor for both shots for a fair comparison. Just my 2 pennies in a fountain that already has a couple of thousand pennies dropped in.
I have been told that I have an inherited, rare foot type called pronation. My foot pain has increased over the past 20 years to the point where I am now in constant pain. It feels as if something is being pinched between my foot bones. I have tried countless orthotics and have been to the podiatrist many times. Is this something that would work for my foot type?
Too hard to give advice over the internet. You may have a sever deformity that needs a surgical fusion or reconstruction. Would need clinical exam and radiographs to discuss more.
I am a first hand example of this. I spent my whole life with “flat feet.” Got ’em from my mom. I had prescription orthotics that I had to put in my shoes. About two years ago someone informed me about minimalist/barefoot running because I complained about knee pain from running. After a few months of barefoot/minimal shoe running I noticed my feet getting stronger and I had a natural arch! I wasn’t expecting this and never read any research that said minimal shoes lead to stronger feet and create arches, but it totally makes sense! This may be early hypothesis and research, but I’m convinced that there is a link.
Thank you for the response!
I don’t know who put these shoe companies in charge, but its all really simple really. If you look at Roman construction it is all done with arches. When weight compresses on them they become stronger, not weaker. What makes them weaker is actually putting a support in the middle because it chances the force distribution. Same thing goes with the “arch” in our feet.
Just by way of adding another testimonial, i transitioned away from traditional shoes over a 2 year period, first occasional short fivefingers runs on concrete and now using Minimus on usual rocky hills trails. Took a while because after 5Fingers i could feel my foot and heel muscles sore. Now, once the transition done my entire body feels so much better, feet and ankle feel super strong. Dr Nick’s writings instinctively seem right. Most of all however its a question of pleasure, ground contact feels so good, it’s renewed my love for running which had been waning before the new shoes.
I also read about this phenomenon in ‘Born to Run’ and if I can remember the text correctly the patients shoe size also dropped several sizes……is this the same as you have seen? As I understand, the arch strengthens, pulling the foot up and the toes closer and making your shoe size different. Would love to hear your findings!
thanks much.
Very interesting study. I have a 15 yr old with feet exactly like your pics. We have spent hundreds of dollars on custom orthotics and “good” shoes. He is not a runner but plays baseball, football, & golf and forever complains of knee, hip and back pain. Would you advise the same slow transition to less shoe in his case?
I switched over to Hokas and swear by them. Yes, my study might be anecdotal but I used to wake up after a 50k run and hobble a bit. Now after running the same distance in my Hokas, I am pain free and recover much faster. It’s night and day. I still like to run in my minimalist shoes for shorter distances but will go to my Hokas for anything longer than 20k.
Thanks David MacPhail & Robert – you had me in stitches!
Merrel actually make some zero drop shoes that can be made to look dressy enough. Problem is the loss of heel means the pants are always going to be marginally to long unless taken up
I want to see a barefoot runner do a Presidential Traverse, then get back to me about the horrors of cushioning.
I love my Inov8’s, but they really don’t have enough protection for running long distances over sharp rocky terrain.
Sometimes you NEED a beefy protective shoe.
Hello Nick. My name’s Gio. I’ve read you article about running with the minimalist shoes and to be honest I’m very very happy about what you said. I got flat feet but inside of me, even if all of the doctors told that is impossible I was always sure that I can make them right and your article gives me the strength to start with a better motivation and believe more in what I’m doing. May I ask you some question so I can start to work on my feet with a better knowledge. 1: What kind of exercise can I do when I’m at home or in the gym in order to reinforce my feet and stimulate them to change their shape from flat to normal. 2: Which kind of shoes do I have to use in the everyday life? Do I have to wear the orthotics inside of them or no? Please give me all the tips that I need cause I wanna start with 100% energy and make one of my dream comes true. Thanks in advance Nick. Wish you a really good one.
Thanks for reading!
I haven’t seen your feet so will speak in terms of those who do not have truly pathological flat feet. With that said do not strive to change the structure of your feet or the shape. With regards to strengthening, please refer to this youtube video for a plyometric activity I teach runners. http://youtu.be/DZ4ikkbQ2RE
Another exercise I recommend are simple toe raises. Do them barefoot and try to do them to fatigue. I usually tell all runners to do 100 everyday. Initially not at one time but in increments.
As for shoes this is my favorite question. Think of it this way. Our feet were not designed to be in shoes. They were meant to work with nothing between them and the ground. So what ever shoe you choose to wear in everyday life, it’s sole function is to protect your foot from the external environment. There is no reason to support the foot unless you have a pathologic foot that has arthritis or severe deformity. If you’re currently wearing orhtotics you will need to gradually transition out of them by going without them an hour each day for a week then two hours a day etc until they are no longer needed. Always start day without then put back in for the rest of the day. The same goes for transitioning shoes.
Hope this helps!!
In the early 1990s, the Human Performance Laboratory at the University of Calgary was doing studies that found that anything placed on the foot, even a sock ,caused a degree of dysfunction. Prior to his recent retirement Benno Nigg, who ran HPL, criticized orthotics as lacking in scientific evidence. In a NY Times article, ‘Close Look at Orthotics Raises a Welter of Doubts’, Nigg said in relation to flat feet, “Arches are an evolutionary remnant, needed by primates that gripped trees with their feet. Since we don’t do that (grip trees) anymore, we don’t really need arch”.
http://www.nytimes.com/2011/01/18/health/nutrition/18best.html?pagewanted=all&_r=0
Well David, to that comment I would ask how many years of practical clinical experience do you and Dr Nigg have. It’s all well and good to do controlled studies with relatively limited sample sizes.
The rest of us in the real world that see patients with foot pathologies on a day to day basis might have a little more practical experience with feet and a lot more positive experience with FUNCTIONAL foot orthoses albeit anecdotal evidence – but hey, anecdotal evidence seems to be pretty satisfactory for this crowd.
Have you ever seen a flexible pes planus that has pre ulcerative callus with aseptic tissue necrosis on the plantar aspect of the navicular because it is fully weight bearing? I have, it’s not pretty and it hurts like hell so Well David to that comment I would ask how many years of practical clinical experience do you and Dr Nigg have. It’s all well and good to do controlled studies with relatively limited sample sizes.
The rest of us in the real world that see patients with foot pathologies on a day to day basis might have a little more practical experience with feet and a lot more positive experience with FUNCTIONAL foot orthoses albeit anecdotal evidence – but hey, anecdotal evidence seems to be pretty satisfactory for this crowd.
Have you ever seen a flexible pes planus that has pre ulcerative callus on the plantar aspect of the navicular because it is fully weight bearing?
I have, it’s not pretty and it hurts like hell, so don’t try to tell me that the arch is a vestige of our primate days gone by.
I think the thing YOU need to understand David, is that just because something may work for a small sample of your friends and people that you have run across over the years or a small research sample over a short sampling period doesn’t mean that it applies to the entire global population.
Try getting your head out of books and do some real time hands on research outside of the lab or articles on the internet, there’s a big wide world out there.
There’s no such thing as a one size fits all or one theory saves all approach to physical medicine.
Please stop picking and choising the research that you find that supports your own theories and ignoring those that do not to support your own brand of pseudo science.
Was there a point to your rant? If so I missed it.
I guess that in itself speaks volumes David.
Spare me. Talk about extremes. One podiatrist had the gall to write an article in which he claimed that barefoot was completely unnatural and that man was never meant to walk barefoot. Another podiatrist wrote an article on his orthotics where claims that for the skiing the foot functions best when its joints are completely immobilized. Translation: the foot functions best when it is made dysfunctional. The heart functions best when it is arrested. I doubt that anyone on this thread is making comments that pertain to people with extreme foot pathologies. I posted Niggs comments. If you don’t agree with Nigg that’s your prerogative. But it doesn’t make you right. The rest of us have the right to disagree with you. There is a growing movement questioning the science of lack of same behind orthotics. Get used to it.
Clearly attempting to reason with someone who’s blog is a “Manifesto” is pointless – shall we agree to disagree and part on friendly terms?
A manifesto is a published verbal declaration of the intentions, motives, or views of the issuer, be it an individual, group, political party or government.
Somewhat amusing comment by Gord. Even more amusing is that Gord continues to read and comment. My blog must be interesting enough to read for the comments to continue. I don’t quite get it. These posts are about not remaining status quo. I’ve been introducing this concept into my practice now for 4 years, have evidence based research as well as countless anecdotal examples to continue to do this. The ACSM has even recognized this concept as the new way to recommend shoes. The old paradigm of fitting by foot type and arch type as well as controlling pronation has been tested and does not work. Controlling pronation is analogous to eating more carbs to lose weight. It was an attempt which failed and has been proven. It just takes time to get the rest of the world to change. This will all work itself out. People will choose to run this way or not. And, right now a lot of people are. So much in fact the shoe industry has changed. Is that proof in itself? A billion dollar industry who influenced what we told our patients to wear with no evidence based research has changed the construct of the running shoe. You don’t have to believe me, just look at what’s happening to the shoe industry as well as what us being published. I know change is tough, but it happens as we move on. If we didn’t change we sometimes wouldn’t advance.
I do not have an issue with your blog Nick, I think it is great, I don’t disagree with change, change is good. I’m not closed minded at all and I certainly have an issue with the orthotic industry as it exists.
I’m commenting because I don’t like it when people jump on a band wagon and reactively go to the opposite extreme. There has to be some middle ground.
Also for the Record I am not a PODIATRIST in your sense of the word I am a Canadian trained Chiropodist practicing Podiatric Medicine and specializing in pathomechanics.
The problem I have is that there are a lot of Shit orthoses out there being dispensed by people that have NO business touching feet. There is a huge backlash against orthoses from people that make wrong assumptions of what an orthosis is actually supposed to do – most foot orthoses are excessively rigid and under contoured by mass production labs.
It is irresponsible to white wash all foot orthoses as bad, many people have been helped by foot orthoses as I’m sure there are many that have been hindered. Is there scientific proof that foot orthoses do what we think they do – NO, most of the evidence is anecdotal ( but there is a Lot of it ) in fact it is easier to prove that they don’t do what we expect them to do
( because most orthoses are poorly conceived and implemented )
Is traditional footwear bad – YES, was the foot designed to be shod – NO. The oversight when this argument is brought up ( ie 10,000 years ago man was barefoot… blah blah blah) is that the foot was not designed to be used for most of it’s lifespan on hard flat concrete / modern society.
It is a mobile adaptor and a rigid lever. If it is adapting to the modern surface by collapsing how can it become a rigid lever.
I’m not saying that orthotics are for everybody nor do I believe that they should be the sole treatment. I stopped recommending rigid shoes long ago, everyone I see gets stretching exercises, not orthoses and I have started ( thanks to this blog ) giving out short foot strengthening exercises.
Foot orthoses should not act as a rigid brace, their function is to be a dynamic assist that absorbs the kinetic energy put into it and use it to help prevent the system from over shooting it’s anatomical limit. They should act as a proprioceptive assist in gently guiding the foot along its gait path to enhance natural forward motion. IMO
There are many different foot types and many different body types out there.
My point is there is no one solution to fixing foot and MSK problems and we can’t just throw out the baby with the bath water here. I’m afraid that many people will read into this that the solution to fixing their feet is running in minimalist shoes or barefoot and abandon most other methods of treatment.
Cheers!
Gord the issue is that you are hopelessly biased. That aside, I could care less what you think. So let’s leave it that.
Actually Nick, I think Gord is referring to my blog which I call The Skier’s Manifesto. In this context, manifesto is a declaration for change, in this case, change in the ski industry. The purpose of my blog is to provide interested parties with a information. This issue aside, one has to wonder why Gord keeps coming back to this thread if he disagrees with the agenda. When the minimalist shoe movement started the backlash from podiatrists like Gord was predictable. Portraying the human lower limbs as an anatomical disaster is a source of revenue as is aggressively attacking anyone who has the audacity to suggest that foot function can be improved with exercises or, worse, (Lord have mercy) that the human foot was designed to be stressed. It is laughable to encounter situations where a scientist has written papers in which they discuss how the plantar fascia and intrinsic muscles support the arch of the foot in a compression-tension mechanism then do a 180 degree about face after being retained by a company that makes orthotics then claim that tension in the planter fascia should be minimized because it can cause injury and that orthotics are protective. Seriously? If this were correct, how did humans survive for millions of years let alone run after prey?
Again, another incorrect assumption David.
Peace
You have one foot in your mouth Gord. Do you want to go for two? There is study underway on this very issue by some of the most qualified people in the field for a project I am involved with. BTW, I am just the idea guy. Any research is done by academics who are eminently qualified to support their conclusions. So you might want to consider whose position you are disparaging.
How can it have one foot in my mouth if the study is underway and the results have be publishid
Do you even read and let others comments sink in. You don’t hear unless it is music to your ears ( you seem to love the term preaching to the choir ) I’m not disparaging anyone – I just don’t like over generalizeation and vilification of an entire industry based on picking and choosing the research that supports ones position – I believe that is called pseudo science.
I’m willing to hear, I’m willing to change, I don’t see the world as black and white.
If I have one foot in my mouth, you have one in each ear..
Did you even bother reading my response to Dr Nick’s comment in this thread??
So how about we both grow up and let this go?
You could be so kind as to share the names of these top academics and info on this study topic that I touched on resulting in my foot being put in my mouth though.
Peace
Hello, Dr. Nick!
I stumbled across this article, and was intrigued with your findings, because I suffer from some of the same problems your subject did. However, I suffer from mild-moderate scoliosis, and have been doing a physical therapy called Egoscue for several years, and it’s really helped, but one of the things my therapist and I have uncovered is that I have extremely weak ankles and my feet tend to balance on their outer edges, and I have slight-moderate knee pain possibly due to rotated femur from my hips being out of alignment, or the feet problems, or both.
My question is, have you ever had a patient with mild-moderate scoliosis benefit from barefoot/minimalist running? I know that it’s impossible to diagnose someone over the internet, and your specialty isn’t spines, but I would be very interested to hear if you have had any success in the past with cases >similar< to mine, or if you know of any resources?
Thank you for any help you can give!
Here is something to consider. I have treated those with leg length discrepancies by removing heel lifts and encouraging a forefoot strike pattern. What happens is the foot adjusts to the length difference by plantarflexing the ankle. The length is then adjusted by the ankle’s position. I had this discussion with an elite runner who wore custom orthotics for years with a heel lift due to a leg length discrepancy and he no longer wears them and runs in minimalist shoes. More importantly then what he wears is that he no longer heel strikes and lands with a mid foot strike pattern. This is the key. It may help your situation but I have no direct experience in treating scoliosis in this manner.
Hello dr. Nick. I’ve post something on the 27th of April. Could you please give me an advice. Thanks a lot. Gio
I agree with so many of the other posters here. I had a freakish ankle dislocation/fibula snap and was in a cast for over 6 months. Not only is my leg weaker and shorter, the ankle itself is just a ball of scar tissue. I have developed wretched hip (probably also from have kids), back, shoulder, and neck issues, and the accompanying headache problems. At the time I jumped into VFFs, I had bought $80+ NB walking sneakers every 4-6mo, since I was no longer actually able to run any more. In 2009, I tried on a pair of VFFs (a style they unfortunately no longer make and which was the most effective!) and 3 steps later, the ankle literally slipped into place and everything was miraculously better. The cost of these shoes was a stretch for a 1 income household, but oh man, these were the best. I’ve since moved to also having the MiniMil boots (awesome for hiking and cold/wet weather) and Luna sandals. I thought a couple years ago that I had imagined seeing an improvement in the arch, and recently saw a wet footprint and thought “wow, it’s not the embarrassing blobby clump it usually is!” Your blog has confirmed my suspicions that my foot has heeled itself, without any surgery, even if the ankle hasn’t. I advocate loudly to coworkers and the teenagers I teach to look at and research alternatives to their ails, and now I have inspired a lot of people to look at minimalist footwear thanks in part to the blog! Thanks for the awesome pictures!
your very welcome! Please continue to encourage others to read and ask questions. I will do my best to respond!
Is the increase in the arch of the foot really an advantage? Has it been proven scientifically? If then, I would really advocate myself to become a runner. 🙂
Finally, someone is asking the right questions.
Let’s ask another question – does all of this fabulous minimalist goodness apply to good old walking, standing and living our daily lives or do we actually have to RUN to get all this magical goodness?
No actually even just walking with barefoot shoes will have an effect.
You will fell it in you calves and soles of your feet until they adapt to the new stress involved.
Its actually advisable to start out just walking with barefoot shoes before running with them, it will give your feet time to make a more gradual adaption.
So then by extension flip flops are fine too?!?
Assuming 0 drop from heel to ball.
Over the past 2 years I have tried several different minimalist shoes, some better than others. I used to do a lot of walking in New Balance shoes with a 12 mm drop. So I was aware of the need to make a slow transition. My first 3 pair of minimalist shoes were all Merrells with zero drop. I ended up ditching them because, like most shoes I have tried, the sole was contoured in a manner that hung up on my medial arch. Next, I tried a New Balance Mimimus with a 4 mm drop. It was much better than any of the Merrells. I still wear them. Then I tried a very flexible sole New Balance Z. I found the tactile feel way too intensel. Although they have a few minor glitches, the best shoe for sole feel I have tried is the Altra. I plan to get another pair soon. When I am assessing any shoe I like to walk around the shoe area in my sock feet for a few minutes before I try on shoes to get a kinaesthetic sense of the feel in my feet and legs. If a shoe feels foreign I reject it. Although no shoe will ever provide the same feel as barefoot, some feel much closer to it than others.
On a purely interesting note. I have kids and they have all been mostly barefoot and in minimalist shoes their whole life. Well we went into a shoes store recently to look at the shoes and my daughter who is 6 begged me to try on “normal” shoes. So she tried on a pair of sneakers. She nearly FELL to the ground. She could not figure walking out and was so confused by the whole experience of what she said was like having her foot stuck in a cast that she begged us to take the shoes off her! She kept wondering why people would ever put those shoes on them to begin with! I am not at all making any claims here and just sharing what my daughter whose feet are basically perfect felt when they put on rigid/normal shoes. If someone’s foot has adapted to shoes and their intrinsic muscles are not wired and working, then clearly that shift one day to the next can be irresponsible. But it is a good thing to encourage families of small ones to let the feet develop naturally and with little interference. Cheers.
Has this data been published in a peer reviewed journal? That is something I’d like to see!
As someone with high arches, but very flexible feet that tend to overpronate, I find this really interesting! I tried the bulky shoe and orthotic combo and found that my hips and back started hurting more the more rigid my shoes became.
Did the switch also improve her knee alignment?
Yes. Wearing traditional running shoe with a cushioned heel will force the foot into plantar flexion which angles the foot with respect to the lower leg. This forces the body to lean backward to compensate which places stress on the lower back as well as the knees indirectly. So the knee alignment doesn’t improve it just reduces the stress and in turn allows more natural function leading to less pain. The overall knee alignment is irrelevant.
Thanks!!!
Dr. Nick
Hi Dr nick. I was recently diagnosed with tarsal tunnel in the left foot. Do you think a similar processes could strengthen thefoot to the point that the tarsal tunnel could be reversed?
I looked at this and found it very interesting. I am not a runner but I was very active in rugby when I was younger. Recently I had some problems with my ankle so I consulted a foot doctor. I went though a oparation to align my ankle and the process was to cut the main bone close to the ankle and after plates and skrews and 8 weeks in a moon boot, I have been out of the boot for about another 8 weeks and i still have a lot of swelling and pain. I would like to know if this is a long healing process or sould I maybe consult a physio for more treatment.?
These are interesting pictures. It would be nice to see some research on the different types of minimalist shoes vs. barefoot running vs. zero drop shoes not only on conditions like pes planus, plantar fasciitis, achilles tendonitis but also knee varus and valgus, PFPS, and even individual with weak glutes, ITB, or piriformis syndrome, or SIJ dysfunction in runners who change to minimalist or barefoot running. We focus so much on foot biomechanics, muscle strength which is important but need to pay attention to what’s happening to other joints during different phases of running. I also like your 10% rule. Great way to minimize any injury caused by switching shoes and subsequent gait changes.
I certainly hope that your comment about “Accusing people of doctoring photos” was not aimed at me as I made no such accusation. I only pointed out that the lines were not done consistently. I also pointed out that I love the idea of minimalist shoes although I don’t feel there has been enough scientific evidence to support either argument. I do not feel informed enough to take a side on this debate but I did feel that the red lines were not drawn consistently and therefore over illustrated the argument.
I used to have pain in my feet and my ankles and knee pain. I taped my arch and ankles sometimes when it was really bad. I also have functional flat feet. When I went to the orthopedist he told me I had arthritis in my ankles and knees. I kept getting more and more ‘supportive’ sneakers and It only seemed to be getting worse. I then read an article where they had done a study on people with arthrtiis and found that people wearing flip-flops had less pain. Really? I made a switch to more flexible shoes all around and it has been a significant change. I have no pain and never tape my feet anymore. My arches don’t hurt and my ankles and knees feel ‘stiff’ only if I’ve been sitting too long. It has been about 4 years and it was a life-changing decision.
I read this article. I converted to barefoot running 2 years ago. And I was surprised to see my arch develop as I was completely flat foot. I am 48.
This is not anecdotal as I witness the same.
My shoes used to wear at the inner side. Now they have even wear (ie when I wear shoes)
However The Process to BF was not easy for me.
Every change is followed by pain and it can occur when you least expect it.
The Inner cavities under bone used to pain after 42 km run.
Now I have Achilles tendon pain just above the heel.
I know that its a matter of time.
But these symptoms tell me that body is correcting its form.
Just curious. I’m a PT and am wondering if this particular individual was prescribed any specific exercises and if so what were they? And how long did it take her to experience consistent relief from pain? Thanks!
Hi,
I have a few questions !
#1 Has the person in this study been running for several years or did she just recently start running (1-2 years before the study) ?
#2 Did the person change her running level (increase of cadence, increase of pace, increase running time) during the study ?
I know it is difficult to control every variables but these seem essential.
Obviously this is a case study so we cannot talk of «proof» yet, but this is very interesting !!!
Lets go science, one step at the time !!
Cheers
Thomas
Funny how easy it is to manipulate that talus…
Yes. It is held in a more rectus position as a result of a stronger abductor hallucis muscle. Unlike an orthotic device, this will actually provide functional improvement to the foot as opposed to splinting it.
Dr. Nick – thanks for posting this. I don’t have a problem with barefoot running or running in minimalist shoes (I run in them myself), but please just be careful on how far you go with some of your statements. As a sports medicine professional and scientist, it is impossible to say “proof” in a case study. I know there are many anecdotal reports of arch changes, but until this is summarized into double blind randomized controlled trials over and over and then into meta analyses and systematic reviews, we can’t use the term “proof”.
Obviously, this is important for numbers of reasons, but mostly because there are less informed reading this blog who will take this as Gospel. You mention in the comments above, “don’t focus on the shoes focus on the form” – this is the truest statement of the whole lot. Thanks again.
Excellent!!
Nice to see a longitudinal case study like this. Logically it makes sense that a minimalist shoe requires the foot to do more work but with all the controversy out there about injuries and poor efficacy, it’s nice to see a positive case study (and to read some of the comments with more personal examples).
I think the problem is that people usually expect things to change in a matter of weeks, yet they’ve been moving one way their entire lives, so they have to be willing to stick with it for a considerable time to see such results take hold in a safe way.
Thanks for this post!
Another great example demonstrating that rigid orthotic (with arch supports) weakens the arch. Discontinuing their use, e.g., running in minimalist shoes, strengthens the arch.
Professor Rothbart
hi, im from Dominican Republic, so my english isnt very good, the case is that i have a boy that have the problem like the first picture, he has seven years old, he is using orthopedic shoes from 2 years old and i dont se any progress, what can i do??? what shoe can i buy and put him to run.
thanks.
If he has no pain and can run, play, etc.. I would not worry. Obviously without seeing him I cannot give medical advice so I recommend seeing seeing a physician if you’re truly concerned.
Are you measuring the actual arch OR measuring the size of the shadow in the arch area of the Side View photos?!? These photos are NOT taken under the same lighting. The 2014 side view has a more gradual fall off of the shadow area which creates the illusion of an increased arch.
Likewise, the shot from the heel, again, is under different lighting as well as NOT taken from the same exact angle (maybe not even same focal length lens…).
There has to be a more controlled way to study this…
I have walked bare foot for many years but still remained flat footed, the only relief i have ever had in 54 years from my flat feet is from Chiropractic care!
Please forgive my suspicion, but any chance weight bearing X-rays were taken before and after?
Yes. See the post with the X-rays. Separate. Let me know if you can’t find
http://www.drnicksrunningblog.com/foot-x-rays-revealing-structural-changes-from-transitioning-to-a-minimalist-shoe/
You actually make it seem so easy with your presentation but I find this
matter to be actually something which I think I would never understand.
It seems too complex and very broad for me. I’m looking forward for your next post,
I will try to get the hang of it!
I wish I had pics off transformation bc it is also very similar. My wet foot print used to b just a sploosh….now it looks like a foot! I transitioned out of asics nimbus with a rigid arch support eventually down to Vibrams. No more metatarsalgia! Never had any knee pain (unless I’m not stretching well to keep my ITband loose). My bunions have shrunk and I never knew I could control my big toe side to side….that muscle never worked before! It’s been amazing. I tell everyone! I just wish I has the proof to show it.
Will someone please help me before I am crippled. I have posterior tibialis tendonitis in both legs after an accident. The great PT I have used Graston on me and I started to improve. I could get up on my toes with a bit of support, but after working two long shifts in more minimalist shoes I am in horrible pain and I have regressed to the point I can not stand on my toes and I walk like a snail. My right leg kicks out when I walk upstairs. And my left knee torques to the outside going down.
The podiatrist wants me to get custom inserts for my “flat feet”, feet he barely examined.
Today I stood on a brown bag with wet feet and it looks like I have high arches, so I am a supinator -just like the PT said.
The podiatrist recommended running shoes, but made no comment about brands or toe rise.
I have to work and I have to be on my feet about half of the time so I need advise and I need it soon.
I have Powerstep inserts with glued on pads from the Podiatrist. My sneakers are an anti pronating Merrill, yes I made a mistake. The Podiatrist says they are not rigid enough.
I am considering wearing a brace when I work to overload some of the forces on the tendons and wear compression stockings.
I have ordered correct toes.
Finally, I am close to retirement age so be gentle with me.
Rather than looking for advice online, in a forum that espouses minimalism I would suggest continued work with your current PT and doing some research on finding the best local Podiatric Physican that has a good reputation for practicing physical/rehabilitative medicine, as opposed to the most financially successful one ( this doesn’t usually indicate the best practitioner but the best at business practice )
Look for one that’s not focused on surgery and one that spends time doing a physical exam of your lower extremity as well as your feet. Oftentimes the symptoms manifest in the feet but are due to issues further up the kinetic chain ( knee, hip back, limb length discrepency etc )
It is much less common to have a tib post tendonitis with a Cavus ( supinated foot ) but not uncommon if it is extremely flexible.
Orthotics are not necessarily to be ruled out, however the right one for the job is obviously required and they are certainly not the only or prmary course of action in the case.
Perhaps ask your PT about using High dye taping to see if it assists at work if so consider some sort of dynamic ankle brace like the Swedo ankle loc style.
Good luck
Thanks for reaching out! I’m not sure what you mean by being in an accident. This could certainly be important in your diagnosis and there may be more to a posterior tibial tendonitis. Here’s some info on posterior tibial tendonitis. Sure this is a running blog, but the condition is the same regardless who has it. In fact, runners get it, but usually due to overuse, poor training form and patterns. Not foot type as previously thought. When the foot type leads to a posterior tibial tendonitis, it’s typically a dysfunction which requires surgical reconstruction. An orthotic device and help, but it would have to be an ankle foot orthoses, not a shoe orthotic. If you have to control subtalar joint motion, you must cross the ankle joint to stop the abnormal forces playing a role in this deformity.
Treatment is typically rest by waring a cam walker. If you try this and it’s not helping, an MRI with tell us if there is tendonopathy in the tendon itself. If there is, a decision must be made to continue immobilization or proceed with surgery. If you have a normal arch or even increased according to what you are describing, it sounds to me like you have some type of overuse of the tendon and they need rest. More of a time frame is needed to give more insight on this. As for wearing Powerstps orthotics or special shoes, I would say if you want to rest the tendon, you need to immobilize it with a cam walker or cast. If this works you would benefit from an AFO or Richie type brace. Wearing minimalist shoes are going to recruit more muscles and ultimately worsen your problem. You would benefit from a more cushioned shoe and a brace as mentioned. Once healed you could probably return to less of a shoe, assuming you have no severe foot pathology or true deformity.
Thanks!!!
This information provided is not intended as medical advise. If you are not improving or need medical help for your problem it is recommended to seek a professional in the medical field who can render appropriate medical care.
Amazing!
My feet and ankles, that look just like the before photos, were an issue pointed out by my ballet instructor when I was fifteen.
I was prescribed rigid little orthotics which I wore most of the time (yes I continued to dance in ballet slippers and I wore heels and wedges in my twenties).
Fast forward to me now at 35 after having had two babies (youngest is still only 8 months old) and performing boot camp, yoga, cycling and other forms of dance and I’ve been experiencing lots of ball of foot pain.
A pedorthist said my foot structure has permenantly changed (in the forefoot) and I have ligament laxity and metatarsal fat pads that migrated toward my toes, leaving my metatarsal heads exposed.
He’s said I will need orthics and shoes every moment I’m on my feet.
In another article you wrote, published in Podiatry Today, one of the exclusions to barefoot running are people with my type of condition but that they’re typically seniors with rheumatoid arthritis; so am I an exception that I experienced this condition at my age?
Should I seek a second opinion?
Also I don’t run, would there be any way for me to benefit by going barefoot more often or ditching the orthotics?
Note I am performing foot strengthening exercises focused on strengthening my arch, my Hallucinating longus, and my ability to dorsiflex.
I posted a reply quite some time ago. I went through a bad patch last year. I realised that its very imp for Barefoot runners to continue bare foot and NOT change to another footware. I used shoes for sometime during rains , as there are pieces of glass on the road. By end of rainy season i developed foot ball pain. The answer lies in my calf muscles which had small knots..painful to remove. In BF, you use every finger as individual. In a shoe the toe gets redundant..back to BF can create injury as you just lost the touch of BF. Its imp to continue BF or at least do toe curls and tip toe ..Take off shoes in office.etc.. I am back to BF after this learning
I recently read the book “Born to Run” and a lot of what the book said about barefoot/minimalist running seemed to make a lot of sense to me. I’m fairly new to running (less than 2 years in) and have always had extremely flat feet. I thought this article was very interesting, but what I found even more interesting were the comments. While the evidence in the article is anecdotal, it seems like there are a tremendous number of people who have had the same positive experience. Those who don’t like the article, seem to only be concerned that it doesn’t contain more proof, rather than even hinting that it could actually help even some people. It seems so simple. Let the foot do what the foot is supposed to do.
I have tried the Nike Freerun. But i get pain in my left knee. I can not run without my orthotic insole. Is there a way i could transition out to a minimalist shoe ?
I have a 10 year old son with Down syndrome who has moderate to severe pronation. He has worn AFO’s since he started walking, shortly after his 2nd birthday. But in the last year and a half, he has graduated to shoe inserts. He plays soccer and is going to start playing basketball soon. But he cannot jump properly. He jumps only about an inch off the floor with his feet parallel to the floor. He does not jump off his toes. His physical therapist says it is because the AFO’s did not give him enough flexibility to learn to jump off his toes. She says all the muscles used to jump off his toes are weak. Even his walk and running are affected, because he slaps his feet down all at once when he walks. He does go without shoes indoors most of the time. Barefoot in the summer and socks and/or slippers in cold weather. But that has not strengthened his arch, as he just walks flatfooted, as I described. What would you advise to help him?
All I can say is I tried to do this after wearing orthotics for 12 years. … I did it slowly..weaning myself off, lots of foot strengthening exercises, trigger point etc…the first 6 months with aches and pains and then for the next 2 years just a downhill battle with my ankles( which never had lain before). I wasn’t even running either…just walking. A recent MRI showed all these splits developing along my brevis/ Peroneal tendons. So I think it really depends on the individual, there are just sooooo many variables. Sucks because I do believe minimal is better and my body was getting stronger but ultimately collapsed for some unknown reason.
Interesting. I’m wondering if you had tendonitis in the peroneal tendons that had been occurring prior to you weaning off the orthotics? Usually the intratendonious tearing is a chronic situation.
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I’m 43, a little overweight, but strong.I’ve had plantar fasciitis since I was 17. I’ve been running on and off for about 15 years. For the first 6 years I purchased various types of running shoes, many based on a “cuteness factor”. Toward the last 3 years or so, of those first 6 years, my mileage increased substantially (75-100 mpw) and I began to notice more aches and pains. Then I started nursing school, my running decreased, and I gained weight. During my years in school, my feet, knees, and hips would ache so bad. I knew my shoes were part of the problem and purchased a new pair every few months, or at least until I couldn’t tolerate the pain. I came across a pair of new balance minimus at a runners store. They advised me towards a pair of mizuno for stability due to my near flat feet and over-pronation and size. Against their advice, I purchased the New Balance and haven’t looked back. Over the course of several weeks, my foot pain decreased to a manageable level, my knee and hip pain were completely gone. Fast forward to today. I have 4 pair of New Balance MT10, and 5 pair of Five Fingers. I alternate between each shoe based on which shoe I wore the precious day. Recently, I wore cushioned nike flip flops for the entire day, which flared up my plantar fasciitis. I saw the podiatrist in hopes he would help me with some stretches or refer me to a physical therapist who specializes in PF. My exam showed a normal to high arch with zero pronation. This podiatrist recommended a few stretches and encouraged me to continue doing what I’ve been doing and continue wearing the same shoes. All research stems from anecdotal evidence. Too bad some of you are unable to think “outside the box”. Awesome and very relatable article. Thanks Dr. Nick.
i was googling to find out if getting a stronger/higher arch could cause your feet to ‘shrink’, or take a shorter shoe over time. and i came across your post which pretty much describes what has happened to me.
after many years of running in big padded air soles where the heel took part of the pounding and sent the rest up my spine, i switched to minimal running. it was a long process to strengthen the feet and lower legs to where i was a full on minimal runner. now the legs/feet naturally cushion impact, reducing it and sending much less up into the rest of my body.
corresponding with the strengthening of my feet, especially my arches, has been my taking about a 1/2 shorter shoe size in a number of shoes…western boots and hiking boots, going from an 11 to 10.5 in western boots in many brands, and from 12 to 11.5 in certain brands of euro hiking boots.
the strong correspondence of this effect is also anecdotal proof, along with your article, of how minimal running can shorter the foot, the mechanism being a higher/stronger arch which takes some of the foot length and uses it to rise higher, which offers a type of stronger spring/lever with which to absorb the impact of running.
Dr Nick:
I came across this log thread today and needed to react. Sorry if I am so late.
I have no doubt that in your anecdotal case, the navicular sag was improved , the feet shortened and the “two many toes” sign improved.
However the rearfoot tendo Achilles position and the calcaneal pose does not seem to have changed. What has changed is the was you drew your red lines which do not seem to be accurate.
Also, please note that in the two years in between the study, the patient;s 1st MP Joint has more dorsal hyperostosis and hallux limitus showing a degenerative compensation for the barefoot training.
I doubt that you have a later followup photo’s and history but that would be interesting 2-3 years later.
Dennis (Dr Sha)
Why would you expect to see increased degenerative changes to the MPJ with barefoot training. You need less ROM in the hallux with less shoe. In fact, those who wear shoes with thick cushioned heels and heel strike place increased stress on the 1st MPJ and have to get more motion there to move forward. You need propulsion with the great toe in this manner as opposed to the entire foot with a natural gait.
Thank you, Dr Sha!!
How does someone know if this is a possibility for them? Both of my feet over-pronate, whether I’m running walking or standing unless I consciously activate the muscles to create an arc. My right foot has always been worse in terms of being flat and overpronating, and I’ve had sprains here and there over the years…I think the first may been when I was about 5. I’ve never been a runner but always into fitness, mostly weight training and sprints (end zone to end zone on a football field) when I was in my early 20’s. I quit sprinting due to ankle sprains/posterior tibialis pain on my right side. At the time I didn’t know much about minimalist shoes or going barefoot and was running in stability shoes.
I’m 33 now and in about 2011 I started researching about minimalist shoes due to having illiotibial band syndrome tightness starting to occur on both legs. I’ve worn pretty minimalist shoes since then in everyday stuff and barefoot when weight/bodyweight training. But my feet still seem to be about the same.
I’ve been researching again lately and maybe wondering if I haven’t done enough in specifically training my feet/ankles/lower legs. I’m willing to do whatever it takes to stay out of orthotics/arch supports which it seems every podiatrist recommends, but I can’t stand the thought of being reliant on those. Whether that’s running, sprinting, exercising specifically my feet/ankles barefoot…I don’t care, I’m willing to try.
I guess I’m wondering how do you know when it’s something structural that can’t be fixed with training, or may need surgery, or other interventions. Thanks for your time and knowledge, it’s refreshing to see a podiatrist recommend other methods than exclusively orthotics.
I have been battling chronic plantar fasciitis off and on for years…and the minimalist, or zero drop shoe seems to go against everything my doctor(s) have advised…(although I am doing my research and finding some differing opinions) What is your advice for patients with plantar fasciitis? (I also seem to have a good bit of myofascial restriction especially in the soleus.) Thanks!
Your blog has created a great deal of interest – demonstrated by all the comments you have received (positive and negative).
Keep up the good work – anecdotal observations are important in the process of understanding how the foot functions.
Professor Rothbart
I thought this was a possibility for me but sadly I have stupid PTTD. No amount of running or exercise can fix that.
I have flat feet, as well as a morton’s neuroma in my right foot. At the moment I wear altra’s intuition, as well as a powerstep orthotic to minimize my pain, but the clunkiness and the fear of making my arch even weaker make me want to search for alternatives. Are minimalist shoes advisable for those with MN? I keep hearing arguments for both sturdy, supportive shoes and minimalistic ones.
A wide toe box is best for s neuroma. Minimalist shoes can also help since there should be a low heel height. Less stress to the forefoot.
this has happened to me after several years of running minimal…my shoe size has gone down a half size.
also, do note in the pictures how the entire foot has not only a higher arch, but is more muscular and well formed from working the foot more. both of these things have been true for me.
most important, especially for someone like me who has back disk issues, the foot itself (as well as improved calf, achilles) becomes more of a shock absorber to reduce overall body impact, which means to the spine as well. studies show 30% reduced impact of minimal running vs. regular cushioned high heels which force heel striking.
Hi Dr Nick. I’d be keen to see a study comparing results of barefoot and non barefoot runners over a period of time. Perhaps starting off two people who are of similar physique and running technique. I wonder how far reaching the shoes’ effect would be. If there is one already, would you please point me in the right direction. Many thanks
Thanks Mark!