Barefoot Bandits

During the past year, more and more runners and readers have asked for my opinion regarding the increasingly popular barefoot running styles of shoes.  I was recently interviewed about my thoughts about the trend of changing over to barefoot style running

Have you seen your patients change their regular running shoe to as style of shoe to simulate barefoot running?

I have, over the past year been asked questions about barefoot running seem to parallel the influx of new barefoot running shoes available. The most common I’ve seen in my practice include NikeFree, Vibram Five Fingers and Newton Running shoes.

The NikeFree was the first introduced in 2004. During that time, Nike who was sponsoring Stanford University’s track team discovered that some of their training had been done barefoot. Stanford’s athletic coach at the time, Vin Lananna felt that barefoot training reduced athletic induced injuries and improved ankle strength. Nike saw an opportunity and then the NikeFree was developed. Basically it has a soft, non-supportive cloth upper with a wide, cushioned midsole having deep grooves to enhance flexibility.

A little later on the scene was the Vibram Five Fingers, which were introduced in 2005. Vibram originally designed these to be worn while yachting and was surprised initially that anyone would want to run in them. Once this was realised, the Vibram with individual toes became mainstream.

Newton Running was developed in 2007 and is similar to the NikeFree in appearance. The main difference between these two is that this little guy provides more forefoot cushion. It was designed by Runners and is heavily endorsed by runners.

In regard to shoes that simulate barefoot running, what in your clinical opinion are the biomechanical strengths and weaknesses of these shoes in comparison to the basic and conventional running shoes?

Barefoot running shoes are designed to promote forefoot contact over heel contact – in other words, a lighter strike to the ground.

This does two things.

1)   it reduces the impact of heel strike, improving shock absorption throughout the midfoot and forefoot.

2)   it alters the centre of gravity forward with the feet being better centred below the hip, which is a much more stable alignment.

My concern with barefoot running shoes isn’t with the biomechanics of the design but rather the concern that runners will see this as this new, sexy fluoro shoe and train without proper conditioning or assessment.

It doesn’t matter whether you are wearing NikeFree 5.0 or Nike Zoom Structure Triax +12. If the running shoe isn’t a match to your type of foot and running biomechanics, injuries will occur.

I also think in addition to shoes, too many runners have not been adequately coached in proper form.

The best running shoe design in the world coupled with poor running form has little chance of benefiting a runner.

ChiRunning, Pose Tech Training and Evolution running are all running methods that simulate barefoot running form and are often helpful in reducing or eliminating injury.

Are there other considerations Physiotherapists should keep in mind when asked for recommendations of these shoes by patients? Are there certain foot types that would prohibit use of these shoes?

When asked by patients about barefoot running I say it may have a place in an overall training strategy, but based on most of the patient’s pathology I see coming through the door, few would benefit from this as a primary treatment. In fact I have taken quite a few runners out of these styles of shoes because they caused injury.

It amazes me that so many experienced runners (triathletes, marathoners, ultrarunners) who presumably know everything about their running are oftentimes clueless when it comes to their shoes.  Then it is my time to shine! J

They are sponsored by a particular shoe company consequently have to wear that company’s shoe and no one has really ever analysed whether it’s right for them or not. Or, they have run in the same shoe for the past 10 years but never realized that the shoe design has changed so dramatically during a version change, that in spite of the name being the same it’s not the same shoe.

In your experience in treating athletes, are there any particular brands of these shoes that simulate barefoot running that you have found to be effective?

The few patients I have who use these types of shoes as well as readers of my blog find that Vibram Five Fingers are really the only shoe that simulate the true feel and biomechanics of barefoot running. NikeFree and Newton Running seem to be losing ground in the battle of barefoot running shoes. However, I’m sure as time goes on, more and more shoe companies will jump on the barefoot running bandwagon and incorporate even more designs and styles into their manufacturing lines.


So in other words, keep it simple and use what works for your own running style…



The Office Athlete



What are Shin Splints?

SHIN SPLINTS: Not Such a Simple Diagnosis

Running training - The Office Athlete

‘Shin splints’ is one of the most common reasons for exercise-induced leg pain. One of my favourites, too!

The incidence is as high as 6-16% of all running injuries. With this gorgeous weather at the moment and with the prospect of the 2013 marathon season closing in, further awareness of the possible causes of your leg pain is essential in effective management and prevention.

Shin splints, as it is most commonly referred to, refers to pain on the inside of the shin bone. It does not imply a specific diagnosis, but rather the presence of pain over the shin. Specific anatomical and pathological differences exist that lead to differential, and more specific, diagnoses.

The pain felt can be due to problems of the muscles, the bone, or the attachment of the muscles to the bone. Therefore based on your specific diagnosis, management and treatment will vary.

For optimal management and recovery, assessment by a physio should be undertaken to ensure an accurate and specific diagnosis. The three main pathologies that can cause shin pain are:

1) Medial tibial stress syndrome:

Medial tibial stress syndrome occurs when overuse causes irritation and microtrauma to the soleus (our deep calf muscle) at the attachment to the shin bone. Repetitive stress can also cause irritation to the tibialis posterior muscle, and inflammation of the periosteum (the connective tissue that covers the bone.) This is what most people are talking about when they refer to ‘shin splints’ as their diagnosis. Patients complain of a diffuse pain along the inside of the shin, which usually decreases with warming up so they are able to complete the rest of their training. However pain returns after finishing training and is worse the next morning.

2) Medial tibial stress fracture:

This is most common in athletes involved in running, jumping and impact sports. The incidence increases if play is on a rigid, unforgiving surface. It results as a continuum from increased bone strain, to stress reaction, to finally a stress fracture. Pain has often developed gradually, and usually correlates with an increase in training. Pain worsens throughout a training session and often is present at rest or a night. There is often a focal pain when palpating the shin bone, and a bone scan or MRI can accurately confirm the fracture (an X-ray will often not show it in the early phase.)

3) Exertional compartment syndromes:

The lower leg has a number of muscle compartments, each enveloped by a thick fascia which has limited flexibility. Increased blood flow to the muscle with exercise causes the muscle to increase in size- hence increasing the pressure within compartments. This can lead to decreased blood flow and tissue perfusion, which in turn causes pain. The athlete complains of an increasing achy pain and tight sensation with exercise, but these symptoms usually have disappeared within a few minutes of rest, and are absent at night. Treatment is initially conservative; with deep massage therapy, dry needling, lowering the heel in a shoe, and reducing exercise load. However if this is unsuccessful, surgical release may be necessary to release the fascia surrounding the compartment, with 80-90% of people being able to return to their previous level of sport.

The foundation of treatment starts with an accurate diagnosis.

As evidence to date has still not specifically determined a cause, prevention is difficult; however there have been proposed risk factors. Predisposition factors include abnormal biomechanics, (for example pronated feet) ankle instability, weak soleus or tibialis posterior muscles, stiff ankle joints, inadequate shoes, body mass index, inadequate calcium intake or recent growth spurts. Symptomatic relief, (rest, ice) identification of risk factors and treating the underlying pathology are essential for effective management. Regular calf stretches and releases are integral. Increasing the strength and endurance of the soleus/tibialis posterior, controlling over-pronation, and promoting adequate shock absorption via insoles and new shoes is successful treatment. Committing at least one day per week to a pool/cycling/cross-fit session is shown as effective management of medial tibial stress syndrome and also at decreasing load to reduce the risk of medial tibial stress fractures.

Continuing to push through shin pain can have dire effects on not only your sporting performance and event participation, but also cause further damage in the long term. See your physio for an accurate diagnosis and management to maximise your ability this upcoming running season

in other words…. take care of yourself and get a little TLC from your physio!

All the best,

The Office Athlete

Mud, Sweat and Tears

Tough Mudder 2013

It’s time for the mud, sweat and tears. But let us take away the tears.

From the Warrior Dash to the Tough Mudder; along with all the other adventure runs out there… Whichever the event you’ve registered for; an understanding of the intense challenge your body will endure is just as important as getting muddy.

Find out what you need to know to get your body primed for these unique events.

Tough Mudder girls