Another Metatarsal Stress Fracture from Vibram FiveFingers???

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I just received a private e-mail from a runner who seems to have injured himself by running on a treadmill in Vibram Fivefingers. He has given me permission to reprint his letter on Podiatry Arena to urge other runners to be cautious when running in the Vibrams.

I guess the Vibrams don't prevent injuries after all?!......:craig::butcher:

 

Forgive me Kevin, and all those posting negatively about vibrams. But I have to ask, where is the evidence that these shoes, other than your reported clinical encounters, cause harm? In my view, negative anecdotes are as weak as the blindly optimistic accolades one finds on the barefoot running blogs.

I say this as someone who is NOT (necessarily) an advocate of this running style as a panacea for all that ails the runner but as someone who is open to the possibilities that may accompany it. When you look at what we do know from the literature, and not just Liebermann, but read Robbins, Medicine and Science in Sports and Exercise 1987, Dewitt, Journal of Biomechanics, 2000, Squadrone, Journal of Sports Medicine and Physical Fitness 2009, and Divert in International Journal of Sports Medicine, 2005 and 2008 you see that "barefoot" mechanics are rather well documented. These parameters- shortened stride length, knee flexion at contact, an adapted (supinated, plantarflexed), shorter, foot contact phase, compared to heel to toe shod gait are documented among "trained" barefoot runners and are NOT seen in newly "converted" barefoot runners. We know that runners adapt at various speeds to this gait pattern and that high impact loads are recorded in those who retain a heel to toe gait while minimally shod. An older article, Robbins, Medicine and Science in Sports and Exercise, 1988 speculated about a neuro-adaptive mechanism that forms a protective mechanism for the unshod lower extremity.

We also know, Kerrigan- American Academy of Physical Med and Rehab- 2009, that running shoes generate potentially negative lower extremity torque, and that, Richards, among others, Br journal of Sports Med 2009, has found negative associations between motion control footwear and injury rates.

It is likely that many on this board will be familiar with most if not all these references, and I am not playing "my article can beat up yours", only to refer to what is out there if one looks. And if these things are true, what might this mean for the converted (BF) runner? Consider- increased shock attenuation from knee and ankle flexion- both generally lost to the shod runner. Less hindfoot eversion- Dewitt found less RF eversion in barefoot runners due to the shorter and supinated contact phase. Less patello-femoral syndrome, due to less internal tibial rotation? Resolution of achilles tendinopathy due to the unique eccentric contraction resulting from the plantarflexed ankle at contact? (very well documented- Alfredson et al- as the best non-operative strategy for mid-portion tendinopathy)

All I'm asking is that we don't engage in the highly emotive commentary that drives the BF community. Many runners will do (have done) very very well BF (one of my 2011 graduates completed her first (trail) marathon, winning her division, in Bikila's- how's that for an anecdote) , many clearly won't, and I think we can speculate clinically, which is which based on mechanical principles. I'm old enough to recall the days when the MD and orthopedic medical community reacted to running injuries by saying "stop running!"- shouldn't we be as open minded now as we were then? Let's not be as emotively anti-BF as those who so blindly advocate for it. The truth, as in all things clinical, is far more subtle. Let's hang in there with the BF community and see how this shakes out.

 

rather than hanging in there we should be leading the debate about which running style x,y,z shod or unshod fits best with patient x,y,z to reduce injury

my opinion of course

 

Bob:

I am well aware of the literature on barefoot vs shod running and just got done debating Irene Davis, PhD, on this subject at the California Physical Therapy Association's Annual Meeting in Long Beach to a standing room only audience last month. I will be debating Irene again on Barefoot vs Shod Running at the American College of Sports Medicine Annual Meeting in June of 2012 also. Should be fun.

I could really care less if a runner chooses to run in Brooks Beasts, in Vibrams, in bedroom slippers, in high heeled pumps, barefoot, or run backwards or sideways. It is their choice. Personally, I prefer running facing forwards in training flats since I am more comfortable in these styles of shoes and like to see where I am going, rather than where I have just been.

The point in posting these anecdotes is to offer another side regarding the potential harm that may come from these shoes to those who become overly enthusiastic by somehow thinking that they will "become more natural" by running in the Vibrams. I am not interested in changing the minds of the barefoot runners and I don't think that any of my comments will "drive the barefoot community", as you say. All I am trying to do is to warn runners of the potential harm that may come from running barefoot or in Vibrams. Nothing more, nothing less.

 

Kevin , thanks for your prompt comment- I might ask what you are doing up so early? Out running in your racing flats no doubt.

I wish I could attend one of your debates, I know you will fairly represent the issues, as will Irene.