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Barefoot walking initial contact variations

Discussion in 'Biomechanics, Sports and Foot orthoses' started by drdebrule, Dec 14, 2011.

  1. drdebrule

    drdebrule Active Member


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    Dear Podiatry Arena Friends,

    I am wondering about barefoot (unshod) walking initial contact variations. Does anyone know of any studies looking at this?

    In my podiatry clinic heel strike is the usual barefoot strategy, unless I am seeing a toe walking child with equinus or someone with severe heel pain. However, the recent paper by Lieberman et al (Nature 2010 ) describing foot strike patterns in unshod runners has made me question heel strike as a norm. Will patients who are unshod also use a forefoot or midfoot strike strategy for initial contact weight acceptance when walking? Would this be an accepted variation or pathologic? Would this eliminate the heel strike transient and theoretically protect from injury? :dizzy:

    Thanks!

    Dr. Michael DeBrule
    Marshall, MN
     
  2. Craig Payne

    Craig Payne Moderator

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    Don't put a lot of weight on Liebermann's study. There are significant and multiple flaws in the methodology (eg simple things like the big difference in the mean age of the two groups compared). We have discussed that many times before.

    However, Liebermans study was based on running and you probably right that heel strike is the norm when barefoot walking. The rhetoric and propaganda is the barefoot running hurts when heel landing so that creates an alleged better running form by creating a forefoot strike, but that does not quite explain some barefoot runners do actually heel strike first (Some barefoot runners heel strike first) ... though they do like to explain this away as 'proprioceptive heel striking' (they need to look up the dictionary on what proprioceptive actually means)....they also need to look up the the chapter in Stephen Laws book on 'Moving the Semantic Goal Posts' (chap 4 in Believing Bull****; How Not To Get Sucked into an Intellectual Black Hole)

    The thesis of Liebermanns argument is that by eliminating heel strike, you eliminate that impact shock that causes most running injuries. However, if you look at all the risk factor studies on running injuries, NONE of them have found impact shocks as a risk factor. All the the systematic reviews on impact shock have not been able to find any relationship between impact shock and injury, except for an increased risk of tibial stress fractures (<1% of running injuries) from a higher impact rate loading. I do acknowledge that Irene McClay has a study yet to be published linking it to many more injuries, but that is one study out of how many? I not sure how much weight to give to this work in the grand scheme of things.

    What Lieberman and others fail to acknowledge is that if you eliminate heel strike by changing running form, that the energy has to go somewhere else (law of conservation of energy). Barefoot running (forefoot striking) has higher loads on the forefoot; increases the rearfoot inversion moment; increases the dorsiflexion moments at the midfoot, rearfoot and ankle.......you just trading on set of loads for another. .... it all depends on the injury risk profile for runners as to which one they should be doing and explains the very high incidence of injury seen in barefoot and minimalist runners.

    ...did I answer your question?
     
  3. Craig Payne

    Craig Payne Moderator

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    here is the law:
    http://library.thinkquest.org/2745/data/lawce1.htm
     
  4. Admin2

    Admin2 Administrator Staff Member

  5. Indeed. Which is louder: heel strike running or forefoot strike running? And if a barefoot runner falls in an forest and no-one is around to hear their incessant cack does anyone give a toss? Just a thought.:santa:

    I may have said this already, but a quick search didn't reveal it... Biomechanics Pearl No.2 for 2011- Energy will be the new (stiffness) black in 2012.
     
  6. Craig Payne

    Craig Payne Moderator

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    Heel strike? ... but to reduce the impact of heel strike by transitioning to forefoot to 'lighten' the impact, specific muscles need to be more active to overcome those increased joint moments I mentioned above --> the law of conservation of energy. .... too bad if you have a history of injury in the muscle/tendon complex that has to work harder to forefoot strike
     
  7. So, more of the systems energy is converted to sound energy in heel strike running compared to forefoot strike running- right? In barefoot running compared to shod running? Big bangs might not be such a bad thing, all other factors being equal. Since some of the energy is dissipated from the system as sound then it does not need to be stored within the system as elastic strain energy etc. I used an analogy in a draft paper of a balloon being inflated: as we blow into the balloon we store elastic strain energy in the balloon's skin- if we breath too much air into the balloon and attempt to store too much elastic strain energy in it, the skin fails and the balloon explodes. Kevin didn't like that analogy and the paper never got finished (not just for that reason), maybe next year. Depends whether you want to dissipate the energy or re-use it; sound energy is lost from the system and cannot be re-used, similarly for heat; energy stored as elastic strain within the tissues has the potential to be re-used.

    Stuff on energy here, knock yourselves out:
     

    Attached Files:

  8. Craig Payne

    Craig Payne Moderator

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    So if energy is lost from the system through sound, then the energy in the heel strike 'system' is less --> less load in the tissues --> less injury risk
    If that energy is conserved in forefoot striking --> more energy in the system --> greater load in the tissues --> greater injury risk ?????

    ...performance is a different issue with the reuse of that energy. HOWEVER, if energy is to be stored, surely that means the muscles are working harder (ie to overcome the moments I mentioned above)?

    ......never thought about it that way before....
     
  9. All other factors being equal, yes.
     
  10. Comes back to rate of loading, visco-elasticity and tissue stiffness. Faster the rate of loading in visco-elastic tissues = stiffer tissues = bigger area under the stress/ strain curve = more energy stored. I did tell you this some years ago with regard to the velocity of pronation - do keep up Payne ;)
     
  11. Craig Payne

    Craig Payne Moderator

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    maybe you need to type a bit slower for me :santa:
     
  12. drdebrule

    drdebrule Active Member

    Thanks for your nice comments Craig and Simon. There are some good threads and opinions already on barefoot running on podiatry arena (I enjoy Kevin Kibry's thoughts)and I wanted to focus mainly on walking in this thread. I have done literature searches and can't come up with anything. I was hoping some one had studied walking patterns in unshod populations or something like that.

    I am guessing that heel strike is still the norm. Yet, at as cadence or speed increases, the time spent in double support decreases, and the percentage of forefoot/midfoot striking would probably increase for brisk walking.

    Regarding injury and energy dissipation: whatever your initial weight acceptance walking strategy it is slightly less work if you eliminate the weight of the shoe. Patients who walk bearfoot will still get injured. There is no miracle cure for all foot problems by removing your shoes. Some types of injuries might be less common while other injuries may be more common. The energy doesn't magically disappear.
     
  13. drdebrule

    drdebrule Active Member

    Will switching from shoes to an unshod gait (or low profile flavor of the week shoes) one day become a viable treatment option for common foot problems? I like to keep an open mind. Show me the study and I will abandon foot surgery, orthotics, NSAIDs etc. Since there are no studies, maybe we could comment on what we would like to see studied.

    How about something simple like asking people to walk barfoot over a force plate at increasing speeds? What variables would we want to measure and how would this help us treat patients in a shod society?
     
  14. Michael:

    Like Simon and Craig mentioned, the topic of barefoot vs shod running and walking are very interesting with lots of different opinions on both sides of the subject. I believe that within the last year I read a study done on people walking barefoot heel striking and then being told to walk forefoot striking and showed that forefoot striking was less energy efficient, but I can't seem to find the reference??

    The main point is that shoes are here to stay. Being barefoot may have its place, but as long as we have sharp and hard obects around our floors and walking surfaces, extreme cold and heat, and a need to have specialized jobs and sports that require certain shoe designs to optimize performance, shoes will always win out due to the protection and function they offer the bare foot. We certainly don't have our men and women in the military going barefoot into battle do we? We certainly don't see any world track and field records being set while barefoot do we? Personally, I think all this barefoot talk is laughable and just shows how people who want to believe something need very little evidence to firmly believe it is so.

    As far as I see it, going barefoot is much more talked about than it is actually done in the real world....will eventually fade away until another fad comes along...but it is something interesting to talk about. :drinks
     
  15. drdebrule

    drdebrule Active Member

    Thanks Kevin: If you come across that study again, please post it here. This is an interesting topic.
     
  16. Bobba Booey

    Bobba Booey Active Member

    Kevin,

    I think the study you were referring to is The Influence of Foot Posture on the Cost of Transport in Humans

    Another barefoot walking study that I found is The Effects of Habitual Footwear Use: Shape and Function in Native Barefoot Walkers
     

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  17. drdebrule

    drdebrule Active Member

    Thanks Bobba.! I think these studies answer all my questions and then some.

    I really like Daout's study's, but it fails to associate higher peak pressures with injury or athletic performance or demonstrate a cause effect relationship. Therefore, I think there is no basis for them to recommend unrestrictive foot wear in their conclusion. Also, they failed to quantify exactly what is unrestrictive foot wear.

    Cunningham's study sheds light on why we walk heel to toe (plantigrade) and clearly explains the higher cost of walking digitigrade. I found it really interesting that plantigrade and digitigrade running didn't have any significant difference in cost of transport. Maybe Craig can remind the church of barefoot running about this finding (trying to be funny here and not putting anyone down). Are there any clinical implications for my patients? Probably not yet.
     
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