Plantar Fasciitis and the anti-orthosis, Minimalist Shoe Message

Mark:

I will ask you the same question now for a third time. I don't think it should be so hard to answer one of my questions.

Please provide us with scientific research or other high-level references which supports one of the statements you made from your internet article on plantar fasciitis: "The only way that you can actually fix plantar fasciitis is to address the root cause… weak foot muscles."

Please show us the research evidence that supports your contention that people with plantar fasciitis have weak foot muscles.

We know you are only a family practice physician and not a foot health specialist like all the rest of us are here on Podiatry Arena, you own a minimalist running shoe store and you are not a researcher. However, whether you realize it or not, your comments are taken as gospel by many of the minimalist shoe converts who we all end up eventually seeing as patients. Please explain this rather odd opinion of yours since, in my 28 years of teaching foot and lower extremity biomechanics and sports biomechanics, I have never heard another medical doctor or podiatrist make such a statement.

 

Seriously moderators it's high time to remove Blaise from these forums. His rants are not productive and this latest post reflects a level of disrespect and vulgarity that shouldn't be tolerated. Shame on you Blaise, you're the most unprofessional and disrespectful person I have ever encountered professionally.

 

I come to PA to read and hopefully learn something and I don't think i've ever learnt anything from Blaise which considering the number of posts you have to your name is disappointing. I believe you are a physio? Then why can you not maybe share some useful information with the forum. I'd like to think you have an interest in strength and conditioning, core strength, flexibility work. I can't say I've ever read anything by you on these subjects.

I'm not sure I've heard anything else but venom towards those who think differently to you and it's time to give it a rest. It's boring...

 

Kevin,

I'm not selling shoes or orthotics and I'm a foot specialist (if you don't believe me, define what's specialist). I was prescribing BBS for most of my patient, like you, and switch 11 years ago to less than 10%

I will ask you the same question now for a third time. I don't think it should be so hard to answer one of my questions. Please provide me with scientific research or other high-level references that go against that : increase stress on tissues foot (by exercise or minimalism) is not a good treatment for a persistent fascioses...

 

Mark,

I am certainly not trying to be disrespectful, I hope you know that. You and I ave never encountered each other before and I hope we can have a civil discussion.

That said can you answer Kevin's and my questions please?

and mine:

I would also like to ask that as a physician can you point me to any practice guidelines which support that barefoot/minimalism are a recommended treatment for PF or any other condition. I'm not adverse to people adding barefoot to their routine but the suggestion of it as a treatment Mark.

Sincerely,

 

It is now crystal clear that apart from being arrogant and rude, you are also stupid... I told you I do not care one rat's arse what you think Biase.. hahahahahaha

 

Take a time out y'all, several from both sides are making themselves look pretty callow right now, in my opinion.

Muzak break: http://www.youtube.com/watch?v=tRWSy3RhW0w

Have a good weekend.

 

At the end of the day, I will always go where the evidence takes me and not where the rhetoric and propaganda takes me and I will never promise a second coming of the messiah.

Of course, I will be using minimalism to help manage plantar fasciitis if the evidence tells me that I should.

Currently:
There is NO evidence that plantar fasciitis is due to weak muscles.
The evidence is clear, that foot orthotics work for plantar fasciitis.
There is no evidence that minimalism works for plantar fasciitis, except for one study that shows it will probably make it worse.

If plantar fasciitis was really due to weak muscles, then foot orthotics are indicated as the evidence is foot orthotics actually strengthen muscles and minimalism does not strengthen the foot muscles!

All the anecdotes suggest that both heel strikers and forefoot strikers get plantar fasciitis, which further suggest that minimalism or running form have nothing to do with plantar fasciitis.

What is an ethical responsible practitioner to do? Should they not follow the evidence? Or should they follow the rhetoric and propaganda on blogs that get blindly spread on social media leading to the group think mentality that has not been subjected to scientific peer review and critical appraisal?

 

Here are some more of Mark Cucuzzella's thoughts on "key design flaws" in modern running shoes from Pete Larson's Runblogger website: http://www.runblogger.com/2010/09/interview-with-mark-cucuzzella-of-two.html

Looks like a lot of opinions to me, but, hey, I'm just a foot doctor that has successfully treated thousands of runners and children for over 28 years. Any scientific literature to back up any of these ideas, Mark, or are these just your opinions that are based on anecdote and your training as a family physician?

 

Simon - I just picked up a tweet that NBC have just announced its been cancelled! I can't see any confirmations though.

ADDED: its all over... confirmations everywhere. Interesting how social media spread this very quickly and it took a while to confirm va traditional media sources. Very sad ... had several friends who went over to run it.

 

Just confirmed by NYC Mayors office

 

I have just had confirmation.. it is cancelled.

It is all very sad, but I would have thought Mayor Bloomberg, rather than the vocal masses.. would have know what resources he had to hand and if the city could cope. He is not up for re-election and so had nothing to lose..

 

I believe what Mark have write. If you have a problem with that, please provide evidence that it's not true. In Podiatry Today you clearly said that your own recommendations of BBS was not evidence based.

I'm just a PT foot specialist that has successfully treated thousands of runners and children for over 15 years. Any scientific literature to back up any of your recommendations about BBS or it's just your opinions that are based on anecdote and old school concept?

 

More woried about all the people who have trained so hard for the marathon and now can't race Blaise. And even more worried about the people of New York and New Jersey who have lost everything..

 

Is evidence telling to wear BBS? What do you recommend to your chronic PF? Why not doing like with persistent tendinopathies? ... stimulate it... tons of evidence about mechanotransduction and tissue adaptation

No but there is NO evidence that is not due to : weak foot OR less foot tolerance to load/stress (too much protection that decrease the tolerance of this specific tissue ... like too much orthotics and BBS)

yes on short term only! ... doesn't give us guideline for long term treatment of chronic PF

There is absolutly no evidence that BBS treat chronic PF. The only evidence we have is on non specific foot pain and cavus foot (it's working on short term) and this study -probably the one you were speaking about- . I spoke about the study with Dr Taunton personally. Do you need inside? It was pretty clear for him that the Free was a better long term treatment that the BBS.

Examining the Degree of Pain Reduction Using a Multielement Exercise Model with a Conventional Training Shoe Versus an Ultraflexible Training Shoe for Treating Plantar Fasciitis Ryan, M ; Fraser, S ; McDonald, K ; Taunton, J PHYSICIAN AND SPORTSMEDICINE , 2009, Vol. 37 (4) , 75 -81
... A visual analogue scale item tracked peak pain in the preceding 24 hours taken at baseline, 6- and 12-week points, and at the 6-month follow-up. Twenty-one subjects completed the program (9 FREE; 12 CON). Both groups reported significant improvements in pain by the 6-month follow-up, and the FREE group reported an overall reduced level of pain throughout the study as a result of lower mean pain scores at the midpoint and post-test compared with the CON group. The exercise regimen employed in this study appears to reduce pain associated with chronic plantar fasciitis, and in doing so, the Nike 5.0 shoe may result in reductions in pain earlier than conventional running shoes...

Craig,
If there is one place on the net where I will speak about "rhetoric and propaganda" it's here. If there is a place where people are cherry picking science and speaking more about philosophy that science it's here...
Please commit yourself about your guideline on plantar faciapathy. What do you clinically recommend... because clinician give recommendation even without science. And in the same time, what do you think of my prescription chart about shoes http://www.therunningclinic.ca/medias/pdf/5390-cdc-affiche-organigramme-.pdf
Don't be shy, I'm not susceptible. You can tell me it's bulsh**t... but please explain.

 

Where have I ever claimed that BBS's should be used for plantar fasciitis?

They actually showed the minimalist group did worse, even though they claimed the opposite. I assume you have heard of the CONSORT agreement on how RCT's should be analyzed and reported. The authors did not adhere to that and eliminated the minimalist runners that dropped out the study as they got so bad they could not continue! If they had included their pain scores in the analysis using the intention to treat analysis which is the agreed standard way of reporting clinical trials, the results would have been the opposite of what they claimed.

You asked for evidence that what Mark C wrote is wrong ... well there it is in what you are quoting.
As I said, I go where the evidence takes me and that evidence tells me that minimalism is worse for plantar fasciitis.
I will change my mind if stronger evidence tells me the opposite.

Are you not cherry picking the evidence as well?; you just proved it! And also of the "philosophy that science" - your sole evidence for "minimalism" is that there is no evidence for BBS's!! We not that stupid to fall for those sorts of arguments. When ever you are challenged to provide evidence for the claims to support what you are making (and what Mark C is making) you don't respond with that evidence (anyone can see that by checking this and other treads), but just keep asking where is the evidence for BBS's. How does a lack of evidence for BBS's actauly prove anything about minimalism?

Simple. Plantar fasciitis is due to too much load in the plantar fascia above what the tissues can take. Apart from the initial acute management (ICE; NASAIDs; etc), Treatment is aimed at reducing that load in the plantar fascia and increasing the ability of the structure to take the load.

 

So what do you prescribe? nothing? barefoot? any type of shoes... according to the patient preferences? colour preference?

Where did you pick-up that?

Worse? show me the evidence

Agree, but it's not a reason to promote and prescribe another intervention (BBS) that is more "interventionist' and nor more evidence based

NSAIDs = old medicine. Like orthotics there is evidence on short term only ... and we start to understand the bad 'weaken' effect of this treatment.

YESSSS you do like me. BBS at the beginning and when it's better you start to increase the stress by more loading, activity, exercises, minimalism, ... (even with no specific evidence on that) I call that Mechanical Stress Quantification! http://www.therunningclinic.ca/medias/pdf/quantifying-mechanical-stress.pdf

 

Let’s just deal with the issues of rhetoric and propaganda and cherry picking. Let’s takes just one example:

There are lots of claims that minimalism makes the foot muscles stronger. Is that rhetoric and propaganda or is it evidence based?

The only evidence that I can find (discussed here) tells me that it is not the case (which I did find surprising!). I can find no other evidence. What am I supposed to do? Should I ignore the evidence?

So if someone claims that minimalism strengthens the foot muscles, then is this claim rhetoric and propaganda or is it evidence based? How can anyone claim it is evidence based when the current evidence says it is not true, so it must be rhetoric and propaganda. To me, it will remain that way until there is some good research that provide better evidence than the current available evidence (which, admittingly it is not the best quality evidence, but its still evidence pointing to the claim not being true) (BTW, we are about to start recruiting on a study to do just that)

How is that cherry picking? I am using all the evidence that I can find on the issue. I am not ignoring other evidence that’s shows the opposite as no other evidence exists (at least not that I am aware of). I am not cherry picking one study over others or being selective - I have considered them all. Surely, those who are cherry picking are those who make the claims and choose to ignore the evidence.

 

Craig,
I agree that some claim about minimalism have no sense. (but the one you expose here)
If I was debating juste with you we will not speaking about rhetoric, propaganda and Cherry picking. If you want understand my point about those words listen that http://www.youtube.com/watch?v=k9pU1hMLP-E&feature=player_embedded

I' still interested to your answers to my questions
Quote:
Originally Posted by Craig Payne
Where have I ever claimed that BBS's should be used for plantar fasciitis?
So what do you prescribe? nothing? barefoot? any type of shoes... according to the patient preferences? colour preference?

Quote:
Originally Posted by Craig Payne
... they got so bad they could not continue...
Where did you pick-up that?

 

Let’s look at another example, we have all seen the claims “foot orthotics weaken muscles”. Is that propaganda and rhetoric? Are we cherry picking the research when we say it is not true?

What does the evidence say? – 3 studies have looked at foot orthotics and muscle strength. I am not cherry picking certain studies,as they are all the studies that currently exist and that I am aware of (unless someone can point me to others). All 3 studies have shown it is not true; in fact 2/3 have shown that foot orthotics actually increased the muscle strength.

Should people ignore the research because it does not fit the agenda they are promoting? If they ignore the evidence and make statements to the contrary, is that not propaganda and rhetoric?

Are those who make the claims that “foot orthotics weaken muscles” guilty of propaganda and rhetoric? If they are not guilty of propaganda and rhetoric, then what is the claim about? Why do they choose to ignore the evidence? Are they not being dishonest when they make the claims? Why do they do that for?

Also, how is this me being biased? How is this me promoting an agenda? How is this me being guilty of propaganda and rhetoric ....Put simply, them there are the facts. I do not make them up.

 

Craig,
We discuss a lot about that and I tell you all what I thing in another post

I' still interested to your answers to my questions
Quote:
C : Where have I ever claimed that BBS's should be used for plantar fasciitis?
B : So what do you prescribe? nothing? meaning barefoot? ... or any type of shoes... according to the patient preferences? colour preference?

Quote:
C: ... they got so bad they could not continue...
B: Where did you pick-up that? I can write to Jack to know the reality. Is it an other interpretation of you church group?

 

http://www.physicaltherapyinsport.com/article/S1466-853X%2808%2900118-1/abstract

Does the use of orthoses improve self-reported pain and function measures in patients with plantar fasciitis? A meta-analysis

Results
We utilised the Roos, Engstrom, and Soderberg (Roos, E., Engstrom, M., & Soderberg, B. (2006). Foot orthoses for the treatment of plantar fasciitis. Foot and Ankle International, 8, 606–611) night splint condition to compare our pooled orthoses results. The meta-analysis results showed significant reductions in pain after orthotic intervention. The Roos et al.' (Roos, E., Engstrom, M., & Soderberg, B. (2006). Foot orthoses for the treatment of plantar fasciitis. Foot and Ankle International, 8, 606–611) study also showed significant reduction in pain after night splint treatment. The meta-analysis results also showed significant increases in function after orthotic use. In contrast, the Roos et al.' (Roos, E., Engstrom, M., & Soderberg, B. (2006). Foot orthoses for the treatment of plantar fasciitis. Foot and Ankle International, 8, 606–611) study did not show a significant increase in function after night splinting for 12 weeks.

Conclusion
The use of foot orthoses in patients with plantar fasciitis appears to be associated with reduced pain and increased function.

https://www.jstage.jst.go.jp/article/jpts/19/1/19_1_41/_pdf
Evidence exists for night splints, orthoses, extracorporeal shock wave, and stretching as interventions for plantar fasciitis.

https://physsportsmed.org/doi/10.3810/psm.2009.06.1712
Plantar fasciitis is a painful condition affecting many athletes. Anatomic and biomechanical factors combined with overuse can contribute to its genesis. Correction of gait disturbances, changes in footwear, use of tension night splints, and stretching of tight calf and plantar tissues have all be proven to relieve symptoms.

http://www.japmaonline.org/content/94/3/229.short
This study evaluated the clinical effectiveness and cost-effectiveness of two different types of foot orthoses used to treat plantar heel pain. Forty-eight patients were randomly assigned to receive either a functional or an accommodative orthosis. General (EuroQol) and specific (Foot Health Status Questionnaire) health-status measures were used. Data were also collected using economic questionnaires relating to National Health Service costs for podia-try, other health-service costs, and patient costs. Data were measured at baseline and at 4- and 8-week intervals. Thirty-five patients completed the study. The results demonstrated a significant decrease in foot pain and a significant increase in foot function with the functional foot orthoses over the 8-week trial.

Lynch et al31 compared the effectiveness of 3 types of conser¬vative therapy for the management of plantar fasciitis. A total of 103 subjects were assigned to 1 of 3 treatment groups: anti-inflammatory therapy consisting of a corticosteroid injection and NSAIDs (n = 35), an accommodative viscoelastic heel cup (n = 33), and a mechanical treatment which consisted of an initial low-Dye taping followed by custom orthoses (n = 35). The primary outcome measure was pain rating based on a visual analogue scale and patients were followed for 3 months. The authors reported that the mechanical treatment group had a greater reduction in pain and had fewer drop¬outs than the other 2 groups. In addition to the fact that pain was the only outcome measure assessed, the foot orthoses group had the confounding short-term effect of taping.31

Turlik et al57 focused on the effect of foot orthoses alone by evaluating 60 patients with plantar fasci¬itis, assigned to either a custom, functional foot or¬thosis group (n = 26), or a generic gel heel pad group (n = 34). While the actual duration of the intervention was unclear, most patients were followed for at least 3 months, with 5 sub¬jects dropping out of the heel pad group. To assess patient outcomes, a 5-item outcome survey was developed by the au¬thors. The authors reported that the custom, functional foot orthoses group had better outcomes than the heel pad group.

Pfeffer et al42 conducted a randomized multicenter trial involving 236 patients diagnosed with plan¬tar fasciitis recruited from 15 orthopaedic foot and ankle clinics. The patients in the study were used to evaluate 5 different treatments: (1) calf stretching only, (2) a silicone heel pad and calf stretching, (3) a felt arch insert and calf stretching, (4) a rubber heel cup and calf stretching, and (5) a custom, functional foot orthosis and calf stretching. The patients were followed for an 8-week period and they used the pain subscale of the Foot Function Index (FFI) as their outcome measure. They reported that the groups treated with the prefabricated inserts (silicone pad, felt arch insert, rubber heel cup) had significantly better outcomes than the group treated with custom orthotics and the group treated with stretching only. Although the 8-week intervention pe¬riod for this study was extremely short, the results indicate that prefabricated orthoses are effective and that stretching and prefabricated orthoses are more effective than stretch¬ing alone.42

Martin et al32 evaluated custom foot orthoses in comparison to prefabricated arch supports and night splints in 255 patients with plantar fasciitis. Patients were randomly assigned to 1 of 3 treatment groups and the primary outcome measures were self-reported first step pain as well as pain during work, leisure, and exercise activities using a visual analogue scale. Of the 255 patients initially enrolled in the study, only 193 were seen at the final 12-week follow-up visit. Patients in the prefabricated ortho¬ses group and the night splint group had the poorest compli¬ance rates and the highest number of patients withdrawn, with 21% and 26%, respectively. At the 12-week follow-up visit, there was no significant difference in pain reduction between the 3 groups. The authors did indicate that patient compliance was greatest with the use of custom foot orthoses.32

To date, the most long-term, comprehensiveclinical study of the effectiveness of foot ortho¬ses in the management of plantar fasciitis was conducted by Landorf et al.29 They conducted a partici¬pant-blinded, randomized trial utilizing 136 patients with a clinical diagnosis of plantar fasciitis. Patients were randomly allocated to 1 of 3 treatment groups: (1) a sham orthosis constructed of soft, thin foam (n = 46), (2) a prefabricated firm foam orthosis (n = 44); and (3) a custom, semirigid thermoplastic orthosis (n = 46). The outcome mea¬sure used was the pain and function domains of the Foot Health Status Questionnaire (FHSQ). Outcomes were as¬sessed prior to initiation of treatment, at 3 months, and at 12 months. At the 3- and 12-month follow-up visits, each group lost only 1 to 2 members to follow-up, so that the total num¬ber of patients reviewed at 12 months was 131. After 3 months,

Keep selling your fad theories that are not approved by any professional body, practice guidelines, professional organization etc and are completely unsupported by even ONE study. Keep arguing, keep deflecting, keep your head in the sand..

Show us ONE positive outcome study or professional organization recommendation for barefoot/minimalism in the treatment of plantar fasciitis or go away. You never answer a question because you can't, all that you have is anecdote and bias and you don't care about facts.

Cat got your tongue Blaise?

 

Dear David,
You just show me what I know and what I tell. Orthotics are efficient on SHORT term for FOOT problem!

LOVE you cite the Landorf study... just sad you cut the conclusion : NO DIFFERENCE at 12 months between sham insole and other 2 orthotics on pain and function.
Now I now you are not really looking for truth but just want to protect your job.

So now you have 3 choices in your practice 1. continue to SELL orthotics on LONG term for ALL musculo-skeletal problem.... OR 2. think a little more ... a little further... and accepting the evidence are limited or absent to clearly establish clinical guideline ... and taking the indirect evidence (not just about orthotics but all medicine domain) to have the best practice possible with available knowledge (if it's the case you will probably NOT prescribe orthotics on long term for plantar fasciapathy OR 3. listen expert http://www.therunningclinic.ca/medias/pdf/5390-cdc-affiche-organigramme-.pdf :drinks

Blaise
PT and foot specialist

 

Actually those studies have not been done to my knowledge Blaise, where is your evidence otherwise? You appear to have changed your stance over time after being pummeled with the evidence that orthotics work for acute PF and have now conveniently shifted to chronic as your attack point. Guess what? This thread is about FOOT problem and –itis not –osis. Pay attention.

I’ve never seen one patient who ascribed barefoot/minimalism to resolving their PF, in fact the opposite is true; most of them report developing their problem during the barefoot, flip-flop and sandal season, overuse from training etc. I have also never had a patient tell me their physician prescribed barefoot/minimalism. Interesting, perhaps arch support and decreasing tissue loading is the key for most patients (Craig)?

Of course I included the Landorf study. Unlike you, ethical people like Craig, I and others are critical of the evidence but do not obviate the truth and where the evidence leads. There are problems with studies such as Landorf’s when comparing “customs” because of the high variability of design options but I digress. You’re deflecting and adding a straw-man argument.

What you’re not saying is they work, which is what the study found Einstein (so did ALL of the other studies I provided. No comment on that of course, just construct another straw-man argument, shift to -osis, deflect and avoid bringing ANYTHING to the table. No evidence Blaise, that's what you have. Nada, Zip, Zero.

As for the notion that I “sell” orthotics, as a Pedorthist nearly 90% of the orthotics that I dispense are on referral from specialists. The fact that they’re referring them says something about those doctors as well; not all foot specialists profit from orthotics (the ones that do, do so as a medical service based on medical necessity just as a PT does therapy and benefits). Regardless, I am a practicing chiropractor so the bulk of my day is spent treating chiropractic concerns, not just the feet so your assertion is just plain ludicrous.

A lot of my own patients over the years have experienced recurrence of their PF when they remove their orthotics. Why is that Blaise? Since I dispense most of my orthotics on referral (from REAL foot specialists), there is NO conflict of interest even possible Blaise. I perform a service and I perform it well, medical necessity is met (by rational physicians with real title to calling themselves a foot specialist).

You’re only revealing yourself for the narcissist that you are. No one of any real import considers you any sort of expert on anything. My prediction is that this fad will die down and you’ll be left explaining why you have been treating patients outside of accepted clinical practice and guidelines and discredited.

To date I have seen a lot of talk and no case studies or clinical trials performed by you of your clients. I guess they will just have to take your word for it that you are an expert and that you know what you’re doing and that barefoot/minimalism is a treatment for anything, let alone PF (chronic). Read the title of the thread again, -itis not -osis.

Is that what the script the physicians send you say, treat with barefoot/minimalism? Show us just one? Why is that so many of my patients whose PF resolves have recurrence when they remove their orthotics? Almost all of them have been referred and are being seen by PT’s for therapy and “strengthening” and yet recurrence happens. Fascinating, only when SUPPORT is reintroduced do they improve and almost universally when they go barefoot or wear unsupportive footwear recur. I’m sure everyone here has seen that (except Blaise and possibly his network of barefoot/minimalist advocates). Great idea for a poll?

This thread isn’t about shoes and it isn’t about -osis Blaise, stay on topic or leave. Answer the questions or leave; you contribute nothing of value other than self-promotion of thus far a valueless and unsubstantiated ideology that you cannot defend.

You cannot answer and change the subject because you have no answer, just more questions. I think we should take a vote and the next time Blaise wanders off, gets nasty etc his comments should be removed so that we don’t have to sift through his BS “I know you are but what am I” childish vitriol.

I have a 4th choice Blaise, not to listen to the grandiose claims of the few and not to treat my patients as guinea pigs as you appear to be engaged in.

I took a screen shot of your tagline and I intend on sending it to the Canadian PT Board. Let’s see what they think of you claiming to be a “foot specialist” shall we?

Tap out now.

 

:sinking:

PS : please don't forget to send you request it to the Canadian PT Board. igs:

 

I see a huge number of patients who have plantar fasciitis/osis who are barefoot or wear minimal footwear- sandals etc. They have the symptoms just walking.

So Blaise, Mark- Do you think they should go out and start running barefoot/ minimalist?

 

Blaise how about sharing some of your wisdom with regards to long term management? David put a lot of effort to share papers on Orthoses effectiveness can you not do the same? The majority of threads are started by a research paper/report and then it's discussed. Come on take the stage now is your chance. Like I said previously I come here to learn and if you have some good evidence based rehab for a long term treatment lets have it please.

 

Podiatry Arena readers,

This is my final post in reply to the thread.

One area I take pride in is professionalism, respect for opinions, and engaging in honest and open debate. This is science…the field of discovery. I discover new things almost daily in my job and in life. It was a privilege to engage in an honest and open discussion with Simon Bartold of Asics at the AMAA Marine Corps Marathon Sports Medicine Symposium this past weekend. We agreed on a lot, especially the structure and strength issues that lead to many injuries. Yes, we varied in our shoe opinion. There were great audience questions and we each gave our opinions based on how we saw the research combined with our personal and professional experience.

I am a Family Physician and Simon is a Podiatrist and Researcher, so we come at things from different avenues. Simon and some fellow colleagues have taken the talk and made it a personal attack on a podiatry site. You can read the posts at the link below and see my rebuttal here. When one takes a debate on the literature and digresses into belittling friends (see the comments on Blaise and Dr. Nick Campitelli) then it becomes a bit more personal and I feel the need to respond.


Complete thread and Simon’s first post w my responses:

http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=83544
Kevin.. cheers from a hurricane ravaged NYC..
I did indeed debate Dr. Mark Cucazella in Washington D.C. over the weekend, although I am still scratching my head over exactly what it was.
It went something like this.. I gave a 1/2 hour presentation outlining the reasons athletes get injured,what they do about it once they are injured, where minimalism and barefoot fit in, discussed form and the current concepts of FF vs MF vs RF, and tried to piece it all together in relation to footwear for the runner. Every part of this presentation was referenced (There were no references and Simon refused to leave a handout or reference list) with the most up to date literature I could access (none cited), and none of my presentation was based on my own opinion or anecdote (well, there were no references to any peer reviewed research. He showed Steven Kiprotich land on his heel and made opinion on his form)
Mark then took the podium, and for the first 10 minutes showed a random video from the 1979 of a bunch of New Zealand farmers who became runners, with a few snaps of Arthur Lydiard (showed the short clip of the hill springs and Jack Foster running over the hills. This is in jury prevention 101- 5 min w narration to what they were doing). He then spent the next 15 minutes showing videos of himself running, some barechested which was exciting, with the obvious assumption that the audience would immedaitely make the connection between the way Mark runs, the New Zealand farmers ran, injury and "form". Unfortunately, no-one got it at all. (?? Showed the first 4 min of our Principles of Natural Running video. Do not recall any bare chest)
You must remember this was a formal presentation to a medical audience, all doctors, immediately after a couple of good quality evidence-based lectures on medical management of emergencies during a marathon and exercise induced leg pain.
To say I was a little non-plussed would be an extreme understatement...The final 10 or so minutes of his alloted time telling the audience of his own personal opinions in relation to the issues, and he illustrated this by pulling out of a bag 20 or so used pairs of shoes.. all minimalist.. that he lined up along a table. really quite bizarre! (opinion? I went through how to assess and retrain one who desires to reduce their shoes. I had a table of shoes dating back to 1960 to show the progression of footwear)
The interseting thing is that Mark has formed a "syndicate' with a bunch of guys, Biase being one of them, who will only recommend minimalist of barefoot. One of the syncophants is Nick Campitelli, who has called Mark "one of the greatest contemporary running educator of our time!".. I did not observe this unfortunately.. (wow- a syndicate)
These are some of the things the great educator has said:
"Maximum pronation actually occurs when your heel is off the ground, so the foot’s role in this is critical." (true- Steve Magness summary has several cited articles on the topic as well as this article from JOSPT)
"Runners (with or without shoes) who have strong feet have the ability to control the motion just fine." (true- this is the heel raise test done by clinician to test foot control and strength. Can you get up on ball of foot and lower controlled)
"For most modern-day runners, spending a lifetime in stiff, overly cushioned, and supportive shoes has diminished their natural pronation control." (of course- they need the support of a shoe when foot weak)
"Why is natural pronation control better? The foot is the magic spring that adds elastic recoil to our stride. This is free energy. When the foot is constricted by a rigid shoe, it cannot work as a spring and you need to apply more muscle to the stride. More muscle use is equated to more fatigue; and consequently there’s potential for more injury." (true- my opinion)
"once you go minimal donate the traditional shoes. your body will reject them. like eating crap after you have discovered real food." (we have a bin of discarded shoes)
His associated website.. Natural Running Centre makes the following observations:
" if the runner has suffered from patellar tendinitis, shin splints, or IT band syndrome, the pain always diminishes or is eliminated when the runner switches to a minimal shoe and a midfoot strike."... sheeeeez.. (Note: I have a column on this site “Dr. Mark’s Desk” and do not edit or control all content. I did not write this)
'I know there are people, most with perfectly good intentions, who believe that there are different ways of running “correctly”, each way unique to the individual, and that running form cannot really be taught or changed. There is an idea that running form is natural to the individual, but not the species, and any attempt to change an individual’s form is equal to forcing an unnatural change that will be detrimental to health and performance. Unfortunately traditional running footwear always alters a runner’s form." (I did not write this but would agree. We see this in children. See Wegener paper)
" At least we have science on our side." (I gave 100 plus references. Simon none)
"Overpronation (or lack of supination) as with most symptoms, is often treated improperly as the root cause of a problem, especially by those eager to sell runners orthotics or “anti-pronation” shoes." (I did not write but agree that treating functional pronation is wrong. See chapter in Pete Larson and Bill Katovsky’s Tread Lightly with dozens of refs)
"orthotics or motion-control footwear can now become the reason for a new injury as normal gait is disrupted and shock is artificially altered." (I did not write but see Ryan paper and military studies on fitting shoe for foot type)
"How do you know if you really overpronate? There are a few things you can do as a self test. First, look at the shoes you’ve been walking or running in for some time. If the outside of the heels are excessively worn out, then that is a sure sign you overpronate.".... WTF!!! (I did not write and yes this statement is incomplete if looked at in isolation. The post by Dr. Steve Gangemi described this as part of a complete clinical evaluation)
anyway.. I could go on like this all day.. you all get the gist of it.

The bottom line is that like nearly everyone, Mark has something to sell.. minimalist footwear at his minimalist store. (BTW I had no links to my store during talk or even mentioned the name. I mentioned I owned a store selling flat shoes as disclosure. I had no cards, flyers, give aways, or discounts. Asics gave away shoes, bought lunch for the meeting , supplied snacks for 2 days, gave out brochures with discounts, and sent 2 sales reps)The thing that REALLY concerns me is that is see a trend developing that was openly espoused by Mark.. that ALL children of ALL ages should go barefoot or minimalist for ALL activities whenver they can. (yes I would agree here. See Jay’s and my piece in September Running Times)

I just have to wonder if there is panic setting in at the demise of minimalism, and this is one last desperate attempt to sell footwear. (I’m shaking in my bare feet every day ….you have me here Simon)

You be the judge..(true- let each runner be their own N of 1)

SB

…………………………………………………..

Additional stuff
Here is one link to look at the materials I submitted for the conference
AMAA Shoes
Natural Running Resource Sheet
Medical Home Backyard. (keynote talk on community health and engagement. This is what small running retail and race directing is all about at grass roots level)
Natural Running STFM – peer reviewed resource available here too.
http://www.yousendit.com/download/WUJhU2VpSWVwcFV3anNUQw

Look at this video for what Asics considers research. No citation of peer review or publication.
Watch Simon call the Journal Nature the equivalent of Science Digest and belittle Dan Lieberman’s work. Dan not in the room.
Simon used this as his main reference for his research. His Facebook Page . Not sure there is much peer reviewed work here. He did call me out for a post not written by me though. Like he said “You be the Judge…”
http://www.facebook.com/bartoldbiomechanics

Oh…I did run the race this weekend, my 20th Marine Corps Marathon. Lots of fun to be part of the USAF team, seeing old friends, and taking part in this amazing event as member of the US Armed Forces. I finished in 2:48, 47th overall and second in my age group to long time friendly rival and now retired Marine Alex Hetherington. Alex is in the Marine Corps Hall of Fame. We each done this race 20 times and I think our score is pretty close to tied. We’ll need historian George Banker to figure it out.
Alex you looked amazingly strong out there. I tried to keep you in sight into Crystal City but the wind got the best of me. Look out next year…I’ll be back 


Cheers ,

Mark

 

Interesting list of references which includes-
Ultimate Ride by Chris Carmichael
• Learn how Lance built his engine back. Principles apply to runners also.
Might want to edit that one Dr Mark...

 

so at the end of this I can only conclude that your only qualification to sprout this nonsense is that you can run OK.. weird..

 

Mark:

So I take it you can't answer the one simple question I have asked you quite politely to answer three separate times:

Please provide us with scientific research or other high-level references which supports one of the statements you made from your internet article on plantar fasciitis: "The only way that you can actually fix plantar fasciitis is to address the root cause… weak foot muscles."

Please show us the research evidence that supports your contention that people with plantar fasciitis have weak foot muscles.

I would think you would want to explain your medical reasoning behind such a statement before you signed off since, honestly, a statement such as this, made by a podiatrist or orthopedic surgeon at a podiatric or orthopedic surgery seminar, would create quite a stir. Maybe family practice physicians can make such potentially harmful statements, totally out of their area of specialization and expertise, with no worry of recourse??

In other words, Mark, could you please drop the "knowledge bomb" on Podiatry Arena also?

Dr. Mark Cucuzzella Drops the Knowledge Bomb on the Nation

We are all anxiously waiting to be enlightened.

 

Watch Simon call the Journal Nature the equivalent of Science Digest [/URL]and belittle Dan Lieberman’s work. Dan not in the room.

Mark! This is simply not true.. I said Nature was the scietific version of Readers Digest! I said the nature article published by Lieberman and co was terrible science with multiple flaws including randomised stats, claiming they did 3D analysis when they did 2D, comparing a cohort with an average age of 19 to a cohort with an average of 40, mixing their genders and presenting a pilot study a fact when it was not. I said exactly the same thing to Dan when i debated him at the UKSEM confence in London in November last year and also told him, face to face that he had a very poor undestanding of advanced biomechanics, which he does! I have further said that the Nature article would never have been accepted into any peer reviewed biomchanics or sports medicine journal with any decent rating..,and it is clear it would not have.. All this in his presence Mark. i do not hide behind blogs or anything else, and i eventually get to discuss matters with these people face to face. I just cannot wait to one day meet Chris Mcdougall and have the chance to question him.. Anything else you want clarified?

 

I was at the World Congress of Biomechanics just after that paper in Nature came out. It was widely condemned by everyone at that conference I spoke to! Every biomechanist (who know more about this than me) I have discussed this paper with condemned it.

Why is it that those who understand biomechanics and the types of analyses done in that paper do not accept the results and why is it those that promote minimalism accept it?

In fairness to Lieberman, he did take the unprecedented step to publish as disclaimer on his website to distance himself from all the flawed interpretations being made of his research by those promoting minimalism and barefoot.

 

Simon:

When you do meet McDougall, tell him I very much like the name he gave me, the "Angry Podiatrist". I've gotten lots of laughs at lectures telling people how McDougall thinks I'm angry (even though I have never met the man) simply because I publicly called his book "Born to Run" a semi-fictional novel full of half-truths.

 

Itis = some weeks = protection = orthotics, decrease mechanical stress, taping, NO NSAID's...
Osis = some months = adaptation = desensitization with manual therapy, eccentric exercise, mechanical stress quantification, intrinsic muscle strengthening ...

And you? what your treatment : orthotics for everybody?

 

Interesting comment considering you have just stated how you treat PF yet you don't even mention assessing the patient. This would suggest that you are the one who is guilty of the 'same treatment for everybody...'

I asses the individual to determine which causative factors may have lead to the problem and try to address these.

Some of the methods employed include footwear changes (as stated before they are often in inappropriate footwear), manual therapies (stretching programs, soft tissue release, trigger point therapy, joint mobilisation- some of these I do myself, others I defer to my Physio colleagues as they may have more advanced skills in these areas); if they are active then possibly training modifications are appropriate, otherwise it might be lifestyle modifications.

I do utilise foot orthoses often in these cases- why? Because they are very effective- both the research and my anecdotal experience suggest this- and provide very rapid improvement/ relief of symptoms.

Oh... and I do not make one cent from manufacturing foot orthoses. I earn a salary.

 

That is true Craig, but I like you, have now heard him lecture many times. On each occasion he has specifically refused to allow questions, which in itself tells a story.
In addition, he is like all the others in that during a presentation he will say one thing, but privately say something else. It is very dishonest and very duplicitious and this is my main beef.
I debated Lieberman in London for the UKSEM conference in December last year. He told the conference organisers that if anyone disagreed with what he had to say, he would walk off the stage... really... during a debate!!!.. he also tried to get one of his syncophants included on the panel. During the preparation meeting of speakers.. Lieberman arrived an hour late, announcing that he had been for a run.. barefoot of course, because "that is the way man was designed to run".

Like so many of these guys it is all smoke and mirrors and cloaked in dishonesty, but as you have seen, he is still held up as the font of all biomechanical knowledge by people like Mark and co, when in reality he is an evolutionary biologist whos area of expertise is the skull!!