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Vibram FiveFingers Cause Metatarsal Stress Fractures?

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Kevin Kirby, May 5, 2010.

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    Due to the increased usage of the "minimalist shoe", Vibram FiveFinger, there seems to be an increasing number of reports of metatarsal stress fractures occurring due to running in these shoes. However, since both Dan Lieberman, PhD and Chris McDougall, author of "Born to Run" are pushing these shoes as a "barefoot alternative" running shoe, then maybe they should both be a little concerned about the potentially serious injuries they are causing in runners by suggesting they run in these shoes. In fact, there is a recent report that Chris McDougall himself suffered a metatarsal stress fracture running in Vibram FiveFingers, but this hasn't been confirmed yet.

    Here are a few samples of runners that have developed metatarsal stress fractures from running in Vibram FiveFingers from a quick web search. I don't have any patients that wear these shoes regularly and have not seen any metatarsal stress fractures develop as a result from running in them. But it looks like there is a significant correlation here.



  2. That will teach them for wearing shoes while running , idiots !!!! ;) :deadhorse:
  3. Griff

    Griff Moderator

    The following question was asked on a barefoot forum:

    Here's an interesting opinion/answer from 'Barefoot Josh':

    Full story
  4. Griff

    Griff Moderator

    Here's another one to add to your list Kevin:

    And do you know what the answer was??

    So there you have it.
    Barefoot wisdom #1: Stress fractures are not caused by doing too much too soon.
    Barefoot wisdom #2: They are caused by not enough barefoot running.
  5. Here's another report of metatarsal stress fractures due to running in Vibram FiveFinger shoes.

    Now, if Chris McDougall were honest, and not just out to sell books at the expense of the health of other runners, he would come out and say [just like he did in "Born to Run" about "cushioned running shoes"] that these shoes should be banned from being marketed to runners because they are causing injuries, not preventing injuries! How many more of these injuries will occur before one of the barefoot/minimalist runners warns people to not run in these shoes?!

  6. DaVinci

    DaVinci Well-Known Member

  7. Paulo Silva

    Paulo Silva Active Member

  8. Airlie

    Airlie Active Member

    I have a friend who participates in recreational rock climbing, and a few years ago he discovered the VFF and bought them around for my opinion, he and some fellow rock climbing friends were looking at investing in becoming retailers of the VFF. I tried them on in my size and just walking the toe bits were pretty uncomfortable for my narrow foot with long toes. they dont offer much in the way of variable sizing to accomodate for this.
    His girlfriend had been wearing them and claimed she had run 5km that day and had no problem, but her feet were quite warm after this. I havent done much running for a few years, but did alot as a teenager and managed to do a half marathon when i was 20. I would be particularly concerned if my feet got hot after running only 5km.

    It seems that these shoes have a great place in activities where the foot needs to adapt significantly to grip surfaces, like rock climbing and diving/snorkelling and other water sports owing to the close fit and material.

    I cant see that any feature makes them suitable for running. I am also quite interested that most of the quotes in this thread claim they drastically reduced their mileage to allow accomodation of the VFF. I dont know many long distance runners who would vary their training schedule so much to accmilatise to a new pair of running shoes, so obviously most people are sceptical from the start

    For the record, my friend decided not to go ahead with selling the VFF, they wanted something like $Aus 20,000 start up fee and their girlfriends all decided the shoes where too ugly to warrant that kind of investment :)
  9. Iñaki

    Iñaki Active Member

    Very interesting internet research!!
    I didn't know that the use of these shoes could cause stress fractures, but thinking about it, it seems quite obvious to me.

    Here in Spain they are not very popular yet but more and more my patients are asking about information about them. I will start warning people about the potential risk of running with vibram fivefingers...

    Ian, someone should put in jail those who give such stupid advices...
  10. CamWhite

    CamWhite Active Member

    I'm not sure this isn't an urban myth. I have scoured the web looking for confirmation of a McDougall injury, and have come up empty. Given his speaking schedule and public appearances, a stress fracture would be very hard to mask. If he had a metatarsal stress fracture, it would likely affect his gait and probably turn him into a heel striker, wouldn't you think? Unless of course he has a super-human tolerance for pain. I am also fairly certain, that if he pulled up lame during his PR tour, many would have taken notice, and commented about his injury. For now, I am going to chalk this off as a rumor.
  11. Griff

    Griff Moderator

    And another one taken from here:

  12. Griff

    Griff Moderator

    And another:

  13. Griff

    Griff Moderator

    Interesting comment here:

  14. Griff

    Griff Moderator

    I'm getting bored of looking now

    From here
  15. Secret Squirrel

    Secret Squirrel Active Member

    :good: all I can say is that this is extraordinary!!
  16. I am quite shocked at the lack of critical thought associated with most of these posts. Whether barefoot running or wearing Vibrams it is essential that a person work very slowly into this significant change in their training. Did any of these people follow appropriate protocol in moving from running shoe to barefoot or vibram running?! We are blaming the shoe on MAJOR STRATEGIC TRAINING ERRORS. We have to remember that it will take several months to adapt and accommodate this new stress. Just as in the folks who have never run in their adult life need to pick up this new skill (i.e. running) very slowly. I must also add that I would never recommend that someone run exclusively in these shoes and never for marathon mileage. For those of you on this post that have claimed injury to barefoot or vibram running, try the following:

    1) Integrate barefoot training in a technique and drill focused warm-up on an accommodating surface such as grass. There will be no actual "running" to start, just technique drills and a single leg strengthening exercises. Time: approximately 10-20 minutes. Frequency: 2x/week. Continue with regular training minus 10% in regular shoes.
    2) Progress warm-up over a period of 2-3 months. At the end of the 2-3 months should be the first sign of consistent running. This would be no different than the "Learn to Run" programs offered to adults who have never run, at your local running club. Warm-up + an easy interval or walk/run on an accommodating surface. 2x/week. As above, continue with regular training minus 10% in regular shoes.
    3) SLOWLY PROGRESS or continue using this type of training as an implement to improve your running form.

    Some important questions to ask:

    1) What type of foot does this person have.
    2) Have they been running in motion control shoes, stability shoes, neutral or racing flats?
    2) Lower extremity alignment and function (i.e. anteverted femur, poor proprioception/balance, weak hip abductors, etc.)
    3) Technique (do they actually know how to run with good form?)
    4) Previous injuries
    5) Weekly training load (training intensity x volume)
  17. Michael, you post is well made. A question you may need to answer: What difference should the answers to your questions above make to the decision of whether, or not, someone should run in Vibram five fingers? So, a few questions back to you:

    1) So certain foot types should never run in these shoes? Which ones?
    2) The previous shoe preference dictates whether or not an individual should run in these shoes?
    3)(the second: 2 in your list) How does lower extremity alignment such as (your example) femoral anteversion influence the ability of an individual to run in said shoes?
    4) What is "good form"? Moreover, how does this influence an individuals ability to run in these shoes?
    5) How does a history of previous injuries influence an individuals ability to run in these shoes?
    6) How does the weekly training load (training intensity x volume) influence an individuals ability to run in these shoes?
  18. DaVinci

    DaVinci Well-Known Member

    Surely you jest?

    I assume you are saying the same thing on all the barefoot running websites when they make all the unscientific nonsense claims about running shoes as well?

    See this thread:
  19. JB1973

    JB1973 Active Member

    For those of you on this post that have claimed injury to barefoot or vibram running, try the following:

    1) Integrate barefoot training in a technique and drill focused warm-up on an accommodating surface such as grass. There will be no actual "running" to start, just technique drills and a single leg strengthening exercises. Time: approximately 10-20 minutes. Frequency: 2x/week. Continue with regular training minus 10% in regular shoes.
    2) Progress warm-up over a period of 2-3 months. At the end of the 2-3 months should be the first sign of consistent running. This would be no different than the "Learn to Run" programs offered to adults who have never run, at your local running club. Warm-up + an easy interval or walk/run on an accommodating surface. 2x/week. As above, continue with regular training minus 10% in regular shoes.
    3) SLOWLY PROGRESS or continue using this type of training as an implement to improve your running form

    Hiya Michael
    i'm just curious as to why? why would anyone want to follow this program when there is no evidence to suggest that what the end result will be is better than what they are doing just now? why should anyone waste 2-3 months with this? give me ONE good evidence based reason.
    also as Simon alludes to above in response to your 1st question : are VFF only for certain foot types?
  20. Griff

    Griff Moderator


    We are of course being facetious, and if you were a regular on the forum or had read previous discussions such as the Barefoot Running thread you would see that we (the Podiatry Arena community) demand a far more rigorous level of evidence to suggest causality. Personally when posting all of the snippets here from websites I found, my tongue was firmly placed in my cheek.

    But now you have rocked up and 'got involved' I await your responses to Simons questions.
  21. Bugger. I quite like mine and no met fractures either. That said I haven't run in mine (but haven't run anywhere in 29 years) but they do carry 17st around during a diverse range of activities from baking profiteroles to cleaning the lavatory. And wee sharp bits hiding in the carpet don't seem to carry as much of a threat as they used to before. Maybe folk expect too much from them; barefoot running has a certain appeal, but perhaps evolution works faster than we think. What's next: platform shoes for high-jumpers?

    I prefer the gold and black ones myself.
  22. Kevin, no, I haven't paid much attention to the forum and didn't catch the "tongue in cheek", so sorry if I offended you.

    My quick answers to the above:

    1) I don't believe I said this (i.e. never run...). The acknowledgement of foot type is less about the typical classification of pes planus and pes cavus and more about how stable are they in a single leg, forefoot stance. However, any foot on the end of hypermobility and tendency to over-pronate or hypomobility and tendency to under-pronate would be a warning sign that barefoot running may not be the best idea... or at least extreme caution warranted in its application.
    2) The previous shoe preference indicates what type of shoe the person has previously run in, injury free or possibly with injuries. If a person has run injury free in the Brooks Beast, one might think they would have a tough time going from this to barefoot running. If they were previously running in racing flats, injury free, a transition to barefoot running will be an easier transition.
    3) Femoral anteversion places increased demand on the hip abductors and predisposes to excessive adduction and internal rotation of the hip during stance phase of gait (or during the push phase of cycling). This will lead to a couple possible scenarios: a) adduction and internal rotation of hip transfers internal rotation to tibia with a lateral shift of the pelvis (trendelenburg gait) that is insufficient to off-set the medial momentum resulting in over-pronation (often seen as over-pronation late in stance phase or lack of supination towards toe off). b) adduction and internal rotation of the femur that is off-set by a lateral shift of the pelvis. The lateral shift of the pelvis causes a COG shift to the lateral side of the foot. In this case the person has compensated away from the medial arch because they `know`they will be unstable in this position.
    4) this question requires at least 4 hours of lecture and practical instruction...
    5) If your patient has had a history of medial tibial stress syndrome, anterior compartment syndrome, plantar fasciosis, metatarsal stress fractures, or any other injury deemed to be related to excessive pronation... barefoot running may not be the best option to start with.
    6) Probably not the best idea to throw in any foreign training during the building phase of a competitive season. Athletes are often already at the maximum capacity and their bodies or working to the max in order to recover from their already demanding schedule. Adding a new stressor that isn`t off set by a decrease in training volume and or intensity, whether this is barefoot running or taking on a big project at work, may push you over the edge and into over-training. Over-training results in the decreased ability to recover and adapt to an already excessive amount of physiological stress (due to fluctuations in testosterone ratio, cortisol, growth hormone...) leading to an increased risk of over-use injuries.

    Also, please note that when I say critical thought I mean using the best evidence available while using your noggin to evaluate the best method for treating or recommending a prevention or performance based training methods. There is limited evidence for many effective interventions.
  23. DaVinci

    DaVinci Well-Known Member

    Its not rocket science, but its obvious why there could be so many stress fractures with the vibram:

    Last edited by a moderator: Sep 22, 2016
  24. If you are referring to the barefoot running on cement I totally agree...

  25. When discussing foot wear and running shoes there is limited evidence for all of the above. All I have to offer you is anecdotal evidence that technique and performance improves with the application of barefoot training. Please note that I never actually said I encouraged the athletes that I work with to run barefoot. I was trying to provide a more logical progression for those who apparently don't get the importance of very slow integration into such activity, in addition to a thorough evaluation and critical thought as to how beneficial or safe this would be for that person. I do however, encourage athletes to do some barefoot training such as the warm-up I previously discussed. We typically do a drill focused warm-up that promotes coordination and balance/stability followed by some easy accelerations focused on technique.

    Why should anyone do this? Well, this isn't just for ANYONE. This is for the serious athlete looking to gain a competitive edge. Most athletes depend on their performance to put food on the table and the margin of victory is often small.

    Evidence? Is there good evidence to suggest running in specific types of shoes prevents injury? Last I checked, no there isn't. Further, various forms of bodywork and massage have been used for centuries without ANY evidence-based reasons... other than the fact that people noticed it worked and continued to do it. We have been manipulating spines for centuries too... again, with no scientific studies to prove its benefits. But now, in the year 2010 we have 100's of studies demonstrating the physiological effects and benefits of the above.

    The bottom line is that if you wait for the evidence to tell you what to do you will be behind the leading-edge practical application needed to get the best athletes better and the chronic patients to become athletes. It just so happens, though, that there is a lot of evidence in this day in age to support a lot of things we do. But, the evidence will still always lag behind.

    Thanks, Michael
  26. Michael as your a little pro VFF and barefoot running. When making the decission on who could, should and should not. Do you take into account metatarsal lenght.

    ie a person with a short 1st ray and therefore long 2nd, will as studys have show have increased Ground reaction force applied to the 2nd met. In barefoot running forefoot striking is the norm, therefore increased GRF to the forefoot and increased bending moments to the metetarsals- increased likelyhood of stress fractures. Do you consider this or do you think barefoot runners should consider this?
  27. Short answer, yes. But, I wouldn't consider this an absolute contraindication.
  28. Paulo Silva

    Paulo Silva Active Member

    From Vibram FAQ's

  29. Craig Payne

    Craig Payne Moderator

    Michael :welcome:

    You have to take the posts made in the context of previous discussions of barefoot running. We have had a succession of barefoot runners here making all sorts of claims that are just not true and when asked to back it up, we never hear from them again.

    Look at the claims for the kerrigan research. You read on barefoot running websites that running shoes cause osteoarthritis, when they did not even do a study on osteoarthritis. Look at the way that the Lieberman et al research was interpreted by the barefoot runners and the media - it was so bad that Liebermann had to take the step of posting a disclaimer on his website to distance himself from the way the research was being interpreted.

    Then there is the claims about Abebe Bikila - he could run faster in shoes to break the world record.

    Then there is the claims about Zola Budd - she had to resort to running shoes to stop all the injuires that she was getting.

    Then there is the "cult" like worship of Born to Run, when there is so much fiction in it. Are people that gullible that they fall for it?

    Then there is all the claims about high impacts of heel strike causing so many of the running injuries ... I do not know of a single overuse injury that is caused by high impacts and there is NO evidence that high impacts increase the risk for any injury.

    Then there is the claims re muscle strength. There is NO evidence that running shoes weaken muslces (there is evidence that foot orthotics actually increase muscle strength). Weak intrinsic foot muscles actually cause a high arched supinated foot.

    There is no evidence that running shoes increase the risk for injuires, but how often do you see those in the barefoot running community claim that?

    There is no evidence of barefoot running or running with shoes being better or not - the evidence is that they are different.

    You see claims being made by barefoot runners that they have PROOF that running shoes cause injury and that proof is that they got an injury in a running shoe!! Based on that logic, they have to accept that the report of just one stress fracture (let alone the number reported above) in a Vibram Five Fingers is enough proof that Vibram Five Fingers is bad for you.

    You and I might see how absurd that kind of conclusion is, but this is what we continually come across when it comes to barefoot running.

    The comments above needed to be interpreted in that context.

    (and for the record, I will restate it again: I have NOTHING against running barefoot; all I object to is the rationale used by the barefoot community, the nonsense way they misuse and misinterpret research; and the unsupported claims they make. We are very brutal on podiatrists who make supported and unsubstantiated claims, so we not just picking on the barefoot runners.)
  30. robert bijak

    robert bijak Banned

    How silly can you get. All this analysis of what should be common sense. Dr. Kirby presents anecdotal statements re: stress fractures, DUH! Is anyone really surprised that running with minimal or no protection is stupid. End this thread as, my mother knew as much "biomequactics":pigs::pigs::pigs:. Open up your internal medicine book!Robert Bijak, DPM
  31. Michael:

    Welcome to Podiatry Arena. You seem to be quite knowledgeable and so your comments will be a great addition to our forum.

    One question for you, in his book on barefoot running, "Born to Run", Chris McDougall states that (paraphrased) "running shoes, since they cause injuries, should be banned as being 'unsafe' due to their obvious lack of research evidence that they prevent injuries".

    What are your thoughts on this rather provocative statement from Chris McDougall's book? Do running shoes cause or prevent injuries? Or, is it more like I stated in my Runner's World Debate on the subject (paraphrased), "it is not shoes that cause the injuries in running, it is the much greater forces on the foot during running at 2-3 times body weight that cause the injuries associated with running."?

    Am interested in your thoughts. Welcome again!:welcome:
  32. Thanks Craig. Kevin was quick to send me a note on the context of previous posts and this forum... I have never been involved with or paid any attention to this forum before so missed the "tongue in cheek" Kevin was using in his post.

    However, Robert, running barefoot or with minimal protection in the context of improving running technique in the form of doing running drills is not stupid.

    Running marathons barefoot? Now that is silly.
  33. Michael:

    You must be getting me confused with someone else because:

    #1: Ian made the "tongue in cheek" comment, not me.

    #2: I have never sent you a "note on the context of previous posts"...have I???

    The quotes from different people in my first post in this thread are excerpts taken from the internet where individuals claimed they developed metatarsal stress fractures while running in the Vibram FiveFinger shoe. There was nothing "tongue-in-cheek" about my initial post in this thread. I will not be able to recommend this shoe for any runner. If they do want to try and run in this shoe, they will be informed of the high incidence of metatarsal stress fracture.

    What serious runner would want to run in this shoe?.......None that I know of.
  34. I am not a proponent of barefoot running or vibram five fingers, and I too would warn people of the risks of doing so. I would however recommend controlled training drills for technique and for strength training exercises, for certain individuals and circumstances, while barefoot. I know of several serious and professional runners and tri-athletes that use this as an adjunct to training without incidence of injury and improved performance.

    ALL of the excerpts that were posted were in the context of people using vibram five fingers for running... without ANY preparation in the context of barefoot training. This is absurd and was my main issue with the discussion at hand.

    Also, the comments made about the financial profit of the person who has created a "barefoot technology" is interesting considering most of the people on this web-site are selling orthotics or insoles... seems like everyone has some level of financial gain and bias involved in this discussion.

    Kevin, in regards to your question regarding McDougall's stance on running shoes - I believe that the correct running shoe selected for an individual's foot is essential and can prevent injuries. However, much of the "high end" technology or trends developed by manufacturers are a waste of time and can in some instances cause injury. For example, the Nike Free shoe is not a barefoot training tool it is actually putting someone on an unstable foam cushion with no suppport... therefore increasing risk for injury but can be used as an implement for training in specific circumstances (none that I use...); other shoes with inflated air bladders... useless and only done for the purpose of sales. I also believe the significant positive heel is a major problem for forefoot runners, who just happen to be about 99% of the serious running population. Unfortunately this leads many athletes to train in a racing flat or possibly barefoot or vibram running as they feel so much better when they can actually contact the ground in a stable position (i.e. not in plantarflexion)... and because many of these people actually require the stability provided by the shoe they were previously wearing they commonly experience injuries.
  35. Craig Payne

    Craig Payne Moderator

    Michael - I think what it comes down to (and I have written about this before) is that there are two approaches to barefoot running:

    1. Use of barefoot drills as part of a balanced training program
    2. Use of barefoot running as a philosophy that underpins the running

    Its the later group that make all the nonsense claims that I alluded to above:
  36. Vibram FiveFingers are shoes, Michael. Running in Vibrams is not "running barefoot". So, why would I, as an ethical medical professional, want to recommend a shoe for a runner that caused so many metatarsal stress fractures and take so long to get used to running in without getting injured?? Certainly, I would be better off recommending a running shoe with "an inflated air bladder", as you say, since there seems to be many more people who have run quite successfully over the last 20 years in air-midsoled shoes than in thin soled shoes with five separate pockets in them. I was running and racing in thin-soled shoes since 1972....back then we called them "racing flats".....now the barefoot runners call them "minimalist shoes"......what has the "barefoot running revolution" done for us other than cause a lot of media hype and cause more injuries, including metatarsal stress fractures, that would never had occurred if the runners had simply been running in a more proper running shoe for their specific biomechanics all along?

    Another interesting fact about this "barefoot running revolution": what shoe did the author of "Born to Run", Chris McDougall, after spending the first half of his book trashing Nike, Bill Bowerman (coach of Steve Prefontaine, arguably America's best ever middle distance runner) and "thick, cushioned heel running shoe technology" wear while training for his 50 mile run in Mexico....the Nike Pegasus!... one of the thickest soled, most cushioned, running shoes that money can buy!!

    How disingenuous of McDougall. I find this part of "Born to Run" to be the biggest joke of all. Here we have a overweight reporter, getting injured, blaming his injuries on thick-soled cushioned running shoes, then goes out, loses weight, gets more serious about his diet and fitness, gets some better running form, and then buys thick-soled cushioned running shoes (Nike Pegasus), is now able to run uninjured, and writes a book to proclaim that modern thick-soled cushioned running shoe are the cause of most running injuries??!!

    As someone who has been a competitive distance runner for 30 years, a runner for 40 years, a sports podiatrist for 25 years, and has treated thousands of runners successfully with proper running shoe recommendations, shoe modifications, physical therapy and foot orthoses (I also did train barefoot some while in my younger, more competitive years 25+ years ago), I see the "barefoot running revolution" simply as a fad that will eventually die out once all the people who try barefoot running get enough injuries to realize that running in the proper running shoe for them was really a better solution for them all along, not listening and believing Chris McDougall's anti-running shoe propaganda.
  37. I could care less about what McDougall has said, written, or ran in. I haven't read his book, never read an article he has published or heard him talk. I am not debating on the side of the barefoot running revolution. Your anecdotal evidence of runners experiencing stress fractures in vibram five fingers and/or barefoot running is no more valid than my anecdotal experience of never experiencing this. An interesting fact, as I have repeatedly stated, is that all the stress fracture cases posted in this discussion have included stories of BAD training plans and poor integration of a new skill into their regimen, which OF COURSE will lead to injury. I believe in the world of evidence based medicine this would not pass as ANY LEVEL OF EVIDENCE, not even that of a case control study. So, if either the "barefoot revolution" group or the "proper foot wear" group would publish a descent study on this, someone would actually take either of you seriously... other than those with a career of recommending orthotics and "properly" designed shoes who claim the "other side" as biased.

    Congratulations on your 40 years or running and 25 year career.
  38. Michael:

    In order to realize where we are all coming from in this discussion that you stepped into, you should probably read the previous posts on the "Barefoot Running Debate" and should definitely read "Born to Run". Then you will have a much better idea of what all this fuss is about and why I have taken this stance on the Vibram shoe, Chris McDougall and the "barefoot running revolution".

    By the way, I competed with some very good runners, a few of them national class distance runners, and most of them ran heel striking, not forefoot striking while training. In fact, the research evidence does show that 80% of runners are heel strikers, not midfoot or forefoot strikers during races. Of course, while running at a higher velocity, runners will tend to be heel-strike less and midfoot strike/forefoot strike more.

    Since you are a firm believer in world of evidence based medicine, what level of evidence do you have to make this statement? Should we not take you seriously if you don't have evidence for this statement?

    I agree that training errors cause a large number of running injuries. You may enjoy reading this article I had published while I was a podiatry student in 1983.:drinks

    Attached Files:

  39. Craig Payne

    Craig Payne Moderator

    Michael, you will be please to know that this study is currently under review for publication in the British Journal of Sports Medicine and there is rumoured to be another under review at the American Journal of Sports Medicine (but this second one could be the first one and the rumour has the wrong journal).
  40. JB1973

    JB1973 Active Member

    Why should anyone do this? Well, this isn't just for ANYONE. This is for the serious athlete looking to gain a competitive edge. Most athletes depend on their performance to put food on the table and the margin of victory is often small.
    I would however recommend controlled training drills for technique and for strength training exercises, for certain individuals and circumstances, while barefoot.

    Hiya Michael,
    i think one of the problems here is that you seem to be a clever enough guy to distinguish when certain barefoot drills may be appropriate and for who, and i think most people would agree that this controlled, occaisional training could be beneficial. The problem i have and the reason the thread started in the first place probably, is that we have "experts" telling the lay person to throw away their shoes and run barefoot as "science" says it will cure their injuries (while clearly peddling the VFF)

    i dont particularly have a problem with your approach, but a problem with the McDougall/Leiberman approach.
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