Vibram FiveFingers Cause Metatarsal Stress Fractures?

Here is another one that was injured by running barefoot and in Vibram FiveFinger shoes. Why do these people think they should be trying to run barefoot in the first place? [Of course, this guy is also a "sword-swallower" so maybe that explains something?!]

http://roderickrussell.com/running/2009/11/barefoot-running-and-top-of-foot-pain/

 

Here's another runner that seems to have suffered a metatarsal stress fracture as a result of running in the Vibram FiveFinger. I like his comment of being "like a sheep"........

http://www.arunnersblog.com/barefoot-running/

 

Hi Kevin

In my sports clinic on monday i had a triathlete in who was complaining of 4th metatarsal pain. He was a very guy who trained everyday (split between bike, swim and run) and who over the past 8 weeks had found that his pain had got progressively worse. This guy had NEVER had any other injuries in his life during the history taking, but had developed his right 4th met pain over 8 weeks. And guess what in the past 8 weeks he had switched from his neutral sauconys to NEWTONS (running shoes with -ve heel pitch like track shoes). Everytime he wore his newtons his pain increased. The shoes effectively promote forefoot running and have a minimilst design. After arranging and MRI sacn which confirmed a stress fracture he was placed in an aircast boot.

The reason he started wearing the shoes was all the hype around other pals trying them.

So ok this is anecdotal evidence but from what iam reading there is a pattern developing?

 

Pattern = bad training decisions. Newtons = bad running shoe. Lot's of training on top of this = injury.

 

One interesting observation in all this and following some of the links that Kevin provides ... and I do agree with Michael, there are a lot of elements of training errors involved ...

When you follow some of the links and discussions on stress fractures in those using the Vibram Five Fingers is that the barefoot running community are pretty much 100% putting the blame on training errors and not the barefoot running. Yet whenever someone get an injury in a running shoe, its not the fault of training errors, its the fault of the running shoe and they consider it further proof that running shoes are evil .... don't figure!

 

You hit the nail squarely on the head here, Craig. If the injured runner gets injured in a shoe that they think is "minimilist enough", then the injury must be from a training error. If the injured runner, though, gets injured in a thick-soled, cushioned running shoe, then the injury must be from the shoe....couldn't possibly be a training error. The lack of objectiviity in some of these people is a joke!:craig::bash:

 

gosh.. really robert? I thought this was a stimulating and valuable discussion at many levels. Maybe what you are not understanding is that the movement toward barefoot running/minimalist is gaining traction every day, based on a campaign of lies and misinformation. And as a result, people are getting injured, and no longer able to do what they love... run.
To me this certainly seems worthy of ongoing debate.. but.. each to their own I guess

 

It seems to me like the shoes are probably less to blame than are artificial surfaces, inordinate demands on the body, and low body awareness. Our feet are evolved to serve us well in the cross country habits of nomadic, hunter-gatherers. If we needed arch support and extra padding, the need would have over time generated results as an evolutionary selective pressure. Clearly the feet we are given have met the demands of nomadic/hunter-gatherer life. There is however now the new factor of artificial surfaces. Concrete and black top are much harder than dirt, you can tell just by walking on it. Running on these hard surfaces is thus inordinately taxing on the body even in shoes with hefty soles. It seems to me simply unwise to submit your body to the unnatural demands of these unnatural surfaces. Furthermore, 20-50 miles of running may also fall into the category of unnatural demand. If you are going to submit your feet to that much abuse you might either wear ordinary running shoes or ease into running barefoot, and be sure to only run barefoot on natural surfaces.

 

Hi Stuart :welcome: to Podiatry Arena.

I guess that´s the point people around here are trying to make, Good for some in the right conditions, bad for others and not the greatest thing sinced sliced bread as the barefoot community will have you think if you read a couple of bloggs.

Hope you enjoy the Arena

 

To: toomoon: If the movement to shooting oneself in the foot was gaining traction would we be discussing the details of why this isn't a good idea? When you live in a narrow medical paradigm you have to dissect minutia. Increase your scope.

 

Why do you bother coming on to Podiatry Arena if you hate discussing Podiatric related areas of interst, seems like a waste of time to me.

Since you have a much greater scope of practice how does that help in discussions of stress fractures or if a patient comes to you with a stress fracture of a metatarsal from running in Vibram fivefingers do you tell the patient,

" I´m above treating this, its below my scope of practice now Go away "

 

Please check my previous post re medical considerations in differential diagnoses for stress fractures. There's more to medicine than orthotics. And, by the way, there was this german guy who didn't appreciate other points of view too.

 

This forum category is entitled "Biomechanics, Sports and Foot orthoses". Talking about orthoses is probably pretty relevant here.

Is this the German you are referring to?
http://www.youtube.com/watch?v=HevM-35hJUE

 

Obvioulsy, but does it preclude other considerations?

 

While the point about looking at all area of treatment is a good one. If you read your posts you have added nothing else of value but negative and sarcastic comments, all in all most of your posts seem to be this way. If you have something to add of value then add it but by saying you are all practicing with a reduced scope of practice adds nothing.

and PS as the name indicates stress fracture comes from on going stressess exceeding the bones structural make up rather than single trauma. Without stress, forces etc no fracture.

PPS Differential diagnosis in my book deals with different diagnosis which maybe leading to the symptoms ie a list of,

but once a diagnosis of stress fracture has been made then the can and often is many causes which is a whole different ball game.

In this case all people were painfree and running but changed there shoes which often leads to different forces, running gait etc all biomechancial unless they all became osteoporotic over night, which I find unlikely.

PPPS as Cam said this is the Biomechancis and orthotics forum.

PPPPS different ideas are welcomed but you have provided none here just little negative comments. All news ideas backed with some mechancial ideas and or evidence in my book are welcomed, Have you got any Robert ?

 

Correct me if I'm wrong but weren't the VFF designed initially for sailing - to get extra grip on the weather deck by using the natural contures of the feet and toes whilst being protected ? and not for running!

If so WHY use them for running?

 

You are correct, that is exactly what they were designed and made for. They then got quite wide acceptance in the rock climbing community, which seems to make sense. So it seems perfectly valid that a shoe designed for boating and rockclimbing should then be used to run a marathon does it not? I am currently at a runners forum in Austin Tx, and just had breakfast with a bunch of high end retail guys.. they tld me the even bigger challenge than running in VFF is getting into the sukkas!!

 

To Mr. Weber. Ironicaly your quote at the end of your messages says something about common sense being uncommon. My contribution is to affirm that message and ask all of you to look at what you're endlessly analyzing. As I said earlier, running barefoot or nearly barefoot is contrary to common sense. Why are all of you continuing to debate what a child would understand? No I have no erudition to add to this, just as I couldn't endlessly debate how to make a circle a rectangle. It doesn't make sense. Move on already!

 

Robert:

I believe you are missing Michael's point. Instead of being so negative on this forum and only criticizing what others are suggesting and telling them they need more training, why not be more positive and educate us on how we may be better podiatrists by using a more broad, medically-based approach to treating foot related complaints?

I think you would find that the many podiatrists from all over the world who visit Podiatry Arena daily are very eager to learn all aspects of medicine and podiatry. Most of them have not had the training that you have had in the medical approach to foot complaints. Certainly with your knowledge and emphasis on the medical side of foot health issues, your contributions could be quite valuable for many on this forum, including myself.:drinks

 

Austin, Texas?

Stop by Total Relief Footwear if you get a chance.:drinks

 

To Dr. Kirby: I intuit your kind attempt to mollify and redirect my opinion and it is well taken. However, if the truth requires what all of you are calling negative, than negative is what it has to be. I guess I'm just not getting all the discussion about a treatment which should be common sense...just don't do it!

 

they got me bunkered down at a place called Lost Pines, but I will if I can. I am going to be severely disappointed if I do not get into town for some live music!

 

It is a little more complicated than that... because the discussion feeds into what may.. or may not cause injury.. what may, or may not be scientifically supportable. And there are powerful voices in both camps. To be honest, the discussion has to be heard, because it also feeds into things lke form in running and how that may be protective of injury.. and maybe... just a tiny soupcon of maybe... running barefoot may have some merit in teaching form, which undoubtedly has merit in injury prevention. And on this basis alone, I am therefore interested in learning more. I personally do not think we can discount a valid debate on the basis of what is common sense. Many of the great medical breakthroughs of the last century were based on what mainstream medicine probably regarded as "not good sense"... cheers.. I love a good debate!!

 

Simon and Robert:

Exactly, Simon. It was once common sense that the earth was flat and that if you sailed far enough across the sea, away from land, your ship would fall off the end of the earth. Now we know better.

Barefoot running is no different. Barefoot running is used and promoted by some very respected PhD biomechanics researchers and there is certainly some support for its use since it is certainly a metabolically efficient way to run and does show reduced impact peak forces. To say it is common sense to not run barefoot really misses the point. We must be open-minded to these types of issues if we are remain scientifically objective. We must always pursue the truth and we must continually question what seems "common sense" to us, if we are to be true scientists and hopefully, as a result, become better clinicians for our patients.

 

Almost my next point about common sense, just look at eccentric training for Achilles Tendinopathy. Stressed tendon- stress it more - research shows that there is positive results.

 

OMG, I really don't get it. Flat earth, barefoot running and scientific purity. Traumatizing and tearing up your foot running barefoot is empiricaly verifiable. You don't need experimentation and the scientific method here. Don't do it is the correct answer. Prevention is a doctors duty also. Warn any "not so bright barefoot runner" mommy says you'll hurt yourself. Don't touch a hot stove either or should we discuss various hand protective deveices?

 

Common sense is dependent upon the point of view. To an individual growing up in a shod society and having been habitually shod for the vast majority of their lives, it may appear common sense to continue the shod approach to their recreational activities such as running. To an individual who has grown up in a society that is habitually unshod, it may appear common sense that one does not need to wear shoes for activities of daily living, including recreational running.

If one believes in evolution, we cannot possibly believe that the foot evolved to be shod, however, we also did not evolve to run on concrete. The bodies ability to modulate leg/ foot stiffness appears, in part, to be at odds with the "running on a hard man-made surface causes injury" argument. Indeed, it appears from these discussions that a rapid transfer from shod to unshod or more accurately from shod cushioned running shoes, to minimalist running shoes may be too much for some people to tolerate without injury, while for others it does not pose the same problems. Now, given that the runner should modulate their leg and foot-stiffness to match the surface stiffness, why is it that some people who make the transfer from cushioned running shoes to minimalist running shoes end up with injuries, while others do not? So the question then becomes why are some people capable of modulating their foot / leg stiffness in order to avoid injury while others are not?

To me, this is not "common sense". Rather, to me this is the cutting edge of our understanding of lower-extremity biomechanics. I guess on the surface we could ask why run in minimalist shoes if "common sense" dictates it will cause injury in some individuals? But common sense also tells us that running in "state of the art" running shoes results in injury in some individuals... Lets try and find out why one style of shoe suits one person while another suits another... I believe it comes down to the individuals ability to modulate their foot and leg stiffness and to maintain the foot and leg within their zones of optimal stiffness while functioning on surfaces of varying stiffness. If an individual cannot reduce the foot/ leg stiffness enough when running barefoot / in minimalist shoes on a hard surface they will end up with kind of injury being discussed here. Conversely, if a shoe is too cushioned and an individual cannot increase their foot/ leg stiffness enough to accommodate the cushioned/ compliant surface they too will wind up injured. So perhaps its a case of matching the resonant frequency of the limb to the surface. What say you, Robert?

 

Robert:

One other thing you should know about Podiatry Arena.....there are very few podiatrists from the USA who contribute regularly to this site and almost no one who is an expert on the medical issues that we should all be considering for our patients. Since medical issues seem to be your area of particular expertise, you could make a huge contribution to this site.

As an example of how one person can make a difference on this site, a very gifted podiatric surgeon, Dr. Steve Arbes, from Green Bay, frequently contributes to this site, has provided us with some amazing clinical photographs and has really given us some great insights with his many years of surgical experience. Steve has provided us information on his clinical approach and his years of clinical experience have been very valuable for all of us.

I think you could also really help many of us out here since none of us can be experts in everything and certainly medicine is not my primary focus of interest (obviously). However, that doesn't mean I'm not interested in learning more about this important subject, especially if it means by learning more that I will become a better clinician for my patients. I was, by the way, an animal physiology major at UC Davis in my undergraduate days and tutored physiology in podiatry school, so I do have an interest in the medical aspects of podiatry. However, since the biomechanics and sports medicine side of my practice life and academic life consume nearly all of my free time, there are some aspects of my podiatric knowledge base that are probably not up to par.

So....how about it Robert? Please give us some positive things about the medical side of foot health issues in your postings to Podiatry Arena. In other words, teach us. I think you will find there is a huge amount of interest here from the thousands of clinicians that visit this site from around the world every week. The best way to move the podiatric profession in a positive direction is by teaching other podiatrists the clinical utility of the approach you think is best for the profession, so that they can become more knowledgeable of the many important variables which may affect the foot health of our patients.

 

Thank you Dr. Kirby I will attept to share some of my medical knowledge as you suggested. The first lesson is DON'T RUN IN BARE OR MINIMALY PROTECTIVE FOOT WEAR, YOU MAY GET HURT! And, in reference to the shod vs unshod thread assuming evolution preferred unshod. We'll never know how many early men died of infections, gangarene and septicemia from steping on a twig, rock or aluminum can top! Maybe evolution provided some with the cerebration to at least put a leaf on his/her foot. Apparantly some of the recessive genes have not been totaly wiped out by septicemic death and few of the zygotes have returned to their atavistic proclivity of barefoot running.

 

Robert:

It may be of interest to you that one of the world's leading PhD researchers in running biomechanics currently runs barefoot and has been able to run for the first time in many years without pain while barefoot, but can't seem to run injury free while running in any style of running shoes. Maybe this respected researcher would reply to you "don't run with shoes, you may get hurt!"

 

Oh my God! "Slumming it" at a beautiful Hyatt resort - you poor soul! Maybe they will let you out tonight for some live music downtown. Austin IS the live music capitol of the world! Here's a virtual cheers:drinks

 

To Dr. Kirby: One (1) robin does not make a spring.

 

Turn your sound off to watch this:

 

Robert:

I don't understand what you are saying. Are you saying that even though some runners can run the most comfortably with fewer injuries while barefoot that this fact simply doesn't amount to enough signficance to make you want to modify your previous statement of "DON'T RUN IN BARE OR MINIMALY PROTECTIVE FOOT WEAR, YOU MAY GET HURT!"?

Please explain.

 

You touted your example as a PhD in running biomechanics as if his PhD gave credence to running barefoot. My simple statement, poorly parphrased from Shakespeare means, one example, or even several nuts, who feel better running barefoot till they cut themsevles or fracture themselves(which is inevitable) hardly makes a significant argument. One PHd(robin) does not a sping(valid argument) make. Woo boy! this is tough. I think I've wasted enough time on this thread and hope I'm strong enough to resist reading anymore of this silliness. I hope, but don't guarnatee it.

 

You are preaching to the choir here, Robert. You could read what I and others have already written in this thread and other threads here on Podiatry Arena on barefoot running. You could also read the articles that have been written, the research that has been conducted and the enormous amount of discussions on barefoot running that are now occurring within the international running community on the possible benefits and problems with barefoot running. However, I know you won't so you need not respond to this posting. You shouldn't be wasting any more of your precious time with what you consider to be such trivial and unimportant subjects since you are so far superior to the rest of us pitiful podiatrists who treat runners and other athletes and think such things are very important and worthy of discussion for the benefit of our patients.

When we need some medical advice on foot health issues, please feel free to comment. Otherwise, please don't bother.

 

This one just popped up in the introduction.

Heel striking in VFF from the sound of things.

 

Barefoot running is extraordinary and can/will solve all of your running injuries. However, one must approach it with a logical mindset. Why would one get a stress injury such as a metatarsal stress fracture? Because it is weak! One must do very minimal mileage to build up and strengthen his or her feet because running shoes have sheltered and weakened our feet for x amount of years. It has taken me a month to build up to a mile barefoot. But that is the beauty of barefoot running, you can only do so much at once that you learn to love the little time you are actually running. It's all about conditioning and strengthening your feet. For instance, when you go outside think, "Do I really need shoes?" This helps condition your feet to develop callouses which can speed up the transition. Hope this helped!


PS: Vibram Five Fingers gives you a thin layer of cushioning which makes one run at a faster pace than his or her bare feet can withstand before breaking down. I dealt with a forefoot sprain when I first decided to transition (I originally transitioned in VFF but now I do everything barefoot). The vibrams should not be used until you can learn to control your pacing to be a solid 8-9 minute mile while also knowing your limits as far as distance goes as well.

 

What an absolute load of nonsense! Do you have one shred of evidence that there are fewer injuries in those who run barefoot?

Again, do you have any evidence to back this up? Touting the party line is not evidence.

So why are those who are very very experienced at barefoot running still getting injuries and getting stress fractures?

Not at all. It has just confirmed what we have been saying about the non-scientific nonsensical mumbo jumbo we have been getting from the evangelists from the Church of Barefoot Running.