Vibram FiveFingers Cause Metatarsal Stress Fractures?

Just picked up this from a New York DPM:

 

I guess everyone can have an opinion on running, training, technique and footwear etc. This is a great platform to discuss it.
As an athlete, I sometimes warm up before my track sessions in Barefeet and do my drills etc, and then put on a pair of spikes for my session, they have even less behind them than the VFF.
As a Podiatrist, this fad (cause that's what it is) of wearing VFF has lead to me seeing more metatarsal symptoms than I've seen before - unfortunately the met pain seems to happen to those wearing the VFF. Coincidence???maybe....but the newton shoe has just hit our shores here now aswell. So i'm interested to see what other running pathology I will see more in the up coming months?
Remember running injuries are probably multifactorial - someones structure, their function and the training dosage may all contribute to a pathology.
I don't mind fads, i enjoyed the slinky.....I don't mind barefoot running personally, but if there's a correlation with met stress fractures and wearing VFF's, hopefully the fad will pass. Like crossfit...infact, many of my clients who do Crossfit who wear VFF (along with eat their paleo diets) break their PR's in their 5km within 2 - 3 months....unfortnately at the 5 -6 month mark they also break their mets and take 12 weeks off running.....what's the point of that PR when you will need to build up to get back their again?

 

Urban Myth that Christopher Mcdougall suffered a stress fracture

http://running.competitor.com/2010/...ve-interview-with-christopher-mcdougall_15306

 

"Somewhere between 50-80% of all runners are injured every year. Ninety percent of all marathoners are injured every year. That results in millions of people who have to stop running and who want to run. But they can’t, because they’re hurt."


So is Chris saying that 50-90% of runners are injured "because" of their footwear? Whats the stat for barefoot runners? Is he suggesting that 0% of barefoot runners get injured?

"These 230-pound guys you were talking about, if they clang down hard on their heels, then absolutely they are going to get hurt"

See and I find this the difficult part. In terms of "distance running" (excluding the concept of sprinting for the moment), anatomically and physiologically the calcaneus is the single largest osseous structure in the foot, heel strike imparts force to this bone, force is translated sagitally along the foot. Now taking for granted its not a "linear" translation (but for arguments sake we will use the example) force hits calcaneus, translates to the 2 smaller bones in the kinetic chain (navicular/cuboid) then 3 smaller bones (cuneiform's) then 5 smaller bones (metatarsal shafts) etc.. etc... See the pattern here? You want impact to be absorbed by a large structure and then for force to be dissipated through smaller structures (in theory anyhow).

So is there method in the madness that heel strike at the calcaneus is physiologically (and arguably anatomically correct). Possibly I think there is looking at the above analogy.

Which makes me wonder how the statement Chris makes above holds any relevance?

Its a thought provoking discussion.

 

From San Francisco Weekly:
Vibram FiveFingers shoes and the annoying people who buy them

Full story

 

Hello everyone,

I have read all of the previous posts and wanted to share my two cents. I finished reading born to run as well as chi running and about 5 other books on correct running form. I am a runner who watched his dad develop back problems from all of his races and have done lots of research in hopes to prevent the same fate.

Like most things I take in I try and consider both sides to anything especially something that has not gained traction until 2008. This is what drew me to your forum. Even though this is a new "Fad" I would like to share my input.

Anyone who read the book Born To Run and derived the need to take on barefooting has missed the point. The books focus to me seemed more about learning from a tribe who perfected their running form and practicing in their environment more-so than running barefoot. Just like in movies I am certain books can mention labels for extra sources of income.

I believe there will be a law suit for VFF's just like there was for coffee at McDonald's being too hot, or intruders tripping on roller skates in someones house, common sense goes a long way. I do not believe your argument adds any weight however.

I personally run in VFF's as I believe I have perfected my running technique enough to take the risk to trade cushioning for performance. Also like most of your other posts where people have been injured the consensus seems to point to they have enjoyed running this way more than in shoes.

Since this thread seems to focus on born to run I will stick to it. They mention first you run easy, then you run light, then fast. Here is my analogy on the matter. Would you rather drive on railroad tracks with the best baja suspension technology or down a smoothly paved race track with a go cart with no suspension. The book brought up some very valid points such as how much does the 1.5 inch padding really do for shock absorption for the force of a solid heal strike from an average weight man on such a small area, the book mentions something around 2k+ ppsi. The example they mention is wrapping an egg in the same protection and pound it with a hammer.

My take on Born To Run and barefoot running is learn better form because you want to and need to. Throwing on FiveFingers and praying it fixes your stride and alleviates injuries is like throwing a baby in the pool and hoping it learns to swim. Sure it works for some but is it worth the risk? The end goal is running with better form.

I am not trying to flame here but it seems given the nature of this forum you all have either read the book and singled out things that did not make sense such as barefoot running or have not read the book at all. There is a VERY small percentage of the book that relates to barefoot running. The idea behind the book is to look at the lives of the extreme runners and lifestyles of ultra runners and find out the next best thing. Sure it mentions very briefly one of the runners running barefoot and blames nike for a chapter but it also talks about running form, the love for running and the smiles on the faces of the best runners and how attitude has been the missing link to exceptional runners, environment, and painting a fun story to read about very colorful characters. The idea behind barefoot running for the true purist is not about preventing injury, they have already done so by perfecting their form, it is about how this adds to their love for running and puts that smile on their face.

 

There was also someone who mentioned that it might be safer to heel strike on the largest bone in the foot than to transfer through the structure of smaller bones. Sure stress fractures are bad and I am certain in the Podiatry world you see many of these but a larger percentage of injuries are muscular related such as shin splints etc. The idea is lesson the impact...period. By running in a way that you are impacting the mid-foot you also dampening the impact with a bent knee and upright body.

 

My take on "Born to Run" is that it was written by an overweight, mediocre runner who says he was looking for a way to run without injury but, in reality, was looking for a way to increase their income by writing a book with many mistruths regarding running biomechanics, running shoe biomechanics and the cause of running injuries.

Now Chris McDougall after losing a significant amount of weight (which is what his doctors told him to do in the first place in order to run without injury) is advocating running in expensive thin-soled shoes with five toe holes, made by a shoe company that sponsors him, even though he self-selected to run in the Nike Pegasus shoes when he ran the 50 mile race (before "Born to Run" was written). The Nike Pegasus is quite notable in this regard since it is one of the thickest-heeled, softest, most cushioned running shoes made and being produced by a shoe company that McDougall complained about endlessly throughout "Born to Run".

So here is what Chris McDougall is basically saying in his book, "Born to Run": "Everyone should run barefoot, or run in huraches or run in Vibram Five Fingers since thick-soled running shoes cause injuries. However, in my special case, I'll run in the softest-soled, thickest heeled running shoe I can find, the Nike Pegasus, since I picked this shoe to run in when I was desperate to find a shoe that would allow me to run an ultra-marathon. What a joke!! If "Born to Run" isn't the most disingenuous example of biased writing to come along within the running community within the last quarter century, I don't know what book is!!:bash::craig::butcher:

 

The problem is not the shoes or the fact that he is making money off them. In fact it is a great selling book because its a fun read for people passionate about running. Vibram Five Fingers are the best 100.00 shoe with toe holes I have ever purchased because of how much fun they are and how well made they are for what they were designed for. The problem lies in people who buy them because of the fad or because they think they will improve their form or make them better runners overnight. It is not just Vibram, there is also Nike, Newton, Vivo, New Balance, Inov-8, Kigo, Feelmax, Soft Star, Sockwa, Zem and GoLite to name a few.

Just because you do not understand it does not mean that it is wrong or harmful. Buying a Porshe 911 Turbo may be fun and even a Fad but if you do not respect it you will end up in a ditch, much like minimalistic shoes.

 

Care to explain what injuires you think are actually due to high impacts? You do realise that not ONE study looking at risk factors for running injuries has linked any of them to high impacts.


BTW, I spoke last week to yet another reporter doing a story on barefoot running ... you guessed it ... they themselves got a metatarsal stress fracture from using Vibram's!

 

There are many injuries associated directly with high impact sports such as running. Hip Stress Fractures, Patellofemoral Syndrome "runners knee", etc. I guess I am not understanding the question. You obviously do not think running is an injury free activity since the topic is FiveFingers Causes Metatarsal Stress Fractures.

The whole debate is around FiveFinger shoes and im simply stating that it is not the shoes fault or the lifestyle that causes these. What causes this is people with money chasing the next best fad, reporters trying to write a story, and podiatrists who consider authors of the book "mediocre" runners because I am certain you were accepted into the Boston Marathon.

The fact of the matter is Vibram FiveFingers are not the cure all for injuries or the ailment of running. Running is not for everyone and neither is minimalistic running. Much like motorcycles, sure they are fun yet dangerous but not everyone takes it upon themselves to master them to where they should be racing them.

Can people master barefoot running to the point of lessening injury? Would the same amount of effort to perfect the form of running with shoes cause any better ailment? Only time will tell but it is undeniable that better form aids in faster running, less injuries, less impact and more. It just so happens that the true barefoot enthusiasts usually put more emphasis on their form than the average joe.

 

Thats just simply NOT true. Not ONE study has linked any of those problems to high impact. No risk factor study for ANY running injury has linked high impact to it. That is just a myth that keeps getting perpetuated without any evidence to support it.

 

What Are the Symptoms of a Hip Stress Fracture?
People with a hip stress fracture are most often high-mileage runners, military recruits, or individuals doing significant impact sports activities. These athletes will typically complain of an aching groin pain that bothers them with activity, and is relieved by rest. Symptoms are usually noted after a recent increase in level of activity, such as increasing running mileage.

If a hip stress fracture is suspected, an x-ray will be performed. While some hip stress fractures will be seen on x-ray, some x-rays may appear normal. If the injury is still suspected, an MRI or bone scan can also be obtained to evaluate for a stress fracture.

If your saying these injuries are not from the impact of running or "overuse" then why do you not see the same injuries in swimmers?

Injuries are not a Vibram problem or a Nike problem they are a human problem.

 

Show me ONE study that has linked stress fractures to high impacts.

I repeat what I said, not one study has linked high impacts to injury. If you have evidence to the contrary them please produce it.

A number of studies have used cushioned insoles in military populations to see if the reduced impact affected the injury rate ... it did not.

All the prospective studies on running injuiries have found a number of other factors increase the risk, but not high impacts.

The swimming analogy is not a good one.

 

http://books.google.com/books?id=exwUDd7qrcYC&printsec=frontcover#v=onepage&q&f=false

There you go one study.... you are harping about the same argument over and over much like barefoot runners are arguing. If impact is not the cause of injury then where is your study showing FiveFingers are the cause of injury.

The bottom line is there have been many studies on the performance side of things that better form causes more efficient running which makes you faster.

 

Nope. That book is about fatigue and stress fractures and not about impacts. Fatigue has been documented as a risk factor for stress fractures.

I never made the claim that there was a study or any evidence. This thread is all about the high number of stres sfractures that people are reporting after they start using Vibrams. Not sure what one has to do with the other here. Your arguments are getting nonsensical now.

Can I suggest you actually read what the evidence says, then come back and discuss it.

 

BTW, in the past I would have agreed with you re impacts; but over time new evidence and data accumulates and we need to shift our thinkings. I always go where the evidence takes me.

 

If you do not mind me asking what were the recent experiences that have lead you to change your mind? Was it the influx of patients with injuries who were wearing the Vibrams? This would be quite an interesting study to determine out of all the reported injuries what percentage had existing problems that caused them to switch to fivefingers and what percentage were overweight.

I am sure in your position I would change my views as well, I simply love them too much to make the change back. It would be interesting to have a test group of people and have them run for 6 months or so in the Vibrams. During the study you could film the way they run and such. My theory is that there are a high percentage of people who read the book and got inspired to have the chance to run again while having existing complications and such looking to the shoe as a fountain of youth.

Before trying the FiveFingers I watched many videos on the strides on youtube and noticed a majority of the videos the people were still heel striking and then slamming down the front of the foot with no padding. With all these variables I wonder how many of the "experts" are getting injured.

I am going to need to do some more research indeed!

 

Dr. Payne:

2 feet of snow on the ground and possibly too much tinme on my hands today but:

I would like a definition of WE

and I would like to add to your Arena Mantra:

We remove those threads (I think this is the 3rd or 4th of mine that you have removed or stopped at whim) that are a threat to our philosophy and beliefs allowing ourselves to be bullied by those we hold in such high regard as they are above reproach such as Dr. Menz.

We bully those with opposing viewpoints to obedience claiming their evidence is weak, abusing them personally when we know SALRE and Tissue Stress is just as weak and poorly evidenced.

We accept ads on The Arena, run boot camps and sell books and products from the site in order to feeds the boys but how dare any others profit from or market their work.

Dr Sha

 

This is your example of a barefoot runner with speed? What a joke! This guy is likely running slower than 6:00 minutes per mile in the video (I would guess 6:30 minutes/mile pace). Since when has a 6:30 mile pace been considered to be "with speed"? I would have been impressed if he wasn't tiptoeing along and was really running with speed, say around 5 minutes/mile pace on the asphalt.

As I've said before on the "Barefoot Running Debate" thread, show me some elite runners winning races while barefoot and then I'll be impressed that barefoot running allows you to run "with speed". Don't show me some older guy tiptoe running barefoot along a bike path at what many elite runners would consider to be jogging pace and call that type of running "with speed". My guess if he put on racing flats and ran with a longer stride, in a more natural heel-striking fashion, he would be able to run much faster.

 

http://www.lowerextremityreview.com/issues/september-2010/impacts-spell-injury

Here's the Irene Davis study referred to in the above article:
http://www.asbweb.org/conferences/2010/abstracts/472.pdf

 

Oh, OK, we have now have one study. Will look forward to the full publication and chatting to Irene about it in few months!

 

I'd like to see some analyses of the data for those who didn't get injured during the course of the prospective trial, yet had a history of retrospective injury, versus the other groups.

 

At points he speeds it up to probably in the 5's, its his short cadence that is misleading. Also he is just jogging and not in a race, the person who posted the video was the one who said "WITH SPEED" when that is his every day workout.

Here are some elite runners winning races while barefoot.....:

http://barefootrunner.co.uk/siraj-gena-wins-rome-marathon-barefoot

Here we have an Olympic gold medal barefoot:
http://dailyrunningtips.com/inspiring-stories/ethiopian-bikila-wins-marathon-running-barefoot/

Duke Marathon Winner:
http://i16.photobucket.com/albums/b24/rippev/marathon2.jpg

There are MANY more, try google next time.

 

OH pleeeeasssseeee, give us a break, we have been around this trap so many time in other threads:

Siraj Gena, just took his shoes off prior to the finish to run acros the line barefoot to claim a prize

Bikila did win the 1960 marathon barefoot, but he went on to win the 1964 one and break a world record (ie run faster) wearing shoes.

As for the Duke Marathon; Kevin as asking for elite runners, not 2.40 marathoners.

You left out Zola Budd as well, who got so many injuires that she had to start wearning running shoes to prevent them.

You going to have to do better than that...

 

Abebe Bikila, the barefoot Ethiopian, set world records four years apart while winning the Olympic Marathons in 1960 (barefoot) and 1964 (wearing shoes). Not just while he was wearing shoes. You implied that you cannot run fast while barefoot and that nobody elite would do so. I am simply pointing out that it can be done and once it is more widely adopted you will start to see more of this.

 

Did you notice how Abebe Bikila improved his Olympic marathon time once he got smart and put some shoes on?? Give me one example of an international marathon that has been won by a barefoot runner (that ran the whole marathon barefoot) in the last 50 years. I won't hold my breath. There are none!

You are fighting a losing battle here, Pike. You have no evidence, no proof.....all you have are opinion and anecdote. In addition, the thousands of uninjured shod runners who are winning the vast majority races around the world, and are much faster than you are, are laughing at people like you. I know, I talk to them every day.

Happy running.:drinks

 

Kevin,

I sincerely hope you can focus better in your practice than you can in this thread. You have managed to take the topic of the dangers of a minimalist shoe and wander over to the performance aspects of such. You asked for an example of an elite runner that ran barefoot and now are asking for an international marathon winner? For the last 40 years shoes have been the majority. The constant record breaking during this period is not solely:dizzy: due to running shoes. There are many other factors such as training, diet etc. All I was stating is that with the growth of minimalistic running I would wager some very fast minimalist runners emerge. There has been empirical evidence illustrating the efficiency of barefoot running requiring less oxygen intake.

I certainly know there are many faster than myself as you have so kindly pointed out, but I love running and I am happier the way I chose to run. I would wager however that I am much faster than you will ever be behind your keyboard.:deadhorse:

 

Would you agree that running barefoot or in minimalist footwear increases muscle strength? Why does it increase muscles strength? The only way it can increase muscle strength is if the muscles have to work harder. If the muscles are working harder, then you are not going to be able to run as fast. I doubt we will ever see a true barefoot/minimalist breaking any world records.

Nonsense. There has been none. You are making that up.

Be careful with that claim unless you are familar with Kevins running background.

You need to read the Barefoot Running Debate thread (all 1000 posts)

 

I would agree it increases muscle strength of areas not utilized before.

There are in fact many studies based on efficiency of running barefoot vs not. Here is one. http://www.sportsci.org/jour/0103/mw.htm

Also I am familiar with Kevin's PR of 2:28 but that was in his prime and I am certain he cannot get anywhere near that now. Probably due to all the injuries in shoes... kidding. But my statement was more implying the fact that he should get from behind the keyboard and do more running.

 

You going to have to do better than that - thats not even a study! There have been no studies on efficiency. You claimed there have been many. Please show us them.

That nonsense from Warbuton has been totaly debunked and is easy to dismiss as nonsensical pseudoscience. See this: Why does the barefoot running community continually fall for this nonsense?, You are going to have to start reading things a bit more critically rather than blindly accept everything you read.

 

Pike:

Are you sure you aren't also known as "Barefoot Steve"?

 

HAHAHA that made my day, THANKS! :drinks

 

Reminds me of another overweight, mediocre runner who's doctor's told him to loose weight. Both, McDougall and this other runner wrote national best sellers that had a significant impact on the running community, the other author was Jim Fix. It seems McDougall and Fix have demonstrated that you don't need to be a sub 2:10 marathoner or weigh under 130 pounds to qualify to write a best selling book about running.

The Nike Pegasus is nothing more than a middle of the road running shoe that at one time was popular among ultra runners before the development of trail shoes. The Pegasus is far from the softest soled, thickest heeled running shoes. Nike itself makes several lines of shoes that are softer soled and thicker heeled. The Lunar series comes to mind, as well as Vomero and several of the air max shoes.

Dana

 

Craig, the shoes elite runners wear when competing and setting world records are minimalist shoes.

Dana

 

http://en.wikipedia.org/wiki/Jim_Fixx

"Remember Jim Fixx, though? This guy used to write books about jogging. What do you jot down about jogging, you know? 'Right foot, left foot... faster, faster mmm, go home, shower.' OK. Thanks Jim, for putting that literary mind to the jogging issue. But I know how to jog... being the biped that I am. Then this doofus goes out and has a heart attack and dies while jogging. Ahh-ha ha ha ha ha! There is a God. 'Right foot, left foot, haemorrhage.' Yeah, Jim, we're gonna need a happier ending, buddy. What is this 'Right foot, left foot, blood spurts out of nose, Jim?' You having troubles at home, son? Keith Richards is shooting heroin into his eyeball and still touring, all right? I'm getting mixed signals." Bill Hicks recorded live at the Village Gate, NYC 1990

 

I like to spend time in the casinos in Las Vegas. I am a firm believer that timing means everything in gambling. It seems that the results from publishing books with a certain subject matter can also be greatly influenced by timing.

Congratulations to the authors for publishing at the right time. It is the general public that buys the books that you need to wonder about. All the same, I am currently reading Born To Run, I heard in was an entertaining book about running.

Dana

 

Here are some racing flats from 1972 that were called the Nike Marathon. They were manufactured by Onitsuka Tiger (now Asics), imported from Japan, and sold as one of Nike's first ever shoe products when Nike was first formed as a shoe company. The Nike Marathon was one of the first all-nylon upper racing flats ever sold here in the States. Many of my high school and college running buddies wore these shoes in their cross country and road races during the early to late 1970s when I was in running my best marathons.

And some of you think that "minimalist shoes" are a new thing? What a joke!! These shoes were being worn by elite and competitive distance runners over 38 years ago!!

As I've said before, what has this "barefoot running thing" done for the running community at large?......basically nothing other than providing a better income for people like Chris McDougall and for us podiatrists that are treating the injuries caused by those runners who have been sucked into trying to run in "minimalist shoes".

 

You've made some good points Dr. Sha. But, I generally try to turn a blind toward the ego and use the site for learning. There's a lot of information here that one might not easily find other places.

 

What I think it's done, and I say this as a lifelong runner who just spent the last hour reading through the last seven pages of posts after landing here searching for research on barefoot running, is provided an opportunity for curious runners to learn more about their sport. The barefoot running debate is compelling, and it raises interesting (if not misguided) questions about our traditional understanding of running shoes. I understand that there are a lot of folks jumping in headlong without thinking things through, but for those of us who have a curious streak, it's great to step back and absorb the discussion and watch the science behind our sport evolve. And I think that's important.

So, my question:

It's clear that, among the care providers on this site, there is an anecdotal correlation between wearing VFFs and metatarsal fractures, and that seems reasonable - forefoot striking pavement for miles on end might increase risk of that specific injury. But what about other injuries? As an over-pronator of near-comical proportions, I'm curious to see if the podiatrists who have seen a surge in metatarsal injuries related to VFFs have also seen an uptick in injuries related to the absence of any stability that comes with barefoot/minimalist shoes.

Many thanks!