Vibram FiveFingers Cause Metatarsal Stress Fractures?

I would say, the person who overtrains will get the injury(sport and shoe or no shoe specific) and
depending on their inherited biomechanics, they would get the same places would injure as predicted by their pathomechanics.

Barefoot running is new but has many things to offer us differently and I see no reason why it should be blown out of the water before it has time to blossom.

Just my opinion.

Dr Sha

 

I have wondered for some time now how much the podiatry community has contributed to the interest in barefoot running, Vibram Fivefingers and minimalist running shoes in general.

I remember in early 2007, shortly after VFF came to market, I had an email conversation with Ted McDonald, AKA Barefoot Ted. He sent me a link to his website where he spoke a lot about VFF and helping them with product testing. My first impression was that I could never wear "shoes" like those simply because there wasn't enough shoe.

I used to log roughly 90% of my running miles in traditional running shoes that weighed around 12 OZ for a men's size 9. The rest of my running was done in a lighter 9 OZ adidas trail shoe or an 8 OZ pair of Nike Marathon racers.

Fast forward to the beginning of 2010. The interest in Barefoot running had grown to the point where it could no longer be ignored, thanks partly to Born to Run being published in 2009. As a passionate runner, I started reading about barefoot running with interest, not that I had an intent of running without shoes, but I wanted to learn about why all of the interest. I found the podiatry arena in Jan 2010 and started reading the threads relating to barefoot running. As an observer, I found many of the podiatrists that contribute here are as worked up about barefoot running as the barefoot advocates.

What really caught my interest is this huge passionate debate between podiatrists and barefoot advocates. While the podiatrists are arguing about the unsupported claims the barefooters are making, the observing public is interpreting it simply as a debate.

Leaving the pros and cons aside, I find barefoot running impractical for a long list of reasons. But what about wearing minimal shoes? I already do a small proportion of running in light shoes which is somewhat of a traditional approach. But what if I change that proportion?

While reading the Podiatry Arena, you'd have to be dead not to notice the negativity towards Vibram Fivefingers. This very thread is filled with claims from several members of the podiatry community against the shoes that are no better supported than the barefooters claims in support of VFF. I found the debate so entertaining that I couldn't resist trying a pair of VFF to see for myself what all of the stink was about. After buying my first pair, I went on and bought 2 more pairs in different models. In spite of what is being said here, for some, the shoes are fantastic.

While I was fully aware of VFF since they came out in 2006 and had the "famous" Barefoot Ted recommend them to me, I wasn't convinced to buy them until I started reading all of the podiatrists comments about them, about minimal shoes and about barefoot running.

Currently, over 90% of my running is done in shoes the weigh 7 OZ or less. Essentially I completely reversed the mix of wearing minimal shoes to traditional shoes. The irony of all of this is that if it wasn't for all of the debate coming from the podiatry community, I probably would have just happily continued on running in 12 OZ traditional running shoes. Consequently, I doubt I'll ever buy a pair of running shoes that weigh more than 8 or 9 OZ going forward. There simply is no reason what so ever for me to wear running shoes any heavier than that.

Getting back to my initial comment, what if the podiatry community had kept a low profile with respect to this debate? Would the barefoot and minimal shoe trend have already passed on by this point? With all of the magazine debates, etc. It seems the podiatrists have done as much to generate interest in barefoot running, VFF and minimal shoes as the barefoot advocates.

Now it is far too late to turn back, the shoe companies have gotten a hold of the minimal shoe trend and they have all jumped on the band wagon. Yesterday I went into a fairly large running shoe chain, the Foot Locker. I would say that over 80% of the the shoes they were showcasing were various models of Nike Frees and the competitors versions of the Nike Free. It was almost laughable, they all have some version of a highly flexible, low support, ultralight shoe. The direction the shoe companies have taken is very clear and obvious. We have seen the shoe companies produce shoes with more of this, more of that, more, more, more for the last 40 yrs. Will we now see the shoe companies produce shoes with less for the next 40 yrs?

From my point of view, the podiatry community has done an outstanding job of generating interest in barefoot running and minimal shoes whether that was it's intent or not. Vibram is probably loving all of the free marketing it is getting.

For the podiatrists that think this is all a fad, it is a fad that will stay as long as attention continues to be focused on it. Keep up the good work.

Dana

 

I leave it here Dennis.

But have you watched someone run in shoes that is a heel striker and watched them run barefoot ? Where do they strike the ground 99% of people forefootor fore-midfoot strike.

So there has been a change in location, position and magnitude of Ground Reaction Force , which if too much may cause injury.

yes training loads are a cause, but a change in running style and a person who goes from uninjured to injured or injured to uninjured will not have changed their foot type or pathomechancis etc etc , but have change the location, position and magnitude of Ground Reaction Force.

Which is another reason why the understanding of mechanics and physics is vital to treatment of patients.

 

Looks like didn't get back on thread.

Perhaps I can reverse the engines with a set of theoreticals related to the subject.





So if we can agree that forefoot contact running offers greater impact to the forefoot does that eliminate the effect of pronation when running?

Is that why feet are getting stronger for those who can make their way past the metatarsal stress fracture window?

Is it worth getting there?

Dennis

 

It depends on which effect of pronation. Forefoot striking will tend to have a center of pressure farther from the STJ axis than heel striking, so there will probably be a higher pronation moment from the ground. On the other hand a shoe with a lateral flare can increase pronation moment from the ground.

There is no evidence that barefoot runners are stronger than shod runners.

Eric

 

I must start by assuming that your posting applies to all feet and that you would have a platform from which to start that would be used to treat them alike. If that is a wrong assumption, please explain.

My experience, to the contrary is that in the rigid forefoot types, where there is very high first ray weightbearing at contact, the moment upon the STJ Axis would be supinatory and not pronatory?
In those cases, wouldn't the treatment you would install to correct the STJ Axis, eventually lead to compensatory pain, deformity, degeneration or failure?


Second, how would you suggest that using a Kirby Skive, Blake inverted casting or frontal plane RF correction in the form of posts would be as effective as the sagital and transverse plane correction of the forefoot and The Vault of The Foot that I would suggest as the primary treatment locations in forefoot contact gait pathological moments?

Summarily, it is my opinion that using the STJ Axis as a treatment guide in the forefoot contact gait cycle may actually be a Red Herring.


Third, is the lateral flared shoe you are suggesting flared in the rearfoot, forefoot or the entire length of the shoe?
Would the flared addition force more heel contact function and reduce the ability of your patient to forefoot contact and wouldn't it make the shoe less minimalistic?


As to strength of foot, I have examined Dr. Dan Lieberman's feet in my office and I must anecdotally reinforce his comments to me that his feet are now stronger than when he starting barefoot running on much weaker feet and that they are more in line with the rest of his powerful and supportive rigid rearfoot type and posture.

I think that other forefoot and midstance contact runners, who are successful in crossing the metatarsal stress fracture threshold without fracturing, echo this anecdote.

So I would reply to your no evidence argument that until and unless you have evidence to the contrary, you should keep an open mind because perhaps there forefoot contact runners for whom that is the case.

Dennis

 

Just the act of starting and maintaining a running exercise program will "strengthen the feet" regardless if you are running barefoot or running in shoes. I would tend to doubt that if all you are doing is running barefoot for four miles a day, for example, and then wearing shoes the rest of the day, that "foot strength" will increase, versus running that four miles a day with shoes on.

I do believe that someone who totally eliminates shoes from their life and walks barefoot all day long, versus wearing shoes all day long, will likely experience significant increase in digital strength. Of course, this type of habit adds increased risks of other problems occurring. Actually, the individuals that I have seen as patients who most impress me with their foot strength, for their size, are ballet dancers. Just don't tell me that running in shoes makes my feet weak.....that's a bunch of BS!!

 

Habitually barefoot = stronger feet
Therefore, habitually shod = relatively weaker feet

But, running in shoes making feet weak = BS?
http://www.youtube.com/watch?v=QkW13e_om7Y&feature=related
Can you have it both ways?

If I was habitually barefoot for all activities other than running, would the time spent running in shoes have a negative or positive effect on my digital strength? Now, there's a research project: take a group of habitual barefooters and make half of them run in shoes, measure digital strength pre and post in both groups over time.

Lest we forget the posts deleted here. "A turd is still a turd" despite the threats of legal action.

 

Simon:

First we must define what "stronger feet" actually means........

In all my years of treating and examining hundreds of shod runners who are running 30+ miles a week, I have never seen a single one of these individuals have what I consider to be a "weak foot". Rather, when watching them walk, they generally have a more normal gait examination with more normal resupination during late midstance and propulsion than non-athletes of similar ages.

My belief is that aggressive physical activity of the foot and lower extremity, done on a regular basis, will, by itself, make a "stronger foot", regardless if shoes are worn or not. In the end, a competetive runner could care less how "strong their feet are", as long as they are faster than the other guys in the race. The feet only need to be "strong enough" to do the activities required of the individual without foot and lower extremity injury. Right?

How would you, Simon, define a "strong foot" and a "weak foot"?

 

Kevin, you were the one that started on the increased digital strength route among the habitually barefoot. I measure plantarflexion/ dorsflexion strength of the digits with a hand held dynamometer. If you wanted to define strong or weak, you'd take data from an adequate sample. Then you can make delineations either side of the mean or via standard deviations from the mean. Since you have noted increased strength in certain groups, I should be interested to learn how you measure it in your patients?

Whether the competitive runner cares or not, if we make statements regarding what differences shoes do and do not make to intrinsic muscle strength, we ought to be able to look at the research data to back up those statements- right?

BTW, from another post: the position of the net ground reaction force vector relative to the joint axes determines the sense of the net external moment acting about any of the joints at any instant in time. The net moment is determined by the net of the internal and external moments.

p.s. from the "lost posts" is the patent world wide or US only? If it's not world wide, I'll abuse it in Europe- taking the piss. Go... spend some more money.

 

I would think that "foot strength" should also include the extrinsic muscles of the foot, and not just the intrinsic muscles of the foot. Wouldn't you?

 

If you mean by a platform from which to start, a paradigm used to treat the foot, then yes I do have one. The tissue stress paradigm is one where you identify the anatomical structure that has too much stress and then you reduce the stress on that structure. A foot with a stress fracture 2nd metatarsal gets a different orthotic than a foot with a stress fracture 5th metatarsal.

One of the problems of foot typing paradgims like Root et al is that they make the orthotic for the foot type and not for the pathology. You don't need to type the foot to treat the pathology.

Often, in rigid foot types, (I hope are definitions are close) you will see high pressures sub 1st met head. I've looked at a lot of pressure roll over process with the a force platform. There are a few very rare feet that will have high pressure under the first met head at forefoot loading.

However, in a foot with a medially positioned STJ axis, the 1st metatarsal will be lateral to the STJ axis, this the first met is on the pronation side of the axis. This is what makes STJ axis position such a good indicator of foot function. In some feet the first met is on the supination side of the axis and in other feet the first met is on the pronation side of the axis.

Treatment is not directed at correcting the STJ axis. Treatment is directed at changing the location of ground reaction force. Yes, you can get pain, deformity, degeneration or failure if you change the force to the wrong location. However, if you design your orthotic to reduce stress on anatomical structures then you will probably not be putting force in the wrong location. This is the main reason that I like the tissue stress approach over foot typing. If foot typing your are treating the type (unless you make the same device for all types) and not necessarily the pathology. One foot type can have many different pathologies.

Inverted heel cup devices work in all three planes. All orthotics work in all three planes. How do your orthotics differ from a medial heel skive device?

An orthotic with a varus wedge heel cup will shift the center of pressure applied to the foot from the ground to a more medial location and this will reduce the pronation moment from the ground. Pronation moment is a three dimensional calculation. This is one method by which orthotics work.

Dennis, how do you think orthotics work? How is vault different than the arch?

Why do you think that Dennis? See my explanation of first met and STJ axis position above for why I think STJ axis position does matter.

The location of the flare does not matter as long as the shod foot contacts the ground inverted. A longer lever arm will be created when the flare shifts the center of pressure more laterally.

People can forefoot contact if they choose to even if they have shoes with lateral flares. I'm not sure that answers your question. Yes, it would make the shoe less minimalistic, but I was trying to illustrate how shoe design can effect foot movement/moments.

My statement was that there is no evidence that barefoot running makes the foot stronger. That is an open minded statement as opposed to the question that you asked "Is that why feet are getting stronger for those who can make their way past the metatarsal stress fracture window?" That question assumes that barefoot running makes the foot stronger. Of course running barefoot will strengthen the muscles of the foot more than sitting in a chair. The repeated ground contacts will also tend to stress the bones and bones when stressed (not too much) will bet stronger. But that happens with and without shoes.

Eric

 

I meant intrinsic as in "belonging to" the muscles... So back to your statements, Sir...

 

I must argue that in and of itself, all forms of running will strengthen the rearfoot and superstructure but for many pathological feet, especially the flexible forefoot/flexible rearfoot types and the flat rearfoot types, running heel contact will only foster greater forefoot pathology over the long haul in my experience.

Oh, and the ballet dancers. please describe how much heel contact and what type of shoe they train and perform in?
Virtually none and minimalistic.
Do we agree?

and because of their overly developed and trained flexible forefoot types, they wear 3+" heels as a rule, when not training or performing.

But, again, her rearfoot and superposture is unbelievably well toned, stregnthened and balanced but for most ballet dancers, the #1 injury is 1st MP Joint, #2 is 1st IP Joint. There is some rearfoot pathology like FHL tendonitis but that is certainly rare.

Dennis

 

I have been running in my VFF's for a year now and the only problem I've had with them is I broke my pinky toe while accidentally kicking a cinder block. This could have been avoided if they connected the 4th and 5th toes. I am not a podiatrist or a doctor (just a lowly nursing student) so I am qualified to say whether or not these shoes are safe to wear for anyone or only for certain people.
HOWEVER, I love my Five Finger shoes.
I am a 150 lb runner of 4 years and 27 years old. I developed an IT Band injury while training for a marathon in October of 2010 and after a few months of taking it easy and transitioning SLOWLY into minimalist shoes my IT problem is gone and my running form is much improved.
I will post again if I have any metatarsal problems, but so far I'm great.

 

New US Army Regulation:

 

They would not have made that decision on a whim. They would have made that decision based on all the information and evidence and consultations they had available to them. They must have been seeing a lot of problems with soldiers using Vibrams/minimalist footwear. They decided to ban Vibrams.

 

Barefoot-simulating Footwear Associated With Metatarsal Stress Injury in 2 Runners.
Giuliani J, Masini B, Alitz C, Owens BD.
Orthopedics. 2011 Jul 7;34(7):e320-3. doi: 10.3928/01477447-20110526-25.

 

I think it has more to do with the fact that given freedom of choice, 80% of us pick the wrong shoe for the job andf size it improperly.

One advantage that the Army has is the ability to remove choice in this matter and I think that is what they did.

The fact that they called this an interum decision speaks volumes.

Dennis

 

From www.runningtimes.com

http://runningtimes.com/rt/images/BarefootStudyReport.pdf

 

I think the point I was trying to make is that the army would only have made this decision after seeing a lot of problems; consulting widely; accumulating what data was available; and making a decision based on all the information that was available. I have spoken to a physiotherapist for the Australian army and they are aware of this issue and she said they too may have to look at the issue, but any ruling will only be made after considering all the available info.

 

There is a general Concern for the general population who is generally stupid. For those who have an once of training or running insight, minimal shoes can be a great training tool. For most of the idiot population they can be an opportunity for injury.

 

We missed this from 2 weeks ago:
Barefoot running leads to injury "epidemic" - how to avoid it

 

That is pretty close to what actually happened. We were getting injury surveillance reports of things like >50% of those using vibrams in some units carrying an injury compared to a few % in the issued running shoe. We had to act.

 

Welcome to Podiatry Arena:welcome::drinks

I am interested in whether your finding of increased injury in Vibram shoes was on one military base or on a number of military bases? Also, is this data available to share with the public? I ask this question since I will be debating barefoot and minimalist shoe running with Dr. Irene Davis in a few months and would love a statistic like that to hang my hat on with Irene. Here is my e-mail if you could post me a note privately I would greatly appreciate it: kevinakirby@comcast.net

By the way, US Army Doc, here is a quote of mine you may enjoy:

http://www.boston.com/lifestyle/health/articles/2011/01/09/youre_crazy/?page=2

 

Is there any concrete evidence that VFF's are the primary cause of metatarsal stress fractures?.

Runners all over the world, regardless of there training backgrounds & what they decide to put on there feet are experiencing metatarsal stress fractures everyday & they have gone know where near a pair of VFF's.

Moving on: Some runners will go there entire lives wearing VFF's & won't experience injury.

Concluding: Other factors must surely be present in relation to metatarsal stress fractures. Only a narrow mind would place the blame solely on VFF's.

 

Vibram five fingers, minimalist, barefoot..? I think Dr. Kirby and all the other posters are way out of touch with the current trends.
Right now, reverse running is where it is at.. please see http://reverserunning.com/default.aspx
Do try to keep up lads!
Because we at ASICS are a progressive company, we are all over this like a dodgy suit. We are well underway with a prototype shoe built especially for reverse running, which we will be selling with a specially designed hat incorporating a rear view mirror.The shoe will incorporate flashing lights and a beeping sensor.. think Mack truck backing out of a warehouse. This one is gonna be huge.. the health benefits are enormous.. no more MT stress fractures

 

PS.. for those of you in the UK, the London reverse Run is THIS SUNDAY.

I think that is a must

 

You are so behind the times, Bartold!! Rope skipping running is the latest and greatest....forget about that minimalist running, barefoot running and reverse running... you are so old fashioned, Simon!!

Here are recently acquired top-secret training program videos showing the intense indoctrination that preschoolers are now getting in order to prepare them for the latest running craze!!

 

Oh it's nothing new. When I was in high school we would run mile forward then a half mile backward before soccer practice.

Eric

 

I have never had a pair of Vibrams on my feet but I can promise you Vibrams do not cause stres fractures.
Now maybe doing tmts in Vibrams will cause a stress fractrue. I got a stress fracture when I started BFR. I don't blame BFR but blame my dumb ass for doing more than I was ready for.

 

This made me cackle

 

I heard a ridiculous question posed at a podiatry talk at a running centre recently (woman aged about 35yrs):
I have never run before, but have just purchased a dog and would like to walk and run with him on the footpath in VFF..is this a good idea?
I have also heard a lot of VFF advocates saying that it's good for the untrained/overweight to 'just get out there and walk'
Correct me if I'm wrong...but is walking not an entirely different gait pattern to running - especially when comparing lightweight, well trained runners to the obese???
I have VFF myself, and would not set out on a major concrete footpath stomp. Having tried it, it feels like a heel stress# waiting to happen.
I believe that running or walking on man made hard surfaces with next to no man made shock absorption is a recipe for all kinds of impact related injuries up the kinetic chain.
I have recommended to the local running shop to maybe apply a layer of about 3mm of neoprene to their Vibrams for comfort and safety. This may detract from the proprioceptive promoting aspect of the shoe, but maybe worth a try for the cautious.
I believe VFFs maybe a good tool when slowly incorporated into the right speed session of an experienced runner, with the correct biomechanics, with a direct purpose, that does not risk injuring the athlete. Otherwise they are great for other activities such as kayaking, reef walking, rock climbing etc.

 

We trained runners to run backwards, I think it was in the 80's, especially indoors, in order to power the accelerator/decelorators backwards for more well rounded strength and function.

We stopped at the eigth wrist fracture when they fell after losing their balance some months later and I have never seen it resurface.

Dennis

 

Reverse running.

Something Bruce Lee was a big advocate of.

Maybe working the anterior side of the body?.

Must have been something in it.

 

Somewhat off topic for thread:

Press Release:
Vibram Sues Fila USA for Patent Infringement

 

This was the advert on the back of a recent Footwear news:

(The bottom of it reads: A message to anyone thinking about infringing on any of our 200+ patents)

 

Additionally to the patent infringements, there are also probably >200 websites selling fake Vibrams The ones I checked out were all based in China).

 

Thanks Craig, on that picture above, the two blue blocks of soling unit proximal to the 1st MTP sole unit... interesting positioning. Would be cool to test hallux dorsiflexion stiffness with and without these shoes, don't you think? Nice little undergrad study.