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“Barefoot running and minimalism: Good, Bad, Or just plain Ugly?”

Presented by: Dr Peter Garbutt B.Sc. (Anat/Physiol), M.Chiro., M.Chiro.Sp.Sc

Will commence LIVE from Canberra, Australia at 8pm AEDT

Dr Matthew Bulman BSc (chiropractic)

World Health Webinars (Australia) Chiropractic Program Coordinator

World Health Webinars (Australia) Host

Editor of the Chiropractic and Osteopathic College of Australasia NEWS

Owner of The Runner’s Clinic, Sydney

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Dr Diana Robinson

• Runs a multidisciplinary sport’s injury and healthcare centre in Canberra

• Chairman of Sports Chiropractic Australia

• President of the ACT Branch of Sports Medicine

Australia

• Pacific Representative for the International Sports Chiropractic Federation

Chiropractor

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Barefoot running & minimalism:

Good, Bad, Or just plain Ugly?

What have we been told?

Foot Basics—The Gait Cycle

Heel Strike

• Lower extremity accepts vertical impact forces

Pronation

• Foot absorbs and somewhat dissipates impact across a flexible mid and forefoot

Re-Supination/Toe-off

• Foot becomes a rigid lever providing horizontal propulsion

The extremes of arch architecture and foot mobility can interfere with this intricate mechanism

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The Flat Foot (Pes Planus)

Tend to have foot hypermobility

Predisposed to over-pronation.

Foot remains in a pronated, unstable position during toe off

Center of weight shifted to the medial portion of the foot.

Ultimate effect--increased medial foot, leg, and knee stress from excessive internal tibial rotation

High-Arched Foot (Pes Cavus)

Tend to have reduced foot mobility

Predisposed to under-pronation

Foot remains in a supinated, rigid, position during pronation phase

Center of weight remains on lateral portion of the foot

Lack of flexibility in the intrinsic joints of the foot leads to reduced shock absorption.

Goals of Shoe Design

Support

Cushioning

Guidance

These goals can be achieved by altering material properties or construction features of the shoes.

Nigg BM, Segesser B: biomechanical and Orthopedic Concepts in Sport Shoe Construction. Med Sci Sport Exerc 24: 595-602, 1992

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Shoe Construction: The Last

Board, slip, and combination-lasted features provide varying degrees of stiffness and flexibility to the shoe

Board Lasted Footbed

Sturdy insole board running the entire length of the foot bed is stitched to the upper and glued to the midsole

Provides the greatest stability.

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Slip Lasted Footbed

Upper is pulled over a form, stitched together and glued to the midsole

Constructed without an insole board

Provides the greatest flexibility and lightest weight

Combination-Lasted Footbed

Insole board in the hind foot to provide motion control

Slip lasting in the forefoot for enhanced flexibility

S

Straight Semi-Curved Curved

Wear Pattern

"The wear pattern on your running shoes suggests that you watch too much TV."

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http://www.junkertoons.com/toonMatwearpattern.htm

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Neutral Wear Pattern

Tend to wear most heavily along lateral aspect of heal

Even wear along the remainder of the outsole

No excessive midsole wrinkling or tilt

Forefoot-Strike Wear Pattern

Focused outsole wear over mid and forefoot

No visible heel wear

Wrinkling of midsole in mid and forefoot

Over-Pronation Wear Pattern

Excessive wear along medial outsole

Excessive wrinkling of the medial midsole

Medial tilt

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Under-Pronation Wear Pattern

Excessive wear along lateral outsole

Excessive wrinkling of lateral midsole

Lateral tilt

Arch Height

Inspect arch seated

Inspect standing

Inspect with toe raise

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Static Foot Type—The Wet Test

Place piece of dark paper on floor

Wet bottom of feet and stand on paper

Match your foot prints to one of the foot types pictured

Runner’s World, © Rodale Press, 1999

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Gait Analysis

Have the patient walk about 15-20 meters away from you

Observe from behind:

• Location of heel strike

• Foot motion during single-leg stance phase

• Part of the foot with which they push off

Cushioned Shoe Candidate

Underpronator whose shock absorption will be further compromised by motion control features

Underpronation wear pattern on old shoes

High arch on exam and Wet Test

Underpronates on gait analysis

Biomechanically efficient runners who do not require pronation control will often do well in cushioned type shoes

Stability Shoe Candidate

Mid-weight runner who needs some basic medial support

No evidence of abnormal wear pattern on prior running shoes

Normal arch on exam and Wet Test

No evidence of significant overpronation on gait analysis

Motion Control Candidate

Significant overpronator or Clydesdale runner

Overpronation wear pattern on old shoes

Low arch or pes planus on exam and Wet Test

Overpronates on gait analysis

Orthotic wearers need stability shoes at a minimum and may benefit from the firm midsole and deep heel counter of motion control shoes

Static foot shape

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Cushioning

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www.worldhealthwebinars.com.au Stability

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Why barefoot?

Increase foot strength (Nurse & Nigg 2001)

Better balance – homunculus (Robbins et.al.

1995)

Better postural feedback – homunculus

Better shock absorption (Lieberman 2010 Nature, Squadrone & Galozzi 2009)

Natural motion of the foot (Donoghue 2008, Squadrone & Galozzi 2009)

Improved running technique (Lieberman 2010)

Less effort (Martin 1985, Divert et.al. 2008, Squadrone and Galozzi 2009)

Better midfoot power generation (Smith &

McConnell 2007)

It’s fun!

We Were Designed To

Foot Strength

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It Is More Energy Efficient

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More Natural Motion

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Injuries?

Currently no research one way or the other.

Anecdotally

• Stress #

• Calf pain

• Puncture wounds

• Sesamoiditis

• Blisters/callouses?

Are minimalist shoes the same as barefoot?

In some ways – Squadrone and Galozzi 2009

Not in others – Bonacci 2013, Rose et.al.

What makes a minimalist shoe?

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When and how to use orthotics

What does a foot orthotic do?

When might you need that function?

What is the right way to go barefoot?

Why do you want to?

Surfaces

Progression

References

Derrick, T. R., et al. (1998). "Energy absorption of impacts during running at various stride lengths." Med Sci Sports Exerc 30(1): 128-135.

Lieberman, D. E., M. Venkadesan, et al. (2010). "Foot strike patterns and collision forces in habitually barefoot versus shod runners." Nature 463(7280): 531-535.

Edwards, W. B., et al. (2009). "Effects of stride length and running mileage on a probabilistic stress fracture model." Med Sci Sports Exerc 41(12): 2177-2184.

Mercer, J. A., et al. (2003). "Individual effects of stride length and frequency on shock attenuation during running." Med Sci Sports Exerc 35(2): 307-313.

Chumanov, E. S., et al. (2012). "Changes in muscle activation patterns when running step rate is increased." Gait Posture.

Dean, J. C. and A. D. Kuo (2011). "Energetic costs of producing muscle work and force in a cyclical human bouncing task." J Appl Physiol 110(4): 873-880

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References

Robbins, S., Waked, E., & McClaran, Proprioception and stability: Foot position awareness as a function of age and footwear. Age mid Ageing, 1995 24. 67-72 (softer shoes decreased proprioception)

Vormittag, K.,Gilonje,R..& Briner, W.W. 2009. Foot and ankle injuries in the barefoot sports. Current Sports Medicine Reports, 8 (5), 262-66.

Squadrone R; Gallozzi C, Biomechanical and physiological comparison of barefoot and two shod conditions. Journal of Sports Medicine and Physical Fitness; Mar 2009; 49, 1;

Donoghue O.A. Et al. Lower Limb Kinematics of Subjects With Chronic Achilles Tendon Injury During Running. Research in Sports Medicine, 16: 23–38, 2008

Robbins, S. E. and A. M. Hanna (1987). "Running-related injury prevention through barefoot adaptations." Med Sci Sports Exerc 19(2): 148-156.

Hart. P.M., & Smith. D.R. 2009. Preventing running injuries through barefoot activity. ¡ournal of Physical Education, Recreation & Dance, 79 (4), 50-54.

Divert, C, et al. 2008. Barefoot-shod running differences: Shoe or mass effect? International journal of Sports Medicine; 29, 512-15.

References

Heiderscheit, B. C., et al. (2011). "Effects of step rate manipulation on joint mechanics during running." Med Sci Sports Exerc 43(2): 296-302.

Miller, R. H., et al. (2009). "Ground reaction forces and lower extremity kinematics when running with suppressed arm swing." J Biomech Eng 131(12): 124502.

Arellano, C. J. and R. Kram (2011). "The effects of step width and arm swing on energetic cost and lateral balance during running." J Biomech 44(7): 1291-1295.

Giandolini, M., et al. (2012). "Impact reduction during running: efficiency of simple acute interventions in recreational runners." Eur J Appl Physiol

Goss, D. L., et al. (2012). "Accuracy of self-reported footstrike patterns and loading rates associated with traditional and minimalist running shoes.“

Delgado, T. L., et al. (2012). "Effects of Foot Strike on Low Back Posture, Shock Attenuation, and Comfort in Running." Med Sci Sports Exerc.

Daoud, A. I., et al. (2012). "Foot Strike and Injury Rates in Endurance Runners: a retrospective study." Medicine & Science in Sports & Exercise

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References

Bonacci J. et al. Running in a minimalist and lightweight shoe is not the same as running barefoot: a biomechanical study. BJSM 2013

Dicharry J et.al. Differences in Static and Dynamic Measures in Evaluation of Talonavicular Mobility in Gait. journal of orthopaedic & sports physical therapy 2009

Ryan M et.al. The effect of three different levels of footwear stability on pain outcomes in women runners: a randomised control trial. BJSM 2011

Clarke T E et al. Effects of shoe cushioning upon ground reaction forces in running. Int J Sports Med 1983

Robbins S et al. Athletic footwear affects balance in men BJSM 1994

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Live Q & A With Peter Garbutt

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Coming up next week

Live Q & A With Peter Garbutt

Thank you

From Peter Garbutt

&

World Health Webinars Australia

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