A new trend in fitness footwear – "Five Finger Shoes and Barefoot Shoes"

There has been a fairly rapid increase in popularity of a new type of shoe gear that runners and fitness experts are promoting and popularizing. I want to try and give visitors to this site some information that might help make decisions on this new footwear craze. These are solely the opinions of Dr. Still.

A growing number of scientists, trainers, coaches and fitness experts believe that ditching cushioned soles might be the best way to protect joggers and runners from chronic injuries. However, in my opinion although some evidence may prove this too be true at some time it is still too early to tell. “The jury is still out” I believe. These shoes may help prevent chronic overuse injuries but they may increase the incidence of acute injuries.

Long distance runners and the growing number of people engaging in Crossfit programs put a lot of forces into the feet and lower extremities with impact of running and heavy Olympic type lifting.

I think people that purchase the Vibram five finger shoes or other thin lightweight shoes such as Clark’s Terra Plana’s Vivo Barefoot Line must be careful and gradually get used to these shoes and not use them for high mileage running, at least not in the beginning. The Vivo Barefoot shoe was developed by Galahad Clark and a podiatrist, a lot of research went into the development of the shoe. The hallmark of this shoe is an ultra-thin sole with a configuration of honeycombed hexagons made from abrasion resistant thermoplastic urethane. Their debut running shoe called the Evo only weighs 17 oz.

The Vibram five finger shoes have several types or models and are designed to hug the toes and also stretch the tendons in the toes. I have started recommending them to patients that have flexible hammertoes and advised them to wear around the house and walking on soft surfaces. The durable rubber sole provides relief against debris and rocks. I need to do more research on these shoes and also wear them more to get a better opinion on them from a podiatrist perspective.

The simple science or biomechanics behind these shoes:

With a bulkier type of running shoe when we run our heel strikes the ground on the outer edge first. Without a shoe to cushion it while running the human foot strikes the ground on the outer edge of the forefoot. Next the forefoot rolls towards the toes and the toes grip the surface they are on while preparing the leg for impact. In human running the body can sustain 4-6x body weight! Incredible isn’t it?

While barefoot when the heel finally hits the ground the arch is compressed more than it would be with a shoe. The heel has an intricate network of fat that are actually organized into enveloped septae for excellent shock absorption. Next, when the toes push off they have a wider range of motion and muscle balance than is possible when wearing a shoe.

However, the heel also has the origin of the plantar fascia and the attachment of the vital Achilles tendon. The plantar fascia is the culprit in causing acute and chronic heel pain and runs the length of the foot (it starts at the heel). When a person is not used to running this way or with shoes that don’t provide the normal amount of support and cushioning they are used to the forces into the plantar fascia and Achilles may be too high to tolerate and cause injury or rupture. For persons over 200 lbs., I don’t recommend running in these shoes, if you do don’t exceed a few miles per run. The forces are just too high!

An argument can be made that when the heel strikes the ground while wearing the traditional running shoe with a thick layer of white foam (EVA) there is a lot of force that transmits up the kinetic chain (heel bone connected to the leg bone connected to the hip bone, etc) all the way to the spine, mandible and skull.

However, it is quite hard to change the way we run and it takes time. Be careful of who may be instructing you to change your running style and who encourages you to use these types of running/ exercise shoes. Make sure they have some knowledge and take you gradually into this type of knowledge.

Christopher McDougall has written a best-selling book called “Born to Run” documenting the running of the New Mexican Tarahumara Indians. These Indians have been very successful ultra marathoners wearing thin soled rubber soles or not shoes at all. This tribe has been adapting to their environment and have a certain body stature that has evolved over hundreds years. If you are a 6’ 1” 215 lb. male your body likely will not tolerate these shoes very well except with shorter distances or walking. Pain in the calves is common when using these shoes at first and also pain to the front of the calf along the tibialis anterior tendon is also common if one does a significant amount of downhill running.

Show caution when starting to wear these shoes, moderation is the key when exercising in these shoes. I do think that can help stretch out intrinsic muscles in the foot which are often atrophied and not very functional, especially for people with a high arch or a severely low arch and curled or hammered toes. Intrinsic muscles are muscles that originate and end in the foot and do not come from the leg. I don’t recommend these shoes to the elderly that have a severely depressed arch and hammertoes. If there is some question if these shoes may be right for you visit a podiatrist knowledgeable on this new trend in footwear.

Dr. Still