Barefoot Runner: To Be or Not To Be

It seems that lately everywhere that media exists, there is a discussion of a hot new topic in the area of sports medicine and the current "tweet" is barefoot running. This technique has been utilized by some professional athletes and marathon runners. One particular individual who has become very famous through barefoot running is known as “barefoot Ken Bob”. True barefoot runners believe that barefoot running keeps their feet in their neutral position and therefore helps them with overall biomechanics of the foot, mainly their balance and stability. The strategy and the thought behind this is that all throughout history, our ancestors have been on their bare feet walking, running, working, and providing for their families. It was not until recently that the idea of supportive shoes came around. Later, orthotics were introduced along with their benefits of giving runners the opportunity to sustain less injuries and less pain while having the ability to run longer distances.

From a foot and ankle doctor's point of view, supportive shoes absorb shock from the ground while we run and they provide cushioning against hard surfaces; they increase stability and lessen the chances of injury. Furthermore, the use of custom orthotics perfects the biomechanics of our feet so that pressure is distributed equally and at the right phase of the gait cycle. Those average runners who currently use custom orthotics due to poor biomechanics will not benefit from barefoot running in any sort. In fact, they will only increase their chances of hurting themselves and sustaining an injury while running. On the other hand, those with good biomechanics who currently do not need the support of an orthotic may benefit to a certain level by barefoot running in a safe environment. Barefoot running is not at all suggested for diabetic patients, those suffering from peripheral neuropathy, peripheral vascular disease, heel spurs, previous foot injuries and plantar fasciitis.

There is much debate going on about this topic and until more research and study is done there will be no certain answer. The original research done on barefoot running showed that there is less damaging pressure placed onto the hips, the knees and the ankle joints while the patient walked barefoot on the treadmill compared to when they were walking in supportive shoes. What the article fails to do is to test this strategy on alternate surfaces for the patient.

What each individual needs to keep in mind is that our feet have become accustomed to the arch support, and cushioning provided by shoes. To take that and to suddenly go from great support to no support will exhibit an enormous amount of stress onto our feet; stress that the feet will not be able to handle and will therefore get injured. Forces anywhere from two to eight times of our body weight go through our body as we run, without the support of shoes, we will get hurt due to lack of adequate motion control and stability. If you are an individual who would like to experiment with barefoot running, start in a safe environment and start slowly. Also, keep in mind that certain shoes in the market mimic the mechanics of barefoot running and could possibly be a good starting point. Barefoot running is really like starting over and is a process that needs to be “eased into” in order to allow the body to adapt to the new forces being exerted onto it.

As physicians and podiatrists, we are most concerned about our patient’s health and want what is best for them. Further biomechanical studies are certainly needed to determine the best remedy for our professional runners. Until then, we will advise to our patients what we have been trained for and that is to have support at all times while walking and running to prevent injuries. Always remember the general rule of doing things in moderation and to consult a physician before starting any exercise regimen.

For further questions, call us at 713-999-6600 or view us online at www.myfootdoc.com.

Achilles Tendonitis and Achilles Tear

What Really Happened to David Beckham and Can It Happen To You?

On Sunday March 14, 2010, the world’s most elite soccer player lost his chances of entering The World Cup due to a sports injury. This injury was an Achilles tendon rupture, often a career-ending injury for soccer, tennis, football and basketball players.

The Achilles tendon is made up of fibrous tissue bonded together in a ropelike manner. The tendon connects the heel bone to the calf muscle in each individual. It is the largest tendon in our body and is capable of bearing large amounts of weight. The function of the tendon is to pull the heel off the ground and allow the toes to push off the ground in order for us to make a step as the calf muscle tightens. The ‘tendon’ is actually a combination of the three muscles of the lower leg, often called the gastrocnemius complex. The ‘tendon’ is the terminal attachment of the Soleus Muscle, as well as the Medial and Lateral Gastrocnemius muscles. The action of the tendon/muscle group is necessary to allow walking, running, and different activities such as participating in sports. Once an interruption (tear) is made through this band of fibers, a simple task such as walking becomes unbearable. This condition is known as an Achilles tendon rupture. Bruising, swelling, redness, inflammation, pain and sensitivity in the back of the affected leg are just a few of the symptoms to mention that result after a rupture. Patient may also hear a sudden pop as the injury occurs. Often, patients relate being hit with a 2x4 or feeling like they were shot in the back of the leg!

The chances of a rupture increase as the tendon grows weak. This weakness can occur due to aging, medications such as corticosteroids (and some drugs known as Quinolones) as well as conditions like arthritis. With that said, it is important to know that tendo Achilles rupture is most common in middle aged men, especially those known as “weekend warriors” who play an extensive amount of recreational sports such as basketball, soccer, surfing, etc. after a long time of no activity. A sudden fall, a sudden push-off of the foot with the knee straightened can all result in injury.

It is important to seek medical care as soon as the injury happens. Podiatrists are trained to diagnose an Achilles tendon rupture by some important and simple clinical testing techniques. An MRI or ultrasound are then ordered to verify the rupture and determine the level at which the rupture has occurred. Once a rupture is confirmed, surgical and nonsurgical treatment plans are decided by the physician. Both are a long term course of treatment that can last about 6 months. Immobilization, casting, and physical therapy are some standards to achieve the ultimate goal of treatment which is restoring the original length and strength of the tendon.

A word of advice from your sports podiatrist: always RICE after any injury. To RICE is to Rest, Ice, Compress and Elevate the site of injury.
Unfortunately Beckham’s injury crushed his hopes for a chance to win at the world cup and is causing him to miss a big portion of the MLS season. We all wish him a full recovery to return to the sport that he loves most.

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