A recent study in Medicine and Science in Sports and Exercise compared the injury rates between forefoot strikers and rearfoot strikers showed that there was a higher injury rate in the rearfoot striking group. Here is how Vivobarefoot and several other blind barefoot runners interpreted this study:

Memo to Vivobarefoot:

1. What makes this an official study? It is no more “official” that any other study ever published!
2. The study was retrospective. You need to look up the difference between retrospective and prospective study designs. Retrospective studies actually prove nothing!
3. It was done on almost elite level college runners. You cannot generalize the results of that to non-elite runners!
4. It was not even on barefoot running! They were all wearing shoes!
5. I assume you are not aware of all the issues that have been raised in a number of places now re the way the statistical analysis was done that raises some questions about the results.

Hang your head in shame for the way you have interpreted this study. The barefoot community should be embarrassed by this intellectual dishonesty if it want to be taken seriously

I am really starting to wonder about this. It’s is the only explanation I can come up with to explain what I am seeing. First, we had all the barefoot websites claiming that running shoes cause osteoarthritis based on a study that was not even about osteoarthritis. Then we had them all claiming that barefoot runners get less injuries based on Liebermann’s study that got published in Nature when the study was not even about injuries. I even had barefoot runners email me the Kerrigan et al study and say things like “this is all the proof you need”, when it did not prove anything. I even got an email last week asking what I thought about the Liebermann study and why would I not accept the proof from that. I have already discussed the Liebermann study and there was no proof in it that barefoot running was better (even Liebermann had to put a disclaimer on his website to distance himself from those sorts of conclusions being made of his research). I was really starting to wonder why these people were so blind and making all these kinds of conclusions when that was not what the research was showing.

Now I finally have some proof that barefoot running does indeed make you blind:

I was reading the self proclaimed America’s Podiatrist’s (Dr Michael Nirenberg) blog, who is a barefoot runner and read this:

A stunning medical study has reversed conventional wisdom on runners who pronate moderate to severely: The researchers found that it’s actually preferable to ditch your athletic shoes!…

It has long been believed that athletic shoes can provide additional stability to a running foot due to cushioning and binding, therefore controlling excessive pronation: but that erroneous common belief was turned completely on its head by this study!…

Barefoot running now has the weight of clinical evidence to conclusively prove that it lessens over-pronation.

Interesting claims. I thought I had been asleep at the wheel and missed some new amazing research on this. I am normally good at keeping on top of this. I will always go where the research evidence takes me. I would also have thought that a medical professional who has to make clinical decisions about people’s health would be good at analyzing the veracity of research and its applicability. I thought I had better go and look at the research he was claiming showed all this. I already had the research in my files and it certainly was not ‘stunning‘. All I can conclude is that he just proved that barefoot runners really are blind. The research did not come close to supporting the claims he was making. I fail to see how someone who you think you could trust with clinical decisions to treat patients based on research can get it so wrong when reading research.

Let’s take a closer look:

This is the publication that he was refering to: Joanna B. Morley, Leslie M. Decker, Tracy Dierks, Daniel Blanke, Jeffrey A. French, Nick Stergiou:  Effects of Varying Amounts of Pronation on the Mediolateral Ground Reaction Forces During Barefoot Versus Shod Running. Journal of Applied Biomechanics, 2010, 2, 205-214

Here is the abstract:

Despite extensive research on running mechanics, there is still a knowledge gap with respect to the degree of relationship between mediolateral ground reaction forces (ML-GRF) and foot pronation. Our goal was to investigate whether differences exist in ML-GRF among runners that exhibit different degrees of pronation. Seventeen male and 13 female recreational runners ran with and without shoes while ML-GRF and frontal kinematics were collected simultaneously. Subjects were divided into groups based upon their peak eversion (low pronation, middle pronation, high pronation). Discrete parameters from the ML-GRF were peak forces, respective times of occurrence, and impulses. No significant differences were found between groups regarding the magnitude of ML-GRF. Based upon the relative times of occurrence, the peak medial GRF occurred closer to the peak eversion than the peak lateral GRF. Findings support the idea that the ML-GRF have less to do with pronation than previous research suggested.

Notice that there is nothing in the abstract that supports the ‘stunning‘ claims made by Dr Nirenberg. If you read the full study, it’s clear that the researchers showed none of what ‘Americas Podiatrist’ was claiming and no where do they even state what he was claiming. I am sure the authors of the study would not be impressed knowing that this sort of intrepretation was being made of their research. And this interpretation came from a medical professional who should know better when it comes to reading and appraising research! If you do not believe me, read it yourself and please show me where any of this was shown by that research? It wasn’t even ‘clinical evidence’! I would have though that a medical professional would know the difference between ‘clinical‘ and ‘labartory‘ research, but apprently not. There are even comments to the article that Dr Nirenberg wrote praising what he wrote. Did those barefoot runners even read the study that he is quoting or is this blind praise?

Why does barefoot running make people so blind? If it does not make them blind, then why is it that when they read research they reach conclusion that no one else does, let alone the study’s authors? Does anyone have another explanation?

Do running shoes cause osteoarthritis? According to a lot of barefoot running websites and blogs they do. Where do that get that information from? They either seem to have made the claim up or based it on the press release that accompanied the Kerrigan et al study. Which is just another case of intellectual dishonesty as Kerrigan et al did not even do a study on osteoarthritis! How can you claim running shoes causes osteoarthritis based on research that did not even look at osteoarthritis? !!!! And we exposed two barefoot websites that even lied about it (how can we trust anything else they say if they do that?).

What does the actual evidence say from those who actually did a study on osteoarthritis? Given that 99.99% of runners use running shoes, then if running shoes caused osteoarthritis, then you would expect to see more osteoarthritis in runners compared to the general population, wouldn’t you? Like the well documented track record of not letting facts get in the way of a good story, the barefoot running community conveniently ignore that fact that there is no more osteoarthritis in the running shoe wearing population compared to the general population. This has been clearly shown in numerous studies now. Lets look at a few of them:

Rogers et al way back in 1985 showed that:

here is no association between moderate long distance running and the future development of osteoarthritis. Furthermore, the evidence suggests that neither heavy mileage nor the number of years running are contributory to the future development of osteoarthritis.

Before than in 1975, Puranen et al found no more OA in the hips of former elite runners. Lane et al in 1986 found that:

Running is associated with increased bone mineral but not, in this cross-sectional study, with clinical osteoarthritis.

Lane et al in 1993 showed:

In summary, running did not accelerate the development of radiographic or clinical OA of the knees

A more recent study in Germany by Schmitt et ak (2006) conlcued:

Osteoarthritis of the knee joint is rare in former elite marathon runners. The risk of osteoarthritis of the hip joint seems to be higher than in control subjects who do not engage in much sport.

Running shoes do not cause osteoarthritis. Get over it.

Well they don’t really, but why can I not make up that headline like that as the barefoot running community do it all the time (see Intellectual Dishonesty). Surely if they do it, why can’t the rest of us do it? Mainly because we are not that irresponsible and dishonest.

But, here is my logic behind the headline: Stress fractures have been related to muscle fatigue in the this study: The Influence of Muscle Fatigue on Electromyogram and Plantar Pressure Patterns as an Explanation for the Incidence of Metatarsal Stress Fractures (the study did not actually show that, but they speculated that in the discussion and title -  but the barefoot community do not let little facts like that get in the way of how they interpret and tout research that they pretend supports their cause, so give me some latitude here). And we have this study: Motion control shoes may reduce the injury risk in runners (my fake headline!)  that was recently published and suggested that there is less muscle fatigue in motion control running shoes (the study did not actually show what my fake headline claimed,  but the barefoot running community do not let little facts like that get in the way of how they interpret and tout research that they pretend supports their cause, so give me some more latitude here).

So now let’s apply the 2+2=5 logic that the barefoot running community apply so often and conclude that shod runners get less stress fractures. They get less stress fractures as they have less muscle fatigue and more muscle fatigue is associated with stress fractures. This means that barefoot runners must get more stress fractures in comparison.

This is the logical conclusion, isn’t it? But, I am not that irresponsible as I know there is not one study that shows there are more stress fractures in barefoot runners. So I am not going to make the claim that barefoot runners get more stress fractures.

The point I am trying to make, is that this is the typical way the barefoot running community act in making their extraordinary unsupported claims. They make them up. They misrepresent and misinterpret research. They even lie about research. Then they pretend the research supports what they are doing, when it does not.

I got am email asking me what I thought of the recent study in the Physician and Sports Medicine about those with plantar fasciitis improving more in barefoot or minimalist shoes (Nike Free) compared to conventional shoes. Here is the abstract:

Plantar fasciitis is a common injury to the plantar aponeurosis, manifesting as pain surrounding its proximal insertion at the medial calcaneal tubercle. Pain is typically worse in the morning when getting out of bed, and may subside after the tissue is sufficiently warmed up. For running-based athletes and individuals who spend prolonged periods of time on their feet at work, plantar fasciitis may become recalcitrant to conservative treatments such as ice, rest, and anti-inflammatory medication. Exercise-based therapies have received only limited attention in the literature for this common problem, yet they are becoming increasingly validated for pain relief and positive tissue remodeling at other sites of similar soft-tissue overuse injury. This study reports on pain outcomes in individuals experiencing chronic plantar fasciitis while wearing a shoe with an ultraflexible midsole (Nike Free 5.0) (FREE) versus a conventional training (CON) shoe in a 12-week multielement exercise regimen, and after a 6-month follow-up. Adults with >or= 6-month history of painful heel pain were recruited and randomly assigned to wear 1 of the 2 shoes. All subjects completed the same exercise protocol. A visual analogue scale item tracked peak pain in the preceding 24 hours taken at baseline, 6- and 12-week points, and at the 6-month follow-up. Twenty-one subjects completed the program (9 FREE; 12 CON). Both groups reported significant improvements in pain by the 6-month follow-up, and the FREE group reported an overall reduced level of pain throughout the study as a result of lower mean pain scores at the midpoint and post-test compared with the CON group. The exercise regimen employed in this study appears to reduce pain associated with chronic plantar fasciitis, and in doing so, the Nike 5.0 shoe may result in reductions in pain earlier than conventional running shoes.

The data presented in the study did not support the conclusion made by the authors and this shows how easy it is to jump to conclusions based on just reading the abstract. The data may have actually shown the opposite to the authors conclusion!

When researchers publish their research, they like to publish it in what are called high impact journals. This is a complicated formula based on a number of factors. Due to competition only the best research theoretically makes it into the high impact journals. Because of this, poorer quality research theoretically makes it into the lower impact journals. The Physician and Sports Medicine is a lower impact journal. To publish a randomized controlled trial (like the above one) in a high impact journal, then the reporting almost always has to comply with the CONSORT standards. This is a standard method of analysing and reporting the results of randomized controlled trials agreed to by the editors of many of the high impact medical journals. This allows for a high level of transparency in analysis and reporting. Most of the low impact medical journals also adhere to this standard, but based on the above research, the Physician and Sports Medicine does not appear to.

In the above research, those with plantar fasciitis were given a standard treatment protocol with the only difference being one group kept their conventional running shoes and the other group were given the Nike Free. Their analysis showed non-statistically significant greater initial improvement in the group using the Nike Free (which is problematic conclusion on its own, but I won’t go that way). What the abstract does not say (but the full publication does say) is that the symptoms of two subjects in the Nike Free got so bad that they had to withdraw from the study, so their data was not included in the final analysis. One of the key tenants in the CONSORT statement for the analysis of randomised controlled trials is what is known as ‘intention to treat’ analysis, in that the data from those who withdraw need to be included in the analysis. So the pain scores from the two subjects who got worse in the Nike Free’s who had to withdraw should have been included in the analysis. I am sure you can see if they had done that, the results from the study would have been very different. The results would have probably have been no difference between the two groups or even the Nike Free group doing worse (as two subjects got that bad they had to withdraw!).

I do not know why the Physician and Sports Medicine allowed publication of this study without the ‘intention to treat’ analysis which is the accepted ‘gold standard’. One thing I do know is that this study will find its way into the teaching resources of research methods courses as a classic on how to understand ‘intention to treat’ analysis and why it is important.

I did check around the barefoot running websites and was pleasantly surprised that they were not touting this research as being evidence for minimalist running shoes (or even barefoot running!). Good on them for that. They will certainly be making fools of themselves if they did and providing more evidence of their intellectual dishonesty.

I wonder how the barefoot running community will respond to this one? Despite claims by the anti-running shoe lobby, there is NO evidence that running shoes do any harm (see: Intellectual Dishonesty), now we have some research that shows that motion control shoes do some good. How will they respond to that?

Here is the abstract that appeared in the American Journal of Sports Medicine:

Motion Control Shoe Delays Fatigue of Shank Muscles in Runners With Overpronating Feet
Background: The motion control shoe is a well-developed technology in running shoe design for controlling excessive rearfoot pronation and plantar force distribution. However, there is little information on the leg muscle activation with different shoe conditions.
Hypothesis: The motion control shoe can prevent excessive shank muscle activation and delay fatigue.
Study Design: Controlled laboratory study.
Methods: Twenty female recreational runners with excessive rearfoot pronation were tested with running 10 km on a treadmill on 2 days. Participants wore either a motion control running shoe or neutral running shoe on each day. Activities of their right tibialis anterior and peroneus longus were recorded with surface electromyography. The normalized root-mean-square electromyography and median frequency were compared between the 2 shoe conditions.
Results: Significant positive correlations were found between the root-mean-square eletromyography and running mileage in both the tibialis anterior and peroneus longus in the neutral shoe condition (P <.001). The median frequency dropped in both shoe conditions with mileage, but paired t tests revealed a significantly larger drop in the neutral shoe (P < .001 for peroneus longus, P = .074 for tibialis anterior).
Conclusion: The motion control shoe may facilitate a more stable activation pattern and higher fatigue resistance of the tibialis anterior and peroneus longus in individuals with excessive rearfoot pronation during running.
Clinical Relevance: The motion control shoe may increase the running endurance, thus reduce overuse injuries, in athletes with unstable feet during long-distance running.

Now, if I was as irresponsible as some barefoot running websites in which they tout research they imagine supports barefoot running (see those two barefoot websites that lied here), I would be perfectly entitled to use this headline for the research: Motion Control Shoes Improve Endurance and Reduce Injuries.

Why can’t I say that? This is the way the barefoot running websites write headlines for research that they totally misrepresent to promote their cause. Why can’t I do the same? Maybe because I am not so blinded by an agenda. I know the research did not actually show that (which is something that the barefoot running community try to get away with all the time. See: Intellectual Dishonesty).

Lets take a closer look at the research and be honest about it:

1. It was done on females, so the results may not apply to males (though there is no reason to doubt that it does not, but there are biomechanical differences between the way that males and females run).
2. It was done on ‘pronators’, so the results cannot be generalized to non-pronators.
3. It was done on a treadmill, so the gait there is not the same as overground running. It will be interesting if the anti-running shoe community are going to try and dismiss this study as it was done on a treadmill, but were happy to accept the Kerrigan et al study which was also done on a treadmill, but we know that those with an agenda like having things both ways.
4.  They used the Adidas Supernova cushion and the Adidas Supernova control, so everything is ok there, except they probably should have used the term ‘cushion’ rather than ‘neutral’.
5. I checked in with a professor who knows more than me about electromyography to see if there were any issues there and he had found no issues.
6. It was funded by an independent grant and not by the running shoe industry.

What did they find?

This study compared the lower leg muscle recruitment with and without fatigue in recreational runners who have excessive foot pronation when running with different footwear. The results revealed that motion control footwear was able to maintain more stable activity in the TA and PL muscles and delay fatigue of these muscles with prolonged running better than neutral cushioned footwear.

That’s all they found. They did not find that “Motion Control Shoes Improve Endurance and Reduce Injuries”.

However, if we want to extrapolate and develop some theory from that research, then yes, the data is suggestive that there would be less fatigue in the leg muscles in those with a pronated foot when wearing a motion control shoe. This should translate to a better endurance performance and a theoretical reduction in injury risk. But, we are not as irresponsible to jump to definitive conclusions as this was not a study on endurance or injury (not like the barefoot running community who made up headlines about the Kerrigan et al study claiming that running shoes cause osteoarthritis, when it was not even a study on osteoarthritis!)

How will the barefoot running community respond to this study? My money is on they will ignore it as it does not fit in with their agenda.

Who can remember the media flurry and hype on barefoot running sites when Craig Richards published his systematic review last year: Is your prescription of distance running shoes evidence-based in the British Journal of Sports Medicine? Here is the abstract:

Objectives: To determine whether the current practice of prescribing distance running shoes featuring elevated cushioned heels and pronation control systems tailored to the individual’s foot type is evidence-based.
Data sources: MEDLINE (1950–May 2007), CINAHL (1982–May 2007), EMBASE (1980–May 2007), PsychInfo (1806–May 2007), Cochrane Database of Systematic Reviews (2nd Quarter 2007), Cochrane Central Register of Controlled trials (2nd Quarter 2007), SPORTSDiscus (1985–May 2007) and AMED (1985–May 2007).
Review methods: English language articles were identified via keyword and medical subject headings (MeSH) searches of the above electronic databases. With these searches and the subsequent review process, controlled trials or systematic reviews were sought in which the study population included adult recreational or competitive distance runners, the exposure was distance running, the intervention evaluated was a running shoe with an elevated cushioned heel and pronation control systems individualised to the wearer’s foot type, and the outcome measures included either running injury rates, distance running performance, osteoarthritis risk, physical activity levels, or overall health and wellbeing. The quality of these studies and their findings were then evaluated.
Results: No original research that met the study criteria was identified either directly or via the findings of the six systematic reviews identified.
Conclusion: The prescription of this shoe type to distance runners is not evidence-based.

This was greeted with headlines in the news media, on running forums and on barefoot running websites as evidence that expensive running shoes are bad (do you remember the headlines?). Can anyone actually see anywhere in this study where they actually showed that? This is just further evidence of the intellectual dishonesty of the barefoot running community that they would interpret the research that way and promote it as saying that.

All the study found was that there was no evidence to support the prescription of distance running shoes. They found no evidence because there is no evidence as no one has done any good research on it! Just because there is no evidence for it, does not mean that running shoes do not help. It does not mean that they don’t either. Why did the barefoot running community take this as evidence that running shoes are bad?

I have no problems with the study and agree with the conclusion. I do have a slight problem with the way the article was written and its tone as it was obviously written by someone with an agenda (the author is a barefoot runner and has a financial interest in a barefoot running product). However, I will not dismiss the study because of that. The barefoot runners with their blinkers on will love the biased tone that the article was written with!

If a study did come out and did show that running shoes helped and was funded by the running shoe industry, how would the barefoot running community react to that? Would they dismiss it because the running shoe industry funded it? Are they prepared to dismiss the study above because it was done by a barefoot runner? Are they prepared to dismiss the Liebermann et al research because it was done by a barefoot runner and funded by a barefoot running company? It will be interesting to see how the barefoot running community react, as that research is coming.

Despite claims to the contrary by the barefoot community, there is NO evidence that barefoot running is better than running in running shoes. How should we interpet that lack of evidence? Should we do what the barefoot running community did and conclude that barefoot running is bad as there is no evidence to show that its good? Can you see the absurdity of that conclusion? Well, that is exactly what the barefoot running community did in the way they interpreted the Richards review above!

The key point is, you can’t have it both ways.

I have already gone over how the barefoot running community generally misrepresented and misreported the Liebermann research and how they misrepresented and even lied about the Kerrigan research, so now let’s take a closer look at the online article that they all seem to quote as ‘evidence’ (and we all know that the barefoot running community does not even really know what evidence is).

The article I am referring to this one by Michael Warburton that was published online as part of the online journal, Sports Science.

Lets look at it. The article starts off with:

“Well-known international athletes have successfully competed barefoot, most notably Zola Budd-Pieterse from South Africa and the late Abebe Bikila from Ethiopia”

Off to a really bad start there, as we know that Abebe Bikila could run faster and break a world record when he started wearing running shoes and Zola Budd is now running in shoes!

“in this review I will show that wearing running shoes probably reduces performance and increases the risk of injury”

You will soon see that the author failed miserably in achieving what he claimed.

“Where barefoot and shod populations co-exist, as in Haiti, injury rates of the lower extremity are substantially higher in the shod population (Robbins and Hanna, 1987).”

This study on injury rates in Haiti does not actually exist. It was made up. Surely the fact that Robbins and Hanna did not cite a reference for it should have been a give away? Never let a little thing like this stand in the way of those who have an agenda.

“This association between injury and wearing shoes is consistent with the possibility that wearing shoes increases the risk of injury”

There is NOT one study that shows that. The ones cited by the author did not show that. Anyone reading those studies with the blinkers off can see that.

“However, there have been several studies implicating footwear in the etiology of injuries in runners”

Again, there is not one study that shows that. The author is being dishonest. He does present some studies that he claims support that, but they do not. Let’s look at them:

“It is claimed that footwear increases the risk of such sprains, either by decreasing awareness of foot position provided by feedback from plantar cutaneous mechanoreceptors in direct contact with the ground (Robbins et al., 1995)”.

Robbins et al never showed that, they just CLAIMED that in the editorial like conclusion to their research which not even on ankle sprains!

“or by increasing the leverage arm and consequently the twisting torque around the sub-talar joint during a stumble (Stacoff et al., 1996). “

That was a good study, but did not actualy show an increased risk for ankle sprains (it wasn’t even about ankle sprains!) and shoe design in the heel has changed significantly since the late 90’s, so this study is irrelevant to the authors argument.

And besides, since when has ankle sprains been an issue for runners? It makes up less than 1% of injuries that runners get and I bet in the vast majority of those the shoe would not have been a factor, so the author really is barking up the wrong tree here.

“One of the most common chronic injuries in runners is planter fasciitis, or an inflammation of the ligament running along the sole of the foot. There is some evidence that the normally unyielding plantar fascia acts as the support for the medial longitudinal arch, and that strain on the proximal fascial attachment during foot strike leads to plantar fasciitis (Robbins and Hanna, 1987). Barefoot running may induce an adaptation that transfers the impact to the yielding musculature, thus sparing the fascia and accounting for the low incidence of plantar fasciitis in barefoot populations (Robbins and Hanna, 1987).”

Robbins and Hanna did NOT do a study on plantar fasciitis and there is NO evidence that there is less plantar fasciitis in barefoot populations, so I have no idea what the author is talking about here. If you look at all the prospective studies on what causes or increases the risk for plantar fasciitis, NONE of them have shown that this is a factor! The author is barking up the wrong tree again.

The rest of the section on chronic injuries is equally nonsensical as it all focuses on the changes in impact moderating behaviour allegedly induced by running shoes and impact related injuries. The flaw is that there are NO injuries caused by impact. Not one study has shown that high levels of impact increase the risk for any overuse injury in runners (see this for more). So who cares if the shoes induce some sort of sensory illusion and affects impact moderating behaviour or not? Its not an issue, except in the minds of those with an agenda.

The next section looks at performance:

“Wearing shoes increases the energy cost of running”… “Flaherty (1994) found that oxygen consumption during running at 12 km/h was 4.7% higher in shoes of mass ~700 g per pair than in bare feet”

Anyone see a problem with this? Running shoes now weigh half that amount, so the performance argument can’t be used anymore. Why do the barefoot running community continually trot this one out? Again, barking up the wrong tree on this one as well.

So now lets look at the conclusions:

Running in shoes appears to increase the risk of ankle sprains, either by decreasing awareness of foot position or by increasing the twisting torque on the ankle during a stumble.

Wrong (see above).

Running in shoes appears to increase the risk of plantar fasciitis and other chronic injuries of the lower limb by modifying the transfer of shock to muscles and supporting structures.

Wrong (see above).

Running in bare feet reduces oxygen consumption by a few percent.  Competitive running performance should therefore improve by a similar amount, but there has been no published research comparing the effect of barefoot and shod running on simulated or real competitive running performance.

Wrong (see above). However, I agree with the bit I put in itallics, but we do know that no elite runners choose to run barefoot.

Research is needed to establish why runners choose not to run barefoot. Concern about puncture wounds, bruising, thermal injury, and overuse injury during the adaptation period are possibilities.

Surely research into why the barefoot running community continually promote bad research and get it wrong so often is more important?

In the introduction to his review, the author claimed:

“in this review I will show that wearing running shoes probably reduces performance and increases the risk of injury”

Did they achieve that aim? Of course they didn’t!

Why is it that the barefoot running community are so gullible that they continue to repeatedly fall for this kind of intellectually dishonest nonsense?

You often see barefoot runners responding to comments about the lack of evidence for barefoot running by doing one of two things:

1. They point to evidence. However, when you look at it, it’s not evidence (they are really good at doing this intellectual dishonesty. For example, see how they fell for some of the research: Hook, line and sinker).
2. They claim that they have all the evidence they need as they can run barefoot and they know some others that have successfully transitioned to barefoot. If they think this is ‘evidence’, then it is really further evidence of how they delude themselves. They need to go back to school to learn what the word ‘evidence’ means.

Within medical and health research, there is what is known as a hierarchy of evidence. At the top of the hierarchy are the meta-analyses that combine data from several prospective randomized controlled trials. At the very bottom of the hierarchy is the individual experiences. The n=1 (ie research involving one person individual experience) is not research. It is just one persons individual experiences. These experiences can be flawed or misinterpreted. Let’s look at examples and analogies:

I think everyone is clear on the evidence of the risk of harm of smoking during pregnancy, yet a number of women still smoke during pregnancy. Often when asked why they are doing it, they respond with something like, ‘My friend smoked during pregnancy and she had no problems’. That is pretty much the sort of argument that barefoot runners like to make. They have a friend that can run barefoot, therefore it must be OK, despite all the scientific evidence. Well, this kind of argument is not acceptable in the context of smoking and pregnancy, why is acceptable in the barefoot running community? I will concede that there is NO evidence that barefoot running is harmful, but there is NO evidence that it is beneficial either, despite the claim that the barefoot runners like to make – in this pregnancy and smoking analogy, the evidence for barefoot running is knowing some others that do it! That is NOT evidence.

Would you like to be operated on by a surgeon that has only done one of a particular type of procedure before? Would you be happier about it if the surgeon had a couple of other surgeons they knew who had also done the procedure? What kind of evidence is this? I assume you can see where this analogy is going…

Any number of medical and health treatments that people swear work have been shown not to work by good clinical trials. There are no good trials on if barefoot running is beneficial or not, yet the barefoot running community constantly talk about the evidence of the n=1. This kind of evidence is not acceptable elsewhere, so why is it acceptable to the barefoot running community?

How often do you see comments that go something like “I used to get all these injuries and now that I run barefoot, I don’t”. Lets dissect that kind of comment. How do you know that the injuries are less because of the barefoot running?:

• most runners tend to go through phases of getting more injuries and then not getting injuries. It is just the way it happens. So, how do we know that a particular individual that transitions to barefoot running was not just due to enter a phase of less or no injuries. The reduction in injury could be due to this and NOT the barefoot running (but then again it may not be).
• now that they are running barefoot, there is a good chance that they are now running on a softer surface. Maybe the lack of injuries is due to surface and nothing to do with the barefoot running (but then again it may not be).
• maybe at the same time they transitioned to barefoot running, they also started doing more stretching exercises. The reduction in injury could be due to that and nothing to do with the barefoot running (but then again it may not be).
• maybe they changed how many sugars that they have in a cup of coffee in the morning at the same time they started barefoot running.  Maybe that is the reason for the no injuires (but then again it incredibly unlikely to be the reason, but we can not rule it out).

Can you see where this is heading? It is often easy to blame the most obvious factor and not consider other possible intervening factors. It does not mean that the barefoot running was the reason or not the reason, it is just you cannot jump to that conclusion based on individual experiences (or are you happy for a surgeon to operate on you who has done something once and knows a few others that have also done it?).

Why are individual experiences so flawed? For those who want to explore this further, I suggest you read: Why do ineffective treatments seem helpful?. While this is written in the context of medical and health interventions, and about how an individual’s own clinical experiences can be flawed, the principle can be applied here to an individual’s experiences with what they perceive as the benefits to themselves of barefoot running. If you want to make claims about your experiences, that’s fine, but convince me first that you understand what this article is talking about. Otherwise stop making the silly claims about what you think is evidence.

You can often read comments or statements to the effect that running shoe technology has allegedly improved massively over the last 20-30-40 years, yet when you look at the epidemiological studies of running overuse injuries, there has been no change. The barefoot running community tend to use such statements as evidence that running shoes are bad. You also see many claims in barefoot running books and websites, that the injury rate is actually going up. But like other bits of intellectual dishonesty, they just do not seem to get it and repeatedly twist things to suit their agenda.

Yes, if you look at the marketing of running shoes and the technological development of running shoes, there is an apparent improvement in the features that are claimed to help reduce running injuries.

Yes, if you look at the old and more recent prevalence and incidence of running overuse injury studies, the rates of injury are pretty similar (as an aside, most comments I have seen in running barefoot books, on running forums and barefoot running websites on this, show that they do not even know the difference between the words ‘incidence’ and ‘prevalence’, so how can you trust any interpretation they make of the research of they can’t get the basics right?).

But, if you dig a little deeper, the comparisons between then and now do not stack up to scrutiny. You will not be able to find a single epidemiologist (the specialists who do these sorts of studies for a living) who would agree that the comparisons between the older studies and the newer studies are valid. If they are adamant you can’t do this, then why do the anti-running shoe community think they can do it?

Why can’t you compare them? Because:

• The populations used are different in different studies
• The selection of the populations are different in different studies
• The definition of an injury was different in different studies
• The collection of the data was different in different studies
• Running has changed over time (I came across a comment recently that the average marathon time in the 80’s was 3hr 8min and these days its around 4hr 20mins – how can you compare these two different populations?)

On the surface, it does appear the injury rate across studies over time has not changed, but dig below the surface and you cannot make that comparison. It’s simply not valid. If you want to beat up on running shoes, you are going to have to find something else rather than dig a bigger hole for yourself using this data.