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

How often have you seen claims that barefoot activity improves the immune system? I have seen some recent claims from barefooters that there is increasing amounts of evidence that going barefoot has immune system benefits.

I am going to type this next bit really slow:

There is not one piece of evidence that even comes remotely close to showing that there are any benefits of going barefoot for the immune system.

Could those making the claims, please direct me to the research that you think is showing this. If you are going to make such claims, then the burden of proof is on you to back them up.

I wish someone could explain to me the motivation to lie about this. Why do they make up this stuff for? No one has yet offered up an explanation for this lie from two barefoot running websites. Why do they do it for?

No sooner than I wrote about the possibility of barefoot running making people blind, Dr Nirenberg has come back with another post about  Barefoot Running With Eyes Wide Open which clearly proves beyond doubt that barefoot running does indeed make you blind.

He claims: 

The weight of the scientific evidence which supports barefoot running has reached such an elevated level that no one can seriously dispute it any longer

There is absolutely no scientific evidence that shows that! The only people that believe that are barefoot runners! No one in the scientific or biomechanics community is agreeing with that. Are you telling me that the entire biomehanics community is “no -one“? These people are the people that study human motion for a living and have no vested interest in the outcome of the research.

Here is the evidence that he offers up:

German study determined that inadequate shoes worn as children is correlated to the increased prevalence of bunions and flat feet in today’s adults

Here is the actual study:
Wolf S, Simon J, Patikas D, et al. Foot motion in children’s shoes: a comparison of barefoot walking with shod walking in conventional and flexible shoes. Gait Posture. 2008;27:51-9

There is absolutely nothing in that study to do with flat feet in today’s adults? It was only a study in children! Where did he get that from? Someone would have to be really blind to reach that conclusion from reading the study. Can someone show me anything about problems in adults in that study?

He goes on:

The average runner strikes the ground one thousand times per mile, thus they are highly susceptible to repetitive stress injuries (3). The greatest possibility for injury in a running foot occurs when it strikes the ground

The refernce he uses for that claim is: van Gent RN, et al. Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review. Br J Sports Med. 2007;41:469-480

… hmmmm nothing in that about impacts causing injury. No one has yet shown that high impacts are related to injury.

He further claims:

One of the luminaries in foot research, Dr. Daniel E. Lieberman, recently stated in the science journal Nature that his research has proven that barefoot runners generate smaller collision forces than shod runners.

A “luminary” in foot research? Dr Lieberman has only done one piece of foot research! Certainly does not make him a luminary. I guess to the blind, he might be called that. Again, where is the evidence that high impacts even cause injury? Yes, there is less impact under the heel in barefoot runners, but why not mention the greater load under the forefoot and going through the Achilles tendon when running barefoot? The biomechanics community have generally dismissed the scientific validity of Lieberman’s work. The only people who have not are the barefoot runners. Why is that?

Dr. Lieberman’s research showed that since many running shoes on the market today feature stiffened soles and arch supports these lead to a reduction in arch strength due to the weakening of the muscles of the foot

Can someone please show me where in Lieberman’s research they did anything on the stiff soles and arch supports in running shoes leading to a reduction in arch strength? Where did Lieberman publish this research on arch strength? How can anyone read Lieberman’s study that was not even on arch strength and claim that it was. How blind do you have to be to see that when you read his paper?

A notable Canadian study stated that when a runner’s foot is shod in an athletic shoe, the sensations of running are minimized. Modern running shoes tend to isolate the foot from “sensing” the conditions and thus are responsible for the elevated frequency of injuries suffered by runners.

Here is this study: Robbins SE, Hanna AM, Running-related injury prevention through barefoot adaptations. Med Sci Sports Exerc. 1987;19:2:148-156

Again, no one in the biomechanics community is taking this work seriously because of flaws that underpinned the methodology and the ‘editorializing’ of the research done by the authors. Could someone please show me where in this study that they even looked at injury rates? They certainly did not show that this was “responsible for the elevated frequency of injuries suffered by runners.” This notable Canadian study did not even look at injuries! How blind is Dr Nierenberg?

The overwhelming medical evidence of these studies is more than sufficient to take the blinders off those who truly want to see and open their eyes to the reality that the preferred way to run is with bare feet.

Like the claims made by Michael Warburton, Dr Nirenberg and the “evidence” he claims supports his conclusion, he has totally failed to provide anything to back up that conclusion.

Thank you Dr Nirenberg for helping me prove that barefoot running does indeed make you blind. A clinician who is responsible for making clinical decision should be much better and much more critical at apprasiing research. 

Previous post: Does Barefoot Running Make you Blind?

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?

I got an interesting email from someone who I assume is a barefoot runner. The email simply said “this is all the proof you need” and it included a link to this.

This link is a reproduction of the press release from the Kerrigan et al study, which I described as:

This will have to go down as an all time classic to show just how intellectually challenged the barefoot running movement is. They fell for this study ‘hook, line and sinker’!

Remember, this was the study that two barefoot running websites actually lied about.

This study proved nothing. I do have to agree with the sender of the email in that it is all the proof I need. It’s all the proof I need to further show how gullible and blind the barefoot running community is. How else can I interpret the email? They obviously fell ‘hook line and sinker’ for the press release that accompanied the research.

What is the relationship between barefoot running and plantar fasciitis?

In the research by Liebermann et al published in Nature, in the discussion they made the somewhat remarkable claim that:

“Furthermore, many running shoes have arch supports and stiffened soles that may lead to weaker foot muscles, reducing arch strength. This weakness contributes to excessive pronation and places greater demands on the plantar fascia, which may cause plantar fasciitis.”

As their research results was not about this, you would expect them to cite a reference to back up that claim. Those with an agenda never let a little fact like no one has actually shown that get in their way. They made this up.

There is no evidence that running shoes lead to weaker arch muscles. There is no evidence that weak arch muscles contribute to excessive pronation (in fact weak intrinsic foot muscles actually lead to a high arch supinated foot which is the opposite!). There is no evidence that this even causes plantar fasciitis. There is evidence that foot orthotics actually strengthen muscles and certainly NONE that they weaken muscles! Never let it be said that those with an agenda won’t let a little intellectual dishonesty get in their way!

If we look at Michael Warburton’s review on barefoot running that I totally demolished, he claimed:

“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).”

He quotes Robbins and Hanna, 1987 as the reference for barefoot running accounting for the lower incidence of plantar fasciitis in barefoot populations – Robbins and Hanna never showed that (they did make that claim up though)! There is NO evidence that there is less plantar fasciitis in barefoot populations. Robbins et al in all their study’s never even did a study on plantar fasciitis, so I do not undertsand how people can use Robbins and Hanna as a reference to back up the claim when thats not what they showed! More intellectual dishonesty!

Then you can read claims on barefoot websites that make claims typically like this:

It stands to reason that if habitually barefoot people don’t experience Plantar Fasciitis while those of us with shoes and arch supports do, there has to be a reason.  That reason is likely that their feet are strong while ours are weak.

How much more intellectual dishonesty are these people capable of? They wonder why so many do not take them seriously and think they are nutters? Come up with the evidence and data if you are going to make such bold statements. I will be the first to change my mind when someone does.

Of all the risk factor studies that have ever been done on plantar fasciitis, NONE of them have linked plantar fasciitis to a weakness of muscles or the use of running shoes. There is not even the tiniest shred of evidence to even suggest that it is. Why are none of the studies finding these factors being claimed for plantar fasciitis? Why are those with an agenda making up these claims for?

Plantar fasciitis is due to too high a load in the plantar fascia that is higher than what the structure can adapt to. A number of risk factors have been shown by the evidence to increase the risk for plantar fasciitis – all of those factors increase the load in the plantar fascia. The treatment of plantar fasciitis involves using strategies to reduce that load and to get the tissues to heal. It does not matter if you run barefoot or not.

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.

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.

That is what the barefoot running community and the anti-running shoe community would have you believe.  You see this claim being made all the time on barefoot running websites, books and on running forums. We know that the barefoot running community are really good at all sorts of intellectual dishonesty, should we believe them on this one as well?

Given the strength of the claims being made, you would expect there would be at least some evidence to back it up wouldn’t you?, but there is none! They only want to believe it to be the case as it helps their agenda. Certainly many individuals who start barefoot running claim that their foot and leg muscles are stronger – but are they really stronger? Or do they just feel different as the barefoot running gait is different? Or do they deceptively feel stronger because they want them to feel stronger? (see this post on why individual experiences are flawed).

In the context of the lack of evidence either way as to if running shoes weaken muscles or not, what other information do we have that could guide us to some sort of rational conclusion rather than some uniformed nonsense due to the wearing of blinkers. What about foot orthotics? Do they weaken the foot? You certainly see it claimed a lot by those who have not read the evidence. Two studies have looked at muscle strength and the use of foot orthotics. One by Mayer et al actually showed the opposite and foot orthotics increased muscle strength! The other study that looked at this showed after 4 weeks of orthotic use that there was a non-statistically significant increase in strength, so certainly no signs of a decrease in muscle strength which I would have thought would start to show by 4 weeks if it was going to happen. Now, obviously foot orthotics are not running shoes, but despite widespread claims that foot orthotics decrease muscle strength, all the research evidence is that either they do not or they increase strength!. Can this be extrapolated to running shoes? Maybe? Maybe not? What this research does do is calls into question the unsupported claims that running shoes do weaken the muscles.

Then there is the one EMG (electromyography) study that compared running shoes to barefoot. They found no systematic differences between barefoot or running shoes. Some muscles activated earlier in barefoot and some activated earlier in the running shoe. If the running shoes were weakening muscles, then why are the EMG studies NOT showing a systematic decreases in timing and amplitude of muscle activation? Certainly no sign of any muscle weakening here!

What about the Bruggeman et al study that looked at muscle strength after runners were randomised to their conventional shoe vs the Nike Free (which is not really barefoot, but is a minimalist shoe). They showed what appeared to be an increase in muscle strength in the Nike Free group. I have no problems with the study (except a few minor issues and it was funded by Nike). But consider these two points:

1. The study was NOTHING to do with conventional running shoes weakening foot and leg muscles (which strangely has been interpreted as showing that by some!).
2. Why did the Nike Free group of runners get an increase in leg muscle strength? Was it because being close to running barefoot is a good thing? (this is the interpretation that the barefoot running community would like to put on it). But what about the opposite conclusion? Could it be that the muscles got stronger because they had to work harder in the Nike Free shoe? Increased muscle activity is a bad thing as it is a sign of an inefficient gait. If the muscles are having to work harder, then performance will be affected. Surely that is a bad thing? Strange how the barefooted community with blinkers on can draw one conclusion when there are other possible conclusions that can be drawn.

Conclusion: We actually have no idea if running shoes lead to weaker muscles or not. However, if we want to extrapolate the orthotics and the EMG evidence, then it could certainly be suggested that they do not. There is certainly more information pointing to running shoes not weakening muscles than the nonsenscial and unsupported claims by the barefoot running community.

Again, this is something that only exits in the minds of the anti-running shoe lobby. I have already shown how they have misused the research to scam us into believing that there is no decrease in the rate of injury from the alleged improvement in running shoes over the years. Some have even tried to claim there has been an increase. They are making this up as there is no data to support it.

Libermann et al in the first sentence to his paper on barefoot running says “Running can be most injurious at the moment the foot collides with the ground”. I notice that they supplied no citation to back this claim up. In that work of semi-fiction, ‘Born to Run’, Chris McDougall makes numerous unsupported claims about impact injuries. Robbins et al in their editorialization of what is otherwise good research, talk about the sensory illusion that soft running shoes can cause alterations in impact behaviours and this makes running shoes increase the risk for impact injuries in runners. I could go on and cite many more examples and claims that get made about impact causing injury in runners.

What do all these claims and the many more numerous ones have in common? They don’t even tell us what an impact injury is. They provide no evidence of impact even causing overuse injuries in runners. The reason is because there is no such thing as impact causing overuse injuries in runners! They are all making it up and perpetuating the myth! Why would they do that for?

There is not one study that has shown higher impacts cause an increased risk for injury! (Obviously I am not talking about the extreme high impacts that might cause an acute fracture).

What are the common injuries that runners get:

Patellofemoral pain syndrome/anterior knee pain (Runners Knee) – none of the studies done on this have linked it to impact.

Medial tibial stress syndrome (shin splints) – not one of the prospective risk factors studies done on this has linked it to impacts.

Plantar fasciitis (heel pain) – not one of the risk factor studies have linked this to impacts.

Stress fractures – none of the studies done on this have linked it to impact.

I should not need to cite any more examples, as these make up most of the overuse running injuries. If you do not believe me, do this: Pick any injury. Do a literature search on the studies that have looked at what increases the risk for that injury. Notice how none of them find impact as a problem?

In fact the opposite is the case. We need higher impacts from weight bearing activity to prevent osteoporosis and make the bones stronger! (The research evidence on this is unequivocal).

Where are all these people getting their information from about the myth of impacts causing overuse injuries in runners and it reaching epidemic proportions? Why are they perpetuating the myth? Why are they making this into a problem? Why are they making up this epidemic? Is it because they have an agenda to promote and the myth suits their purposes? High impacts being a problem in runners only exists in the minds of those with an agenda.