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?

Who is opposed to barefoot running? The barefoot running community have a track record of playing the person and not the ball and always like to go after or criticise the perceived opponents of barefoot running rather than rationally discuss the issues. Why do they have to criticise these opponents? Is barefoot running really that bad that it cannot stand on its own two feet (excuse the pun)? Is barefoot running really that bad, that the only way for the barefoot runners to justify what they do is to attack the opponents of barefoot running?

Who are these opponents of barefoot running? Are they real or are they figments of the imagination of the barefoot runners?

The most obvious targets of barefoot runners are Podiatrists and the running shoe companies.

A check of the popular podiatry forum, Podiatry Arena, shows that they have had many discussions on barefoot running.  None of the Podiatrists who post there seem to be opposed to barefoot running. They are like me and just object to the way the barefoot running nutters twist and manipulate the research and are intellectually dishonest when it comes to interpreting and representing the research (and in the case of two barefoot websites exposed here, they lie about it). They also seem to object to the consistent way that barefoot runners always avoid discussing issues and attack the person (ie play the person and not the ball).

A regular commentator on barefoot running, Craig Payne commented on Podiatry Arena: 

I not opposed to barefoot running….it’s just the fanaticism and irrationality of so many of its supporters. How they blindly accepted and reported the above research is a perfect example of exactly what I am saying.

It’s called the Straw Man argument. ….characterise your opponents position as something it’s not and then go after or refute that characterisation. They never really refute the original proposition. The barefoot runners are really good at that. …but we can see through them.

Are there actually any podiatrists who are opposed to barefoot running? (I have made my views very clear many times). Barefoot runners like to use Podiatrists as the ‘bogey man’ — but how many podiatrists actually are against barefoot running? If you look at all the threads we have had on the topic, it’s all been about how the barefoot runners misuse, misrepresent and misunderstand the research and how they promote the badly done research.

Simon Bartold, a podiatrist who works for ASICS said pretty much the same thing in the same discussion and never said he had any opposition to barefoot running. Kevin Kirby in a debate in Runners World magazine never came out and said he opposed barefoot running. Do you notice how many of the pro-barefoot running comments do not really deal with any of the issues that Kevin Kirby raised and just attack him. This is what the barefoot running community do (ie play the person and not the ball).

Ian Griffiths, a sports podiatrist in the UK wrote an article evaluating the Liebermann et al and Kerrigan et al studies that the barefoot running community fell for. The critique was not too dissimilar to mine here. He then got himself into a debate with a barefoot runner on twitter and the best that the barefoot runner could come up with was that he was biased as he treats injuries. Yes, he does treat injuries, but what about the issues Ian raised in the critique? Why not deal with or refute them?  See that this is the best that they could come up with! (I not biased by that one as I do not make a living treating injuries).

Robert Isaacs summed it up nicely: 

It takes far less knowledge and thought to attack the messenger than it does to attack the message. It’s easy, anyone can do it. And It diverts attention nicely away from the science.

There are even Podiatrists who are barefoot runners and openly promote it. They are obviously not opposed to barefoot running.

It is really hard to find any podiatrists actually opposed to barefoot running. I can find many expressing caution about doing it, which is exactly what the barefoot running community express as well. The only difference is that health professionals have professional accountability and are licensed to practice and have laws governing what they do. The barefoot runners giving advice do not have that accountability for bad advice (for example, I have seen no one in the barefoot running community hold accountable the two barefoot running websites that lied about the Kerrigan research. Why is that?)

What about the running shoe companies? Are they opposed? Not according to statements made by them (but we know that the barefoot running community will not agree with that because of their tin foil hats). The barefoot running community make extraordinary claims about how bad running shoes are, but none of it is backed up by any evidence. There is evidence that they are being intellectually dishonest about and claim it shows running shoes are bad, but it does not. They have been extremely silent on the most recent research that shows running shoes may reduce injury and increase endurance .

But what if running shoes are bad or not, what has that got to do with the merits of if barefoot running is good or bad? Why do the barefoot runners even care? See the point I am making? If barefoot running was any good, it would stand on its own merits and not stand on attacks on imaginary problems with the running shoe industry.

The opponents of barefoot running are a figment of the imagination of the barefoot running community. As the barefoot running community have demonstrated that they cannot rationally discuss issues and continually misrepresent research, then the only thing left is to attack these so called opponents. Does that just not show you the weakness of the position that they are arguing from?

Is barefoot running really that bad, that it cannot stand on its own merits? Is barefoot running that bad, that the only way the barefoot running community can defend barefoot running is to attack opponents. My advice to the barefoot running community: Start playing the ball and not the person.

One thing you quickly learn about the barefoot running community, in general, is that they are very sensitive to criticism and cannot engage in rational discussion about the issues (more on that later). Instead they resort to name calling and use other diversion tactics, which is a classic sign of people arguing from a position of weakness. One classic line I came across recently was a barefoot runner trying to defend barefoot running from a criticism by calling Podiatrists the biggest snake oil salesmen of all time (they should have said salespersons!). Typically, they could not defend the criticism and had to introduce this attack rather than deal with the actual issue. See the Wikipedia entry if you do not know what is meant by snake oil.

What intrigues me is that what if Podiatrists are snake oil salespersons or not, what has that got to do with barefoot running?

There are podiatrists who are even barefoot runners and even promote barefoot running! (see this). Are they also snake oil salespersons? A look at some of the discussion on podiatry forums will show that podiatrists are not opposed to barefoot running. However, most podiatrists seem to take the position I take here and that is they have a problem with the intellectual dishonesty in the barefoot running community, the misrepresentation of research by the barefoot running community and the non-scientific nonsense that they espouse. Just becuse a Podiatrist (or for that matter, any other type of health professional) point this out, rather than deal with the issue raised, they come out with a criticism of Podiatrists.

Podiatrists are really good at critical self analysis of the underpinnings of their professional work. For more see these discussions on snake oil and their criticisms of their own. I do not see the barefoot running community doing the same self critical analysis. For example, is the barefoot running community going to hold accountable the two barefoot running websites that blatantly lied about the Kerrigan research? (see Hook, line and sinker).

However, I still do not see what all this has to do if barefoot running is good or bad and why some in the barefoot running community try to defend barefoot running by attacking podiatrists. It’s really a nonsensical argument.

But anyway, lets address the concept of Podiatrist’s being snake oil salespersons. I assume they are saying this as Podiatrists use foot orthotics as one tool of many in their armamentarium used to treat overuse injuries in runners. Physical therapists, orthopaedic surgeons, chiropractors, pedorthists, etc also use foot orthotics for the same reason. Are they also snake oil salespersons?

Do foot orthotics work? I challenge anyone to find me one (just one will do) study that shows foot orthotics do not work (I know they cannot, as there are none!). Every single study that has looked at this (and there are over 200) has shown foot orthotics work. Most of those studies were not even done by Podiatrists! Even the ones with bad methods and flaws still showed they work. The ones with good methods and minimal or no flaws still showed they work. Have those who choose to call podiatrists snake oil salespersons read any of these? I doubt it.

The patient satisfaction studies show people are satisfied with their foot orthotics; the outcome studies show people get better with foot orthotics; even the well designed randomised controlled trials show that those in the foot orthotics treatment group get better. Most of the results of these studies show that there are 70-80-90% satisfaction, improvement in outcomes etc with foot orthotics. Where does anyone ever get the impression that foot orthotics do not work? There is certainly more evidence accumulated for the use of foot orthotics than there is evidence for the benefits of barefoot running.

As the numbers show 70-80-90%, that’s still 10-20-30% of the time that they were not helpful. But those figures are pretty consistent with most medical interventions. For example, surgical procedures do not work all the time; antibiotics do not work all the time. Are surgeons and family practitioners snake oil salespersons because their surgery or antibiotics did not work 100% of the time?

Why do foot orthotics not work in those 10-20-30% of the time? Could be they were the wrong prescription; could be due to biological variation (i.e. antibiotics do not work all the time); could be that they should not have been used in the first place; could be a failure of the runner to follow instructions; could be any number of reasons. At the end of the day, there is a failure rate for every medical, surgical, pharmaceutical, mechanical or physical therapy. Should they not be used because of that reason?

My advice to the barefoot running community: Stick to the issues; discuss and debate the issues and stop throwing up nonsensical oneliners when you feel you are backed into a corner. You are only showing the weakness of your position when you resort to those tactics.