Over at MyFiveFingers.com, Brian Patterson recently asked Is Podiatry a Problem? His question was prompted by a new study, Effect of a five-toed minimal protection shoe on static and dynamic ankle position sense that concluded that those who run barefoot (and, incidentally, those wearing minimal shoes) get a better estimation of the slope they are running on than shoes wearing padded running shoes.
The Barefoot Professor, Dr. Daniel Howell, responded with
I don’t think it’s an issue of greed, but worldview. You?
Here’s where I weigh in.
I agree with Dr. Howell. I don’t think greed has much to do with it. But there are also other considerations.
What really caught Brian Patterson’s attention was a comment on a podiatrists forum:
Maybe instead of looking at whether minimalist/barefoot shoes are ‘bad’ or ‘good’, we should be concentrating on pooling our thoughts on what kinds of solutions for particular injuries podiatrists are able to offer the barefoot runner who wont go back to shoes? Maybe, then..if we are unable to treat these unshod problems we can start preaching about shoes/insoles/orths?
I have to admit that that last sentence looks pretty bad and makes it appear that greed could be a factor. Yet, other comments by other podiatrists on that forum don’t go anywhere near that far.
The truth is, podiatrists are seeing a large increase in barefooted and minimalist shoe patients who are having such things as top-of-the-foot pain. At this point, we don’t know if that increase is greater than, less than, or the same as the increase in barefooted and minimalist shoe runners. But that doesn’t change the perceptions of those podiatrists. It also doesn’t say they are wrong.
From reading other comments and thread on that forum, we can see that those particular podiatrists sometimes refer to the Church of Barefoot Running. I think this is a reference to the way that those who promote barefoot running do so is a rather zealous way. It worked for them, and they want to spread the gospel. And they have to be careful not to make an excuse every time they are told about a barefoot (or minimalist shoe) running injury. What we need to do is be able to look at these things objectively.
Objectively, the data are not all in. However, I’m not sure that the data can ever be all in. Investigating the human body is a tricky thing (way too many variables that cannot be controlled). I suspect that nobody will ever do the sort of definitive study that needs to be done to really tease out what is happening with those barefoot (or minimalist shoe) injuries. At this point, we are mostly reduced to speculating, or touting studies that give hints as to what is going on.
I’ve mentioned before that people who have not grown up barefoot and have continued to wear shoes have a weak foot structure, just aching to get injured when something like barefoot running is started. On top of that, minimalist shoes make it easy to overdo things, and that can further lead to injuries. There is also the issue as to whether minimalist shoe runners use proper barefoot form; that padding on the bottom makes it easier to slap the foot on the ground, something a real barefoot runner would quickly find out to be a bad idea.
The study I’d like to see would have people doing barefoot hiking for at least three months first, to properly strengthen and build up weak and underused feet. Then, and only then, would you put them into a study to compare the effects with new runners. [By the way, I'm not saying that all, or even most, barefoot runners need to do this. I'm just saying this is what I'd like to see in a study to eliminate weak feet as a variable in possible foot injuries.]
Where I think a lot of podiatrists are falling down when it comes to barefoot or minimalist shoe running injuries is that one has to be careful not to attribute every injury to being barefoot. They also see a lot of injuries that are coming from the shoes. However, they may not recognize that those are “shoe” injuries (as opposed to “running” injuries) since being shod is the default state (in their minds). Podiatrists are susceptible to selection bias just like everybody else.
So, no, I don’t think that greed is high on the list of podiatrist resistance to barefoot and minimalist shoe running. As Dr. Howell points out, a lot of it is worldview. The whole podiatry medical program is geared to dealing with people who have injured their feet mostly when wearing shoes. That is just about all they have been taught, and just about all they have exposure to. Within that shod population, an orthotic works. After all, there are a bunch of studies showing that a shoe-with-orthotic works much better than just-a-shoe. But if they’ve never seen any study comparing just-a-shoe to no-shoe-at-all, they don’t know any better.
They are also not likely to find out better, because of the way that society makes it difficult to do such a study.