A couple of weeks ago a study titled “Foot Bone Marrow Edema after 10-Week Transition to Minimalist Running Shoes” was published on-line by the journal Medicine and Science in Sports and Exercise. The study created a bit of a stir in the news, with the typical hyped up headlines accompanying articles on the paper. “Barefoot Running Can Cause Injuries, Too” proclaimed the New York Times. “Whoa there! Quick switch to ‘barefoot’ shoes can be bad to the bone” was the headline on Sciencedaily.com. The reality is that the results don’t say much of anything about barefoot running (the study didn’t investigate barefoot running), and may not even say anything conclusive about injury risk in minimalist shoes (I’ll explain why below).
Study Summary
The study was conducted by a group of researchers from Utah who set out to investigate how transitioning into Vibram Fivefingers (VFF) from more traditional shoes might affect the anatomy of the legs and feet. They split a group of 36 experienced runners into two groups – 17 continued running in their typical shoes for the next 10 weeks, and 19 made a variably gradual transition to running in Vibram Fivefingers over the same 10 week period (following transition advice that was published on the Vibram website in 2011 – this advice has since changed). The researchers took MRIs of the legs and feet of all runners both before and after the ten week period with the goal of assessing whether there might be any signs of increased injury to the tendons or bones of the VFF group relative to the non-VFF group.
The results showed no difference in soft tissue response – the the tendons of the Vibram runners were similar to those of individuals who did not make the minimalist transition after the ten week period (they looked at the Achilles tendon, dorsi-flexor, plantar-flexor, peroneal tendons, and plantar fascia). Good news for those who might be worried about injuring the plantar fascia or Achilles tendon during a transition to more minimal footwear, especially since other anecdotal reports have suggested that those tissues might be at risk (It’s worth noting that it is possible that longer term usage could still lead to soft tissue problems).
Bone was a different story. The researchers were looking for signs of bone marrow edema (fluid accumulation) on the MRI images, and scored various bones of the foot using a standard rating protocol (0-4, with 4 being a full-blown stress fracture). Below are the results for bone as reported in the paper:
“These results show a higher incidence of intense signal sub-fracture bone marrow edema as designated by an MES of 3 (stress injury) in the Vibram group (3 out of 16 subjects in the Vibram group compared to 0 out of 20 subjects in the control group)…Increased signal intensity in the feet of the Vibram group to an MES of 2 was found in 8 of the 16 participants. Including the two subjects who suffered from stress fractures, 11 of the 16 subjects in the Vibram group were classified as “injured” (at least one structure with an MES greater than or equal to 2 ) at the end of the study.”
So approximately 2/3 of the runners in the Vibram group experienced an amount of bone edema (level 2 or higher) that would classify them as suffering from a “stress reaction” or “stress injury” in at least one of the bones measured (Note: there is a discrepancy in the number of subjects listed in the control and experimental groups reported in the Abstract/Methods/Discussion vs. the Results. The former sections list 17 control/19 Vibram subjects, the latter lists 20 control/16 Vibram subjects. Not sure why.) Two of these individuals developed stress fractures – one in the calcaneus, the other in the 2nd metatarsal. All makes sense, but here’s where things get more complicated.
Tissue Adaptation
Suppose you don’t lift weights. Tomorrow you go to the gym and do a bunch of curls, some sets on the bench press, a few rounds of leg press, etc. What would happen to your muscles? Chances are they’d be really sore the next day. They’d likely be swollen (which is why you might think you’ve buffed up a bit on one day of lifting!). You probably have done some actual microdamage to the muscle tissue. But, is that an injury? Or, is the process of repairing this damage what will make the muscles stronger? – i.e., the damage done by lifting triggers a repair response that ultimately makes you stronger.
If you’re smart you’d let your muscles rest and recover from the initial stress, go lift again several days later, and in a slow progression of lifting over the following weeks and months your muscles get larger, and you get stronger (and you don’t get hurt). If you’re not smart and you lift again the next day, and the day after that (maybe Spring Break is coming…) you might do some real damage. The reality is the training muscles is very much about stressing them a bit so that they repair and come back bigger and stronger. But you have to be smart about it.
Bone is not unlike muscle in this way. It adapts to repeated stress in order to better withstand future application of similar stress (Google Wolff’s Law). Bones that are used get stronger, bones that are not used get frail. The textbook example I use in my Anatomy and Physiology class is to compare the thickness of bones in the racket arm of a tennis player to those of the non-racket arm. Guess which ones will be more robust?
A difference between bone and muscle is that bone adaptation in response to stress can take longer. Bone regularly undergoes a process called remodeling. When we apply stress to bones they develop microdamage – think of this as small cracks that appear in the bone. However, just like the damage we do to our muscles, this is not necessarily a bad thing or an “injury” in the traditional sense of the word. Your body has little cells called osteoclasts and osteoblasts that travel around chewing up damaged bone and replacing it with fresh, new bone. This process is the basis for remodeling – making bones stronger in response to applied stress.
The thing with bone is that this process takes time, and bones can get weaker before they get stronger since damaged bone needs to be removed before it can be replaced. If you add a new stress too quickly, microdamage can add up faster than the body can repair it and this can cause the bone to break – this is what we call a stress fracture. What do you do when this happens? Put on a boot, take 6-8 weeks off, and let the osteoclasts and osteoblasts do their thing. They’re pretty effective little buggers, and in a few months you’re right back out there on the road or trail.
So what does all of this have to do with the study we’ve been looking at here? Well, edema in bone is a sign of remodeling. In the authors own words:
“An MES of 1 could very well be the product of the physiologic phenomenon of osseous remodeling due to stress which is essential to the normal development and maintenance of bone(2).With appropriate application of stress, the remodeling process results in a stronger bone structure – which is visible on the MRI by low levels of bone marrow edema.”
Edema measurements might simply correlate to the intensity of the remodeling process. A little bit of edema is indicative of bony repair that will lead to stronger bones. A lot of edema might indicate that the bone has really been damaged and is working really hard to repair itself before something really bad happens. The categorizations applied to the different levels of edema observed are simply a way to try and classify what is in actuality a continuous scale from normal remodeling to injury. Where you cross the line from one to the other seems rather uncertain for reasons I’ll describe below.
Research on Bone Marrow Edema
Rapid transitions have a tendency to stress the body. A transition can come in the form of a new or altered form of training as in our lifting example above, or it could be something as seemingly benign as running in a new pair of shoes. The transition exposes the body to a new condition, and this can stress the body in some way.
For beginning runners, simply taking those first few running steps is a stress (we all can recall how those first few weeks as a runner felt – it hurt!). For more experienced runners, adding speedwork is a stress. Adding mileage to a long run each week is a stress. Yet, we commonly employ these training methods to stimulate a training response that will ultimately make us better runners. Similarly, switching to any kind of shoe with different properties than you are used to will be a stress.
When we stress the body in a new and different way, tissues respond. For bone, one possible response is marrow edema in the feet and legs associated with a remodeling response. But here’s the key point – this bone marrow edema may not be symptomatic or progress to an actual injury. It may actually serve to make the bone stronger. Quite a different conclusion than that made by many articles that have covered the Vibram study. Here is some of the evidence I’ve found to support this:
1. The authors of the Vibram study point out that studies have shown that bone marrow edema can occur in the feet of new runners after only one week of running. Add a new stress, and the bones respond. See Trappeniers et al., 2003.
2. Schweitzer and White, 1996 placed a longitudinal metatarsal arch pad under the lateral side of one foot of subjects and had them wear it continuously for two weeks. Bone marrow edema was found in the foot/leg on the pad side in 10 out of 12 subjects. Only one subject showed signs of edema in the non-pad side. The femur and tibia even showed signs of edema in a few of the subjects. Two subjects showed a level of edema typically indicative of a stress fracture. None of the subjects were symptomatic (i.e., no pain) upon pad removal or after 1-week or 1-month follow-ups. Three subjects were followed up with again after another two weeks with the pad removed. Two showed no signs of edema, one showed reduced edema. The authors concluded that “altered biomechanics” such as via altered weightbearing should be added as an additional cause of bone marrow edema, with emphasis that it may not be of clinical significance (not indicative of symptomatic injury).
3. Lazzarini et al., 1997 imaged the feet of 20 collegiate runners immediately after the end of their cross-country season and 12 non-runners. 16 of the 20 runners exhibited bone marrow edema, only 2-4 of the 12 non-runners exhibited edema (there were two MRI readers hence the range). Runners exhibited edema in an average of 3.4 separate bones. None of the subjects who exhibited edema were symptomatic.
4. Bergman et al., 2004 took MRIs of the lower leg of 21 college runners (Stanford University) after their 8-week pre-season training program (men were running 50-70 miles per week, females 40-60 miles per week). Nine of the 21 runners had visible edema in at least one tibia, and 6 of these had edema classified as level 2 or 3 (using the same grading scheme as in the Vibram study). Interestingly, none of the runners with tibial edema were symptomatic in the 8 weeks of running leading up to the MRI, and none of them developed symptoms or signs of tibial stress injury in the year following the study. This demonstrates that a runner could have grade 2 or 3 bone edema and not be symptomatic or develop a clinically significant injury.
Putting all of this together it seems clear that when we stress our bones in a new or unusual way (e.g., starting running, running big miles, changing the positioning of our feet), edema is a pretty normal response, and probably a sign of bony remodeling that will ultimately make the bone stronger. And, the edema that occurs may or may not be clinically significant, even when it reaches levels that would be graded as a “stress reaction” or a “stress injury” using standard classification procedures. This is where I take issue with the Vibram study – it’s not clear to me that grade 2 bone marrow edema really constitutes an “injury.” Based on the Bergman study, even a runner with a score of 3 (classified as a “stress injury”) might also be asymptomatic and not go on to develop a stress fracture.
Each increasing grade of bone marrow edema is just a step along the continuum of the remodeling response, and in the Vibram study only 2 of the 16 VFF runners were actually classified as suffering a stress fracture. The rest? We don’t know how things would have turned out had the study continued. Maybe the edema would have died down in each and all would be normal after another 10 weeks (i.e., remodeling would have done its job and the bones became stronger and more robust). Maybe we would have seen a bunch more fractures had the study continued. Hard to say. What we can say is that switching to Vibrams did seem to trigger edema, and thus likely bone remodeling. This could make the bones weaker for a time and justifies a slow and careful transition. But, ultimately it’s not entirely out of the question that a headline for this study could have been “Vibram Fivefingers Stimulate Bone Remodeling and Adaptation.” Far from causing injury, they might actually make some of the foot bones stronger in the long run.
My biggest problem with this study is that it compares change to no change. It compares a novel condition to which a group of subjects are not adapted to a familiar condition that involves no change to what is normal. Thus, we have no way of knowing specifically if Vibram Fivefingers are particularly dangerous, if minimal shoes as a category are dangerous, or if the simple act of changing shoe type (to any type) might be dangerous. Is it the shoe, or is it the change?
The study would have been much stronger had they added a control of having a group of runners switch to a new shoe that is similar to the one they were used to, or perhaps something only slightly more or less cushioned than what they typically wear (motion control or a racing flat perhaps). If a lateral foot pad can cause edema in non-runner in just a few weeks, it’s quite possible that any footwear change can cause bone marrow edema in a runner when the shoe is unfamiliar. Thus, another headline could simply have been “Adapting to New Footwear Causes Bone Marrow Edema.” Maybe it has nothing to do with the fact that the shoe was minimal.
The above is similar to why drug studies use placebos. Placebos allow researchers to know whether an effect is due to some property of the drug being administered, or whether it is a property of the patient knowing they are getting a pill. The Vibram study needs a control to allow us to determine if bone marrow edema is caused by a footwear change, or whether it is specifically linked to a minimal shoe, or even more specifically to the Vibram Fivefingers.
Despite all of my concerns expressed here, I do believe that an ultraminimal shoe like the Vibram Fivefingers stresses the foot in new and different ways, and that the added stress to the foot can be quite high for someone used to more cushioned footwear. I absolutely believe that pushing a transition too hard in these shoes can lead to bony injury since I know people who have broken their feet running in them. I myself rarely ever run in them anymore because they make my forefoot ache (VFFs are the only shoe that does this to me, I think it has to do with the toe pockets). That being said, I also have two very good friends who have broken metatarsals in the past few years who never run in ultraminimal shoes like the VFFs. Broken foot bones happen to runners regardless of what they put on their feet, and we still have little conclusive data on whether stress fracture rates are higher in one type of shoe than any other.
The true value of this study is that it reminds us that any shoe change should involve some amount of caution, and it gives us something to point to as backup when we make that claim. The more different the shoe is from what you are used to (i.e., the bigger the change), the more care you likely need to take in transition. Running in a shoe like the Vibram Fivefingers will stress the feet and legs of someone used to running in a cushioned shoe, and if you push the transition too hard and too fast you’re potentially asking for trouble.
You might also like:
University of Colorado Study Determines that “Running in lightweight, cushioned shoes is equally as efficient as running barefoot.”
Foot Strike, Running Shoes, Barefooting, Injuries, and Biomechanics: The Importance of Both Science and Anecdote
Shoes, Form, and Minimalist Running: My Interview with Jeff Kline of PRS Fit
Do Minimalist Shoes Increase Injury Risk?: Merry Christmas Vibram
Form Differences Among Barefoot Running, Minimalist Shoe Running, and Standard Shoe Running
About Peter Larson
My own problems occurred more than a year into my transition to minimalist shoes. I began with new Balance Minimus Trails, went to the the Merrell Barefoot Road Glove, then the VFF seeya and later the VFF Bilkila. My problems began with the Bikila. I started having “top of the foot” pain that finally got severe. I quit my training for a half-marathon and dropped to running no more than two miles a day. I stayed at that level until recently, because breaking the two-mile mark could cause the pain to start again. I’m now running more or less okay in New Balance MR00’s. The wear patterns on my Bikilas showed that I was running very far up on my toes. I have moved back to landing a little behind the balls of my feet and that feels comfortable.
Not scientific, but I think the risk of injury from minimalist shoes is not limited to beginners. You have to make careful adaptations in form with each change.
As I mentioned in the post I tend to only get forefoot pain in the Vibrams, not in other minimalist shoes, and I think it may have something to do with fit of the toe pockets and restriction of tow flexion. that’s why I think it’s really important to weight each footwear condition on its own merits – Vibrams are a lot different than barefoot, and a lot different than some other minimal shoes.
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Pete Larson’s Web Links:
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Hi Pete,
I switched from thick heal to 4 mil kin 3’s 2 months ago. Been trying out Flows this week. Been thinking about getting a more cushioned shoe for running on hard road surface this spring. I’m thinking About trying out new Sauc Rides? Any advice? Ive just now recovered from a sore met 2 head that kept me from running for a week.
Rides are 8mm drop, more cushioned, and stiffer, but decent for a more traditional style shoe. One of the few in that category that I’ve run in the past year.
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Pete Larson’s Web Links:
-My book: Tread Lightly: http://ow.ly/bdUO0
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I don’t like those things. My Bikilas are the only shoe that consistently made my forefoot hurt in a weird spot.
Same here. Didn’t seem to happen when I first started running in them, now seems like it happens every time I run in them. Maybe it’s because I don’t run in them enough to allow myself to adapt.
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Pete Larson’s Web Links:
-My book: Tread Lightly: http://ow.ly/bdUO0
-Blog: https://runblogger.com
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I’m guessing that the results of this study would be the same no matter what minimalist shoe was used, but it seems possible that there is something about the VFFs (maybe the toe pocket issue you mentioned) that makes them more likely to cause injury. That’s a shame because it appears that most people equate natural running with running in Fivefingers. The first question I get whenever I talk about my new obsession is “so you run in those toe shoes?” I wonder how many people have been put off of running more efficiently by an unpleasant experience in these things?
It’s quite possible that the results would be similar in any shoe that’s a departure from what your body is used to.
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Another well-written analysis of those (seemingly anti-barefoot) published studies!
Sounds like more evidence to support not putting all your shoe eggs in one basket.
I would agree, very much. Mix it up, unrelenting repetitive stress is a killer.
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Pete Larson’s Web Links:
-My book: Tread Lightly: http://ow.ly/bdUO0
-Blog: https://runblogger.com
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This is why I like this blog….you look at things like a scientist (seeing as you are one, that makes sense ;) ), and don’t just toss around headlines and broken-telephone -style, out-of-context quotes or “findings”. Thank you.
ditto
makes everything…..make sense
brings up ideas and observations i hadn’t thought of
thanks again pete!
*more research paper material*
I had a foot injury caused by vehicular accident 5 months ago with an open III fracture 1st metatarsal shaft on my left foot. I’m still waiting for my titanium plate which is very costly. I’m a bed patient for almost 3 months but my tissue has been healed. Now, I managed to jog in a slow phase even if I had an open fracture. I’m just wondering what would be the danger doing some exercises having an open fracture without any bone grafting or titanium plate attached but my tissue is already healed. Will it lead to a possible bone cancer?
Sounds like a question better directed at your physician/doctor since they know the specifics of your case.
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I think the 10 weeks they took to ‘transition’ to VFFs is way too short. I’ve been taking much longer to adapt to such minimal shoes, and would likely had run into troubles (no pun intended) if I had been taking such little time for such a big adaption. If the study shoes anything, it’s probably that the past transitioning advice by Vibram hasn’t been very sound.
I think the issue is that we really don’t know on an individual level how long the adaptation period should be. We each probably have slightly different capacities for adaptation, and that makes one size fits all programs difficult to apply. But in general I agree, better to err on the side of longer and slower when making a big change of any type.
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To repeat my initial reaction when this study first came out, did they omit the stride comparison or foot-strike data? Or was this just not controlled for? If that’s the case then, yeah, not surprising that a group of possibly “typical” heel-strikers showed early signs of injury due to transitioning from “traditional” running shoes to VFF without any coaching or intentional thought given to stride correction for minimal shoes.
There was no biomechanical comparison. My guess would be that the calcaneal fracture was due to continued heel striking in the VFFs, but I suspect that 2nd metatarsal issues are more likely associated with bending on toe off and thus initial contact location would not be the problem. Forefoot strikers don’t contact on the 2nd met.
This does raise a question about whether explicit form advice in conjunction with a gradual transition might yield different results.
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Pete Larson’s Web Links:
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I feel that a gradual transition to more minimalist shoes
would help with the occurrence of injuries. However, I’ve never worn vibrams but I do run
in many other minimalist shoes and I’m a forefoot striker. The past 5 or 6
years I’ve had no injuries to speak of. While, it could be just luck that has
not caused me to become injured.
I agree though that any change in shoe by any person should
be with caution. To me it’s almost the same as going from 2 miles a day to
running 12 miles a day with no transition period. You could be lucky but you
are bound to get hurt at some point with such a large transition.
I have a couple of questions:
1. I’ve been involved in a bit of coaching of beginner marathoners. This is a program which is essentially couch potato to marathoner in about 6 months. There have been 4 stress fractures happen that I have been aware of, all in the feet. All were wearing fairly conventional trainers, I think one of them wore Newtons. My question is, what do you tell them to do differently when they are ready to return to running???
2. Is “minimal” footwear for advanced runners only? If a beginning runner shows up to a training session with minimalist shoes should they be discouraged from training in them? What is a responsible coach going to say to them???
Regards,
Greg
The honest answer to question 1 is that they shouldn’t be trying to go from the couch to a marathon in 6 months. Starting running is stressful enough to the body, starting running with the intent to build up to a marathon in six months is way too fast in my opinion. I’d have them scale back and start with the goal of completing a 5k, then maybe moving up to a half marathon by the end of the first year of running. I’d not recommend anyone to run a marathon unless they’ve been running for at least a solid year. Can people manage it? sure. But it’s just not worth the risk.
Question 2 – I see no problem with someone starting out in minimal footwear if the plan is to build up very slowly. I think it’s best to get people developing good form habits early, and a beginner is less likely to overdo it. I think there’s probably just as much risk running in conventional footwear for the beginner, but the risk will be to different parts of the body (foot for minimalists, knee, hips for conventional).
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Pete Larson’s Web Links:
-My book: Tread Lightly: http://ow.ly/bdUO0
-Blog: https://runblogger.com
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The program I have experience with doesn’t build up slowly! I calculated a 15% per week build-up from the beginning to first 10 mile long run. They start at 3 miles. There is a high success rate, at least amongst the ones who stick with it. Also, their pace is probably averaging 12 minute miles, using the walk-run approach. That slow pace more than anything is probably what keeps them in the program.
So it would seem the right thing to say to a newbie runner in this program is to keep the minimal shoes, but don’t use them for every run during the week. The build up is simply faster than possible for gradual adaptation. That’s what I’m going to tell them.
I agree with you that 6 months to a marathon is too fast. But an entire industry has been built on this concept!
It’s unfortunate that that’s the case, I really think a year minimum is prudent for a marathon for someone just starting out. I’m coaching a couch to 5k team starting tomorrow, and we are building up really slow even for that. Too many people want instant gratification! Took me years to learn how to best tackle a marathon.
As for shoes, I’m a big advocate of mixing it up – it varies the stress.
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Pete Larson’s Web Links:
-My book: Tread Lightly: http://ow.ly/bdUO0
-Blog: https://runblogger.com
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I did 5 years of training and 5 and 10ks before I felt I was ready to tackle the marathon. I still believe that to be reasonable. I wonder if the claimed success rate might have a bit of “survivorship bias” built into it.
Can I ask what the program is that is following the 6 month to marathon program?
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Pete Larson’s Web Links:
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Check out the specifics of “Galloway Training”. I suspect a lot of the charity type running organizations follow a similar pattern. The group I run with is for-profit and the goals and training plans are similar. Your previous comment about instant gratification applies. Extrapolating this, if training behavior is the first-order reason for running injuries, and tomorrow all shoes magically became orthopedically perfect it wouldn’t make much of a dent in the injury rate.
I echo Pete’s sentiment. Six months is way too short of a time frame for a beginning runner to build up to the marathon distance. It may be enough time for the cardiovascular system to adjust, but we all know the musculoskeletal system takes much more time to adjust to that kind of mileage without incurring injury. I am afraid that this program or industry you speak of will just be economically feeding the health care system:)
I’ve been running in inov-8 bare-x 180’s for about 3 months now and i feel completely adjusted. The first month wasn’t great because I had sporadic foot soreness throughout the weeks but now it’s all gone after about a good month and a half of regularly running in them (wearing Kinvaras for about 8 months before this). I feel this study didn’t have a good control group… to run in shoes that are as minimalist as VFFs you need to have pretty close to perfect midfoot or forefoot landings.. I’m sure some of these guys did have good mechanics to be able to run in them for 10 weeks.. but for the people who didn’t, I highly doubt ten weeks was enough for them to “transition” into zero drop VFFs! You can’t transition into them going from standard shoes with a huge drop and some double the weight, of course their feet had showed a stress fracture in the future! They should’ve at least told us what shoes they were wearing beforehand.
It’s not about foot landing, it’s about bone strenght. Forefoot strikers also get metatarsal stress fractures when switching to shoe with less cushioning or when increasing mileage / speedwork. It’s a typical injury for track runners when they start doing more hard running in spikes.
Exactly, bending on push off seems to me the likely culprit. Bones need to strengthen to tolerate increased or altered load.
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yep, after using the Merrell trail gloves for 1 month then over stretching the big toe backwards because it felt so tight, I blew my metatarsal out !!! wish i knew this information prior, makes so much sense. i didnt read into my body signals either to ease up… cheers as always for a good informative read Pete. (4 months later can now only start doing small runs, worst injury for surfing as well, 80% of my weight bearing in loaded on that area, sucks)
I have been running in the Vibram Bikila LS barefoot shoe now for more than 2 months. At first I was extremely skeptical. Transitioning to barefoot shoes is much different than transitioning to minimalist shoes. You WILL feel some pain at first, especially in the ball of the foot. In the beginning I thought that I would never be able to run more than 12 miles in these shoes. I kept with it though, and as of last weekend I ran a 21 miler in them. There was some pain in the last mile or two but much less than my previous 13 milers. I am happy to say that I have not encountered any injuries and will continue to use these shoes. I wrote a complete review of my Bikilas at
http://www.forkstofeet.com/201…
As Always pete you are “sur la coche” (means well written… very accurate:)
Blaise
Ahh, I can only translate Spanish, and “South of the car” makes little sense :)
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I’m still trying to find a minimalist running shoe that I can use for long distances. I seem to get a lot of discomfort in my shins with these types of shoes; I’ve actually injured my feet from testing shoes on longer (8-10 mile runs). My form seems to go haywire (I think it may be because I have slight asymmetry between my feet). After trying my VFFs, however, I’ve felt much better and lighter on my feet. To give my bones and joints a break, I don’t use them for every run -or I try to run on softer surfaces when doing consecutive runs. To date, I have run on road surfaces for up to 15 miles and have felt fine. If I can’t find a pair of shoes I like in the next week or so, I’m considering running a marathon (in less than a month) in them.
You are right to be cautious! I spent 6 months in the Brooks PureCadence as a transition shoe. In this time I ran several hundred kms, culminating in a marathon. As a ‘reward’, and because running barefoot made my ITB pain disappear, I bought a pair of VFF Bikilas. Until today I’ve loved them. I love the ‘road feel’ and the fact they are so light. I’ve run 20kms in them at a time, and a 14km race with a new PB (I’ve run this race 4 times previously). My feet have developed callouses which suggests they are becoming accustomed to the lack of padding. I’ve done all this at the same time as working through the Pose Method of running to try and further improve my form.
HOWEVER. Today, during a local 10km fun run in the VFFs, I was on track for another PB when I felt like I’d been shot in the foot at kilometre 7. I’ve just returned from the hospital. Diagnosis? Stress fracture in the 3rd metatarsal …
Be careful kids!!!
In my (non-expert) opinion, many of the injury problems I have encountered have actually come from thinking TOO much about form and technique. In this instance, the quest to land on my forefoot appears to have resulted in me landing more on the toes. Hence the fracture just below the toe.
I can confirm that Vibram Five Fingers causes stress fractures.
I am wearing a plaster cast, due to a stress fracture in one of the metatarsal bones on the sole of my foot. I didn’t feel the moment of actual impact, but had been carrying this feeling of pain in the foot for some weeks prior. All stemming from when I started doing 5k Park Runs with my KSO Vibram Five Fingers.
I loved the shoe, but now I’m spitting nails….
Just don’t use the damned shoes
Hi Peter,
Great article, and I very much appreciate your consideration that there are often too many variables changed in studies such as these to draw a logical and confident conclusion!
At our clinic, we completely agree with your opinions, and add another aspect which I’d be keen to hear your and others perspective on:
Put simply, no one shoe is appropriate for everyone, and everyone will not respond in the same way to the same shoe.
For some of our patients we recommend Vibram Five Fingers, for others Hoka One One’s or Gaitlines, for others it may be a more traditional shoe or trainer but with a particular property such as a wide lateral heel flare. For some patients we suggest a moderate heel would work very well with their body, but for others it would damage them and we have to advise against heels.
The requirements for a shoe are determined on a patient’s pathology, anatomy, and biomechanics.
Thus, from our clinical perspective, there’s no way of knowing whether any of the runners in the studies were actually appropriate subjects to be testing the VFFs in the first place.
To us here at BxClinic it is such a ridiculous and unscientific suggestion that a shoe will perform and support everyone in the same way, and yet it’s even more amazing that very few seem to have cottoned on to this way of thinking!
But then, perhaps as most so-called “gait analysis” and subsequent trainer advice is performed on a treadmill, viewed soley from behind, with no consideration of what’s going on above the ankle, it’s no surprise there’s a lot of strange one-size-fits-all advice being handed out by those insufficiently qualified to do so.
I agree totally with all of this. Everyone is different, and the challenge is finding the right match between runner and shoe. I also agree that gait analysis is often a mess – done on treadmill and only looking at what the feet do. I prefer whole body video taken outside.