This interview with Irene Davis PhD on Peter Attia’s The Drive podcast caught my attention because it is a discussion about cushioned/minimalist running shoes, heel/forefoot strike and impact forces and injuries, transition to minimalist shoes and process for changing gate. I’ve read/listened to a range of clinician/researcher views on this and I appreciated Dr. Davis’ professionally cautious survey of the topics. She is the founding Director of the Spaulding National Running Center at the Harvard Medical School after all.

 

My Take Aways

Some insights that stuck with me were her detailed critique of the forces a heel-strike runner endures in their joints even when running on extremely cushioned shoes. She makes the point that cushioned shoes to not spare a person from the steep jolt of forces at the strike, only disable the role the foot needs to play in dampening them. 

A big counter-intuitive take away for me, as a minimalist shoe runner, is to practice barefoot running exercises on a hard surface (as opposed to running on grass) because on a hard surface the leg softens in anticipation of the touch down while on a soft surface the leg stiffens in anticipation – this changes the way the leg handles those forces.  This also contributes to the explanation for why highly cushioned and so-called ‘support’ shoes actually increase injury statistics rather than reduce them. 

I appreciate her approach to helping runners change their gate – there is wisdom for when to try this and how and when not to try it. I advocate for a very cautious, but optimistic approach to this.

I am inspired to be even more intent on strengthening my feet beyond what they get from running in minimalist shoes. They are the first in line of a chain of joints that need to be strong and hold up for many more years!

She also discusses her changes in view and prescription of orthotics. The point she made is that in so many cases the foot is becoming painful because it is losing functional strength from the constraints of shoes (since toddler days!). When putting an orthotic in the shoe to support a weak foot, it is making the foot weaker and more susceptible to injury and pain, not less, because the foot is made exempt from doing the supporting work it is suppose to do. It’s addressing a symptom of the problem, not the cause. She points out a related medical situation: what happens when the neck is injured and in pain? They put a neck brace on to keep it temporarily supported and safe. But the neck brace makes the neck weaker and ultimately less safe, so it is not the medical intent to permanently support the neck but to get the brace off and rebuild functional strength, to let the structures do what they are meant to do. Why is this sensibility blaringly absent with regards to the foot?

Photo by Seoyeon Choi on Unsplash

 

How I Left Orthotics Behind

I have a history with orthotics repentance myself, which got me on the path to stronger, pain free feet and happier joints. I will tell my story briefly if it interests you…

At 19 years old, I was a triathlete and when not in school I was a heavy-construction worker (building roads, bridges, highways, etc) paying my way through college. I was on my feet all the time needless to say. At work I was wearing high quality work boots yet after just a couple years of this I started to get increasingly uncomfortable feet, especially when standing on hard surfaces. Naturally, the doctor prescribed orthotics.  Orthotics are expensive in themselves, and require buying new (expensive) shoes that fit them. Then the foot adapts to the device and one eventually needs a new orthotic and so on. 

I wore orthotics for about 15 years. I even started crafting my own spares to save money. I wore orthotics in my work boots, in my casual shoes and in my running shoes. The only time without them was when I was wearing hiking sandals in warm weather and my feet seemed to tolerate those for a few hours. 

Then I moved overseas to the Mediterranean Coast of Turkey – far away from my orthotic supply and into a fairly hot climate 6 months of the year. In Turkey people take shoes off in the home, which was not my custom in the USA. The floors were hard tile on concrete, with rugs in some places, and people often wear ‘house slippers’ or sandals inside. Outside the home, Turkish men wore fashionably pointed dress shoes. I adopted the shoeless foot at home and started to walk around without any orthotic support for many hours of the day. Outside, I could not assimilate to this style. The pointy shoes were way too uncomfortable and it was too hot for my feet to be in shoes that much of the year anyway. In my home culture in the Pacific Northwest USA, the principle here is “function = fashion” which makes many of us look like we’re ready to go for a hike in the rain forest at any time, dress-up be damned. So I maintained a decidedly foreign look on my feet out of comfort and functional bias. 

The turning point must have came about a year into living there when my shoes with orthotics inside were stolen from outside our apartment door. I was stuck with an inferior back up pair for my tender feet. However, in the months after I started to realize that during the shoeless half of my year my feet did not hurt! The less I had on my feet for extended periods of time the better they felt. I would go back to my shoes for the cooler, wetter winter months, but then the aches and pains returned as well. 

Right about this time I crossed paths with two barefoot runners in Europe who introduced me to these (new to me) ideas about naked feet and their movement. I read The Book with amazement like many others did. And as I explored these anatomical, mechanical, and economic ideas more, I found an explanation that fit my history and a pointed a way out of the pain. My counter-fashionable insistence on wearing sandals was validated. I very carefully started practicing barefoot like running and changing my gate in response. I gradually transitioned into zero-drop running shoes, and then into minimal cushioned ones to much greater comfort to run for much longer distances than ever before. 

A change in my contact with the ground changed the way I walk and run which changed the way my joints handle those impact forces which removed so many of the problems I had experienced as a runner and while just walking around on hard surfaces. But, as Dr. Davis points out, and I emphatically agree, making a good transition requires a very cautious, very gradually process of transition to get the foot and then the rest of the body back into proper relationship with the ground and with itself.  

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