When It Comes to Shoes, More is Less

I have watched as shoe companies have done everything they can to produce footwear that is intended to improve our ways of life. Years ago I remember when a new style of walking shoes came out that had little air bubbles in the soles. As you stepped, the air bubble would cushion your feet and then move through a channel to the front of your foot as you rolled off your forefoot. The idea was to provide more cushion to the walker, relieving pain and soreness that so many other shoes left in their wakes.

Those shoes still exist today, but more recently companies like MBT, Z-coil and Gravity Defyer have released footwear that adds even more cushioning to the sole in an attempt to remove as much shock to the body as possible while toning muscles and fixing what ails you. MBT, which stands for Masai Barefoot Technology, even calls themselves the "anti-shoe," claiming improvements in posture and muscle development while providing a more barefoot stride.

It has always baffled me that they claim that they provide an experience akin to walking barefoot. How could a shoe that has a thicker sole provide a more barefoot experience? The whole notion seems inherently counter-intuitive. Heck, people don't say that a walking shoe for a plaster cast is more barefoot, yet that is what MBTs remind me of.

Which one is for a broken leg and which one helps you walk more "barefoot?"

I have three issues with any manufacturer that claims that their shoes fix a problem with the body: First, any research I've seen has been based on comparisons of their products to regular shoes, not to bare feet. The new-fangled footwear is compared to a "baseline" running or walking shoe, which is all well and good except for the fact that each person's foot will react differently to any given shoe than someone else's foot would. Second, all of these shoes are designed, manufactured and marketed based on the same faulty premise that they will fix a problem when they really don't. All they actually do is compensate for it. Big difference. Third and finally, you never hear about how these shoes help the feet. All of their claims talk about improving the legs, hips and/or back. Why do the health of one's feet, the very base of our ambulation, get left out?

Research is a funny animal. The outcomes of your study can be forced in certain directions simply by how you set up the parameters. And let's face it. Shoe companies are in the business of selling shoes. They're going to make sure that whatever research they promote is going to support their claims about their product.

I believe that society's thinking about shoes is approached from the wrong direction. So many people from "experts" to lay people believe that footwear needs to be additive instead of subtractive. Additive thinking assumes that shoes are necessary and that adding features to a particular set of shoes will work to cure an ailment of the body. Subtractive thinking instead presupposes that removing footwear and letting the body act on its own accord is the better approach.

For example, when a runner has an issue with foot, ankle or knee pain, the typical course of action is to analyze how to adjust their shoes in order to fix what was wrong with the combination of the feet in the shoes. By adding an orthotic, arch support, cushioning or other feature, the shoe can be adapted to work better with the runner's physiology. The expected outcome is to counteract whatever dynamics about the feet within the shoes were causing injury.

But what if removing features of the shoe -- or the shoe altogether -- and letting the body's physiology work for itself is the best course of action? Instead of locking the foot in a rigid shoe and making the orthotic, legs and hips do most of the work, you could unlock the feet and allow them to do what they were born to do?

What if, instead of creating a shoe that has springs in the heels to counteract the forces of heel strikes, you work to strengthen the person's own muscles and encourage them to walk with a less forceful foot fall? Instead of a heel strike with every step, the foot is encouraged to flex and use its 26 joints, the ankle and knees to naturally cushion each step via a mid or forefoot strike?

The idea is to literally start from the ground up, something this entire blog is based upon. I believe that most people would do just fine going barefoot most of the time and in most places. They just need to give their own feet a chance. I'll admit that sometimes, even after some strengthening and time, someone may find that an orthotic is necessary due to complications from an injury or other problem. In those cases, why not try a minimalist shoe with whatever simple orthotic is required? Add only what is needed and otherwise let a foot be a foot.

Could it be that our feet would be healthier by subtracting footwear, giving our feet a chance and adding only the most necessary of "support," if needed? I welcome your comments below.

(Please Note: I realize that going barefoot is not a good option for people with conditions such as diabetes that hinder the body's ability to heal and/or fight infection. Anyone with conditions that leave them immuno-suppressed should consult their doctor first before trying a more barefoot lifestyle.)

Juggling Numbers Image: The IP-Kat
Feet Image: The Hub Pages

My Achilles Heel: The First Stressful Week

I thought I'd post a brief update about how things have shaken out regarding the stress fracture in my left heel.

I'll be honest, it's been confusing. My doctor originally said I should wear a cast boot (similar to the one pictured below) and my heel would heal in about four weeks. He said I could still walk on it but try to reduce how much walking I do each day. So for a couple of days following my diagnosis I wore a boot and walked on my heel like normal. This ended up causing continued pain in my heel due the cumulative effect of pressure on my foot.

With further research, I found that his recommendations seemed quite liberal compared to how many other doctors treat stress fractures. A standard treatment for an ailment like mine has usually been a cast boot and no weight bearing for at least a few weeks, with the total treatment time being six to eight weeks. Some outlets have even said that just walking on a stress fracture can cause more damage up to and including the need for surgery.

So I had a number of concerns.

First, it seemed like walking on a painful heel was a bad idea. It wasn't so much a problem for very short periods or distances (i.e. from one room to the other), but being on my feet for any length of time was painful. So I questioned my doc again whether I should even be bearing weight on my foot.

Second, walking with pain was compounded by the fact that my job is tied to walking a lot. Just to give you an idea, wearing a pedometer last year showed that I walk an average of 11,000 steps a day at work. That ends up being a little more than 5 miles each and every work day or a near-marathon length 26 miles a week. What's more, all that walking ends up being long distances in chunks spanning almost 1/4 mile one way to get from my office to another location in my workplace. I asked the doc if there was any way to help with getting from place to place during the day.

My doctor decided that I probably should be non-weight bearing if my heel continues hurting. As for how to get around, he said crutches or a wheelchair would work. I asked if an electric mobility scooter could be a viable option. He agreed it would but thought it would be cost prohibitive.

I have researched the possibility of getting a mobility scooter but have run into some bumps along the road. It seems as though insurance won't cover the rental of such things. My insurance also wouldn't pay for purchasing one as my condition is not a life-long or long-term disability. So it seems like the only options I have left are to either use some of the funds we've set aside in our Flexible Spending Account (you know, that "cafeteria plan" you can put tax-free money into at work to pay for medical expenses) or pay out of pocket. The FSA would be a good option, but we've already designated those funds to pay for outstanding bills from our baby's birth in August and other expenses. Paying out of pocket isn't a very good option because we don't really have money available to do that.

So right now I'm using a combination of crutches and a manual wheelchair (pictured), both which have been borrowed from friends who have no immediate need for them. They work out okay, but traversing the long distances has proven exhausting.

So my arms are tired and, quite honestly, my spirit is too.

It's bad enough not being able to go barefoot AT ALL for a couple of months (though I cheat at bedtime and when I shower each morning), but to have such limited mobility when my job is so reliant on me walking around? That really sucks, I won't lie.

But, I know I'll come out of this stronger and better for it. I already have a new appreciation for those that must always use crutches or wheelchairs. Maybe, just maybe, I'll also get some pretty hearty biceps, too?

I guess tickets to the gun show go on sale in six to eight weeks.

I welcome your comments below.

Q&A: Return to Running

When is your next run? - Submitted by Anonymous

Thanks for your question!

At this point it's hard to say when I'll return to running. Though my doctor wants a follow-up at four weeks, it could be a total of six to eight before I'm back out there. That could mean that I don't start running again until April. After that, it could take a while to recondition my legs to the point that I'd be ready to run an organized race.

As of right now I'm tentatively planning for my first race back to be the Hospital Hill 5K here in Kansas City on June 5, 2010. That should give me plenty of time to recover from the stress fracture and recondition for the race. Let's all cross our fingers.

Question(s) About Barefooted Living?

My Achilles Heel: Stressed. Out.

I'll try to keep this brief.

I'm reminded of a movie quote, though I can't remember who said it in what film. It goes, "I hate it when I'm right." Everything I wrote in the previous post came to pass. I DO have a stress fracture in my heel and I won't be running the 5K on Sunday. So...

An MRI image of my heel. The yellow arrow is pointing to the primary fracture, but the white area around it also indicates weakening of the bone. My heel should look evenly dark like the other bones displayed.

I honestly don't know how this would have happened. As a barefoot runner, I use a forefoot strike which should completely eliminate stressful forces on the heel. I can only surmise that all of the walking I do at work in minimalist (read: uncushioned) shoes plus the forces of my achilles pulling on my heel while running weakened my heel bone enough to cause this fracture.

So I'll be doing no load-bearing exercise for the next four weeks. That means no running. I also will wear a boot, at least to work, in order to allow my heel to heal. That, along with a note saying I should "limit the amount of walking (I do) throughout the day," will probably be enough to allow this problem to fix itself. I'm going to pursue using a motorized scooter of some sort at work so that the long walks to the other end of the facility are a lot shorter and less strenuous on the feet. My employer needs to accommodate my injury, so we'll see what our Occupational Health department has to say.

The doctor doesn't seem overly concerned about me wearing the boot all of the time. He believes the problem should resolve itself so long as I don't run and wear the boot at work. I take that to mean that generally avoiding strenuous activity or heavy use of the foot should be enough. I think I'll probably still try to go barefoot around the house. I often walk with a forefoot strike and gently touch my heels to the ground when barefoot, so that should be okay. I'll also sleep barefoot.

So, thus begins four weeks of taking it easy on the feet even if I still try to get workouts in. I want to try to find alternate ways to do cardio. The good doctor recommended a stationary bike or swimming as good non-load-bearing exercises. I'm sure our city's community center has inexpensive memberships available to use their gym, so that sounds like a good option for the bike. A local middle school has an indoor swimming pool, so I'll investigate what usage costs there are. I can always also do core exercises as they don't require significant forces on the heels.

In a way, I'm kind of glad that this happened now. If I'd gotten a stress fracture right in the middle of the spring-through-autumn months, that would have really given a hit to my barefooting. This way I'll be able to heal up, get reconditioned and go enjoy a number of runs this summer AND do them all barefoot. Sounds like a plan.

Thanks for reading. I welcome your comments below.

My Achilles Heel: A Quacked Calcaneus?

Interesting things have occurred since last I spoke to you about my ankle. You might recall from my Jan. 22 post that I was diagnosed with Achilles Tendinitis. I wore a cast boot, did heat therapy and took an anti-inflammatory drug for a week in the hopes that it would clear up. If I did, in fact, have Achilles Tendinitis, I believe that it cleared up.

But there's still pain in my ankle that has lingered. More specifically, when you squeeze in particular spots on the sides of my heel it triggers hearty amounts of pain. Now, the X-ray I'd gotten didn't show anything, so my sports medicine doctor wisely decided to send me for an MRI. Magnetic resonance imaging, in case you don't know, is a very sensitive series of pictures of the body's internals. It can show many things that X-rays can't, like the condition I now think I probably have. He wanted to see what exactly is going on in there, but didn't make any assertions as to what the problem really could be.

One thing he DID do, however, is clear me to run in the 5K I'd been planning on for this Sunday. He said, "It's only a 5K. It's not like you're running a marathon. Go for it." Now, while that might seem insulting to some readers, I took no offense and realized that he meant that the relatively-short 3.1 mile race could do very little extra harm to my heel/ankle.

So I left his office with just as many questions as answers. What would the MRI show? What if the MRI showed something bad enough that I really CAN'T run the 5K? If the issue isn't Achilles Tendinitis, what could it possibly be?

After getting the MRI done last night, being given a CD of the images and surfing the interwebs for pictures of heels and MRIs, I've used my junior radiologist deduction techniques to make a prediction of what is wrong with my ankle. It's all I can do until the radiologist gives his/her report to my doc. So I can't be sure until 8 a.m. tomorrow morning when I have a followup, but a guy can still make an educated guess, can't he?

And boy, what an educated guess this is. I'd like to think I'm a smart guy. I am kind of "techie" by trade and actually work in a hospital, so I am sure of two things about reading medical imaging: 1) MRIs are REALLY cool and really detailed in what they show & 2) Medical films are REALLY hard to read. That said...

Based on my continuing symptoms and MRI, I think it is highly likely that I have a stress fracture in my calcaneus (heel) bone. After looking at the MRI images of my ankle/heel and comparing them to images readily available via a simple Google image search, I believe there are striking similarities between them. Check it out below. On the left you see an image I found on the Radsource Web site. It shows an T2-weighted MRI of a calcaneus with a stress fracture (indicated by the white arrow). On the right, I have displayed an almost exact T2-weighted image of my calcaneus with what I believe is a stress fracture (indicated by the yellow arrow).

(Click image for larger version)

There's other evidence in my set of MRI images that lead me to believe I have a stress fracture, but the similarities between the two indicated parts of the images above cannot be ignored. Heck, the dark line in my heel (on the right) even curves in a very similar way to the fracture in the left photo.

So, where does that leave me? It leaves me waiting to see my doctor tomorrow morning to find out what's REALLY going on. I also have to wonder what kind of treatment and limitations I might have in the near future. Most articles about calcaneal stress fractures indicate that a standard treatment is a lot of rest for up to 8 weeks. That may even include a cast and no weight bearing for that period.

If I do have a stress fracture and I have to wear some kind of cast or cast boot, I'd need to work with my doc to see if it'd be acceptable to do some walking in order to fulfill my job responsibilities. As someone who typically walks about 11,000 steps a day at work -- and who only has about 1 1/2 weeks of sick time accrued -- I would really need to find workarounds so I can heal but still work. I've thought about proposing using a rented scooter to motor around my workplace and then park it when I get to whatever room I need to work in. When finished at a particular location, I could scoot away to somewhere else. Minimal walking while the job still gets done. It's worth a shot.

And the 5K? Well, if I really do have a stress fracture I doubt the good doctor would still be okay with me running it. After all, it might have been running that caused the problem in the first place.

But hey, I suppose there's a possibility that I don't have a stress fracture. Maybe, even though the MRI looks ridiculously similar to other confirmed cases of stress fracture AND the fact that I have symptoms that are completely consistent with said condition, I don't actually have it. We'll see. But as I've told my wife and a few others today, "If it walks like a duck and it quacks like a duck...it's probably a stress fracture." Wait, what?

I'm planning an update to the blog tomorrow with the final news. To stay remotely on point with this blog, however, I will finish by saying that I have a feeling this is going to negatively affect my barefooting mojo...again. Hopefully, I'll be all better by the time warm weather comes around and it's prime barefooting season. I guess we'll see.

I welcome your comments below.

Detective image: http://mohsinali.name/wp-content/uploads/2009/02/detective.jpg
Scooter image: http://electricwheelchair-electricscooter.com

Listen to My Thoughts on Barefooting

Want to hear my thoughts on barefooting beyond what you read here? The good folks over at Living Barefoot have released their ninth episode of The Living Barefoot Show. It's the recording of the live call-in show in which I participated back in October. Hear my thoughts on what makes a "barefooter," why I don't go barefooted everywhere and more. Check it out at the following link or download off of iTunes (search for "The Living Barefoot Show"). My participation begins at about the three-minute mark.

The Living Barefoot Show Episode 9 - LIVE Call-In Show from Oct. 2009
"An Ode to Baby Wipes," the blog post I referenced in the show.

Image from Sagworks

My Achilles Heel: These Boots Weren't Made for Barefooters

Well, it's now been just over a week since I initially hurt my ankle.I went to a sports medicine doctor two days ago and was diagnosed with Achilles Tendonitis. Since then I've been wearing a cast boot, taking an anti-inflammatory, doing heat therapy and trying to rest as much as possible.

This Wednesday I go for a one-week followup to see how things have progressed and find out if I'll be able to run the 5K on January 31 that I've been training for. I'm hoping that he'll give me the go ahead and I can use kinesio tape such as KT Tape to support my achilles during the run.

So how is my achilles right now?

As of this morning my ankle doesn't feel much better at all, actually. It doesn't hurt while I'm wearing the boot, however any time I walk without it on, my ankle starts hurting in exactly the same way it has been. It also continues to be just as swollen even after two days of the (strong) anti-inflammatory drug.

Injuring my achilles has turned my barefooted world upside down!

My barefooted "spirits" are down, too. For a guy who normally always wants to go barefooted or wear only minimalist shoes, wearing a cast boot and regular boot (to offset the height difference of the thick sole) is almost like a prison sentence; punishment for my wrongdoing of overtraining for the 5K. Sigh.

What this does do is reinforce my feelings about going barefooted. I'd been unshod or minimalist for so long that going back to such restrictive footwear -- even in the form of a "regular" boot -- is a good reminder of how truly comfortable and unrestrictive bare feet really can be.

Honestly, I've really wanted to rip this stuff off of me. Last night, while at a youth event that I'm helping support for my church, I cam so close to getting my elastic wrap, ditching the boots, wrapping my achilles and going essentially barefooted the rest of the night. But alas, I knew that wouldn't be best. I've got to fight the good fight and be patient for my achilles to heal and me to be able to return to walking, running and living barefooted.

So we'll see what happens. If there's any more news I'll share it here, Twitter, Facebook, blah, blah, blah.

Injured Achilles/Ankle and Upcoming 5K

I've decided to pursue medical attention for my left ankle ahead of my scheduled 5K on Jan. 31. If the doc says to not run the race, I won't.

I hurt my ankle last week on what ended up being a pretty good run. Afterward it started hurting from what I thought was pressure caused by my Vibram Fivefinger shoes, and I took a couple days off. The big mistake was to go out and run again on Saturday and push myself too hard while still in pain.

At this point I'm almost totally certain that I have, at a minimum, achilles tendinitis in my ankle from overuse/overtraining. I'm beginning to wonder if the persistent swelling and pain is an indication that I could have a partial achilles tear as well.

It KILLS me to potentially give up racing my first 5K on Jan. 31, but it's appropriate for a medical pro to look further into the problem and determine whether or not my ankle will be able to tolerate it. Better to take it easy and recover than potentially make it worse.

If you're a person of faith, please keep me in your prayers, thanks.

Mark My Words: Accidents Happen

I was at a gathering yesterday when the topic of my barefooting came up. A close person in my life, who's made it very clear they don't think my preference for bare feet is a good idea, said to me...

"Mark my words, Michael. Someday you are going to get seriously hurt."

This person shared with me that they seriously hurt their foot when they were younger because they weren't wearing shoes. I hear this a LOT.

I can't tell you how many times someone's told me, "I don't go barefoot because I ______ my foot by ______ when I was a kid." For the first blank space you could insert the words hurt, cut, broke, punctured, burned or one of many others. The second space could be completed with stepping on a bee, stepping on a nail, stepping on a knife, stepping on a rock, pouring boiling water on it, running into a wall or something equally traumatic and painful.

To these sentiments, my response is always the same by sharing my own stories. I, Barefoot Michael, stepped on a bee at a swimming pool AND punctured my foot by stepping on a nail when I was kid. So, I know it sucks. I know it's not fun. But you know what? I recovered.

I reminded this acquaintance that if we hurt our hands we don't just start wearing gloves all the time. I might point out, at this time, that I have seriously hurt my hands a few times in my life:

• I cut a finger with a razor blade as a child and have a scar to prove it.
• I got a few fingers smashed in a door jam as a kid because I wasn't paying attention.
• I burned some fingers in college by grabbing a hot lid off the oven.
• I burned fingers a couple years ago on a bundle of firecrackers with a lively wick.

And yet, I don't wear gloves on a regular basis. We get hurt, we heal and we move on smarter for the experience. It's the same with our feet.

I use an abundance of caution when I go barefooted. I keep an eye out on the ground while I walk. I avoid things on which I could catch or stub a toe. I try not to walk barefooted in places where it would be easy to get hurt. Lastly, I am careful about the possibility of heavy objects falling on or rolling over my feet. But, taking all that into account, I could still get hurt. Accidents happen.

To me, the benefits of going barefooted FAR outweigh the risks. The comfort and health benefits of going barefooted are something that I deeply desire for my feet. If that means that I introduce a little more risk into my life, then so be it.

Thanks for reading! I welcome your comments below.

Drawing from: University of South Florida

Q&A: Bare Feet and My Children

Do your children go barefoot too?-Jake, from Wisconsin (where we savor the 8 months of the year that we can go barefoot.)

Thanks for the question, Jake! We DO encourage our kids to go barefooted a lot. Research has clearly shown that children's feet should be uninhibited as much as possible while they're still in the process of growing.

Do they go barefooted everywhere all the time? No, but if my wife and I don't perceive a risk of the kids hurting themselves due to inattentiveness of the environment around them then we'll generally let them go unshod.

If we do have them wear shoes, we try to make more flexible "minimalist" footwear available that allows their feet to breathe and move naturally.

In the end, we want our children to grow up knowing that shoes are NOT usually necessary and that they're feet are healthier overall when not confined in footwear.

Smiles,
Michael

Question(s) About Barefooted Living?