Podcast 96: Minimalism Shoes, Toe Trauma, Meniscal Impingement.

The Minimalist Shoe Index, Pincer toe nails, toe problems, anteromeniscofemoral impingement syndrome and much more on today’s show !

A. Link to our server: http://traffic.libsyn.com/thegaitguys/pod_96f.mp3

Direct Download:  http://thegaitguys.libsyn.com/podcast-96

Other Gait Guys stuff

B. iTunes link:
https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138
C. Gait Guys online /download store (National Shoe Fit Certification & more !)
http://store.payloadz.com/results/results.aspx?m=80204
D. other web based Gait Guys lectures:
Monthly lectures at : www.onlinece.com type in Dr. Waerlop or Dr. Allen, ”Biomechanics”

-Our Book: Pedographs and Gait Analysis and Clinical Case Studies
Electronic copies available here:

-Amazon/Kindle:
http://www.amazon.com/Pedographs-Gait-Analysis-Clinical-Studies-ebook/dp/B00AC18M3E

-Barnes and Noble / Nook Reader:
http://www.barnesandnoble.com/w/pedographs-and-gait-analysis-ivo-waerlop-and-shawn-allen/1112754833?ean=9781466953895

https://itunes.apple.com/us/book/pedographs-and-gait-analysis/id554516085?mt=11

-Hardcopy available from our publisher:
http://bookstore.trafford.com/Products/SKU-000155825/Pedographs-and-Gait-Analysis.aspx

Show notes:

1. New Cameras In Japan Can Detect Drunks At Train Stations
http://www.popsci.com/cameras-japan-detect-drunks-train-stations

2. It takes a lot of nerve: Scientists make cells to aid peripheral nerve repair
http://www.medicalnewstoday.com/releases/297854.php
-Scientists at the University of Newcastle, UK, have used a combination of small molecules to turn cells isolated from human skin into Schwann cells

3. The Minimalist Shoe Definition study

http://www.jfootankleres.com/content/8/1/42

A consensus definition and rating scale for minimalist shoes
Jean-Francois Esculier123, Blaise Dubois13, Clermont E. Dionne14, Jean Leblond2 andJean-Sébastien Roy12* http://www.jfootankleres.com/content/8/1/42

modified Delphi study, 42 experts from 11 countries

http://www.jfootankleres.com/content/supplementary/s13047-015-0094-5-s1.pdf

-Results

The following definition of minimalist shoes was agreed upon by 95 % of participants: “Footwear providing minimal interference with the natural movement of the foot due to its high flexibility, low heel to toe drop, weight and stack height, and the absence of motion control and stability devices”. Characteristics to be included in MI were weight, flexibility, heel to toe drop, stack height and motion control/stability devices, each subscale carrying equal weighing (20 %) on final score.

4. CASE:
Ivo: broken toe, prioprioception
this: http://www.ncbi.nlm.nih.gov/pubmed/2245598
and this http://www.ncbi.nlm.nih.gov/pubmed/19955289

5. CASE: anterior meniscofemoral impingment syndrome
http://tmblr.co/ZrRYjx1d8503W

http://thegaitguys.tumblr.com/post/17713779565/anterior-knee-pain-in-a-young-marathon-hopeful

6. Pincer Toe nails:

http://thegaitguys.tumblr.com/post/127638788139/pincher-nails-who-knew-note-there-are-two–  

The Minimalist shoe Rating Scale and Definition

Last year we were two of 42 experts worldwide from 11 countries asked to participate and offer our thoughts in an investigation whose goal it was to come up with a rating scale and definition for minimalist shoes. 

Here is that study: 

A consensus definition and rating scale for minimalist shoes.  Jean-Francois Esculier¹²³, Blaise Dubois¹³, Clermont E. Dionne¹⁴, Jean Leblond² andJean-Sébastien Roy.   Journal of Foot and Ankle Research 2015, 8:42 

^{here is a link for that study: http://www.jfootankleres.com/content/8/1/42}

This study was performed by very capable and respected folks so you should pay attention. 

Here was their background statement:

“While minimalist running shoes may have an influence on running biomechanics and on the incidence of overuse injuries, the term “minimalist” is currently used without standardisation. The objectives of this study were to reach a consensus on a standard definition of minimalist running shoes, and to develop and validate a rating scale that could be used to determine the degree of minimalism of running shoes, the Minimalist Index (MI).”

We might not do the study justice if we paraphrased the conclusions, so here they are as written,

“The following definition of minimalist shoes was agreed upon by 95 % of participants: “Footwear providing minimal interference with the natural movement of the foot due to its high flexibility, low heel to toe drop, weight and stack height, and the absence of motion control and stability devices”. Characteristics to be included in MI were weight, flexibility, heel to toe drop, stack height and motion control/stability devices, each subscale carrying equal weighing (20 %) on final score.”

So why is this study important ? Well, it creates a common term, a standardized definition, we can all agree upon which is paramount for clear communication amongst professionals in fields (shoe fitters, shoe fabricators, clinicians and researchers) who are dealing with these types of shoes. This study also create a rating scale that will be meaningful to all users in all related fields, again allowing a common dialogue with standardized meaning. From this study they wisely recommended “the shoe industry use such standardised ratings to orientate the running community when selecting their running shoes”.  

This is an important study, it should be part of your knowledge and vocabulary. You should familiarize yourself to the rating scale. 

Shawn and Ivo, the gait guys

On and on goes the barefoot debate. 

There is no single right answer, so use your head.

article link, click here

We have been saying what this article talks about all along, even years before the Vibram 5’s hit the market, back when Vibram came to us to ask us for our thoughts on the early versions.  You will see our soapbox rant on this topic over and over again in our blog posts and it is the modus operandi behind our new 2012 Shoe Fit program that will likely launch February 1st in several forms for several professions to meet everyone’s needs.

That modus operandi being that not everyone has a foot type, anatomy or biomechanics to get into minimalist shoes, without a possible cost that is.

In this nicely written article by Cynthia Billhartz Gregorian “Barefoot running: Sales grow, but so does debate about benefits, safety” at the link above she lightly covers some of the aspects of the debate.  We have read just about every piece that has come out on the barefoot-minimalist trend. Sadly, some of the blogs are mere opinion and it is rare that the honest truth comes out.  That truth being our mention above that some folks just do not have the skill, endurance, strength or anatomy to delve into footwear that does not support or protect their physical limitations.  Lets be honest, at 5'9’’ I have to come to the realization that no matter how much i practice to be in the NBA I am not going to make it. I just do not have the physical anatomy to be an NBA star.  And some people, no matter how much they want to run barefoot or minimalist, just do not have the anatomy to allow it. Someone with a history of foot pain who has a rigid forefoot varus really is not going to do well in minimalist shoes. There are articles written out there that just tell people to bite the bullet and go 100% into their new minimalist shoes, into the natural way they were supposed to run from the very start and force the body to adapt, that the new form they adopt will take care of any problems. Well, in our experienced and educated opinion, that is just not smart. Someone who has a shortened posterior compartment (calf-achilles) after being in heel shoes for years is going to have several flaws biomechanically going to minimalist shoes right off the bat. One example, just one for now, is that the person is going to have premature heel rise and thus premature forefoot loading response around a compromised ankle rocker mechanism. And there are many others of course.

Here is the bottom line as we see it. No shoe company is going to run a commercial or add on their product with the warnings on the cover or in the fine print. We are not talking about cigarettes here.  Admitting that some people should not be in their product would be admitting that the product has limitations and risks.  What kind of advertising add would that be ? Besides, admitting to limitations or mentioning warnings is a mere step away from liability cases.  We are pretty sure of this, after all, look what happened to the Shape Up Shoe in the courts.

Here is what we say to the naysayers, look at the research and use logic.  If you are new to the game, leave the extremist blog sites for those that are looking for radical opinions. Because we do not have any openings in our clinics for the next several weeks if you throw caution to the wind.

Good running to you all in 2012, use your head, for the sake of your feet.

Shawn and Ivo

Barefoot? Minimalism? I thought barefoot WAS minimalist?

Barefoot fever has really caught on over the last year or so. It seemed to start with the advent of the Vibram 5 fingers several years ago (which Dr Waerlop was a biomechanics and design consultant for) and seems to have blossomed to include many different types of footwear.

In the strictest sense, barefoot means NO SHOES or UNSHOD. There are hygenic and social reasons we cover  (or need to cover) our feet, and thus the advent of the many types and styles of footwear we are seeing crop up in stores everywhere. This shoes have minimal amounts of bells and whistles (read support and rigidity) and thus promote a barefoot STYLE of walking or running. These “shoes” also have a low (or no) ramp angle. The ramp angle is how much higher the heel is in elevation than the forefoot.  Most traditional running shoes have a 2:1 ratio…..the heel is twice as high as the forefoot.  The average might be a net 10-20mm rise in the heel height over the forefoot rendering a ramp angle of approximately 15degrees.  So when we say barefoot and include these minimalistic shoes we are referring to shoes with a ramp angle of less than 2-3 degrees and less than 5 mm heel rise.

According the the last two studies published in Nature, by Dr Daniel Lieberman, barefoot or minimalistic activites appear to have many advantages: less stress on the joints, less impact forces on the body and increased proprioception (awareness of your body parts, in this case feet, in space).

The barefoot model is based on the simple fact that the movement of our anatomy for thousands of years has been always been that the heel and ball of our foot rest on the same plane. This is the ground work for the normal workings and biomechanics of the foot.  When we take the heel and raise it onto a level above the forefoot (as most running and dress shoes do) the body will have to make biomechanical changes to that very same anatomy that loves level ground. It is now being proven over and over again that this altered positioning and corrupted biomechanics may be what are driving much of the foot and lower limb problems we see out in the world.  Whether it is plantar fascitis, shin splints, achilles problem, toe problems, or just general foot or ankle pain, these altered biomechanics are highly suspicious culprits.

This is not to say that everyone can go barefoot or is ready to immediately go barefoot, despite the picture the shoe vendors and media are painting. Some folks have to gradually work their way down into lower ramp angled shoe affording the time and tissue changes that will come with adapting to different heel heights.  It can take some time for the calf muscles and achilles to restore their original length or take time to regain the strength of the foot intrinsic muscles so that the foot can no longer depend on the shoe for stability but rather it can learn to depend on the anatomy of ligaments and muscles to provide the support like our shoeless ancestors of centuries past.  This is where  minimalsitic shoes come in. They provide a transition from where you are to where you want to be. Other folks have anatomic foot types that just cannot cope well with a pure “barefoot technique” and will probably need to remain in some type of transitional shoe.

There are exercises and drills, along with types of manual therapy and muscle activation techniques that can help speed the transition from your current footwear to being a minimalist. Make sure you consult with providers with plenty of experience that are familiar with and competent with these methods.

We are still 2 foot nerds, out there making a difference…The Gait Guys

Shoe Review: The Brooks Pure Project Line.

Ok, we have been meaning to get to this for months but are just getting around to it now. So for those of you who have been hounding us for the data, sorry, but thanks for keeping us on it.  Here are the specs for the EVA midsole thicknesses and ramp numbers. Remember, ramp angle can only be given if the length of the foot is known, so those numbers will not be given here.  What is good to know is that we have another shoe in the category of the Saucony Kinvara, the Brooks Pure Project line.  Below you will see the specs for all 4 in the line up.  All have a 4 mm forefoot to rearfoot rise, in other words……the heel is only 4 mm lifted compared to the plane the forefoot is resting on.  This still changes the biomechanics and neuromechanics that we were all given at birth that would really prefer the rear and forefoot to be on the same plane 1:1 ratio although a 4 mm rise is pretty darn close !  Our man beef with the Saucony Kinvara is that they did not use much black rubber outsole on the shoe other than the small thin layer glued to the traction lugs  throughout the mid and forefoot.  We have found that these shoes barely get 200 miles on them (give or take) and we and all our clients are already into the EVA midsole which wears down as fast as bubble gum might.  This is a serious design flaw in our opinion. We like this shoe and like it for many clients but we are having to explain that they will burn through them in under 350 miles most likely.  So, we are excited for the October Release of the Brooks Pure Project line……in the hopes that they have not made this same design choice.  Remember, if you are new to this line of shoes, the 4mm lift variety, wean down from your old 12-20mm rear-foot lift trainers and try these with your shorter runs until skill, endurance and strength are achieved in this new foot orientation.  It is gonna take some people some time to accomodate.  (remember, there is no substitute for a doctor’s exam and watchful eye to see if you can even entertain this shoe type with your foot type). (Do not be fooled into believing there is going to be much stability provided by these shoes.  They are all pretty neutral. If you have a  forefoot varus, you better look in another direction !)

Here is the data …….

Brooks Pure Connect

lightest and most flexible shoe in the line, the PureConnect puts as little as necessary between the runner and road. 7.2 oz men, 6.5 oz women – 14 mm heel:10 mm forefoot

Brooks Pure Flow

For runners who want to connect with the run without losing the comfort
of dynamic cushioning. 8.7 oz men, 7.5 oz women – 18 mm heel :14 mm forefoot

Brooks Pure Cadence

Runners who need more supportive features can still experience the feel
of a more natural stride. 9.5 oz men, 8.3 oz women – 18 mm heel:14 mm forefoot

Brooks Pure Grit

Trail runners will love the hug-your-foot upper, slim midsole, and pliable
yet protective outsole. 8.9 oz men, 7.6 oz women – 15 mm heel:11mm forefoot

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