To Vibram or Not To Vibram: On Minimalist Footwear and Calf or Foot Pain

by Dr. Christopher on February 20, 2012

Barefoot? Shoe? Orthotic? Type of shoe? So many questions …

With a chiropractic practice named Barefoot Rehab and how much barefoot running, Vibrams (those funny looking toe shoes), Inov-8s, and other minimalist footwear are buzzing around the interweb, I guess I should be ready for all of the questions on minimalist footwear.

What are your thoughts on Vibrams, Inov-8s, or Nike Frees?

You’re not supposed to wear orthotics, are you?

Shouldn’t everyone run and walk around barefoot?

Why do my ankles hurt when I run barefoot or when I run with $200 pairs of Nike “Fluffs”?

In this post, I will address some of these questions.

Writer’s note: Please keep in mind, this information comes from the perspective of a doctor who deals with acute and chronic pain, and takes it as his responsibility to get and keep people out of pain.  This perspective may be different than your runner who took up barefoot running without problems, strength coach, or other hippie type who all have their own motives and beliefs.

The Barefoot Theory

Whenever discussing movement, diet, mindset, beliefs, behaviors, or any earthly idea at all, it helps to put it into context so that you have a framework of thinking that governs where the idea belongs in your brain hierarchy.

Benjamin Franklin looks like an idiot when flying a kite in a thunderstorm.  But when you find out that in the context of figuring out how to prevent buildings from burning down by lightning strikes, suddenly Ben’s actions make sense.

People have been walking around barefoot or with nothing but a piece of cloth on their feet for millions of years.  Just like the Paleo Diet works because we eat the food that our genes evolved with for millions of years, so did our feet evolve to not need so much support.

We wonder why when we start sitting in chairs for eight hour days or wearing shoes that the human body has never seen before the past forty years why so many people suffer from musculoskeletal pain?

Ideally, people should be barefoot or wear shoes that resemble being barefoot in order to be healthy, with a multitude of scientific reasons as evidence.  And your kids should never wear any type of fluffy, expensive shoes if you want them to turn out to be super babies.

Anything you can do to live in congruency with your genetic requirements will cause you to be healthier and happier.  Any healthcare intervention that does not take into account evolutionary biology should not be trusted.

We’ll address the caveats afterwards.

The Science of Being Barefoot

We’ve all heard the principle:

 Use it or lose it. ~ God.

Being barefoot asks our body to do more work (more load).

Tom, Dick, and Harry (when dissecting the human body in chiropractic school, these were the names we used to remember the muscles of the deep calf) are going to do at least their 9-to-5 job, and likely be asked to work overtime.  Tom is Tibialis Posterior (the highlighted muscle on the right), Dick is Flexor Digitorum Longus (just to the left of highlighted muscle), and Harry is Flexor Hallucis Longus (just to the right of the highlighted muscle).  All of the miniature intrinsic muscles of the foot will work overtime too.

But it is largely Tom, Dick, and Harry’s job, when on the flat ground, to keep the arch up vs. flat footed.  This is in opposition to conventional wisdom, which states that it is those muscles right underneath the arch.   It’s the calf is responsible for whether someone is flat footed or not!

To confirm the importance of these muscles, in anecodotal studies, when tibialis posterior is torn, the arch completely collapses.

Tom, Dick, and Harry will do their job as long as their asked, before they burn out.  : (

When they burn out, a variety of conditions can fall upon us such as:

  • plantar fasciosis
  • achilles tendonosis
  • Tom, Dick, or Harry strain or otherwise known as “shin splints”
  • Gasctrocnemius or soleus strain
  • Peroneus longus or peroneus brevis strain
  • Tibialis anterior or extensor digitorum longus strain
  • Hip flexor strain (with the calf’s inability to push off when walking or running, something has to compensate, and it is often the psoas, iliacus, or quad)
  • 1st toe metatarsalgia or “John Bunion
  • “Ankle weakness” (which is what I experience from scar tissue in my Tom, Dick, and Harry)

The Pathophysiology of Vibrams (layman’s terms: “how your foot pain develops”)

Another earthly principle for you:

The only healthy posture is one that is always changing. ~The humanly Stu McGill

Going through kindergarten, high school, and college sitting in chairs with nice “fluffy” shoes diminishes our capacity to do work significantly.

Capacity is diminished because of two problems:

1.  Adhesion

Remember, we’re not meant to be sedentary. When we are, muscles stop contracting, blood flow stops.  When blood becomes stagnant, toxins build up (How are the garbage men supposed to get though when there’s a traffic jam?  They can’t!), free radicals enter the scene, damage is done, “adhesion” or scar tissue builds to repair that damage.

Short term solution.  Long term problem.

Many people who start running with no or minimal footwear and develop pain have significant adhesion in Tom, Dick, Harry, and the rest of their crew.   Adhesion glued to the muscles is like breaking the right leg of Tom, Dick, and Harry.  You want your guys to have both arms and both legs to work and not be handicapped.

You can roll out the deep calf with a lacrosse ball.  This can make it less painful to run.

But the only solution to this problem is getting rid of the adhesion in Tom, Dick, or Harry by finding a licensed ART or MAR provider.  Graston or any instrument assisted technique will not be able to penetrate to the proper depth because the gastrocnemius and soleus are more than an inch thick.

2.  Weakness

Load your body close to what it can ultimately handle.  Let it be damaged.  Let it recover.  Then load it more.  Repeat. ~Mother Nature

You won’t realize how much you use your calf and foot muscles until you try barefoot standing or running.

The tricky part is to know when you’re doing too much.

The key part is this: ramp up load (amount of running or standing) slowly. 

With no adhesion present, and you slowly and gradually increase load, then Tom, Dick, and Harry will gradually get stronger without incidence.

And you can run barefoot successfully.

For example, if you run 10 miles a week total in Nike “Fluffonator” Max 95 with a big and bulky heel, Tom, Dick, Harry, and the rest essentially have part time jobs.

Running 10 miles a week in “Fluffs” and too quickly transitioning to running 10 miles a week in Vibrams, Innov8’s, Nike Free’s, or barefoot is like going from working a 20 hour work week to a 40 hour work week, if not a 60 hour work week.

Your lazy, just graduated brother from college just can’t handle that much work!

Exit “Crutch”, Enter “Load Management”

Me – “Dr. Brady, why would I ever want to use a lifting belt when doing deadlift, an orthotic when walking or running, use a chair when sitting, or even a bed when sleeping?  Why wouldn’t I just deadlift 600 lbs, run barefoot all of the time, sit on a physioball at work, or sleep standing straight up like a Conehead?  Aren’t these all just “crutches”?  Why wouldn’t I always ask my muscles to do as much work as possible?  ”

Dr. Brady – “Stupid question Chris. [Just kidding, he didn’t say that.]  No, they’re not “crutches”.  They’re “load management” devices.

Every movement you do has a limiting factor that prevents you from doing more work.

For example, say you’re doing a deadlift or just picking something up off the floor, perhaps your capacities look like this:

  • Your legs can lift 300 lb.
  • Your shoulders can lift 300 lb.
  • Your ankles can lift 300 lb.
  • But your low back can only lift 200 lb.

While the rest of your body can lift more weight, your low back is going to prevent you from lifting any more by rounding over and possibly even getting injured at 200 lb even though the rest of your body can handle it.

You can circumvent this solution by managing the load on your low back by wearing a weight belt and actually giving the rest of your body a workout.  This way, you won’t be limited at 200 lbs and can increase the load up to 300 lbs.

Back to the barefoot conversation ….

If you have:

  • a) adhesion: aka “scar tissue” aka “bubble gum” aka “super glue” in your calf and foot that you can’t get rid of
  • b) overload: your job or life activities require that you load your calf and foot alot, then an orthotic as a load management tool is a good idea.

For example, as a chiropractor, I tend to stand all day.

When I started wearing sole support orthotics, I experienced a great amount of comfort and much less fatigue and achiness in my deep calf and foot.  The orthotic decreased the load on my calf/foot so that it didn’t exceed capacity and I had no symptoms.

To Vibram or Not To Vibram

Long story short:

1.  Sound Theory: I agree that ideally, we’d all be walking or running around barefoot or in minimalist footwear.  Unfortunately, this is reality and not everyone can do this without messing themselves up.

2.  Experiment: In minimalist footwear, increase activity slowly.  Add a mile or two every couple of weeks and notice how your body responds

3.  Stretching: Either before beginning to run in Vibrams or meanwhile, increase ankle dorsiflexion range of motion.  Kelly Starrett uses a band, which is the most effective way to make sure you’re stretching Tom, Dick, and Harry, and not giving yourself an ankle impingement caused by the posterior ankle ligaments.

4.  Orthotics: Generally a good idea if you tend to run or stand alot and are worried about calf health.

In my experience, I’ve found that wearing orthotics throughout the day and working out with minimalist footwear or barefoot is a good strategy for load management of the legs and feet.

5.  Pain: If pain sets in,  find a licensed ART or MAR provider and back off the running.

When it comes down to the ultimate question.  The answer is clear: “Yes … and no.  It depends.”

As always, if you have personal questions, feel free to ask.

Dr. Christopher Stepien is a chiropractor, chronic pain specialist, and A.R.T. provider, and clinic director of the Barefoot Rehabilitation Clinic in Morristown, NJ.  He has been trained under the Integrative Diagnosis system for “clinical excellence”.  He practices out of Guerrilla Fitness:Crossfit Morristown.

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{ 8 comments… read them below or add one }

Natalie Neckyfarow February 20, 2012 at 7:05 pm

Thanks for the excellent article. I’ve been looking for perspectives such as this to share with my clients.

Dr. Christopher February 20, 2012 at 7:08 pm

Happy that you enjoyed it Natalie.

Alexander J. Rinehart, MS, DC, CCN February 20, 2012 at 8:03 pm

Great advice Chris…I like your balanced look at what’s optimum versus the transition/journey of getting there with respect to our lives. “Average” advice doesn’t work for individual people…we each have our own unique set of circumstances/pre-disposing factors/etc that need consideration instead of just jumping on a new fad. Look forward to future posts!

Julie Scarano February 21, 2012 at 7:39 pm

Hey Dr. Chris – Loved this article – Any chance you can direct me toward any “anecodotal studies, where when tibialis posterior is torn, the arch completely collapses”? Would love to use as a resource!

JS

Dr. Christopher February 21, 2012 at 9:37 pm

Thank you Dr. Rinehart! We like to make things black or white, don’t we? The answer is usually gray though, I know you agree.

Glad you enjoyed it Dr. Scarano! My anecdotal information is actually from Dr. Brady, who I’ve asked for his references if he has them. But I did a quick search on pubmed.gov and found the below two articles. They don’t mention “tears,” just “tibialis posterior tendon dysfunction.”

1. “Biomechanical and clinical factors related to stage I posterior tibial tendon dysfunction.” http://www.ncbi.nlm.nih.gov/pubmed/21765219

“The runners with PTTD demonstrated significantly lower seated arch height index.”

2. “Effect of extra-osseous talotarsal stabilization on posterior tibial tendon strain in hyperpronating feet.” http://www.ncbi.nlm.nih.gov/pubmed/21908205

“Posterior tibial tendon dysfunction is considered one of the most common causes of progressive adult acquired flatfoot deformity. “

buy shoes on redmixer.net May 14, 2012 at 4:46 am

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Chino May 20, 2012 at 5:07 am

Hi Jan,Well i guess it could be a combination of thgnis,1. Overdoing the time/milage.The muscles and tendons need time to adapt to the new running form hence the very slow start to barefoot/vibram running.2. There may also be a tendancy to run to much on the toes, instead of the balls of the feet which can apply additional pressure on the arch,toes,achillies and calf.So we all need to remember that our poor feet have been covered up and held prisioner for the last 30+ years and we need to give them time to adapt

Dr. Christopher May 20, 2012 at 8:34 pm

Well said Chino. I like the words you used, “held prisoner”, bound up by shoelaces.

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