3 Reasons you hate running: part 2 - your footwear
At SOF we are lucky enough to be surrounded by some well nourished minds, particularly around all things regarding health and wellness. This week, we are lucky enough to have insights from Izzy O’Sullivan, a PhD Candidate of UQ SHRS, physiotherapist and SOF’s very own pilates instructor (Tuesdays 6am for those wondering). Izzy has given us a peep into the world of footwear and barefoot running. Enjoy!
My research specifically looks at patellofemoral pain syndrome in adolescents. A part of this and a study I am currently working on is the effects of flat versus contoured orthoses as a treatment for PFP in adolescents (protocol). Through the process of this study many more questions have developed for me in terms of the effect of footwear and how important it is for injury prevention or management. Another important question is barefoot running and where that fits in.
Now more than ever we have access to unlimited information. When we go to the shops we are flooded with choices for footwear. For me I want to know what the best evidence says …
Before looking at footwear a number of other factors should be considered that will be major players in injury prevention and management. These are:
- Education around what’s occurring to cause this
- Load management
- Analysis of running or walking style
- Strength and conditioning!
Most running injuries can be managed by proper education, load management and a good strength and conditioning program prescribed by a physiotherapist or exercise physiologist. The impact of shoe choice is not as significant as people believe.
Some important factors to consider around shoe type and injury are:
- Sudden change in footwear: large changes in footwear may lead to large changes in running style and increase injury risk. It’s important to make small changes over time to allow your body to adjust to the changed distribution of load.
- Does running in a specific type of shoe feel more comfortable: comfort is an important factor along with symptoms for injury management.
Sudden change in footwear to minimalist footwear or no footwear is a major injury risk. Barefoot running has been a phenomenon since 1960 when an Abebe Bikila won an Olympic gold running barefoot in the marathon. Since then many studies have shown its ability to improve running performance and economy. When considering the evolution of our foot, humans have been running for 2 million years. Major anatomical changes are said to occur when humans went from walking to running:
- Medial longitudinal arch developed
- Joint surfaces got larger to distribute the forces
- Achilles tendon got longer to store more energy
These changes occurred to optimise running performance. We evolved to have feet to walk and run without any need for footwear. When you consider the anatomy of the foot it is very complex, much like the hand. Within the foot there are 26 bones, 33 joints each with 6 deg of ROM and 4 layers of muscle that make up the arches. The foot is diverse in function in that it can be malleable to adapt to uneven surfaces but also a stable and stiff lever to push from.
Only recently has footwear come into play. It is understood that major forces occur at the lower limb when running. Biomechanical studies have shown peak GRF is 2.5-3 x your body weight at the achilles and 7 x at the knee. Motion controlled footwear started when sports podiatrists were hired at Nike to help prevent injuries in runners. Acknowledging these large forces, podiatrists clinically reasoned that shoes should be adapted to suit the individual and reduce load on the lower limb. The problem with this is that when you apply cushioning or support to the shoe people start landing with greater force through the heel and the muscles get weaker. In a study by Knapik et al., 2010, when shoe type was matched to the foot i.e, motion control shoe for a low flat foot that’s flexible, a cushion shoe for a high arch foot and stability shoe for a normal arch and then you compare that to a group of people that all received the same shoe - there was no difference in injury risk.
Overall message here is…
Humans have been running for a long time, supportive footwear has only come about in the last few years. Human bodies are adaptable to the environments in which they are placed in: if you strengthen intrinsically and gradually increase load you will adapt to any footwear or lack thereof.
However, this must be done appropriately.