A Cautionary Tale of Toes and Woes: Part Two

Löpning illustration, Running illustration

Anyone who takes notice of the other creatures in this world will clearly see that we are all made differently. Humans come in all shapes and sizes and have unique patterns of movement (gait) – the feet are no different: some are arched, some are flat, wide or narrow, etc. As our bodies develop, we adapt to how our bodies are built, and movement develops accordingly. When we put a shoe on our foot that forces a change in how the foot is supposed to function, or even shift its anatomical development from what the foot is supposed to become, we are forced to adapt our motion further.

I have been a shoe-wearing human for almost 51 years. The youngest of 3 boys, I might have been 16 before I put a shoe on my foot that was newly purchased in a store. I grew up during the running boom of the late 70s and early 80s and my fascination with running was cemented while watching Dick Beardsley and Alberto Salazar running up Heartbreak Hill in 1981, standing with my friends’ father, following the race on his transistor radio. It’s been 40 years, almost to the day, of that race.

For almost the last 30 years, I’ve dedicated my life to understanding feet and trying to help runners not just finish marathons, but, most importantly, get to the starting line. The late ‘70s and early ‘80s were the best of times for running as they brought so many into such a wonderful and meaningful sport and way of life. It was also the worst of times because so many people new to the sport bought shoes that didn’t allow the feet to work in the way feet needed to work.

An industry then boomed to try and solve many of the problems they created in the first place.

The thought was that we needed more cushion, more support, more motion control against pronation, more, more, more. In response, more was provided by the shoe industry and more injuries ensued.

In 2009, Born to Run by Chris McDougall was released. For so many people, that book changed the paradigm of how they viewed running and shoes in general. The shoe industry, for so long, forced us to believe you needed something in a shoe to allow you to run properly and safely. This book showed that you don’t even need shoes to run in even the harshest of environments and seemed to herald the minimalist shoe movement.

While my peers (podiatrists) seemed to scoff at the notion of feet that don’t need support, millions of runners embraced a different way – including me. The shoe industry and “experts” who (think they) know best have some validation that minimalist shoes can lead to stress fractures and other problems and like to point at a class action suit against Vibram 5 fingers settled in 2014 that “proved” that claims made by Vibram saying the shoes would reduce foot injuries and strengthen foot muscles.

In my opinion, the only thing proven was that humans are impulsive and often fail to read instructions properly.

The reason so many injuries occurred (and I saw an uptick in stress fractures and metatarsal pain) after Born to Run was released, was that runners switched philosophies overnight; they went from a shoe that their running form and feet were accustomed to, to a shoe that had no support or cushioning. Runners who didn’t allow their feet or form to adapt to this change made themselves susceptible to injury.

Remember what we said about how everyone’s foot is made and moves differently? That means what we need to cover our feet is also unique to the individual.  Ironically, the pandemic (worst of times) created another running explosion (best of times) – only this time, we have many more options available for runners’ feet.

While I don’t believe shoes are necessary in most circumstances, the reality is that we have developed our feet and movement patterns while wearing shoes so they have become a necessary accessory. Even still, shoes can only do so much.

It is my sincerest belief that the best shoe we ever wore was the one we were born with.

Those shoes fit perfectly, were extremely light weight and didn’t alter our posture, just as nature intended. When the fit of the shoe is different from the foot it envelopes, then the shoe is providing a deforming force to the feet. This is especially detrimental to growing feet. 

Not every shoe is bad. Nor is every foot going to be negatively impacted by a shoe that isn’t a perfect fit. The key is to find what works best for our feet and our movement and allows us to reach our potential while at the same time minimizing the potential for injury and setback.

For many years, the shoe industry has been trying to use technological advances in materials, cushioning and/or support to offset the mechanical problems that running with bad form causes. Of the conditions that most runners will be likely to experience, let us next look at where the problems start so that we know how move forward with addressing them.

Spoiler alert: it’s not just the shoes.

About Dr. Feldman

Dr. Neil Feldman is the Director of Central Massachusetts Podiatry., specializing in reconstructive surgery and sports medicine. With more than 20 years of private practice experience, Dr. Feldman is board-certified in Foot Surgery, active in the Massachusetts Podiatric Medical Society and is a Fellow of the American College of Foot and Ankle Surgeons. Previously, he served on the Massachusetts Podiatric Medical Association Board. 

An accomplished athlete, Dr. Feldman has run numerous marathons, including 12 Boston Marathons, and clocked in a personal best of 2:51 at the Bay State marathon in 2013. He also completed 7 Ironman triathlons, including the Ironman World Championships Kona in 2004 and 2008. He also took his endurance running endeavors to new lengths when he completed seven 100M events, including 2 Leadville finishes and twice breaking 20 hours at that distance while sporting the MT-3 (Javelina Jundred in 2016) and Terraventure (Vermont 100M in 2017).