Vibram Vilified

Last month a settlement was announced in a lawsuit against Vibram. This suit accused the company of making false statements about the health benefits of wearing Vibram Five Fingers (VFF) shoes. As you presumably know these are the shoes that I run in, and which I credit for many things including curing my plantar fascitis. Without getting into the nitty gritty of the lawsuit, I do want to speak about some of the issues raised and about my personal experiences. I particularly want to discuss the dubious role played by some podiatrists. The gist of the settlement is that Vibram has agreed to pay penalties, and to refrain from making any claims not based on science, although Vibram has not admitted doing anything wrong. In truth, it is likely to be the case that many, if not all, of Vibram's claims will eventually prove to be true. My belief is that the villains in this case are bad science and bad medicine. I won't go into depth about the science, but will state that I have yet to see a scientific study of barefoot running which has a methodology that makes any sense to me either as a barefoot runner or as a research scientist. One example is an oft-cited comparison between minimalist running and running in more traditional running shoes.  This study is so badly designed that none of its results can be considered significant. They took 103 runners, randomly assigned them to different types of shoes, and then had them spend ten weeks training for a 10K race. As far as can be determined, none of these runners had previously run in minimalist shoes. A significant number of the people told to go out and train for a 10K in Vibrams got injured. I could have told them that would happen. Ten weeks is nowhere near enough time to transition to minimalist running.

Despite this sort of shoddy methodology, the negative results are embraced by those who wish to condemn Vibram. Which would perhaps be resonable if podiatrists relied on a scientific basis for their approach to treatment. Oddly, if we were to hold the podiatrists to the same standard to which Vibram is being held, almost everyone who has ever had plantar fascitis (PF) would probably be able to win a malpractice lawsuit. 

As many of you know I used to have PF, and minimalist running has cured me. Yet there are people who report that trying to transition to minimalist running causes PF. How can we make sense of these apparently conflicting data points? Let's start by examining what PF is.

I looked at a number of sites from respected medical organizations, such as the Mayo Clinic.  Every site I found agrees that PF is inflammation of a tendon that runs along the bottom of your foot. But why is that tendon there? The Mayo Clinic says that it is there to support the arch of the foot. But that isn't actually correct. The arch is supported in part by the shape itself, which is how Roman arch bridges work. The rest of the support comes from a set of muscles in the middle of your foot that sit above the arch and pull it upwards. The tendon attached to the bottom of the arch isn't actually supporting the arch, it's stabilizing it: it helps the arch move correctly as your foot changes shape while you are moving. The doctors are correct that PF is a result of the arch being weak, as a weakened arch places more stress on the stabilization mechanism. However none of the recommended treatments for PF involve any measures that would strengthen the muscles in the feet. In fact, one of the most common 'treatments' is to prescribe orthotics. Which provide artificial support for the foot, and restrict the way your foot moves. And what happens when you restrict the movement of muscles? You weaken them. That's right, prescribing orthotics to treat PF might alleviate your symptoms, but they are weakening your feet and making it more likely that your PF will recur. As to the rest of the treatments, while rest seems reasonable enough, standard medical practice is to escalate to steroid injections and surgery rather than exercises to strengthen your feet. And the kicker on all of this? Well, according to WebMD the effectiveness of the standard treatments for PF have "...not been proved in scientific studies." Which means that Vibram is actually being held to a higher standard than the medical profession.

As to VFFs causing PF, this is easily explained. If you have been running and walking in 'normal' shoes, you have been supporting the arches in your feet. Which means that the muscles that are supposed to support that arch on their own are not as strong as they should be. And we've already established that if those muscles are weakened, PF is more likely. This is part of why it is so important to be slow and patient with a transition to minimalist running. Your muscles almost certainly aren't strong enough to run the way a minmalist runner runs, and your running technique is probably not ideal either. The combination of these two factors makes you much more likely to be injured early in your transition. This is also why most people who run, in whatever
sort of shoes, can benefit from doing at least some of their running in minimalist shoes or barefoot.

Which brings us back to the Vibram lawsuit. All I can do is shake my head. Vibram's greatest error was perhaps in marketing VFFs to people who lacked the patience and knowledge to make a succesful transition to minmalist running. Vibram can also be faulted for not being clear that minimalist running isn't for everyone. How it is that a company selling a product which, when properly used most likely will have a positive result for their customers ends up losing a lawsuit; and a profession which commonly prescribes a course of treatment which makes no sense, just treats symptoms, and is likely to increase the chance of recurrence of an injury is unquestionably accepted as experts is beyond my powers to explain.