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Irene Davis, Ph.D.: Evolution Of The Foot, Running Injuries, And Minimalist Shoes | The Drive with Peter Attia #128

Key Takeaways

  • “If the feet aren’t working correctly, the injury can go all the way to the neck.” – Peter Attia
  • Running shouldn’t be just a skill, it’s an activity of daily living – we run from danger  
  • The two features most often seen with injuries are high impact (landing hard), and malalignment – most commonly the knees tracking inward towards each other
  • The impact is lower when you run on the ball of your foot, which happens more naturally when running barefoot  
  • Choose shoes that let your feet do what they were supposed to do
  • Walking in minimalist shoes is as effective as a foot strengthening program
  • Even kids should wear minimalist shoes as prevention for many of the gait issues and chronic joint pains developed in adulthood

Introduction

Irene Davis, Ph.D. (@IreneSDavis) is a professor of physical medicine and rehabilitation at Harvard Medical School. She’s also the founding director of the Spaulding National Running Center, dedicated to the diagnosis, treatment and prevention of running injuries in runners of all ages and abilities.

In this episode of The Drive, Peter Attia and Irene Davis discuss the biomechanics of running, foot health, running injuries, and modern footwear.

Host: Peter Attia (@PeterAttiaMD)

Evolutionary Changes in Biomechanics of Gait and Running

  • We transitioned from walking to running about 2 million years ago as our brains were getting bigger and we needed meat
  • We evolved to have feet well-equipped to walk and run without any support
  • Running shouldn’t be just a skill, it’s an activity of daily living – we run from danger  
  • Anatomical changes as we went from walking to running: arch developed, joint surfaces got larger, Achilles tendon got larger

Running Injury and Relationship to Foot Anatomy

  • Some people have feet that can’t support themselves
  •  “If the feet aren’t working correctly, the injury can go all the way to the neck.” – Peter Attia
  • Knee is the most common site for injury because it’s the primary shock absorber
  • A second common injury seen in runner’s is a shin splint  
  • The two features most often seen with injuries: 1) high impact (landing hard), and 2) malalignment, most commonly the knees tracking inward towards each other
  • Pattern of injury: Ankle-knee-hip-pelvis-back-neck  
  • Cause of injury: joints experience an amplification of force because muscles have to respond to ground reactive force and compress joint
  • The impact is lower when you run on the ball of your foot, which happens more naturally when running barefoot
  • The softer you land, the more you reduce your chance of injury
  • Try walking barefoot to make your leg compliant – it might be uncomfortable at first but your feet know how they’re supposed to work

Foot Strengthening Techniques

  • “Your hardware is the strength of your musculoskeletal system, the software is your motor pattern.” – Irene Davis
  • Think of your feet like you would the tires on a car – every bit of force generation comes from those two points of contact
  • Feet have muscles and just as much ability to strengthen as other parts of the body
  • The goal is to get people into minimalist shoes to preserve strength
  • You can change your gait but it requires patience
  • Slowly take orthotics out for short period at a time and wean off
  • Try not using orthotics in 1-hour intervals throughout the day while around the house
  • Pre-gait program: anywhere from 1-3 months of foot strengthening, functional activity, muscle engagement practice
  • When you start wearing minimalist shoes, walk 30 minutes briskly and incorporate running slowly

Origins and Consequences of Footwear

  • The prime purpose of footwear is to protect from the elements
  • Bark with straps appeared about 10 million years ago to protect the bottom of the foot
  • Instead of letting evolution develop tough feet and waiting for calluses, we basically took a shortcut by developing footwear
  • Running shoes started as a flat piece of leather that protected the bottom of the foot
  • Up until the 1960s, runners wore what we would describe today as minimalist footwear
  • People got excited about running and fewer fit newbies developed injuries
  • As Achilles tendonitis became more common, people sought a bit of cushion and heel lift
  • Shoe variations developed: flexible shoe for low, flat foot; cushion shoe for a high arch, rigid foot; and stability shoe for a normal arch
  • Instead of having the shoe adapt to the runner, we made shoes and had the runner adapt their gait
  • There is no difference in injury pattern even when you match the foot to the shoe 
  • Focus on strengthening and controlling your feet over tailored shoes
  • Studies show that runners land harder with an increase in shoe cushioning  
  • “Footwear changed our mechanics from a forefoot strike to rearfoot strike.” – Irene Davis

Results of Force Place Treadmill Studies

  • If you’re running in a highly cushioned shoe (such as Hoka), you’ll likely heel strike
  • In heel strike, the load rate is higher
  • There is a difference in forefoot strike in regular shoe versus a minimalist shoe
  • Anterior-posterior effect of forefoot strike in a traditional shoe: more plantar flexion, greater stress on Achilles, greater braking force
  • Medial-lateral effect of forefoot strike in a traditional shoe: tendency to be on the outside of the foot when landing (bottom of feet point toward the midline of body), greater lateral force applied to the ground
  • Forefoot strike in a minimalist shoe: toes are less pointed, the foot is more leveled when landing, reduce forces, reduce rates of loading – overall softer landing
  • When people transition to forefoot strike pattern in regular shoes, injuries and discomfort often develop
  •  “If you transition to forefoot strike pattern, it should be done in minimal shoes.” – Irene Davis
  • “If you remain a heel foot strike, make sure there’s cushioning under your heel because you’re going to need it because you’re hitting hard.” – Irene Davis

Minimalist Versus Partial Minimalist Shoes

  • Patterns of striking in runners wearing partial minimalist shoe resemble heel strike of traditional shoe wearers   
  • You need to be in shoes that let your feet do what they were supposed to do
  • Even kids should wear minimalist shoes as prevention for many of the gait issues and chronic joint pains developed in adulthood
  • Walking in minimalist shoes is as effective as a foot strengthening program
  • Transition to minimal shoe requires changes in walking and imposes greater demands on foot and ankle
  • There is a difference between a minimalist shoe and a partial minimalist shoe
  • In a study comparing traditional shoe, partial minimalist shoe, and minimalist shoe – partial minimalist shoe wearers had most injuries
  • Features of a minimalist shoe: no elevation of the heel, no cushion or support, no midsole, flexible heel, can be rolled into a ball
  • Recommended brands for minimalist shoes: Xero, Vivobarefoot, Innov8

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