A new study accepted for publication in Arthritis & Rheumatism says patients walking barefoot or wearing minimalist shoes have reported a reduction in knee adduction as well as reduced pain.1 This article is greatly needed in the world of orthopedics where the majority of orthopedists are still prescribing foot orthotics to treat many of the lower extremity injuries that do not warrant surgery.
Despite the fact that literature does not support the use of foot orthotics for conditions such as plantar fasciitis, shin splints, knee pain, iliotibial band syndrome, piriformis syndrome and many other running injuries, an overwhelming number of physicians and healthcare providers implement orthoses in their practice.
For years, physicians prescribed orthotics to prevent excessive pronation, which they thought to be a biomechanical fault in individuals leading to injuries. This continues to be an indication for use although excessive pronation is not as detrimental as we once thought. Many times it becomes nothing more than convenience for a physician to prescribe an orthotic for a patient with unexplained foot pain. In my practice, these patients tend to show up with bags of shoes and orthotics with continued pain.
The Arthritis & Rheumatism article acknowledges that current studies have demonstrated that both barefoot walking and walking in a minimalist shoe is associated with reductions in knee loading in comparison to conventional footwear. The primary focus of this particular study was to demonstrate a reduction in force to the medial knee as well as decreased symptoms of knee osteoarthritis over a longer period of time, which in this case was six months.1 The study authors looked at the peak external knee adduction moment and the adduction angular impulse. Both parameters reflect the extent of medial compartment knee loading during walking. The results demonstrated an 18 percent reduction of the force to the medial knee as well as a reduction in pain of 36 percent.
This is extremely significant because of its follow-up time combined with previous research that demonstrates decreased force to the knee joints as well as pain as a result of functioning in less of a shoe. A previous study from 2012 showed similar results with minimalist footwear, demonstrating decreased force to the knee joints and reduced knee pain.2
It will take time to see the effects of these studies make their way to actual medical practices, especially the orthopedic and podiatric specialties that focus more on surgical therapy than “running form” and “technique.”
Remember that for the past 40 years or so, podiatrists have believed in and recommended countless amounts of orthotic devices to their patients. They have also taught this philosophy to students and residents. We have seen the evolution of industries in which the primary focus is manufacturing foot orthotics that are custom made for the patient’s feet. It has become commonplace for specialty shoe stores to recommend over-the-counter inserts as an adjunct to the traditional running shoe they sell to their customers. Our society has accepted that we need to support our feet and arches.
While it may take time, I believe we will see a gradual change from supportive running shoes and orthotic devices to more minimalist style footwear. However, the change is beginning as is evident by the focus of current research as well as the evolution of more minimalist shoe gear. Over the past several years, heel height in shoes manufactured by Saucony and New Balance has decreased from an average of 12 mm to 8 mm. More than likely, the change is going to occur in the running and shoe industry first before it makes its way to the medical community.
1. Shakoor N, Lidtke RH, Wimmer MA, et al. Improvement in knee loading after use of specialized footwear for knee osteoarthritis: Results of a 6-month pilot investigation. Arthritis Rheum. 2013 Apr 10. Epub ahead of print.
2. Trombini-Souza F, Fuller R, Matias A, et al. Effectiveness of a long-term use of a minimalist footwear versus habitual shoe on pain, function and mechanical loads in knee osteoarthritis: a randomized controlled trial. BMC Musculoskelet Disord. 2012 Jul 12;13:121.
Editor’s note: Dr. Campitelli has disclosed that he is an unpaid Medical Advisor to Vibram USA.