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Research Study Looks at Foot Injuries from Transitioning to Vibram FiveFingers

Recent research released late Feb. 2013 implies that there’s a good chance transitioning to Vibram FiveFingers may cause injury—specifically, bone injury.

The study was titled “Foot Bone Marrow Edema after 10-week Transition to Minimalist Runni…

Recent research released late Feb. 2013 implies that there’s a good chance transitioning to Vibram FiveFingers may cause injury—specifically, bone injury.

The study was titled “Foot Bone Marrow Edema after 10-week Transition to Minimalist Running Shoes,” and the abstract can be found below. In brief, the study did the following:

  • Looked at 36 experienced, recreational runners, divided them into two groups, kept 17 running in their traditional shoes for the 10 week study period, and had the other 19 transition to running in Vibram FiveFingers over the 10 week period.
  • They used MRI scans before and after the 10 week running period to look for “bone marrow edema,” which is an indication of injury/inflammation as fluid builds up inside the bone.
  • The experimental group undergoing transition to FiveFingers running followed “[A] plan based on one offered at the time of the study (early 2011) on Vibram’s website. In the first week, they did one short run (1-2 miles) in Vibrams. During the next two weeks, they added another short run in Vibrams each week; that is, by the third week they were to do three runs of at least 1 mile in Vibrams. After the third week, they were told to increase the amount they ran in Vibrams as felt comfortable, with the goal of replacing one short run a week in conventional shoes for a short run in Vibrams.” [Details per RW]

The study found that slightly more than 50% of those transitioning to running in FiveFingers showed increases in bone marrow edema in at least one bone at the end of the 10 week period.

A cursory interpretation of the study would be that you’ve got a 50% chance of injuring the bones in your feet on transitioning to toe shoes like FiveFingers. As you might expect, the research is making waves in the minimalist/”barefoot running shoes” community.

What would a more nuanced take on the study be? I wanted to know, so I reached out to a few of the usual suspects—runners who have transitioned to minimalist/barefoot shoes including Vibrams and have personal experience around the subject.

What follows (after the jump!) are their thoughtful responses to this study. Read on!

Round the horn on responses to the study

I reached out to take the pulse of a few runners whose experience and opinions around running minimalist or “barefoot” I respect. A few are regulars here on BirthdayShoes — Tim Kelley, Greg Woods, and Rob Youngren — and I also had Tuck of Yelling Stop and Barefoot Ted’s barefoot/minimalist running forum fame weigh in, too.

Here’s what they all had to say!

Rob — “Extreme motivation needs to be tempered with extreme patience!”

I’ve actually just been reading through the many comments over at the Runner’s World write-up on this study and my thoughts closely match what Mathew Wallden said:

This is a great study – well put together and interesting results. The key is surely to get the right balance.

In essence what it shows is that there is a training stimulus to the bone if you wear VFF’s, or no training stimulus to the bone if you wear normal running shoes (having already been wearing them for years).

If that training stimulus is too great, the tissue will break down. If the training stimulus is correct, the bone will strengthen. It is much the same as lifting weights – we all know that this also stresses muscle (and bone for that matter).

If I were to ask you to lift a load you have been lifting already – and have been doing so for years, when I reassess your muscle at the end of 10 weeks, I would see no change, no training effect, and no inflammatory markers on MRI. If I asked you to increase that load (and we know BF running increases loads to the 2nd Metatarsal head as it creates a more efficient running action) then after 10 weeks we would see a) inflammatory markers and b) gains in muscle strength. However, if I asked you to either lift extreme loads, or take no rest days, I would expect to see an injured muscle with a lot of inflammatory markers… This is simply what is going on here.

Anyone who is in touch with their body will not have these problems and will only strengthen as a result. Anyone with a no-pain, no-gain mentality is at high-risk of injury. Which category do you fall into?

I’ve honestly seen enough injury testimonies on BirthdayShoes.com from VFFs and other extreme minimalist footwear over the last couple of years that I firmly believe this study is spot on.

We can’t ignore the fact that people are indeed getting injured wearing this class of footwear.

Now what I can’t comment on is, overall, is this injury rate out of the norm compared to the injury rate of folks wearing more traditional footwear. I could be convinced either way. Running is extremely tough on your body: joints, muscle tissue, ligaments, bones etc…, especially for those who are relatively new to the sport. It takes A LOT of time on the feet for your body to adapt which is why you often see so many traditional running shoe folks suffer from shin splints or plantar fasciitis and other ailments. So perhaps what we’re seeing is just growing pains but in a different way; the dreaded TOFPs, stress reactions/fractures and other issues with minimalist footwear. Either way the answer is to back off the approach as it’s obviously too much too soon!

My own view is that you can probably get MOST of the benefits of “going minimalist” by just wearing more minimalist footwear casually and NOT on your run (it’s what I’ve finally done); we spend more time NOT running in the shoes we wear everyday right? We may all be “born to run” but sadly not all of us have the proper mechanics, build, and skeletal structure to just get off the couch and expect to NOT get hurt.

Extreme motivation needs to be tempered with extreme patience!

Rob

Tuck — “I think they’ve got their conclusion completely backward”

As far as the study goes, I thought it was interesting, and while the injury rate was a bit higher than I would have expected, they’re of the sort that people typically report online. I think they’ve got their conclusion completely backward: “This study supports the idea that, while running in barely there shoes can strengthen lower leg and feet muscles, the lack of cushioning can increase risk of bone injury.” What this study demonstrates is that wearing cushioned shoes prevents your body from learning how to run naturally in a way that prevents injury: the way you evolved to run.

Shoe companies sell you something that makes you dependent on their products. Even a decent runner is so dependent that going to a more natural shoe leads to serious injuries. Why on earth would people want to do that to themselves? 10 weeks sounds like a reasonable adaptation time although longer might be necessary. Mine was about 6 weeks, and I did suffer from various sore bits as I relearned how to run. Once the transition was done, it was well worth it. Years of shin splints are a distant memory.

Tuck

Tim — “I agree with the findings completely!”

I agree with the findings completely! If you make the transition to VFF running too quickly, you’re bound to hurt yourself and I think that’s exactly what happened here. I remember when I was first starting out—about three months into wearing them—I used a pair of VFF Sprints for a triathlon. The fatigue from the race effort made my form breakdown towards the end, but coupled with adrenaline of the race, I pushed through the discomfort in my foot. I ended up not being able to run for several weeks afterwards because one of my metatarsals ached whenever I tried.

In the study, starting out with a distance of 2 miles and working up to multiple runs of more than that in a week is VERY aggressive. I’d recommend starting out doing less than a quarter mile for the first couple of runs and then slowly building up more, especially if you’re new to running. If you’re a seasoned runner, try adding some VFF running as part of your cool down after a workout. Another tip would be to ease into VFF running with an intermediate shoe that has a zero drop heel and a bit of cushioning (Skora’s offerings or New Balance’s Minimus Zero lineup are examples).

Tim

Greg — “The idea that it might take more than a few months to [transition] isn’t absurd”

I’ve been thinking about this a lot, actually.

I think there’re more facets to both the study and its presentation than it seems at first blush. Some minimalists may react strongly to the story, since athletes are often very passionate about their styles/preferences/technique. But hopefully some can approach it with an open mind. I may not have done as much if the study hadn’t mentioned pain in the second metatarsal, which is where I experienced a lot of pain and swelling (but thankfully no fracture) during my transition.

First, what’s wrong with the study: I think that leaving it up to the runners to follow the transition plan on their own is inadequate. It makes a big difference to have someone show/coach you during the transition. Otherwise you’re evaluating varied data since each athlete may understand and take to it differently. Take condoms, for example. Very effective as birth control and STD prevention, but only if used correctly. Problem being that they rarely are. Likewise, the study seems not to control for proper use. All that said, I do agree that it may take longer than the suggested 10 weeks. For me it did. It’s been a little over year and a half since I first ran in FiveFingers, and only in the past week when I finished my first marathon — and in huaraches — did I really feel 100% confident that I’ve finally “got it.” And even so, it’s something that I’m constantly refining. (Walking minimalist is something I STILL need plenty of work in, surprisingly.)

In other words: I don’t think this study is basically “bad” or anything. Most of us have been running/walking in very particular ways for a few decades, so the idea that it might take more than a few months to change it isn’t absurd. Although it may sound as much to runners, given what a historically stubborn bunch we can be.

That’s my $0.02.

Greg

What do you think?

Thanks to Tuck, Rob, Greg, and Tim for lending your perspective to this study.

As for my own (Justin’s) view of the study, what jumps out to me are that the study took experienced runners, put them in shoes that were likely very different from their typical shoes, and set them on a fairly one-size-fits-all transition plan to running in toe shoes.

Why do these two things jump out? First, experience matters. The nuances of how we walk, run, and move are educated over the course of thousands of iterations and the shoes we wear affect those iterations — steps — in subtle but profound ways both in how our bodies are built (how strong our muscles and bones are as well as which muscles and bones are strong) and also how those bodies are in motion — the length of our gait, the way we position legs/feet/arms/torso, where our feet touch the ground first, how quickly we lift off, and on and on. When one variable in this incredibly complex equation is changed, we have to adjust everything. What I’d love to see is a study that looks at how long it takes for running form to change (imagine how hard it would be to set this study up!). My hunch is that the more experienced you are running a certain way (and in this case, learned wearing regular shoes versus ultra-minimalist “toe shoes”), the longer it takes to adjust. But even then, your mileage may vary because …

Secondly, success with transition is affected by experience, which means that a one-size-fits-all approach to learning a new way to run is going to be problematic. These adjustments required when switching from a traditional running shoe to a minimalist running shoe are going to be many. They aren’t likely to be made consciously nor are they likely to be made quickly. There’s a reason for the saying “You can’t teach an old dog new tricks.” And while we human beings have an amazing ability to adapt to new circumstances (See: The Brain that Changes Itself), the adaptation takes time and the time and effort required is going to be different for each person. I understand how and why this study applied the transition program suggested by Vibram, but I also believe that one of the reasons minimalist/barefoot shoes can work to improve running form (and ultimately reduce injury) is because they interfere less with the feedback we get through our feet. Since the feedback we get from our bodies (e.g. “ouch this hurts!”) is the only real “coach” most runners have, it follows that you’d want to crank the volume up. Minimalist shoes like FiveFingers go a long way (though not all the way) to doing just that.

What do you make of this study? Does it jive with your personal experience around transitioning to Vibram FiveFingers (or other minimalist footwear)? Let’s hear your thoughts in the comments below!


 

Study Abstract

Foot Bone Marrow Edema after 10-week Transition to Minimalist Running Shoes

Abstract

Purpose: Minimalist running shoes are becoming a more popular choice for runners in the past few years. However, there is little conclusive evidence about the advantages or disadvantages of running in these shoes. While performance benefits may exist, injury may also occur from the added stress of running without the benefit of cushioning under the foot. Bone marrow edema can be a manifestation of added stress on the foot. This study measured bone marrow edema in runners’ feet before and after a 10 week period of transitioning from traditional to minimalist running shoes.

Methods: Thirty-six experienced, recreational runners underwent MRIs before and after a 10 week period. Seventeen subjects were in the control group (ran in their traditional shoes only for 10 weeks), while the other 19 were in the experimental group (gradually transitioned to VibramFiveFinger running shoes over 10 weeks). The severity of the bone marrow edema was scored on a range of 0-4 (0 = no bone marrow edema, 3 = edema in more than 50% of the length of the bone). A score of 4 represented a stress fracture.

Results: Pre-training MRI scores were not statistically different between the groups. The post-training MRI scores showed that more subjects in the Vibram group (10 of 19) showed increases in bone marrow edema in at least one bone after the 10 weeks of running than in the control group (p = .009).

Conclusions: Runners interested in transitioning to minimalist running shoes, such as Vibram FiveFingers should transition very slowly and gradually in order to avoid potential stress injury in the foot.

(C)2013The American College of Sports Medicine

* This is why I think Michael Sandler’s advice on transitioning is probably the best around: let your skin be the guide by maximizing the feedback-training-loop through your feet by doing some actual skin-on-the-ground barefoot running.

Photo via Tyson

By Justin

Justin Owings is a deadlifting dad of three, working from Atlanta. When he's not chasing his three kids around, you'll find him trying to understand systems, risk, and human behavior.

40 replies on “Research Study Looks at Foot Injuries from Transitioning to Vibram FiveFingers”

I’ll also say that Pete of RunBlogger is likely to have a few thoughts on this study but he’s presently on vacation!

Here’s one thought Pete did share with me, “Biggest issue for me is whether edema is a sign of bony remodeling and not an injury per se.”

I thought I saw where he was headed and replied back, “that edema may just be a sign of change — not unlike how muscles tear and rebuild from weight-training.”

Pete noted, “Yes, the muscle analogy is a good one. Edema can be a sign of adaptation and repair, ultimately making the tissue stronger. Nobody would say to stop lifting because it causes edema and micro tears in muscles.”

Looking forward to hearing his full thoughts when he returns!

Great article! I really appreciated the different takes.

The abstract was a bit light on some details of the study (is there a full version somewhere?). Do you know who the study was funded by? Also, is there any mention about which fivefingers model(s) the study participants used?

My initial reaction was similar to Pete’s. What’s wrong with “bone marrow edema”? The real question for me is whether those diagnosed perceived a problem or were able to keep running. I had never heard of it, and wondered if perhaps I’ve experienced it as I’ve transitioned to minimalist and barefoot running. Sometimes the bottom of my feet feel rather sore, but it is usually something that heals rather quickly (less than 24 hours). When I did my first marathon in VFF’s the bottoms of my feet were very sore for a few days, but after that they were fine. When I run long distances in VFF’s (or similar shoes) I find it helps to concentrate on landing lightly. I’ve wondered if the pain of having no cushion on pavement for long distances is a part of conditioning or a reason for worry. More on this would be helpful.

no kidding… i only walked in my vibrams for the first few weeks before i even attempted to run in them and when i ran in them it was short distances to start.

i don’t understand what people don’t get about how a MAJOR change in footwear, protection, and running style can damage your feet if you don’t ease into it

Seems like kind of a biased study to me. You are taking two groups of people and only making a change to one of them. If focus group A is already accustomed to running in traditional running shoes and focus group B also was, and now they are changing it up and introducing minimalist footwear, it would stand to reason that group A would have little or no change and group B would have change. I think a fairer comparison would have been if two groups of non-runners were assembled and then have one group transition into running in traditional running shoes and the other group transition in minimalist footwear. I’d be curious if the results would be the same in each group, both having edema and in which group would it be worse. Oftentimes when a research study is formed, the person conducting the study already has a hypothesis on what results they are going to achieve and oftentimes they are right, because they skew the data to reflect their beliefs, whether intentinally or not. Just my two cents worth.

Honestly? 10 weeks?

Transferring to VFF’s took me 9 months and a very slow build-up. During those months, I experienced TOF pain, lower leg pain and sore calves… Of course. I experienced that all these discomforts disappear, as soon as you allow your body to recover by taking your time.

The biggest challenge of running is taking it easy – and that doubly applies to barefoot(style)running.

The first thing i did was look up what an Edema was. It’s basically a bruise. A bruise within the bone. Is that surprising to anyone that you might have a bruise or two?

Second, Vibram doesn’t tell people to change their running form and they should. A lot of “recreational” runners run with with incorrect form, thanks to running in shoes all of their lives! So running incorrectly without any shoes or in Vibrams may get a person injured, even cause a bruise or two!

What this study implies, is that humans are NO LONGER capable of running without shoes! We can no longer run as we were born to run! How shameful!

I myself was willing to bruise my feet and bones in order to strengthen them to the point that i no longer need shoes. I had to change my form too and i am immensely better for doing it.

I am planning on lifting some weights this Spring too to get into summer shape. My muscles will get sore (MRI will show inflammation and bruising of the muscles) but i expect that has to happen in order to build strength. Hmmm, sounds familiar!

Regardless of the merits of this particular study, I think it is simply important to acknowledge that adaptation to minimalist or barefoot running takes time. It was a process of months, and even years, for me to get where I am now (partially documented in my blog since 2011). And I’m still stretching myself, monitoring the sensations in my feet, as I plan to run my first marathon in Vibram FiveFingers this May. I have no intention of suffering a stress fracture or the like, so if I encounter problems as I increase my mileage, I will certain report on them.

I have been running essentially daily for 40 years now. I started in 1973 and have never had a running injury. When I started wearing VFF in June 2010, I wore them walking for 2 months before even attempting to run in them! Once I started using them for running, it was one day per week again for months. I gradually added a day here and there. It took me 2 1/2 years before fully transitioning to VFF and wearing them on ALMOST all of my runs. I still wear traditional shoes once or twice per month and I wear traditional shoes for walking.

I am completely sold on VFF as a running shoe, there is NO other shoe that provides the running experience that VFF does. BUT if you have spent your whole running life in traditional running shoes, it will take time to transition.

Because people are different, I sincerely believe that not everyone can wear VFF running all of the time. There are people who do need some support, cushion, a stiffer shoe, etc. If a person genuinely likes the experience that VFF provide, it is best for that person to discover a what level they can wear VFF and how often they might need to trade off with traditional shoes.

I would also like to see a study with three cohorts: padded running shoes, VFF, and barefoot. I wonder whether the barefooters would have experienced the same degree of bone edema as the VFFers.

Count me among those who have suffered a stress fracture (on the second metatarsal) after switching to VFFs, but also put the blame squarely where it belongs: on me. I was running a lot, and the idea of switching back to running such short distances was more than I could wrap my head around. I convinced myself that because of the shape I was in, I could switch faster, and I ended up walking around in a boot for 6 weeks followed by another 6 weeks of no running, followed by a year of dramatically slower pace.

It’s been about 2 years since, and they are the only shoe I’ve run in, so I’m doing okay. My pace is now faster than before the injury, and my calfs have never been so amazingly in shape.

I do notice the wear on my feet is much more intense, especially the ball of my feet, and in particular the second metatarsal. So I generally don’t put in the longer distances I used to, but if I’m running a few halfs a month, I think I’m doing okay. I’ve actually been thinking of getting a pair of non-minimal shoes for the 20+ runs I used to enjoy, but my main running shoes will remain VFF.

Hi.

the study might be right – but the time span is to short.
it took me months to fully change my running style.
I even might have had some hidden injuries in my bones.

So I took it easy. that was a pain.
Because I was able to run for hours in my padded fugly shoes.
but with my vibrams I stuck to a small traing unit not to overstress my feet.

Now after one years in vibrams I don’t want my heel strike shoes back.
I have less problems.

rgds

I’d say the transition should be walk in them and work your way up. Like all the info says, when starting out take it easy so you can adjust.they seem to jump right into running in them.

This research is very biased. Changing from normal shoes to minimalist shoes take time. A lot of time. One can’t simply put them on and run right away without going through the process of strengthening their feet.
The research think it would make the result sound more reputable by using experienced runners is totally fail. It’s like weight lifting. if you lift too little weight, you are not seeing gain, if you are lifting too much weight, you gonna hurt yourself. Progression is the key.

I think most of the replies will mirror my comments, so I won’t bore anyone with more. What I would like to add is, I would like to see a study that does the opposite of this one.

Let’s take seasoned VFF runners and put them into conventional running shoes and see what happens. Can anyone say atrophy and bone density loss? The primary problem with this study would be finding anyone willing to put conventional running shoes back on. I know I sure as hell won’t!

As the other comments, slow to go minimal. I don’t like VVF myself, they don’t let your toes do a natural movement. I run in sandals, which I make now. On steep rocky trails about 2-4 hours five to six days a week. This took time and experience to achieve. If you go to REI you see all these people trying on VVF thinking they can just go run and I laugh, cause they don’t do any research. It takes time.

I have Ehlers-Danlos, basically a genetic mutation of my collagen that makes my joints very unstable, my skin easily bruised, and my organs fond of spontaneously rupturing. my joints dislocate while walking, while sleeping, while typing – pretty much all of the time and without excessive force. i am, essentially, the Scarecrow from the Wizard of Oz when he collapses while dancing. i also have an irregular heartbeat and dysautonomia – when there is too much of a load on my heart it does not compensate well and my brain tells my body to shut down. i faint. i live with chronic aches and pains from the constant dislocation and reduction of my joints. i am exciting to exercise with because if i push too hard i will pass out. i have never been able to run – ever. in high school my body would scream in pain from running a single mile of laps. often, i would collapse with a sprained ankle. before my diagnosis i assumed i was clumsy…and people would assume i was overdramatic. as an adult i found VFFs when i was looking for water shoes to wear on vacation. the more i read, the more intrigued i became. reading about the angle from heel to toe of a running shoe made me realize that i was attempting to run, with totally unstable ankles, on something akin to a high heel. the cushiony soles deadened any feedback my feet could give my brain about the terrain. of COURSE i fell. a friend asked me to run with her and my immediate thought was to curse her out violently. i had nightmare flashbacks of the pain associated with physical education and the time i spent with my ankles wrapped and using crutches. then, i thought i would just go minimal. i had zero running form. i had never been able to run so i had no habits to break. no transition to make. and pain? i know pain. i know what’s regular pain and not- regular pain. so…i started slowly…because i am middle aged and out of shape. i have run exclusively in VFFs. i have run a handful of half marathons, a triathlon and i finished the marine corps marathon this year in my Spyridons. the girl who would turn her ankle, had her own orthopedic surgeon, and spent 1/3 of her life on crutches or in some sort of brace. i haven’t had a serious injury. i wear my shoes to work. i wear my shoes everywhere. i think wearing my shoes for 2 years as pedestrian shoes made a transition to using them for running feel more natural. i realize that i am only an anecdote and my n =1 sample size doesn’t make me statistically significant. i do, however, believe that my shoes have helped me to be a healthier person. my feet, my knees, my hips and my back hurt far less. i hike in them. i walk the mall in them. i have walked Disney World, et al, in them TWICE…for upwards of 10 hours. at this point i am almost crippled by regular shoes. they cause such pain within such a short period of time. i think a confounding issue of the study is that these are regular people, wearing regular shoes for much of their pedestrian life…who for a short period of time during their day wear a minimalist shoe for a high impact activity. their foot hasn’t accommodated, their brain hasn’t accommodated – they haven’t transitioned at all to even WALKING in the shoe. of course they hurt themselves running. that’s like asking me to wear a cast on my arm for 23 hours a day…and then spend an hour punching a heavy bag at the gym…and then repeat. i would probably get hurt letting my arm atrophy and then boxing!!!! i think they didn’t adjust for all of the variables. i would have liked to see a control group of people who transitioned completely to only minimalist shoes for all shod activities.

“Biggest issue for me is whether edema is a sign of bony remodeling and not an injury per se.”

my thoughts exactly when I read it. I literally jumped from a lifetime in heavily padded sneakers to Vivobarefoots with no insoles and VFFs for running, just like that, one day this life, the next the new one, no transition. My feet hurt for 3 months to be sure, but my knee and hip chronic pain disappeared instantly so I couldn’t care less about foot pain. They were actually swolen and some bones hurt for a long time. 5 months down the road and I still get a little sore after a long run but my old solar pain on all the boney pressure points also disappeared forver. No matter how much damage may have come from this transition, the strenghtening and readjusting more than makes up for it.

This is going to mirror some comments that have already been made above, btu I’ll at least share my experience…. I’ve been running in VFF’s since 2010, and logged over 800 miles in them, including a few half marathons… I didn’t follow Vibrams “transition” recommendations and instead just listened to my body, meaning that I cranked it up when things felt good and slowed it down when things felt a little tender. This meant going back and forth between normal running shoes and VFFs for the first six months. But now I am 100% on VFFs and will probably never look back.

Anyhow, that’s just my personal experience.

The problem with “bone marrow edema” as a finding is that it is not indicative of true injury. It sounds scary, but doesn’t actually mean anything for short term nor long term health.

I agree with a lot of comments here above. If anything, this study only proved that the 10 weeks recommendation from Vibram was plain wrong.

I switched to a minimalist form due to recurrent injuries a-la “nothing seems to be working so I might as well try that silly idea” and it took me about 2 years of closely listening to my body to build back to my injury-free normal mileage (about 20 miles a week).

After 10 weeks, I was barely running 5 miles a week and was still spending more time taking care of my feet and calves than I was actually running… but my other injuries were already gone.

Any study of that kind needs to be performed over a (few) year(s), mixing more than “just” two groups of runners (runners left alone with a bunch or information, runners closely coached by a physical-therapist etc.) and also considering the benefits of the transition on the long run…

This post kept me up all night.
I think this article highlights the “YOU ARE THE TECHNOLOGY” thing.
Modern society has resulted in weaker lower bodies and people expect to undo years and decades of habits in 10 weeks. That’s akin to asking someone who has a broken arm to lift weight that is more than were able to before it was broken.

It’s not just our feet: hip flexors from sitting anyone? Unless you are blue collar you are basically chair-ridden (unless you grab a standing desk). Excessive sitting leads to shortened hip flexors. Sound familiar to Achilles shortening due to “heel-toe drop”?
Heel-toe drop also results in the same pelvic tilt as sitting (which makes your posture worse)

I am surprised, nobody is talking about running with the Vibrams on trails, grass soft surface. This type of running has a total different impact on the feet. For about 3 years now Im running, walking, doing yard work in them. Yes there were light problems with TOFP, but always after running on the pavement. My transition went smooth I think because of using the vibrams on grassy hills, trails. Which is for me the nose of the salmon of the running experience.Im not a marathoner at all but more a 3 or 4 mile runner right now.
Thank you, Justin for keeping us posted!

Transitioning to Vibrams is a test of patience. I followed the advice and built up very slowly. After 3 years, I would never turn back. Although it was hard to resist adding miles on quickly, I found that as my feet became stronger, I could add the miles on over time. In the end, I have fewer injuries and am a stronger runner. I do know of people who have experienced stress fractures running in minimalist shoes, but watching them run, it is very clear why. They don’t run with proper form and pound very heavily as they land.

I find that whatever results a study wants to find, they pretty much can and would love to know the funding source behind this.

Transitioning is hard.

For me, working on my form is a constant work in progress even after 1.5 years. For the longest time, I have had calf pain after running. This lead me to learn about the soleus muscle which I never knew was there! More research showed me an adjustment to my form to try and lift my foot rather than pushing with it.

Similar form adjustments have been needed on landing (the cause of the foot bruising). Learning where to land on the foot and how to do it properly takes quite a bit of time. Learning to land *lightly* is even harder to master. A great way to show yourself how to do it is to remove the shoes for a 1/4 or 1/2 miles. It is amazing how much lighter, quieter and smoother I am barefoot than even when wearing my Merrell Vapor Gloves.

simply the cause of transitioning too quickly, and/or not learning proper technique

people have to adjust accordingly, or they’ll get hurt. Period.

it’s not Vibram’s fault, therunner usually

i haven’t been injured except for my own fault, and it was only one overworked muscle in my foot, so it wasn’t all that bad, injury free for the last 2 years

i’ve never been injured because of shoes in particular, especially since switching to being in barefoot shoes, or since last may, barefoot

be careful people!

yeah yeah…. but remember vibram and
any other minimalistic/BAREFOOT shoe brands
CLEARLY STATE ON THE BOXES OF THE NEWLY
BOUGHT SHOES THAT YOU SHOULD
TAKE IT EASY
AND SLOW AND INCREASE YOUR MILAGE
OVER TIME WITH CAUTION—-
research is fine but everyone should
see for themselves and by trail and error decide what’S healty and good for them.
listen to your body and you’ll always get it right.

Several others have already commented, but I think the biggest thing that the study points out is the optimistic timeline that old Vibram transition had.

If you check out Vibram’s website now, there is no defined timeline for transition any more. (At least none that I could find.) Instead the eduction area states that the transition time is highly variable with many being able to transition in weeks, many taking months and some needing a year or more to make the complete transition.

The biggest problem with the study in my mind was using all experienced runners and then allowing them to transition as they saw fit… instead of having a prescribed transition plan.

For me, personally, I started walking in VFFs in January 2012… after a few weeks I decided to do a C25K running program (I had never run in my life and only considered it because of how good walking in VFFs felt)… and I did it from day one exclusively in minimalist shoes – about 90% in VFFs (KSOs and later SeeYas), 5% in NB Minimus Trail Zeros and 5% in Altra Adams.

Because I wasn’t a runner, I think my build up in foot/bone strength was natural along with the progression through C25K. The first few weeks I was only running 1/2 to 1 mile at most. After 10 weeks I was just running 3 miles.

As it stood, though, it set me up and I have run 10Ks, 10 milers and 4 half marathons in the first year of running – totaling almost 1000 miles and peaking at about 35 miles per week for a while – all still with the 90+% in VFF SeeYas.

My own anecdotal evidence suggests that there is nothing inherently dangerous about minimalist running. It is always about listening to your body and adjusting your training as necessary. There were certainly days or weeks where my feet were more sore (the week after my first HM is a great example) and I just either cut back on the distance or cut back on the intensity – but I never missed time because of injury.

I very much agree with Justin’s view on this, as well as so many who responded after him. Running in VFF’s SAFELY truly requires a learning curve for both mind & body that is shorter for some people and much longer for others. And indeed WALKING in them should be a part of the sequential training for most everyone, I believe. The researchers in this study should have cautioned readers not to draw conclusions about VFFs based solely on their findings – because it seems that there are SO many variables they apparently did not account for. And most of those variables I see the readers here have already picked up on. And I, too, would love to know more about the researchers and their funding source. One can’t help but wonder because drawing conclusions about the shoe without a discussion of those variables seems so biased and amateurish.

Very interesting! I have been wearing VFF for 5 years (I have about 8 pairs and wear almost no other shoes now) and selling them in Switzerland for 4 years. I can only stress the importance of starting out slowly – something that has been mentioned above a lot – but can’t be said enough. I started wearing them during “normal” activities in my daily life and walking in them. Then running 20!!! minutes only and running back home to change shoes. Then I added hikes – never had tired feet afterwards and you can cool your feet off in a lake or stream on a hot day 🙂 My runs became longer, but I still alternated between VFF and normal running shoes. After 1.5 years I switched to VFF exclusively for running and nordic walking, as well. I must mention that I have never been a “heel-striker” and I also didn’t take long strides, so I didn’t have to change my running form drastically. And I run almost exclusively on natural surfaces (unpaved).
In 4 years I’ve had only one customer report problems to me and I have a lot of repeat customers – I’ve sold over 700 pairs in total.
My take-out of this – take it slowly, work barefoot walking into day-to-day activities, learn to use a fore-midfoot strike and listen to your body – it’s not supposed to hurt! Enjoy the sensation of simply walking barefoot on natural surfaces 🙂

This study seems in no way relevant to running. The best advice iv had on the subject of minimalist footwear is to not wear them at all for transitioning and go strait to barefoot. After finally listening to this advice, and applying it, it made sense. VFFs are excellent, but they still allow you to exercise very, very bad form. Minimalist footwear should be saved for when you can run properly, and gravel. Theres some really evil gravel where i live…. So the entire study is largely irrelevant, except maybe to re enforce the point iv just made.

Justin,

Another great article for potential Minimalist runners to review. Anyone new to the site or new runners should read the advice of the readers. It took me a long time to transition to VFF’s or any type of minimalist running. I’m a larger runner anyways so I have to do it with more caution. One year I over extended myself one summer because one week I ran the Warrior Dash in my old running shoes that turned into lawn cutting shoes. The following week I ran a 10k and pulled the other calf muscle. I stress to everyone that you have to increase your time and distance gradually in your shoes when transitioning. It was a pain but the results were much better. When you posted this article all I could think of a science show explaining how Muay Thai fighters are so dominant and how they can do such amazing feats of strength. They had a Muay Thai master kick and break a solid wood baseball bat with his shin. They explained the logic behind it when the fighters train they creat “micro” fractrues in their bones and when they heal they become stronger. While this wouldn’t apply to any logic regarding joints but any actual fractures in the bone would apply I believe.

I wore VFF’s for over a year before I even tried to run – I wasn’t a runner or even a big “walker”. After a year, I tried and yes, I hurt. I went and got “normal running shoes” and those made things worse. I couldn’t “feel” the ground, I stumbled and tripped which made me twist my whole leg and put me out of even walking for a bit. Months later, I gave up on the shoes & tried again in my VFF’s, this time slower and paid more attention to HOW and WHAT I was doing. Now I can run with min pain (that normally gone the next day). It’s been 2 years almost since I switched and even now, I’ll catch myself “landing wrong” or something. If I feel pain, I adjust, slow down, modify what & how until it stops. But any discomfort I get is now minimal and doesn’t compare to benefit I’ve gotten from switching in the first place. I’m a 24/7 Vibram wearer. And I ALWAYS stress to anyone who asks about them the importance of taking things SLOWLY and carefully to avoid injury.

When I initially switched to Vibrams for running, I actually ended up with a stress fracture in my foot, because I just went too much too soon. I slowed down after that point, and took my runs very carefully, where I focused on my form, landing, and very, very gradually increased my miles. I haven’t had any issues since, but I also train very cautiously, especially when I take any time off, so that I don’t end up with an overuse injury. Which is really the key. Most sports injuries are from simple overuse.

I’m gonna both agree with Justin, and second that I’d like to know who funded this study.  Additionally, were any variables other than wearing VFFs (arch height, heel vs. midfoot strike, etc.) taken into account?

I took the transition route and took about 2+ years before I could run full time in Vibrams. My guess is that you could use this as a guideline: However long it would take you to (FULLY) heal a broken foot (and the accompanying withered musculature) is how long you should take to transition to minimalist running. Do any of the physicians here feel this to be a good timeframe???

before Vibrams were around, I would run barefoot around the track, with socks on. I was never injured. I bought the Vibrams and was injured within 3 weeks. I found the Vibrams to actually prevent “natural” barefoot running. The vibrams forced my foot into an abnormal position. They actually restricted my natural barefoot running style. I believe this is why there are so many injuries with these shoes. (I have run several marathons, and am a seasoned runner) Perhaps there should be a study of true barefoot running verses Vibrams.

I’m fat. I’m working on my previous statement. I got into VFF about a year ago. I saw them on an episode of Showtime’s Weeds. I bought them as a joke, but quickly fell in love with them. I started out simply wearing my VFF Treks around the house and to the store. Being I was out of shape overall, my feet couldn’t keep up more than a few hours a day. Soon I could go a full day in them. Even though I’m fat, I come from and athletic background. Every time I attempted to get back in shape I would wind up with some injury that put me back into bad habits. After a year in my VFF Treks I am steadily improving my fitness. I’m more in tune with when my feet and legs are fatigued. It’s in this way when I know when my form is falling apart. Yes, in the beginning my feet and legs went through a transition. Ever since, my knee (of two surgeries) doesn’t give me the same limitations as before. I reference to this study, I’m not surprised. Just because one is experienced in one arena doesn’t mean it will translate even to a similar vein.

I used to run all the time when i was younger and at 44 i still run as a soccer referee. It was about 2 years ago that i first picked up Vibram shoes. I honestly believe that 2 years is a more reasonable time frame. First i used to blast my calf muscles with weights and would never get them sore. The first time i put the Vibrams on i had sore calf muscles!! i was shocked. It took me 3 months just from walking around until they were not sore. I gradually added more tasks and small amounts of running around and hiking with them, but always took a backup pair of shoes just in case my feet started to get sore. From my memories of exercise, you always listen to your body… it will tell you when you reach your limits. Slowly i got past the sore calves and then my arches would be sore, and then the out side of my foot, and now the tendons between the Achilles gets sore. To me it is just like training and slowly building everything to a point where it is more natural. A 44 year old body has to relearn and rebuild from 42 years of habit… you cannot change it in 10 weeks! Again i am 2 years into changing over and i have seen major changes, but know there is still some time till i am where i would like to be. Right now i am happy cause (flat feet and all) i no longer have sore knees, tendinitis (both Achilles) and no more heel spurs… to me that is a much welcome transition!!

I find it interesting to read through all the comments on this page. As a result I am inspired to share my own VFF story.

About two and a half years ago I was thrown from my horse. My sacrum nearly separated from my pelvis and I spent more than a year unable to do more than take my dog down the hall to pee. I was afraid to walk in the Winter because I might slip, I could not go up or down and stairs or hills, no bending or squatting, not even to tie my shoes. I would randomly fall while trying to walk a few steps. I thought I was done. I had tried everything from physical therapy, chiropractic, acupuncture, massage, faking it through yoga, several dozen new types of shoes, and then just simply finding a way to sit in order to ease the pain. I came very close to giving in to surgery. Then, I read about VFF on birthdayshoes.com, and decided to give them a try. It was no miracle, but all of a sudden I could walk again. no worry of slipping, my balance issues slowly went away, I even started to build my strength walking inclines – and later declines. People gawked at my funny shoes, as I wore them absolutely everywhere. My family calls them “disturbing” to look at. But… I’m back at the barn, I’m gardening again, carrying and lifting, walking several miles a day with my dog, and I am quite literally getting my life back. For me, VFF has been a blessing. Not the easy way, but they are still the only shoes I can be comfortable in. I finally started wearing some of my normal shoes, mainly for safety around horses, and the balls of my feet are suffering for it. It just seems to me, that common sense can be applied, whether you are an athlete, an aspiring athlete, or just need to try something new. That’s my two cents.

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