How I healed my chronic injury with minimalist footwear
If you’re an 80’s or an early 90’s baby, you’ll remember the jelly shoes. Yes, the squeaky and slippery pair of PVC plastic shoes that you wore as a young girl just to match your Barbie’s shoes. Jelly shoes were all the rage. Some say the past obsession with jelly shoes is culturally equivalent to the modern day crocs craze.
What makes shoes so obsessable? Is this not every father’s question about his young daughter?
Maybe we obsess over shoes simply because they are fun! How can you walk through a department store’s baby section and NOT stop in awe of the baby shoes? These are hands down the cutest, most useless accessory, the epitome of fashion- just for show! Because babies don’t walk…
I’ll tell you why I’m obsessed with shoes. Because they physically connect us to, or have the capacity to disconnect us from, the earth. Our feet, precious and unappreciated, are the foundation upon which we humans establish and build ourselves from. And we attempt to protect these valuable nuggets inside our shoes.
I’ll never forget my favorite pair of lime green shoes I received on my 8th birthday. I was so sad when I outgrew them. Now, I wear my shoes until they fall apart. I just can’t let my shoes go.
But I’ll tell you which ones I did let go. My Nikes, Adidas, Brookes, Asics… the mainstream brands that people pour money down the drain for in pursuit of the “right fit”.
Have you spent hundreds of hours shopping for shoes, trying them on, and attempting to “break them in”, only to return the shoes or regret you wasted so much money? Boy, have I! I’ll tell you the story about my struggle with chronic injury and how I found resolution.
My struggle with exercise-induced compartment syndrome
I was a competitive artistic gymnast for nine years. After ninth grade, I retired from gymnastics to have time to pursue other activities outside of the gym. In the fall semester of tenth grade, I took tennis lessons. In the spring, I ran track. As a gymnast, I was accustomed to my individual sport, and I didn’t want to try any team sports. I thought I knew how to sprint from gymnastics, as the only way to flip over a vault is first by running fast.
My ego was quickly deflated when I started track that spring when the coach stopped me one day. He asked why I was sprinting with straight elbows. “Bend your elbows when you run!” he said. I walked back to the start line confused about his question, and then realized what I had been doing. Gymnasts get about 10-13 sprinting steps on a vault runway. Watch any high-level gymnast. They run at the vault with pretty straight elbows to prepare for a mounting skill with fully extended arms. I was so embarrassed.
I performed fairly well that spring track season. So I decided to join the cross country team in the summer/fall of eleventh grade. All of my family members ran long distances, and I thought, why not?
I’ll tell you why not! Some people’s bodies are not designed to run long distance! Mine certainly wasn’t.
In the beginning, I enjoyed cross country and started to improve during summer training, until a couple months in, my progress suddenly declined. My calves began to swell up when I ran, my feet went numb, and my lower legs lost strength.
I was diagnosed with compartment syndrome. Specifically, bilateral exercise-induced lateral compartment syndrome. Talk about a blow to the ego. Here I was a retired high-level gymnast, and it was difficult to finish a 2 mile run.
Essentially, what happens with compartment syndrome is the muscles, which are surrounded by a fascial sheath, become swollen and create excess pressure within the muscle compartment. The disruption in blood flow results in severe pain, muscle damage, and neurological dysfunction.
I made it through the fall season of cross country and then begrudgingly attempted a second season in twelfth grade, thinking that six months off of running would fix the problem. Well, it came back with a vengeance. Within a few weeks of running distance again, I had to stop completely. An orthotist fitted me for stiff orthotics, which didn’t help. I went through multiple pairs of shoes trying to find the right fit.
I couldn’t even jog a lap around the track without having to stop. Even more so, I dreaded the two-minute passing period between classes which required hustle from one end of campus to the other. Every cross country practice ended with me in the athletic training room doing therapeutic exercises and modalities.
None of it made a difference (not surprising, now that I look back retrospectively as a physical therapist). Briefly, I considered the only other intervention: fasciotomy, the standard surgical intervention for compartment syndrome. But it just seemed too extreme of an option. I knew there had to be something else out there.
My transition to minimalist shoes
Those hours I spent in the athletic training room were actually what initially inspired me to consider a career in physical therapy. I wanted to help people like me, the people who were searching so desperately for answers.
So I gave up running altogether and decided to focus my energies on finding those answers for myself. The first ray of light came a few years later in college when I discovered New Balance’s minimalist shoes. Fresh to the market, I had to give them a try. And they did not disappoint.
They had a wide toe box and minimal cushion on the sole. I loved them and ordered a couple of pairs. They were absolute freedom! My toes were free to wiggle in the wide toe box. I could feel the texture of the ground, and my feet were able to move in reaction to the ground. The pain in my lower legs improved drastically.
I tried running again. I had to change my running style from a heel strike to a midfoot strike, which took a lot of practice to retrain and build back endurance. But the way I moved was transformed!
This is when my true obsession ensued. I looked high and low for more minimalist shoes. After the New Balance shoes, I discovered Altra’s. Next were Vibram toe shoes. Then Xero’s and then Lems. Ahhhh, Lems, my heart.
Next, I gradually converted all my family members to minimalist shoes. My sisters know not to take me into shoe stores now. I may occasionally try on a pair of traditional running shoes just for shits and giggles. Then I criticize every shoe on the shelf and mercilessly shame the corporations for marketing misinformation and misleading claims. Yes, unfortunately, we’ve all had the wool pulled over our eyes, or should I say shoes pulled over our feet.
Okay, let’s get to the good stuff. What exactly are minimalist shoes and why do they matter…
What are minimalist shoes and barefoot shoes?
Conversation is meaningless unless terms are defined. So what’s the difference between “minimalist shoes” and “barefoot shoes”?
Many people use the terms “minimalist shoes” and “barefoot shoes” interchangeably. On the other hand, some people consider barefoot shoes just to have less cushion than minimalist shoes. But there is no definitive degree of cushion that defines “barefoot shoes”. So for the sake of this discussion, I prefer to use the term “minimalist shoes” because “barefoot shoes” is really just an oxymoron.
What exactly do minimalist shoes entail? There are four aspects to look at when considering a minimalist shoe: toe box width, drop height, stack height, and flexibility. There is a lot of variation between brands and even between models within a brand. Not all shoes that claim to be minimalist are ideal, but I’ll tell you what I think is best when considering the following four aspects.
(1) Minimalist shoes have wide toe box widths
Take a look down at your naked foot. See how the widest part of your foot is at the ball of your foot? Now place your foot next to your traditional shoe. See how narrow the shoe is where the ball of your foot should rest?
Traditional shoes squish the metatarsal heads (ball of foot) together, compressing the nerves and preventing the natural arch from engaging properly. Traditional shoes also squish all the toes together, creating a point, limiting the toes’ mobility and strength. Ever hear of Chinese foot-binding practice? Our shoes are a modern, yet less aggressive, take on this.
Now, take a look at the minimalist shoes. They have a wide toe box, allowing the metatarsals room to spread and toes to splay naturally, thereby allowing for good mechanics when walking and running.
Nike traditional shoes (left) and Lems minimalist shoes (right). I’m not a great artist (ᗒ ᗨᗕ)
(2) Minimalist shoes have low- to zero-drop height
The drop height of a shoe is the difference in height between the heel and the toes of a shoe sole. Traditional running shoes may have a drop height of 10-15 millimeters (mm), meaning there is a 10-15 mm difference between where your toes are and your heel is.
You can see the difference between the drop height of the Nike shoe and the zero-drop of Lems shoe
So what’s wrong with a high-drop height? Lifting the heel higher causes significant biomechanical changes and postural compensations up the kinetic chain. From the feet up, every joint angle is changed to become less efficient: ankles, knees, hips, and spine.
I believe our cultural norm to always wear shoes is contributing to so much of the dysfunction and pain that we see today in society. It’s why I spend so much time educating my patients on shoes and posture.
With minimalist shoes, the drop height may range from 0-4 mm. I always check the specs on shoes prior to purchasing. They specify the drop height, and I prefer 0 mm drop height, otherwise known as a “zero-drop” shoe. Sometimes transitioning from a traditional shoe to a zero-drop can be too drastic of a change, so try transitioning slowly by first trying low- or mid-drop shoes first.
Zero-drop: 0 mm
Low-drop: 1-4 mm
Mid-drop: 5-8 mm
High-drop: 9+ mm
(3) Minimalist shoes (should) have minimal stack height
Stack height is the thickness of the sole cushion, measured as the height from the ground to the heel. There are zero-drop shoes that have really thick cushions. My first few pairs of Altra’s were zero-drop shoes with a very little cushion. I really liked them because my feet were close to the ground and I could slightly perceive the texture of the ground.
Altra’s changed after a few years and they started designing their shoes with more cushioning. They were still zero-drop shoes but had 20+ mm of cushion on the bottom. I stopped buying them because I felt like my feet were trying to balance on an unstable water bed.
So look at the stack height before purchasing a pair of minimalist shoes. I don’t like a lot of cushion on my shoes when I’m hiking. I like a thin barrier that is just enough to protect my feet from sharp objects but still allows me to appreciate the texture of the surface I’m interacting with. I like Xero shoes for hiking. Sometimes I do like a little more cushion for standing a lot, like at work. This is when I wear Lems.
(4) Minimalist shoes (should) be flexible
In order for any joint in the body to function well, there must be a balance between mobility and stability. The shoe industry has been so keen to educate the public on how to establish stability by using shoes. But what about mobility? Our feet are uniquely designed to very mobile. That’s why one foot has 33 different joints in it! It’s meant to move!
Our feet are meant to be mobile so we can adapt to different surfaces. Yes, they require stability as well, but not immobility! Traditional shoes have been repurposed from the ancient garments of protection into modern vessels of bondage.
The last aspect I look at before purchasing a pair of minimalist shoes is the flexibility of the shoe. I like to play with the shoe. Does is twist, bend, and roll? Feet move in multiple planes, so shoes should move in multiple planes as well to allow for good mobility.
Free the feet!
What are the benefits of wearing minimalist shoes?
The key benefits of wearing minimalist shoes are optimizing biomechanics and properly aligning posture. As I explained previously, minimalist shoes allow for improved alignment of joints to improve the efficiency of muscles and movement. Biomechanical optimization reduces the stress forces on all the contractile and connective tissues, including fascia, muscles, tendons, ligaments, joint capsules, and nerves. Simply put, you move faster, stronger, more powerfully, and less painfully.
But Ali… I hear it…the opposition, the questions. Yes, the questions are good! My (doctor/podiatrist/chiropractor/physical therapist/personal trainer/shoe salesman) told me I need (arch support because I have plantar fasciitis/flat feet/fallen arches/Achilles tendinitis/posterior tibialis tendinopathy/leg length discrepancy). Yes, I’ve heard it all.
I’m not saying that everyone should wear minimalist shoes. It’s not a rule and there are always exceptions. It takes a good movement specialist to determine what’s appropriate for an individual. Supportive shoes, orthotics, and prosthetics are indicated for some people, but not for most.
Most people need to learn how to use their feet again! Minimalist shoes are just one tool to help people rediscover the sacred power of their feet.
Traditional shoe companies claim that cushioned and stiff shoes absorb forces, protect the body, and reduce the risk of injury, but this is not true. Putting a cushion in shoes actually reduces the body’s ability to naturally absorb shock, which increases the risk of injuries up the kinetic chain.
Having a zero-drop, wide toe box, and firm yet flexible sole allows you to engage your small intrinsic foot muscles and improve your natural arch strength. It also promotes your ability stabilize your movements at the ankles, knees, hips, and core, and to reduce risk of injury.
Granted, there are studies that show increased injuries when people transition suddenly from traditional to minimalist shoes. Remember, it takes time to slowly make this transition safely and effectively.
Another benefit of minimalist shoes is the improved sensory input to motor output. The human foot has a high density of sensory mechanoreceptors in the skin, just like the hand does. These sensory mechanoreceptors and the muscle/joint receptors send signals to the brain to tell you where your body is in space. But the high number of receptors in the foot are only as good as the input they’re given.
If you put a foot in a traditional shoe, the foot is essentially squeezed and immobilized. So there are fewer inputs at the foot, and therefore, the receptors have less information to give the brain. The brain has more difficulty determining where it is in space.
Instead, if you put a foot in a minimalist shoe, there is more movement in the foot due to a flexible sole. The thin sole allows the foot to feel the texture of the ground, so more sensory information is sent to the brain. Now the brain can better perceive where it is in space. This improves your balance and ability to react to different terrains.
If you struggle with balance, try out Naboso shoe inserts. Developed by a podiatrist, it’s a patented, thin rubber insole with an evidence-based texture designed to stimulate the nervous system and improve balance and stability.
Minimalist shoes are especially great for children. As the bones in kid’s feet develop throughout childhood, wearing minimalist shoes allows for proper bone alignment and supports the development of natural arches and foot strength. The sensory stimulation is important as well, especially in their early years when sensory input is most important as they discover and learn about the world.
What are the risks of minimalist shoes?
There is risk of injury in any new activity that a human performs. If you were accustomed to wearing traditional shoes all of your life, you have developed specific patterns of movement and compensations. When transitioning into minimalist shoes, your posture will change and present new challenges to your body.
It will take time to adapt to the new ways of moving and the transition may uncover new deficits. If you’re an athlete, you may have to adjust your training load. Be patient with the transition and adaptation periods. You’re in for a life changing experience!
Live in peace, Ali
Reference:
Davis IS, Hollander K, Lieberman DE, Ridge ST, Sacco ICN, Wearing SC. Stepping Back to Minimal Footwear: Applications Across the Lifespan. Exercise and Sport Sciences Reviews. 2021;49(4):228-243. doi:10.1249/JES.0000000000000263
