Foot Fight 3

The latest from a minimalist runner’s barefoot battle to overcome posterior tibial tendonitis

I’ve been working to become a barefoot runner for almost 10 years.

It all started back in 2011 when the book Born to Run, by Christopher McDougall, convinced me that my cool cushy running shoes were doing more harm than good, and that I should instead adopt a weird minimalist running philosophy.

After years of stupid running in Converse All Stars, creepy running in Vibram FiveFingers (VFF), injury setbacks, physical therapy sessions, and a fair number of triathlons, road races and trail runs, I’m finally making some progress and getting (nearly) back to barefoot.

Now, I’m excited to share an update on the barefoot battle.

This article is for anyone interested in minimalist running; thinking about adopting a more barefoot lifestyle and fitness philosophy; or suffering from injuries like collapsed arches or Posterior Tibial Tendonitis (PTT) — it’s broken down into the following sections:

Please note that I documented the earlier stages of this journey in Foot Fight (2013) and Foot Fight 2 (2016), and I incorporated the key points from those first two articles into this one — you don’t need to go back and read them first, although you are certainly welcome to.

This is a pretty long post, so let’s get to it! We’ll start off with why I decided to go barefoot in the first place, and highlight further supporting evidence I’ve stumbled upon recently.

Why go barefoot?

As I mentioned above, I’ve been drinking the barefoot Kool Aid since 2011, when I read the book Born to Run. Here’s one of the main takeaways from my Born to Run book review.

Good shoes are bad shoes. One of the most interesting sections of this book was the story behind athletic shoes as we know them today and the argument against running in expensive, cushioned shoes. Basically (and I’m unfairly summarizing here) our feet and bodies were made for endurance running. The cushioning in most of today’s athletic shoes do more harm than good by weakening our body’s natural running equipment, encouraging improper form and increasing the amount of impact and force exerted on our joints. It was interesting to read that the founders of Nike basically said that humans are running incorrectly, and the only way for them to run correctly is by buying a pair of their shoes.

After I read Born to Run I switched to minimalist running shoes and completed my first triathlon (Bluewater) wearing Converse All Stars. About a year later, while training for my second triathlon (Lavaman), I graduated to running in VFF. In a few months my toes looked like fingers. My arches grew high, my running form strong.

Despite some setbacks, which we’ll get to in the next section, I’ve been a barefoot believer ever since, and I continue to find support for the minimalist, shoeless philosophy.

For example, this 2017 episode of Freakonomics gives a nice look at the benefits of barefoot living; from Freakonomics: These Shoes Are Killing Me! (Episode 296):

The human foot is an evolutionary masterpiece, far more functional than we give it credit for. So why do we encase it in “a coffin” (as one foot scholar calls it) that stymies so much of its ability — and may create more problems than it solves?

More recently, I stumbled upon this fun excerpt earlier this year in the book Drive Your Plow Over the Bones of the Dead, by Olga Tokarczuk:

I have always regarded the feet as the most intimate and personal part of our bodies, and not the genitals, not the heart, or even the brain, organs of no great significance that are too highly valued. It is in the feet that all knowledge of Mankind lies hidden; the body sends them a weighty sense of who we really are and how we relate to the earth. It’s in the touch of the earth, at its point of contact with the body that the whole mystery is located — the fact that we’re built of elements of matter, while also being alien to it, separated from it. The feet — those are our plugs into the socket.

I love that analogy: thinking of our feet as our plugs into the earth.

In addition, my cold adventures earlier this year with the Wim Hof Method — in Poland, where I saw one dude go barefoot the whole way on our icy hike, and in Iceland, where I spent some time every day walking around barefoot in the snow — further convinced me that not only can our feet handle the elements and take a beating, but they actually get stronger from that stress.

Finally, because I can’t get through an article these days without citing Antifragile, by Nassim Taleb, here’s a nugget from a section called Technology at Its Best, in Chapter 20: Time and Fragility (read more in my Antifragile book review):

The shoe industry, after spending decades “engineering” the perfect walking and running shoe, with all manner of “support” mechanisms and material for cushioning, is now selling us shoes that replicate being barefoot — they want to be so unobtrusive that their only claimed function is to protect our feet from the elements, not to dictate how we walk as the more modernistic mission was. In a way they are selling us the calloused feet of a hunter-gatherer that we can put on, use, and then remove upon returning to civilization. It is quite exhilarating to wear these shoes when walking in nature as one wakes up to a new dimension  while feeling the three dimensions of the terrain. Regular shoes feel like casts that separate us from the environment. And they don’t have to be inelegant: the technology is in the sole, not the shoe, as the new souls can be both robust and very thin, thus allowing the foot to hug the ground as if one were barefoot — my best discovery is an Italian-looking moccasin made in Brazil that allows me to both run on stones and go to dinner in restaurants.

Then again, perhaps they should just sell us reinforced waterproof socks (in effect, what the Alpine fellow had), but it would not be very profitable for these firms. * There is anecdotal evidence from barefoot runners and users of “five finger” style athletic shoes — which includes myself — that one’s feet store some memory of the terrain, remembering where they have been in the past. 

Injury background

Despite my passion for, and unconditional solidarity with, the barefoot movement, I’ve made some huge mistakes along the way, with ripple effects I’m still working through years later.

I suffered my first foot injury back in 2012. While training for the Lavaman triathlon, and running strong in VFF, my left foot slammed down on a rock at the start of a six-mile run. Instead of calling it a day, I stubbornly finished running the six miles. To make matters worse, I also jammed my left big toe into the pavement just before I got home.

I knew my foot was hurt, but I didn’t want to pull out of the race. So I took it easy for a few weeks and then went ahead and completed the Lavaman olympic triathlon, wearing Converse All Stars for the run segment. After the race an MRI confirmed I had a stress fracture of the second metatarsal, and I ended up in a walking boot for six weeks.

After a few months of physical therapy — in which I resisted recommendations from sales-driven doctors to wear orthotics, and instead pursued a more natural, barefoot strategy to slowly strengthen my left foot, leg, knee and hips — I bounced back to pain-free VFF running.

Then, in 2013, I suffered my second running injury: PTT. My left arch collapsed while running more than 20 miles, over the course of about 30 hours, in the Ragnar del Sol Relay. I ran in minimalist Saucony cross-country racing flats and my left foot wasn’t ready for that distance.

The posterior tibial tendon’s job is to stabilize the lower leg, helping to keep the foot aligned in a healthy neutral position, where body weight is distributed appropriately to the parts of the foot designed to absorb the impact (eg the arch). When I ran too many miles too soon after my injury, I overloaded my poor posterior tibial tendon, which became aggravated and diseased. When the tendon gave up, the arch collapsed. In addition, my stiff and misaligned big toe was not helping to absorb the impact experienced in a properly aligned neutral position, further flattening and deforming my foot. Thus, I tucked my tail between my legs and spent the next few months back in physical therapy.

During this recovery phase — which included mobility and strength exercises, along with ASTYM, ultrasound, and dry needling — I came to grips with the long road to recovery ahead. My physical therapist was sympathetic to the barefoot philosophy, but convinced me I would need some more supportive shoes to bridge the gap. We also agreed orthotics would not be necessary to get there.

Here’s the big takeaway from this injury section: the biggest mistakes people make when going minimalist or barefoot are really different variations of the egregious errors I made above: 1) not taking the time to slowly build up foot strength; 2) going barefoot too fast, too long, too early; and 3) not listening to your body and resting when you’re hurt, injured or exhausted.

Status update

In the seven years since that last patch of physical therapy, I completed two Ironman triathlons (IMAZ 2013 and IMAZ 2017), got into trail running, and have remained largely PTT and injury free.

For the past few years I’ve cut back on distance to focus on building up my barefoot strength. Most of my VFF runs are in the three- to six-mile range. I usually take it pretty slow, and I keep my mouth closed (only breathing through my nose) as both a breathing efficiency exercise and as a way to keep my heart rate low.

This slow and easy approach, without the pressure of training for a race, has been a great way to really take the time to build up my core and foot strength. Whenever I start to feel some PTT, or even occasional achilles tendon related pain, I can usually squash it by just slowing down my pace and focusing on my running form.

The only other noteworthy injury issue occurred a few months ago, when I stubbed my fourth toe on my left foot while I was in Iceland. The one toe turned all kinds of black and blue and purple. It wasn’t so painful that it stopped me from hiking and having a blast in Iceland, but it remained pretty sensitive (and ugly!) in the weeks and months afterwards. I took the past few months off from running just to give the little guy some time to recover.

Instead of running, I’ve been hiking (wearing Vivobarefoot foot-shaped hiking boots), and cranking out daily kettlebell workouts, a la Pavel Tsatsouline’s excellent Simple and Sinister program, which is comprised of a mix of one- and two-arm kettlebell swings, and a series of Turkish Get Ups. One of the many great things about these workouts is that you can, and should, do them barefoot.

Lingering issues

All that said, even though I’m feeling pretty foot strong these days, there is still work to do:

  • My left arch remains collapsed and deformed.
  • My left big toe is still stiff (likely from my first injury back in 2011).
  • I still need to wear stability shoes for longer runs.
  • My soles are still sensitive walking outside, especially on sidewalks and asphalt, and I have a ways to go before I develop “the calloused feet of a hunter-gatherer.”
  • Both feet are narrow and deformed from years of standard footwear.

Barefoot goals

My broad long-term goal is to become a weird guy who does nearly everything — including snow hikes, trail runs, triathlons, and even just walks around the neighborhood — barefoot.

Short-term I hope to complete my first 50-mile ultramarathon this year or next; in the process, it’d be cool to do at least a 20-mile training run in pseudo-barefoot shoes like VFF.

Five steps to get there

First, I should probably start running more. I’ll likely work in a couple moderate, trail and VFF runs every week over the summer, and build up the distance from there.

Second, I’ll also keep going ham on the barefoot Simple and Sinister kettlebell workouts and focus on building up the weight in my one-arm swings.

Third, I’ll continue my daily practice of foot stretching and strengthening exercises, following the functional foot online workshop I recently picked up from My Foot Function. I highly recommend their online workshops but here’s a quick sample of their exercises:

  • Various forms of bending, twisting and pulling the big toe on each foot to encourage flexibility, strength, and independent range of motion.
  • Squeezing your fingers in between each toe — like you’re holding hands with your foot — and rotating the toes and forefoot in circles to help the toes to splay out.
  • Lacrosse ball roll out on the bottom of each foot, pausing and applying painful pressure in spots that are sensitive, especially under the arch of the foot.

Fourth, taking advantage of my quarantined lifestyle, I’m just not going to wear shoes unless absolutely necessary — even on casual walks around the neighborhood — let’s get weird!

Fifth — and even weirder! — I’m going to use my daily Wim Hof Method breathing exercises and meditation practice to get mystical up in here, and channel some healing and strengthening energy all the way down to my earth plugs.

Principles, lessons learned, obstacles

From all these years of running, reading, PTT suffering, physical therapy sessions, daily foot exercises, and general trial and error, I like to think I’ve learned a ton about barefoot running. In addition, looking back on the first two Foot Fight articles, I’ve also changed the way I think on certain aspects of the barefoot journey.

In this final section, I list out a relatively comprehensive and updated list of 10 takeaways to keep in mind for your own barefoot journey.

If you only remember one thing, remember this first one!

1. Take it slow — really, really, annoyingly, boringly, slow. From what I’ve seen the biggest and most common mistake people make when transitioning to minimalist running shoes is they think they can do the same runs they normally do in stability shoes, right off the bat, without skipping a beat. This is why many people blow out their achilles or (in my case) find themselves with collapsed arches and PTT. Do yourself a favor and give yourself at least a few months to slowly ease your way into barefoot or VFF running. Limit your runs to a mile or so in the first few weeks and see how it goes. Listen to your body and, again, don’t rush to build up the distance.

2. Minimalist shoes are not the fast fix to PTT. Switching over to barefoot or minimalist shoes will not immediately resolve those injury problems. You need to take the time — even if it means canceling a race — to let your diseased and aggravated posterior tibial tendon heal and fully recover before building back up to running again. Barefoot, minimalist running should be more of a long-term goal than a quick solution.

3. Just say no to orthotics. Heal and strengthen your feet naturally instead. Find a physical therapist who gets the barefoot philosophy and is willing to not sell you orthotics, which I view as an expensive, hurried treatment of the symptom, rather than a fix for the core problem.

4. Don’t wear Converse All Stars as minimalist running shoes. Yes they’re flat and zero-drop; however, the narrow footprint — especially of the toe box — means they’re crushing and deforming your feet with every step. This is a terrible way to transition to barefoot, and I realize now that I made a huge mistake wearing them as my primary running shoes in 2011 and 2012. This gaff probably planted the seeds of the PTT, stiff toes and collapsed arch issues I’m still working through.

5. Don’t wear flip flops, which have always destroyed my feet. They make walking around seem ridiculously unnatural and misaligned, and I’m sure there’s supporting literature out there on the destructive impact flip flops have on feet.

6. Walk around barefoot as much as possible. This is obvious, but more difficult than you might think. One big obstacle is that it can be tough to find grassy, natural places to go barefoot if you’re living in a typical, concrete, asphalt and car-paved, city. On the other hand, you can always commit to going barefoot around the house, and see if you can find a nice park nearby to walk around barefoot in for a while.

7. If you have to wear shoes, wear shoes that don’t deform your foot. There are more and more brands and companies developing barefoot style shoes with wide toe boxes so your toes can flex and stretch out. An obstacle is that as weird as it is to walk around barefoot, it’s even weirder and more frowned upon socially to wear foot-shaped shoes — they all look like clown shoes and I haven’t seen a way to get around it. So, if you’re in a professional environment, you probably need to wear standard foot prisons — but if you’re working from home, take advantage of the opportunity to either go barefoot, or try out foot-shaped shoes.

8. Don’t ice your foot if you get injured, or are suffering from PTT like I was (am). This is a revision from my previous advice in the original Foot Fight article, to “Ice the inside and outside of the foot every night.” Now, I think icing is overrated, and instead you should just let your body cool off, settle down and heal naturally. Support can be found from — again, I can’t help myself — Nassim Taleb in Antifragile, Chapter 21: Medicine, Convexity, and Opacity:

I once broke my nose…walking. For the sake of antifragility, of course. I was trying to walk on uneven surfaces, as part of my antifragility program, under the influence of Erwan Le Corre, who believes in naturalistic exercise. It was exhilarating; I felt the world was richer, more fractal, and when I contrasted this terrain with the smooth surfaces of sidewalks and corporate offices, those felt like prisons. Unfortunately, I was carrying something much less ancestral, a cellular phone, which had the insolence to ring in the middle of a walk.

In the emergency room, the doctor and staff insisted that I should “ice” my nose, meaning apply an ice-cold patch to it. In the middle of the pain, it hit me that the swelling that Mother Nature gave me was most certainly not directly caused by the trauma. It was my own body’s response to the injury. It seemed to me that it was an insult to Mother Nature to override her programmed reactions unless we had a good reason to do so, backed by proper empirical testing to show that we humans can do better; the burden of evidence falls on us humans. So I mumbled to the emergency room doctor whether he had any statistical evidence of benefits from applying ice to my nose or if it resulted from a naive version of an interventionism.

His response was: “You have a nose the size of Cleveland and you are now interested in… numbers?” I recall developing from his blurry remarks the thought that he had no answer. 

Effectively, he had no answer, because as soon as I got to a computer, I was able to confirm that there is no compelling empirical evidence in favor of the reduction of swelling. At least, not outside the very rare cases in which the swelling would threaten the patient, which was clearly not the case. It was pure sucker-rationalism in the mind of doctors, following what made sense to boundedly intelligent humans, coupled with interventionism, this need to do something, this defect of thinking that we knew better, and denigration of the unobserved. 

9. Do daily foot strengthening exercises, and make sure to switch them up. I did the following three exercises every day for years: 1) rolling out the bottoms of my feet with a lacrosse ball, 2) squeezing a towel with my toes, and 3) spelling the alphabet in the air with each foot. They’re great exercises, but I should have graduated to new exercises once those original routines got so easy. Stay vigilant and always on the hunt for new ways to stretch and strengthen your feet.

10. Be patient. This last principle relates to the first one. Taking it slow means it takes more time. Recognize that the road to barefoot minimalist running is a long one, and it’s easy to get bored and impatient. It’s not as fun to slow down and ease up on the distance to give your feet the time they need to build up the strength to go barefoot — it’s more fun to just go out and run 10 miles, or crank out sprints, full force. Resist the urge to rush it. Relax, listen to your body, and give yourself the time and patience you need to get there.

Painfully obvious disclaimer: Your results may vary. Take my advice with a grain of salt. I’m not a physical therapist or medical professional.