Are Your Dress Shoes and Flip Flops Causing Your Running Injuries?

Pardon me for this post. I had a sort of epiphany a while back and I need to "think out loud." Please read this with the understanding that I don't have many answers, just questions. But sometimes you have to ask the right questions to get the right answers, don't you?

I've talked a lot on Twitter and in this space about barefoot running. I, as a barefooter and barefoot runner, subscribe to the idea that running without footwear -- or at most, minimal footwear -- is the best thing at preventing injuries from running.

But what if all this talk about a forefoot strike vs. heel strike, pronation, arch support, etc. pitting running shoes against feet is missing the mark? What if the core reason for most running injuries has very little to do with what a runner wears on their feet or how they land? After all, there are runners who are happy to step forward and say that they've never been hurt while wearing trainers. There are people who can go for months at a time wearing the same kinds of running shoes before they get hurt. What's with that?

Could it be that running shoes -- or lack thereof -- are NOT a major factor in runners getting hurt?

What if runners get injured because of all their shoes? It's entirely possible that stuffing our feet into stiff, constricting dress shoes with elevated heels at work five days of the week -- six if you dress up for church -- wearing gait-altering flip flops when it's nice out and any other various kinds of footwear put your feet in unnatural situations can have a collective effect on our bodies.

Consider this: A young woman who eats healthy has a full-time job that requires her to dress in business attire. She goes to work five days a week and usually wears a pair of high heels. Her health is important to her, so after work three days of the week she heads out for a run and averages about five to six miles per run. She varies her courses, from trails to the high school track. After work one Friday, she goes straight home to prep for a night out shopping with the girls instead of running. She dresses casually and throws on a pair of flip flops. Saturday morning is her long run while training for a half marathon that's still a few weeks away. She runs a steady seven miles before donning her flip flops again to run errands. Not long after this, she ends up with really painful plantar fasciitis (PF) that nags her for a very long time. She ends up running the half, but she hurts through most of it.

The big question: What caused the PF?*

A podiatrist, sports doctor or magazine might tell you that she increased her mileage too fast, has poor foot structure and/or that she's wearing the wrong running shoes. The recommended course of treatment might be to keep the running shoes but add an orthotic and have her wear a night-time splint while she sleeps.

In this fake scenario and so many other real-life situations, maybe the running shoes aren't the problem at all. It could be that the combination of her toes being smashed together in heels at work all week, her achilles being shortened by the angle of her ankle wearing the heels, and the biomechanics involved in keeping flip flops on her feet while walking all have a cumulative effect in messing her body up so that when she runs in trainers it hurts. Maybe all that stuff is what really caused the PF and then the mechanics of running made it jump to the fore.

A magician (intentionally) does this kind of thing all the time. While you're watching him make a fuzzy ball disappear in his left hand, you're not paying attention to the fact that he's already putting it in his jacket pocket with the right hand. Your attention is in the wrong place. It sure seems like he made the ball disappear when there was actually something else going on out of sight and out of mind the whole time.

Now, I don't want to imply that podiatrists, sports doctors and so many other experts are using medical sleight of hand to make money when they know full well what the "real" problem is. I'm actually wondering if we're all just missing the big picture here. Maybe what we see happening is an unintentional diversion from what's happening just out of our vision.

It could be that fixing a problem with the foot by conventional means doesn't address the real problem: All the various footwear that we put on our feet on an everyday basis could have a cumulative effect in messing us up. If you really think about it, it seems reasonable that you can't consistently shove your foot into a cramped, stiff space or make it do unnatural stuff most every day of your life and expect it to come out perfect when you want to really make it perform.

As you probably know, I recently finished up treatment for a stress fracture in my left heel. I was non-weight-bearing and wore a cast boot for the good part of six weeks to fix it. I did physical therapy to get me back to the point where my body can now run again. I needed that therapy because I was not properly balanced. My left leg atrophied a lot due to my injury.

Scratch that. No, it didn't.

I didn't go through PT because of my stress fracture. I did it because of the effects of the treatment for my stress fracture. Being off my foot and keeping my lower leg so immobilized caused my leg muscles to atrophy and my whole body to be out of whack.

If that happened to my leg because of consistent use of crutches and the boot, doesn't it make some sense that regular use of restrictive, gait-altering footwear could throw our bodies out of whack as well? I realize that we're talking various degrees and types here. Someone who is non-weight-bearing will have different negative effects than a woman who wears heels every day to work. The point is that it's probably incredibly short-sighted to just blame running shoes for running injuries.

I'm sure that there are many podiatrists and other doctors who address these lifestyle issues when someone comes in for treatment. I know that there are podiatrists who realize the negative effects of high heels on women's feet. But I've also read comments from many experts who essentially throw their hands up and say, "Well, women are going to wear heels so we have to find creative ways to address their foot problems."

To me that seems like telling a smoker, "We know you're going to smoke, so here's cigarettes that aren't as bad for you," when we should be shouting from the mountaintops, "STOP SMOKING! It is bad for you! Don't do it!"

Maybe we, as a society, need to stand up and say that heels, stuffy shoes and flip flops aren't worth it. Our feet are too important to keep screwing them up all the time in the name of fashion, protection or any of the other excuses we've come up with for needing stupid shoes all the time.

It's possible that after looking further into this, we might find that people who don't get injured as much while running don't subject themselves to confining shoes on a regular basis. We might find that all the nasty shoes we wear are the actual cause of many bio-mechanical problems with our bodies when running.

I admit that it would be nearly impossible to ever scientifically prove these theories to be true. There's too many variables. You couldn't compare apples to apples since each person works different jobs, walks on different surfaces, wears different shoes, weighs different weights, has different sized feet and the list goes on. Measuring long-term effects under controlled conditions would be infeasible.

That said, there is one constant for each person: Our own two feet. We wake up and go to sleep with the same feet each day. We've had them since we were born and, barring terrible circumstances, we'll have them until we pass away. Doesn't it seem like it's at least worth considering that our own two feet are optimized for each one of us and should generally stay free of shoes? Doesn't it make sense to do as little as necessary to protect or adjust them, but otherwise let them act on their own accord? Many barefooters including myself would answer yes to both of those questions.

Barefooters have discovered that we in civilized society really don't need shoes all the time. The surfaces on which we walk aren't covered in as much broken glass, used needles, viruses, feces or other nasty things as many people would like to believe. The man-made carpet, tile and paved surfaces that so much of our world is covered in is really very safe to walk on without shoes. Our green spaces are usually well kept and free of hidden dangers. If cuts or other injuries occur, our feet are very resilient at healing and moving on.

Have you run successfully for a long time while wearing trainers? If so, what do you wear when you're not running? Is it possible that the shoes most people wear on a regular basis are the cause of running injuries and NOT the sneakers themselves? Are the best "shoes" for us no shoes at all? Is it possible to turn the tide on terrible footwear like high heels and convince people to take better care of their feet through better footwear or no footwear at all? I welcome your comments below.

* - I realize that this scenario is fictitious. I realize that you may not agree with how the scenario played out. My point was to come up with a story that could happen at some point in Anytown, USA to use for illustrative purposes. Don't miss the bigger picture of the post by getting hung up on, "That wouldn't actually happen."