Injuries While Barefoot: The Elephant in the Room

Okay, everybody. Bring it back in for a minute. We need to talk candidly about something.

"Don't worry. Going barefoot is
VERY safe. I'm not going to
get hurt. Really."

For as much as many others and I promote the barefoot lifestyle and talk about how low-risk it is, a very real possibility is that we will actually get hurt because we're not wearing protective shoes. We can even get hurt wearing minimalist footwear when something might have protected us better. The general public believes that catastrophic injuries to bare feet are waiting in every aisle of every store and under every table of every restaurant. We know that's not true, but injury risks still exist. It sucks.

My intent is not to turn anyone off to the barefoot lifestyle. I think it's so beneficial and that most people can live better through it. But just as "stuff" happens to our heads in car crashes, our hands when working with power tools or any other countless scenarios, "stuff" can happen while we're barefoot that, unfortunately, is really, um, "stuffy."

Why am I bringing this up? "You shouldn't be talking about this!," you may say. And that's exactly the reason I am.

We can't be ashamed, as barefooters, that we might get hurt doing the very thing we promote to others. Just as with ANY injury to ANY part of our bodies, we must do the best we can to pick ourselves up, brush ourselves off and move on after a foot injury. We must also support those who've gone through such a thing by encouraging them to not shy away from what's best, overall, for their feet.

I had an extensive conversation on Twitter the other day with a woman by the handle of @QuotidianLight. We'll call her Q for the remainder of this post since I don't know her real name. Q shared with me about how she hurt her foot two years ago after falling off her chair at work and slamming her foot into her metal desk. It was just a freak accident, but she ended up with a neuroma that's been tough to get healed and still gives her pain today - so much, in fact, that she can't go barefoot. She was wearing Vibram Fivefingers at the time, but told me, "If I'd been wearing shoes at work that morning... I'd have ran THIS morning."

The main point she wanted to impress on me was that she felt isolated and alone because she believes barefooters never talk about injuries and just hold in guilt when we get injured.

She's right. It makes sense to keep that information to ourselves so that we don't have shoe promoters feeling validated in their assertion that going barefoot is dangerous. But it also doesn't help when barefooters never address the proverbial elephant in the room.

"It annoys me that people think NO ONE get's hurt barefooting and if you do it's your fault so people don't speak up," Q said. She continued later, "I just wish more people would be open about their injuries. *shrugs*"

I pledged to her that I'd write this post.

Getting a stress fracture while
running in Vibram Fivefingers
turned my barefoot world upside down
in January 2010.

She thanked me and concluded with, "I hate when people get hurt and give up barefoot entirely cause they feel out of options/support."

I've heard it numerous times. Someone loves going barefoot until they get hurt - whether it's a broken toe, bee sting, cut or something else. After that, they get nervous it'll happen again and they hardly go barefoot for the rest of their lives. I know of at least two people in my immediate family who feel this way. It's very real, and these folks need encouragement to go barefoot again.

So there's three points I'd like to make here:

First, we shouldn't ignore the fact that we can - and probably will - get hurt from going barefoot, but we also shouldn't feel ashamed if we do. Understand that your feet ARE more vulnerable when going without shoes or even just minimalist footwear. Resign yourself to the fact that freak things happen sometimes. No matter how an injury to your foot occurs, don't beat yourself up and don't feel guilty or embarrassed about what happened. Just as importantly, let the criticism of shod people roll off your back when they pitch I-told-you-sos in your direction.

Second, don't give up going barefoot because you do get hurt. Obviously, take care of yourself and do what you have to do to get better. Get medical attention to treat and resolve the problem. That may mean a hiatus from going barefoot, but most injuries can and will heal completely. After that's taken care of, remember that you can still confidently go without shoes again. Though risks still exist, the benefits from living barefoot outweigh the risks. Move on a little wiser for the experience. Seek out the support and advice those of us who also go barefoot so that we can encourage you.

Third and finally, support other barefooters who get hurt. Friends, if we find out that one of us has been injured from going barefoot, let's kill them with kindness and not criticism. We need to be wary of pointing fingers and assigning blame when none needs to be assigned or doing so wouldn't help anyway. We want barefooters to stay barefooters, and the only way to do that is to be friendly and understanding with one another.

In closing, both of my brothers used to ride motorcycles on a regular basis. They always had a mantra about the likelihood of having an accident. They'd tell me, "It's not a matter of if you're going to wreck, it's matter of WHEN you're going to wreck." Yet even when they did wreck, they'd fix the bike, heal their bodies and get right back on. Injuries, minor or major, are all but inevitable when going barefoot. It's the mindset we have that determines what we take away from it. In anything we do, we only fail if we give up. Will we let foot injuries isolate us and make us quit, or make us stronger and wiser when we keep going?

Thanks, Q, for your story and inspiring me to write this.

So, community, let's talk about injuries. Do you share Q's opinions? Should the barefoot community be more open and honest about injuries or keep them in the closet? How do we respond to the I-told-you-so remarks from our naysayers? Please leave your comments in the section below.

A Backwards Look at Liability

I've been told on several occasions to be careful how I promote barefoot activity. The concerned persons say I might end up liable if people end up hurting themselves. This is a completely backwards and thoroughly confusing concept to me.

How is it that our society's collective thinking has gotten so twisted that we now believe that I could be liable if people use their feet as nature intended and that shoe companies are free from liability for weakness, stiffness, skin conditions and other ailments that are caused or exacerbated by their products? Do you see how topsy turvy that thinking is?

I wonder how many billions of dollars have been spent in the U.S. in the last half century to pay for the various treatments of ailments caused - or at least exacerbated - by shoes including...

• Arthritis
• Plantar fasciitis
• Fallen arches
• Bunions
• Hammertoes
• Morton's Neuroma
• Corns
• Callouses
• Dry/cracked skin
• Toenail fungus
• Athlete's foot
• Hangnails
• Ingrown toenails
• Stress fractures
• Fractures
• Sprains
• And more!

I assert that a great number of these ailments would have never occurred if people had gone barefoot more. Would injuries have happened to barefoot persons? Sure, but I'd bet it'd be far fewer than many would like to believe and that the overall costs of treating such problems would have been less.

If I would be liable for someone who goes barefoot getting injured, why aren't the shoe manufacturers liable for all the ailments listed above that their products may have caused for their customers?

It would be interesting to see how a class-action lawsuit against shoe companies would play out. Would it be thrown out by a judge? Would the plaintiffs successfully plead their case that shoe companies sold their products knowing full well that they could cause these ailments in customers without warning them of such dangers? Would the defense actually try to convince the court that shoes don't cause any of these ailments or that shoe wearers should have known the risks involved?

This feels a lot like the lawsuits that were successfully brought against the cigarette industry years ago. These huge companies spent loads of money in reparations after they'd been found guilty of duping and damaging the American public to make a buck. Warning labels were required on EVERY pack of cigarettes thereafter. The shoes available for sale and use today are just as bad for the feet as cigarettes are for the lungs, but many people don't know it.

Daniel Howell, PhD, author of The Barefoot Book and a professor of biology, believes that sellers of high heeled shoes should put warning labels on them. I agree. How many women would stop wearing heels if they knew that 20,000 women go to the hospital each year due to heel-related injuries? How many women would stop wearing heels if they knew they were far more likely to develop bunions, hammertoes, Morton's Neuroma, corns and other ailments because of them? Are the high heel manufacturers telling their customers this vital information? NO, but they should be.

If someone wants to sell us footwear or cigarettes, we should go into the purchase knowing what risks are ahead of us. Most importantly, if we want to opt out of using such products, we have every right do so and should not be forced by anyone to use products that will likely cause us some harm.

Worth noting is that no one had to convince anyone else that breathing without smoke in your lungs is a good, natural thing. That said, why does society put the burden of proof on barefooters that going barefoot is good, natural and acceptable behavior? As I've stated on this blog before, barefoot is the baseline. It is the natural condition for our feet, just as breathing non-smoky air is for our lungs. Sure, there are risks involved, but we understand that as part of our human nature. That said, I can't tell you how many barefooters have been told to put on shoes for their "safety."

Imagine if a restaurant manager changed the way you dine for your "safety.":

"Good evening, sir. I see you ordered the steak. Because of that I'm going to have to ask you to wear these protective gloves while you use your steak knife to cut the food. We don't want you cutting yourself. Alisha here will also be making sure that you've chewed each bite thoroughly and that you're not speaking before you swallow each bite. We don't want you choking, after all. Just looking out for your safety!"

When we use a steak knife with bare hands, we know we must be careful lest we get cut. When we eat steak we know we must be careful not to choke. Likewise, when we go barefoot we understand we must be careful not to step on something dangerous or stub our toes. We don't need someone coddling us and protecting us from things we already know and understand! What we DO need is more public education on the harm that shoes are actually doing to our feet.

What do you think? Should shoe manufacturers be held liable for selling the public on products that exacerbate foot ailments? Should shoes come with warning labels? Please let me know your thoughts in the comments below.

Report: 2011 Groundhog Run (5K)

To say I was excited to run this year's Groundhog Run for Children's TLC is a bit of an understatement. I intended to run it last year, but a stress fracture in the heel bone of my left foot in January 2010 kept me out of the race. I did volunteer at that event, but was sorely disappointed that I couldn't participate. What's more, my running goals in 2010 had to be scaled back significantly because of the setback of the fracture. Running this year's event, to me, symbolized a bit of a "rebirth" of running for me -- a chance to reset what went wrong last year and go at it with renewed gusto.

I should explain the Groundhog Run a bit further before we go on. The whole dang thing is underground in industrial caves. The event is a charity run for Children's Therapeutic Learning Center in Kansas City, a school that helps kids with disabilities. It's a great way for runners to comfortably wear lightweight running gear for a race in January (when the temperature outside this morning was around 22 degrees F) and also support a worthy cause.

I decided to run this race in Vibram Fivefingers Sprints. I didn't want to run it barefoot, as I remembered from volunteering last year that the pavement underground can tend to be pretty rough. I hadn't had a chance to keep my bare feet conditioned and thought it'd be best on the soles to wear some kind of covering.

I was signed up to run this year's 5K race as part of a four-person team for my employer, a children's hospital in Kansas City. The team leader knew fully that I am a slowpoke compared to them, but he was happy to have me on -- I think he knew that my time would be thrown out anyway, as only the top three runners on a team had their times counted.

My wife and I showed up about an hour ahead of time and claimed a spot inside the VIP team area to drop off our stuff and for me to warm up. That was really nice. Instead of the requisite porta potties that most big races have for runners, the "VIPs" could use the official restrooms in the reception area where we were allowed. No lines, no plastic lavatories. While warming up, I noticed that I had a really sore spot in the muscle of my inner right thigh, just above the knee. I worked on it to try to loosen it up.

When it was time to race, I lined up about halfway between the 8-minute-per-mile and 12-minute-per-mile signs, as I expected to run around 10 minutes per mile. The starting area was PACKED. It's one thing when that's outdoors, but when there's stone pillars all around and a solid rock ceiling overhead, you begin to feel a bit like sardines. The right thigh was still feeling a bit sore.

The race began and I started off at what I thought was a pretty decent pace. I tried not to waste too much energy by running too fast, but I also didn't want to make it harder on myself by running too slow. The tight muscle in my leg really started to loosen up and I felt really good upon hitting the first mile marker at 9:47. Not bad.

In the second mile, I started to tire a little bit. My abdomen was cramping just a little bit and I was ready for a drink of water. I would have just taken a swig from my running bottle, but I had decided to leave it behind for this race. That was probably a poor choice, because I think it would have helped me when I needed water instead of having to trudge to the water station. I normally run with the bottle and should not have broken the "don't change anything on race day" rule that all runners are recommended to adhere to.

I'll be honest: I had to take a couple of walking breaks just to catch my breath and recover momentarily. None were more than about 30 seconds long, but it bugged me that I had to stop running AT ALL -- even if I know that walking breaks can lead to a faster overall time. It was disappointing to me, though, because for my first 5K last year after my injury I was able to run the whole race...with a big hill in the middle of it.

I was getting near the end when I noticed a blistery spot developing on the inside ball of my left foot, just behind the big toe. My Fivefingers shoe was rubbing me the wrong way, literally. I kept on going, thinking that I didn't have too much farther until the finish. Then I looked down and realize that what we'd been running on really wasn't that rough. In fact, it was certainly adequate for running without shoes!

Instead of contributing to the developing blister by keeping my shoes on, I decided to stop with about half a mile to go, remove my shoes and finish barefoot. It was GREAT! My feet felt awesome, the ground felt wonderful and I was so happy to be running on my own two feet. The blister didn't end up being bad at all when all was said and done. I'd call it a "pre-blister." I put a little bit of tape over it to protect it from the Fivefingers for when I walked around afterward and left to head home.

I finished the race in 31:05 for an overall pace of 10:01 per mile -- a new personal record! That time beats my previous 5K PR of 32:50 and was the 6th best pace of any run I've had since I returned to running in late 2009. It was definitely the best pace of any organized race I've ever run.

I'm pleased with my performance in the race. I had wanted to finish in less than 30 minutes, but this was a respectable time considering that I did take walking breaks and stopped to take my shoes off. Heck, it still even beat my last PR in a race that I ran the whole thing!

Here's hoping that the gains I've made going into this race continue as I gear up for a half marathon in June -- the same race in which I PRed last year, just 10 miles longer.

Active.com Readers' Sometimes-Ironic Comments on Barefoot Running

Active.com asked on their Facebook page, "How many of you have tried barefoot running?" As you may know, barefoot runners just like me believe it can lead to fewer injuries and greater enjoyment due to the mechanics of landing with a mid/fore-foot strike and the increased sensory awareness from having bare sole to the ground. But there's others that strongly feel the opposite: That barefoot activity can be nothing but harmful.

I couldn't help but notice some amazingly ironic (and sometimes humorous) comments left by Active.com's fans, however:

• "I have enough injuries thank you."
• "no no no i like my feet thank you"
• "not barefoot but without socks !!! OUCH !!! and i got the pictures to prove it,couldnt run for about 2 weeks,i tried after 1 wk blisters would just open up!!! so i'll pass on the barefoot. lol"
• "Tried it - loved it - been doing it since - oct 2009 - in Vibram Five Fingers"
• "Can you say, plantar faciitis?"
• "the last marathon I ran I saw a women running barefoot and she wasn't looking so good."
• "I really wanted to be a "barefoot" runner in my Vibrams, but I keep getting blisters on my heels every time."
• "Running in shoes tears up my pedicures enough! No thanks to the bare feet!"
• "I know so many runners who get injuries from either running barefoot or in those horrid slippers with the toes. Modern man is not designed for this. Stick to what keeps you injury free and trotting down the road. Like good supportive shoes!!! Gimmicky fad shoes are not the answer to running issues."
• "I did 6 miles years ago barefoot...Never again. No blisters but feet were red and hurt for a day or two."
• "You bare foot runners are going to have some really bad backs in years to come ...."
• "No it makes feet DISGUSTING"
• "I have tried it and my feet were so sore. I figure running shoes were invented for a reason. We no longer get a "bonk" on the head with a frying pan before surgery, so I don't think we should revert back to running barefoot either."
• "To you all who think God intended us to run barefoot? He also intended for us to run naked but that wouldn't go over very well either ;)"

And those were just a few from the first 170 or so comments! We in the barefoot community have a LONG way to go to dispel a lot of myths. But then again, there's lots of people out there who are very close-minded and will never hear of barefoot activity as long as they have feet.

What do you think of these comments? Have YOU tried barefoot running? Have you tried any kind of barefoot activity outside your home or the swimming pool? What do you think about the state of barefoot running in our culture? Is it a fad? Just another way for shoe companies to make a buck? Please sound off in the comments section below.

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."

The Return of Nicer Weather and Barefooting

With the dawn of warmer weather and the stress fracture in my left heel almost totally healed, I had a wonderful time going barefoot a lot this past weekend! Highs were in the mid-to-upper 50s (F) Saturday and Sunday, so I took every opportunity I could to kick off my footwear and go bare from the ankle down. Much of it was spent barefoot at home or while driving, but I also had a few chances to walk barefoot while out and about.

My son was to attend a birthday party on Saturday afternoon, so he and I went to Walmart earlier in the day to buy a present and get a few other odds and ends for around our house. At first I wore flip flops into the store. I didn't want to stir up any issues going in because we were on a tight schedule and I honestly wasn't in the mood for a confrontation.

What I discovered was that my left toes were hurting while wearing the flip flops. I can only assume that it was due to my entire left foot being weakened from wearing the walking boot for the good part of six weeks. After unsuccessfully relieving the discomfort by popping one of my toes, I relented and spent the rest of the time in the store barefoot. I kicked off the flops and put them in the cart. The pain in my left toes went away immediately and the rest of the time in the store was quite pleasant.

I did find it reassuring that I had a "good" excuse if I were to be confronted. I would honestly and tactfully tell the person that I am recovering from a broken foot and that my toes were hurting from wearing the flip flops. Without them on I felt much better, so that's how I was going to shop. There were no issues, however.

Who DOESN'T want to play kickball? (from Ghostman on Third blog)

At the birthday party, the kids were playing kickball in the yard so I participated while wearing my Vibram Fivefinger Sprints. Although I wasn't totally barefoot, that was a good time and I learned that my left leg really is quite a lot weaker than before my injury. Just the little bits of running I did to fetch the ball indicated that I really do need PT to fully recover and that I should stick to mostly walking for now.

My wife (@barefootglenda on Twitter) and I went on a date Saturday evening to celebrate our third anniversary. We also managed to find an opportunity to go barefoot together. After wearing shoes while eating dinner and visiting a few stores in the fancy Country Club Plaza shopping district (pictured) in Kansas City, we started walking around. I told her that I really wanted to go barefoot to which she replied with a smile, "If you do it then I will, too." Yes! That was an offer I couldn't refuse. We kicked off our shoes, held hands and walked around for all the world -- or at least pedestrians and shoppers -- to see. It was liberating, refreshing and incredibly romantic. Although her feet did get a bit chilly, she said she enjoyed it and actually liked seeing the expressions on others' faces.

Sunday brought another day of being barefoot or minimally shod. My wife and two girls went to a birthday party in the afternoon, so our nine-year-old son and I spent some time outside at the park. I wore my Fivefingers while we threw around a frisbee and hit the wiffle ball. He eventually wanted to play on the jungle gym, so I kicked off the VFFs and sat down on a bench to hang out. While sitting there, an older lady next to me asked, "Aren't your feet cold?" I replied that they actually felt great and that I like to go barefoot a lot. She told me, "I used to do that when I was younger, but then I grew out of it." I passed that comment aside and we talked about lots of other things until my son was ready to leave.

All in all it was good to herald the return of nicer weather and give my feet a chance to be feet again. After both of them were trapped in a cast boot or "regular" shoes for the good part of two months, they needed it. I did notice some soreness in my left foot at times, which I have to attribute to weakness from weeks of immobility. I can't help but think that the walking around and playing in grassy areas is good therapy in itself to help rebuild the muscles in my feet. I'm looking forward to physical therapy so that I may return to running, but I'm mostly looking forward to having strong, flexible feet again.

Were you able to go barefoot this last weekend? Are you interested in going barefoot more as the weather gets nicer? I welcome your comments below.

Country Club Plaza photo: Fashion Windows

My Achilles Heel: Transitioning & Balancing

I went to the doctor today for a four-week followup in the wake of being diagnosed with a calcaneal contusion and stress fracture in my left foot. It was caused by poor training choices while preparing for a 5K race. It's been more than six weeks since I began feeling pain.

I didn't actually see my doctor. He was out of town to support a U.S. Men's Volleyball tournament in Denver. I saw his associate, a very nice gal who also specializes in sports medicine.

After getting caught up on my condition and how my ankle is feeling, she recommended that I begin water physical therapy. It will be for the purposes of building up my leg muscles again while my heel finishes its recovery. If my insurance won't pay for that, I'll do "regular" PT.

As far as weight bearing and using the boot, she feels I should be in the mode of "weight bearing as tolerated." That means that if it hurts to walk on it, don't. She didn't give me any hard and fast numbers of how many more weeks to stay off of it or wear the boot. I should gauge for myself what I think is best. She did mention, however, that she'd like to see me walking around some at home "in a shoe."


Pain is the real guide here. She doesn't want to order any images if it seems like pain is slowly going away; on the flip side I shouldn't do anything that causes a lot of pain. She did share that most of the pain I've felt likely came from the contusion in the heel and not necessarily the fracture itself. The fracture is likely healing, but the contusion will take a long time to fully go away.

Because of that and all the walking I do with my job, she feels that wearing more of a "walking shoe" or cushioned shoe at work from now on would be best. She understands my preference for minimal footwear, and I understand her points, so it may be that I'll wear the insoles that came with my Terra Plana VivoBarefoot shoes and maybe even an additional cushioned heel cup for a while. Split the difference, in other words.

So we'll play it by...er, foot, and see what happens. I'm looking forward to PT, because that tells me I'm on my way back to an active lifestyle and running. I have another followup with my regular doctor again in two weeks. We'll see what happens between now and then. As always, I'll keep you posted.

I welcome your comments below. Have you ever dealt with a foot injury? I'd be interested to hear your experience in the comments section, too.

My Achilles Heel: Three-Week Update & Vitamin D Information

Here's a quick update on what's been going on with my barefooting lately. It's been non-existent. It's now been three weeks since I was officially diagnosed with a stress fracture and bone contusion in my left heel and just over five weeks since I started noticing pain. The injury occurred as a result of poor training decisions while preparing for a 5K race.

Since the diagnosis I've been faithfully wearing my soft cast boot about 23 hours per day -- the one hour being the time from when I wake up in the morning to when I put it on right before leaving for work. By restricting the motion of the foot and ankle, it's given my heel an opportunity to heal without the achilles tendon pulling on it. That was part of the issue that led to the stress fracture in the first place. The boot's not been a terrible thing. I've gotten used to my ankle and foot being immobilized and I even tweeted a while back that it no longer feels like the boot is on my leg, but instead a part of my leg. I have noticed some atrophy in my calf. Hopefully that won't take a long time to build back up after this is all said and done.

Because of the nature and location of the injury, I've also been non-weight-bearing for most of that three weeks. I have a job that requires a lot of walking, so I've been using a combination of crutches and a wheelchair (pictured) to get around. The wheelchair is used only at work for longer distances (like from building to building) and the crutches are for everywhere else, including shorter treks or spaces in which a wheelchair's not feasible. At first using these devices was a pain, literally. My arms HURT from using them. Now, my arms are much stronger and I come away from each workday simply tired. I'm also finding that I can eat darned near anything I want because I burn most of it off pushing or crutching myself around all day.

My heel doesn't generally hurt like it used to. A lot of that can be attributed to the fact that I have been non-weight-bearing most of the time and the boot is usually immobilizing my ankle joint. I do find that, by the time I'm finished getting ready in the morning, my heel does ache a bit. I hope that it's healing well and that the aching is from the bone contusion that went along with the stress fracture.

I have a follow-up with my doctor next Friday, Feb. 26. It may be that he'll determine that non-weight-bearing for four weeks is enough and I should stick with the boot. Maybe he'll clear me altogether and put me in PT. I kind of hope that's not the case, because I keep hearing that stress fractures of the heel take six to eight weeks to fully recover. I don't want to do anything to jeopardize my recovery and delay my return to running. I guess we'll have to see.

As a side note, but on somewhat related subject, I've begun taking Vitamin D supplements. I've been hearing a lot lately from work and Twitter friends about Vitamin D's relation to bone health. What I've found out is that most people are Vitamin D deficient and that such a deficit can cause bones to be weakened and more susceptible to stress fractures.

I've begun taking 4,000 IU of a Vitamin D3 supplement each day to help boost my levels and then plan on cutting back to about 2,000 IU a day as recommended by a well-known Vitamin D researcher named Michael Holick, PhD, MD (pictured). He recently presented a Grand Rounds on Vitamin D at my workplace and shared a lot of interesting information. To put it simply, he recommends that EVERY adult take a 1,000-2,000 IU supplement of Vitamin D every day to offset the amounts we no longer get from regular sun exposure. More information is available at his Web site, VitaminDHealth.org.

So I'll be non-weight-bearing with the cast boot for another week. I'm hanging in there with only a little pain, but I'm doing what I can to make sure this never happens again by taking a Vitamin D supplement. We'll see what happens.

I welcome your comments below. Also, if you haven't found me on Twitter, I'm a regular user there at the username "BarefootMichael." Come say hi! FYI, my last few "tweets" are always listed in the right panel of this blog.

My Achilles Heel: The First Stressful Week

I thought I'd post a brief update about how things have shaken out regarding the stress fracture in my left heel.

I'll be honest, it's been confusing. My doctor originally said I should wear a cast boot (similar to the one pictured below) and my heel would heal in about four weeks. He said I could still walk on it but try to reduce how much walking I do each day. So for a couple of days following my diagnosis I wore a boot and walked on my heel like normal. This ended up causing continued pain in my heel due the cumulative effect of pressure on my foot.

With further research, I found that his recommendations seemed quite liberal compared to how many other doctors treat stress fractures. A standard treatment for an ailment like mine has usually been a cast boot and no weight bearing for at least a few weeks, with the total treatment time being six to eight weeks. Some outlets have even said that just walking on a stress fracture can cause more damage up to and including the need for surgery.

So I had a number of concerns.

First, it seemed like walking on a painful heel was a bad idea. It wasn't so much a problem for very short periods or distances (i.e. from one room to the other), but being on my feet for any length of time was painful. So I questioned my doc again whether I should even be bearing weight on my foot.

Second, walking with pain was compounded by the fact that my job is tied to walking a lot. Just to give you an idea, wearing a pedometer last year showed that I walk an average of 11,000 steps a day at work. That ends up being a little more than 5 miles each and every work day or a near-marathon length 26 miles a week. What's more, all that walking ends up being long distances in chunks spanning almost 1/4 mile one way to get from my office to another location in my workplace. I asked the doc if there was any way to help with getting from place to place during the day.

My doctor decided that I probably should be non-weight bearing if my heel continues hurting. As for how to get around, he said crutches or a wheelchair would work. I asked if an electric mobility scooter could be a viable option. He agreed it would but thought it would be cost prohibitive.

I have researched the possibility of getting a mobility scooter but have run into some bumps along the road. It seems as though insurance won't cover the rental of such things. My insurance also wouldn't pay for purchasing one as my condition is not a life-long or long-term disability. So it seems like the only options I have left are to either use some of the funds we've set aside in our Flexible Spending Account (you know, that "cafeteria plan" you can put tax-free money into at work to pay for medical expenses) or pay out of pocket. The FSA would be a good option, but we've already designated those funds to pay for outstanding bills from our baby's birth in August and other expenses. Paying out of pocket isn't a very good option because we don't really have money available to do that.

So right now I'm using a combination of crutches and a manual wheelchair (pictured), both which have been borrowed from friends who have no immediate need for them. They work out okay, but traversing the long distances has proven exhausting.

So my arms are tired and, quite honestly, my spirit is too.

It's bad enough not being able to go barefoot AT ALL for a couple of months (though I cheat at bedtime and when I shower each morning), but to have such limited mobility when my job is so reliant on me walking around? That really sucks, I won't lie.

But, I know I'll come out of this stronger and better for it. I already have a new appreciation for those that must always use crutches or wheelchairs. Maybe, just maybe, I'll also get some pretty hearty biceps, too?

I guess tickets to the gun show go on sale in six to eight weeks.

I welcome your comments below.

Q&A: Return to Running

When is your next run? - Submitted by Anonymous

Thanks for your question!

At this point it's hard to say when I'll return to running. Though my doctor wants a follow-up at four weeks, it could be a total of six to eight before I'm back out there. That could mean that I don't start running again until April. After that, it could take a while to recondition my legs to the point that I'd be ready to run an organized race.

As of right now I'm tentatively planning for my first race back to be the Hospital Hill 5K here in Kansas City on June 5, 2010. That should give me plenty of time to recover from the stress fracture and recondition for the race. Let's all cross our fingers.

Question(s) About Barefooted Living?

My Achilles Heel: Stressed. Out.

I'll try to keep this brief.

I'm reminded of a movie quote, though I can't remember who said it in what film. It goes, "I hate it when I'm right." Everything I wrote in the previous post came to pass. I DO have a stress fracture in my heel and I won't be running the 5K on Sunday. So...

An MRI image of my heel. The yellow arrow is pointing to the primary fracture, but the white area around it also indicates weakening of the bone. My heel should look evenly dark like the other bones displayed.

I honestly don't know how this would have happened. As a barefoot runner, I use a forefoot strike which should completely eliminate stressful forces on the heel. I can only surmise that all of the walking I do at work in minimalist (read: uncushioned) shoes plus the forces of my achilles pulling on my heel while running weakened my heel bone enough to cause this fracture.

So I'll be doing no load-bearing exercise for the next four weeks. That means no running. I also will wear a boot, at least to work, in order to allow my heel to heal. That, along with a note saying I should "limit the amount of walking (I do) throughout the day," will probably be enough to allow this problem to fix itself. I'm going to pursue using a motorized scooter of some sort at work so that the long walks to the other end of the facility are a lot shorter and less strenuous on the feet. My employer needs to accommodate my injury, so we'll see what our Occupational Health department has to say.

The doctor doesn't seem overly concerned about me wearing the boot all of the time. He believes the problem should resolve itself so long as I don't run and wear the boot at work. I take that to mean that generally avoiding strenuous activity or heavy use of the foot should be enough. I think I'll probably still try to go barefoot around the house. I often walk with a forefoot strike and gently touch my heels to the ground when barefoot, so that should be okay. I'll also sleep barefoot.

So, thus begins four weeks of taking it easy on the feet even if I still try to get workouts in. I want to try to find alternate ways to do cardio. The good doctor recommended a stationary bike or swimming as good non-load-bearing exercises. I'm sure our city's community center has inexpensive memberships available to use their gym, so that sounds like a good option for the bike. A local middle school has an indoor swimming pool, so I'll investigate what usage costs there are. I can always also do core exercises as they don't require significant forces on the heels.

In a way, I'm kind of glad that this happened now. If I'd gotten a stress fracture right in the middle of the spring-through-autumn months, that would have really given a hit to my barefooting. This way I'll be able to heal up, get reconditioned and go enjoy a number of runs this summer AND do them all barefoot. Sounds like a plan.

Thanks for reading. I welcome your comments below.

My Achilles Heel: A Quacked Calcaneus?

Interesting things have occurred since last I spoke to you about my ankle. You might recall from my Jan. 22 post that I was diagnosed with Achilles Tendinitis. I wore a cast boot, did heat therapy and took an anti-inflammatory drug for a week in the hopes that it would clear up. If I did, in fact, have Achilles Tendinitis, I believe that it cleared up.

But there's still pain in my ankle that has lingered. More specifically, when you squeeze in particular spots on the sides of my heel it triggers hearty amounts of pain. Now, the X-ray I'd gotten didn't show anything, so my sports medicine doctor wisely decided to send me for an MRI. Magnetic resonance imaging, in case you don't know, is a very sensitive series of pictures of the body's internals. It can show many things that X-rays can't, like the condition I now think I probably have. He wanted to see what exactly is going on in there, but didn't make any assertions as to what the problem really could be.

One thing he DID do, however, is clear me to run in the 5K I'd been planning on for this Sunday. He said, "It's only a 5K. It's not like you're running a marathon. Go for it." Now, while that might seem insulting to some readers, I took no offense and realized that he meant that the relatively-short 3.1 mile race could do very little extra harm to my heel/ankle.

So I left his office with just as many questions as answers. What would the MRI show? What if the MRI showed something bad enough that I really CAN'T run the 5K? If the issue isn't Achilles Tendinitis, what could it possibly be?

After getting the MRI done last night, being given a CD of the images and surfing the interwebs for pictures of heels and MRIs, I've used my junior radiologist deduction techniques to make a prediction of what is wrong with my ankle. It's all I can do until the radiologist gives his/her report to my doc. So I can't be sure until 8 a.m. tomorrow morning when I have a followup, but a guy can still make an educated guess, can't he?

And boy, what an educated guess this is. I'd like to think I'm a smart guy. I am kind of "techie" by trade and actually work in a hospital, so I am sure of two things about reading medical imaging: 1) MRIs are REALLY cool and really detailed in what they show & 2) Medical films are REALLY hard to read. That said...

Based on my continuing symptoms and MRI, I think it is highly likely that I have a stress fracture in my calcaneus (heel) bone. After looking at the MRI images of my ankle/heel and comparing them to images readily available via a simple Google image search, I believe there are striking similarities between them. Check it out below. On the left you see an image I found on the Radsource Web site. It shows an T2-weighted MRI of a calcaneus with a stress fracture (indicated by the white arrow). On the right, I have displayed an almost exact T2-weighted image of my calcaneus with what I believe is a stress fracture (indicated by the yellow arrow).

(Click image for larger version)

There's other evidence in my set of MRI images that lead me to believe I have a stress fracture, but the similarities between the two indicated parts of the images above cannot be ignored. Heck, the dark line in my heel (on the right) even curves in a very similar way to the fracture in the left photo.

So, where does that leave me? It leaves me waiting to see my doctor tomorrow morning to find out what's REALLY going on. I also have to wonder what kind of treatment and limitations I might have in the near future. Most articles about calcaneal stress fractures indicate that a standard treatment is a lot of rest for up to 8 weeks. That may even include a cast and no weight bearing for that period.

If I do have a stress fracture and I have to wear some kind of cast or cast boot, I'd need to work with my doc to see if it'd be acceptable to do some walking in order to fulfill my job responsibilities. As someone who typically walks about 11,000 steps a day at work -- and who only has about 1 1/2 weeks of sick time accrued -- I would really need to find workarounds so I can heal but still work. I've thought about proposing using a rented scooter to motor around my workplace and then park it when I get to whatever room I need to work in. When finished at a particular location, I could scoot away to somewhere else. Minimal walking while the job still gets done. It's worth a shot.

And the 5K? Well, if I really do have a stress fracture I doubt the good doctor would still be okay with me running it. After all, it might have been running that caused the problem in the first place.

But hey, I suppose there's a possibility that I don't have a stress fracture. Maybe, even though the MRI looks ridiculously similar to other confirmed cases of stress fracture AND the fact that I have symptoms that are completely consistent with said condition, I don't actually have it. We'll see. But as I've told my wife and a few others today, "If it walks like a duck and it quacks like a duck...it's probably a stress fracture." Wait, what?

I'm planning an update to the blog tomorrow with the final news. To stay remotely on point with this blog, however, I will finish by saying that I have a feeling this is going to negatively affect my barefooting mojo...again. Hopefully, I'll be all better by the time warm weather comes around and it's prime barefooting season. I guess we'll see.

I welcome your comments below.

Detective image: http://mohsinali.name/wp-content/uploads/2009/02/detective.jpg
Scooter image: http://electricwheelchair-electricscooter.com

My Achilles Heel: These Boots Weren't Made for Barefooters

Well, it's now been just over a week since I initially hurt my ankle.I went to a sports medicine doctor two days ago and was diagnosed with Achilles Tendonitis. Since then I've been wearing a cast boot, taking an anti-inflammatory, doing heat therapy and trying to rest as much as possible.

This Wednesday I go for a one-week followup to see how things have progressed and find out if I'll be able to run the 5K on January 31 that I've been training for. I'm hoping that he'll give me the go ahead and I can use kinesio tape such as KT Tape to support my achilles during the run.

So how is my achilles right now?

As of this morning my ankle doesn't feel much better at all, actually. It doesn't hurt while I'm wearing the boot, however any time I walk without it on, my ankle starts hurting in exactly the same way it has been. It also continues to be just as swollen even after two days of the (strong) anti-inflammatory drug.

Injuring my achilles has turned my barefooted world upside down!

My barefooted "spirits" are down, too. For a guy who normally always wants to go barefooted or wear only minimalist shoes, wearing a cast boot and regular boot (to offset the height difference of the thick sole) is almost like a prison sentence; punishment for my wrongdoing of overtraining for the 5K. Sigh.

What this does do is reinforce my feelings about going barefooted. I'd been unshod or minimalist for so long that going back to such restrictive footwear -- even in the form of a "regular" boot -- is a good reminder of how truly comfortable and unrestrictive bare feet really can be.

Honestly, I've really wanted to rip this stuff off of me. Last night, while at a youth event that I'm helping support for my church, I cam so close to getting my elastic wrap, ditching the boots, wrapping my achilles and going essentially barefooted the rest of the night. But alas, I knew that wouldn't be best. I've got to fight the good fight and be patient for my achilles to heal and me to be able to return to walking, running and living barefooted.

So we'll see what happens. If there's any more news I'll share it here, Twitter, Facebook, blah, blah, blah.

Injured Achilles/Ankle and Upcoming 5K

I've decided to pursue medical attention for my left ankle ahead of my scheduled 5K on Jan. 31. If the doc says to not run the race, I won't.

I hurt my ankle last week on what ended up being a pretty good run. Afterward it started hurting from what I thought was pressure caused by my Vibram Fivefinger shoes, and I took a couple days off. The big mistake was to go out and run again on Saturday and push myself too hard while still in pain.

At this point I'm almost totally certain that I have, at a minimum, achilles tendinitis in my ankle from overuse/overtraining. I'm beginning to wonder if the persistent swelling and pain is an indication that I could have a partial achilles tear as well.

It KILLS me to potentially give up racing my first 5K on Jan. 31, but it's appropriate for a medical pro to look further into the problem and determine whether or not my ankle will be able to tolerate it. Better to take it easy and recover than potentially make it worse.

If you're a person of faith, please keep me in your prayers, thanks.