You Don’t Have to Run in Pain

You Don’t Have to Run in Pain: Second Installment of “Voice from the Running Shoe Store Floor”

An early adopter of minimalism, Jim Hixson was the former general manager of an independent running retail store in St. Louis, Missouri. In addition to currently being a running retail store consultant, Jim now writes a regular column for the Natural Running Center called “Voice From the Running Shoe Store Floor.” — NRC

by Jim Hixson

Not too long ago, I helped a customer who appeared to be in dire straits. My first impression of Melissa, (not her real name), was that something had gone seriously wrong in her life. She was unhappy and almost cried with frustration as she told me her recent medical history. For the past year she had been plagued with plantar fasciitis in both feet, Achilles tendinitis in the left, and a stress fracture in the right. Both feet had been in casts for six weeks and she had only recently begun to walk without the assistance of a cane. Although she was only in her mid-30s and still relatively fit, she seemed worn out by her ailments. She asked me if I could heal the lame. I told her she might be in the wrong building, but I would try. First I needed to know if any of the commonly prescribed remedies had worked.

“Well, I’ve tried everything,” she said. “Ice, anti-inflammatory drugs, the Strassburg Sock, orthotics. I guess I just need more support for my feet.”

“Or less support,” I replied.

She shot me a look of complete surprise. “Well, I know that I pronate, so my feet must need more control.”

“Or less support,” I again replied. I can be stubborn at times, as my wife always keeps reminding me.

“What do you mean? Can you explain further?” asked Melissa.

Before I answered her, I had one of those vivid flashbacks. I remembered one of my first encounters with a podiatrist by the name of Dr. Radelman (his real name). After suffering from plantar fasciitis for several months and trying the same steps Melissa had tried to alleviate this insidious condition, it had seemed time to turn to a trained medical professional. As expected, I was hoping for that sudden cure. Here’s what the doctor said to me:

“The nurse tells me you have a serious case of plantar fasciitis. She also told me that you were a runner.”

“Yes, that’s true,” I replied. “It just never seems to go away. The plantar fasciitis, I mean.”

“Perhaps you should think about giving up running,” he said.
“I can’t do that.”

The doctor seemed like a stubborn fellow as well. “You would be following sound medical advice if you did. After plantar fasciitis there will come knee deterioration, hip problems, and then back pain. You will end up crippled for life.”

I silently thought of that passage from Ecclesiastes that begins “For the lot of mortals and the lot of beasts is the same lot: The one dies as well as the other.” I was almost at a loss for words.

“So what do I have to do to get better, if I want to continue to run?”

“You must wear a stability shoe, a custom orthotic, and never go barefoot.”

“And how long do I need to follow this program which, incidentally, will change my lifestyle?”

The doctor paused, before saying, “As long as you run.” He said this with a self-satisfied grin, like a judge handing down a life sentence without the possibility of parole. I got the feeling that he thought all runners were outlaws who needed punishing.

As I left his office it was clear that I needed to chart my own path and listen to my own body instead of someone with a podiatry school diploma hanging on his wall. Furthermore, I realized how odd it was that so many runners, including me, were being told by so called medical experts that they could not support their bodies on their own feet.

I thus began my own search for answers. The first stop in my search for personal enlightenment was the running shoe store where I worked at the time. The owner had suffered from many foot and leg injuries during his athletic career. I asked him what he would do in my situation.

“Have you had a steroid injection?” he asked.

“No,” I replied. “I did a little research and found that steroid injections in the plantar fascia can lead to atrophy of fatty tissue and rupture of the tendon itself”.

He seem unconcerned: “Steroids work. Or why don’t you just have the fascia surgically released?” I preferred not to have my anatomy altered permanently so I changed the topic and mentioned that a new shoe shipment that had just arrived.

Next I serially asked some older runners who regularly came in the store for advice. These were guys who had been racing for over 30 years. “How I could alleviate my pain?” I demanded to know. They all told me that plantar fasciitis was just part of being a runner. It was suggested that I take as much Advil as possible. Or make pain my friend.

At that point I concluded that my circle of friends and acquaintances was too small for me to acquire accurate information about the subject. I had no choice but to look on the Internet. This was 2003, so there weren’t many sites devoted to the subject of “biomechanics of running.” (Although today I can type this phrase into a Google search and find hundreds of articles.) Fortunately there were two very good articles then available: “Why Shoes Make ‘Normal’ Gait Impossible“ , by William A. Rossi, and “Take off Your Shoes and Walk”, by Simon J. Wikler, both progressive podiatrists. Some years later there would be two more excellent articles to complete the four pillars of the gospel of healthy and strong feet: “You Walk Wrong” by Adam Sternbergh, a features writer for New York magazine, and “Athletic Footwear and Running Injuries”, by Joseph Froncioni, an orthopedic surgeon. What hidden knowledge did these authors reveal?

The main secret, which shouldn’t have been a secret, is that there is no such thing as a “neutral” shoe, one that does not interfere with the natural movement of the foot. In the world of running shoe companies, “neutral” means a non-corrective shoe, as opposed to a “stability” or “motion control” shoe, but shoes from all three of these categories significantly change the way one naturally moves. These changes lead to the weakening of the foot and lower leg muscles, muscular imbalance, and inefficient biomechanics. The unnatural gait that follows can lead to an increase in injuries and abbreviated running careers. The shoes that don’t force these changes were the ones I should have been wearing. These shoes have a low drop from heel to toe (a zero drop is even better), a flexible sole, and are lightweight.

There weren’t many alternative shoes at that time, but the Nike Free had just made its way to the market after a long period of incubation in the Nike Sport Research Lab, and through my research I had become fascinated with these shoes before I had even seen a photograph. When I put the first pair on my feet there was an odd sensation, as if I was wearing slippers. I wore them at the store for eight hours the first day and when I left for home my feet weren’t at all sore, but they were very tired. All the muscles that should have been used for stability and balance had been prevented from accomplishing these tasks by the nature of rigid shoes with high heels and they had now been released. Over the next few weeks I could feel my feet become significantly stronger and more flexible. The pain of plantar fasciitis diminished rapidly until it was gone. I was cured.

As my feet became stronger, I felt more balanced and my running became enjoyable again. At first I kept my experiences to myself, perhaps worried that some malevolent spirit would become aware of my good fortune and introduce another plague into my running life. Slowly I began suggesting the Nike Free to customers who were suffering from plantar fasciitis and other ailments of the foot and lower leg. Later other minimal shoes like the Saucony Kinvara, New Balance Minimus, and Brooks Pure Series shoes expanded the selection and Newton Running offered another alternative. I had become convinced that freedom of movement was the key to avoiding many running injuries and encouraging better form. Most of the cases that had walked in the door had been relatively simple, and the results had been almost uniformly positive.

Now here was Melissa whose sense of desperation encouraged me to consider desperate measures. She continued to listen to me carefully as I explained how immobilizing her feet would not lead to any permanent alleviation of her pain. Beginning with her feet, she needed to be able to move through a full range of motion to recover the strength and flexibility necessary for her to function naturally. After we discussed different options she decided to purchase a pair of Nike Frees and a pair of Vibram FiveFingers Sprints. As always I gave a thorough explanation of the necessity of a transition period that could take weeks, if not months, and what sensations she might expect.

Three days later, I received an email from her thanking me. To her relief and astonishment, the pain in her feet had vanished. She mentioned that her calves were quite sore, but otherwise she felt great. Incidentally, she added that her soreness had not been caused by walking, but by running six miles through the streets of St. Louis! I asked her about the transition phase of her recovery. She replied that even on the first day she wore her new shoes she had to try a short jog. The jog had felt so liberating that it quickly evolved into a run. She was convinced that her calves would feel better in a few days.

Three weeks went by. Shewalked into the store wearing the VFF Sprints and bought another pair of Frees. She seemed a different person, smiling, happy and ready to resume an interrupted life. Despite her experience I still recommend a transition period!

Anecdotal reports from the many runners, like Melissa’s, who have made the transition to minimal shoes, have been overwhelmingly positive. If the runner has suffered from patellar tendinitis, shin splints, or IT band syndrome, the pain always diminishes or is eliminated when the runner switches to a minimal shoe and a midfoot strike. These customers might have difficulty selecting a specific shoe, but they soon have no interest in wearing the traditional shoes that have dominated the running market for so long. When I ask them if they ever rotate their new minimal shoes with their old pair of over-supportive running shoes, they look at me a bit oddly and say, “Why would I ever do that?”