Vibram Five Fingers facing class action suit

A class action suit has been filed against Vibram Five Fingers for the health claims that they made for their products that did not eventuate to those who are taking the action. Following the many blog and forums posts on this and the comments on them have been interesting with most missing the point of the suit.

Vibram made health claims for their product that was not supported by the evidence, when there is none that actually supports the claims. It is that simple. Reebok had to settle with the FTC for $25 million for doing the same thing concerning claims about their toning shoes. Skechers is also facing a number of class actions and is in discussion with the FTC for the same allegations. They have set aside $44 million to deal with this.

There have been calls, mostly on minimalist and barefoot websites, for a class action against the traditional running shoe companies. The point being missed is that these companies are not making medical or health benefit claims for their shoes. Just check the most recent editions of running magazines and look at the claims being made in the advertisements. The only claims regarding injury and health are being made by the manufacturers of the minimalist shoes. I suspect Vibram is just the first to face a class action and more will follow. A recent motion to dismiss the case was declined by the judge.

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'Top of Foot Pain' Management in Barefoot Runners

Despite all the propaganda that barefoot or minimalist running is better due to less injuries occurring, it is now becoming increasingly clear that it is not the way to get less running overuse injuries. Just check any barefoot/minimalist website and look at all those looking for advice on their injuries! Just ask any of the health professionals who treat a lot of running injuries. Most will tell you of the barefoot running injury epidemic that they are seeing. There is no doubt that there are some who have successfully transitioned to barefoot or minimalist running who now claim to get less injuries, but there are also those who are getting more!

One of the more common injuries being seen is what has become known as ‘top of foot pain’, which probably is dorsal midfoot interosseous compression syndrome (DICS). The pain of this is usually over the dorsal midfoot area. The cause of this is when the dorsiflexion moments of the forefoot on the rearfoot are higher than the plantarflexion moments, resulting in the dorsal jamming. Forefoot striking has greater forefoot dorsiflexion moments of the forefoot on the rearfoot than does heel striking. I have been involved in the management of a lot of ‘top of foot pain’ now in forefoot strikers or minimalist runners and here is my approach to it:

1. Firstly you really need to understand the runners views on barefoot/minimalist running and just what they are prepared to do. By this I mean how acceptable of different interventions are they to be; are they training for a specific event (to get an indication of the ‘urgency’ to get over the problem); what sort of time frame they have; etc

2. Of course we use the RICE principle with this injury like any others in the short term and make modification to the training regime to manage it.

3. The best way to manage ‘top of foot pain’ in the short term and long term is to decrease that dorsiflexion moment. How can you do that?

• a. If you follow some of the advice on the barefoot sites, you need to change your running form or gait somewhat and try to ‘retract’ the toes. As this will put a plantarflexory load on the metatarsals which will reduce the forefoot dorsiflexion moment. Most runners find this difficult and often it does not reduce the load enough for healing to occur (it may work better in the long term once the problem is treated).

• b. Low dye strapping, correctly applied to plantarflex the forefoot in such a way that it decreases the dorsiflexion moment will work brilliantly in the short term, but is not a good long term option. Correctly applying the low dye tape is crucial.

• c. Foot orthotics are easily the best way to reduce that dorsiflexion moment, however they have to have the right design features to do that or they are not going to work. All foot orthotic failure I have seen in those with ‘top of foot pain’, either did not decrease that forefoot dorsiflexion moment or even increased it!

• d. Depending on where they are at, they are also probably better off getting back to heel striking if they can to help reduce those forefoot dorsiflexion moments that are higher in forefoot striking.

• e. Ankle joint dorsiflexion also need to be checked and often a fibula mobilisation is needed to get that going properly.

• f. Increasing muscles strength may be a longer term option to reduce the dorsiflexion moment. However, as the joint moments are high, the muscles are already having to work hard because of that and are probably already really strong. The problem is the lever arm that the muscles have to the joint axes of rotation.

• g. A windlass dysfunction can also be an issue in creating higher forefoot dorsiflexion moments, so some sort of intervention to preload the hallux to get the windlass active sooner can be helpful (this can easily fit in minimalist running shoes)
  

4. However, depending on some of the answers to the discussion in (1) above, as too how acceptable some of these interventions are, for example:

• a. If they are more ‘purist’ in their views on barefoot/minimal, then they are not going to want to use foot orthotics or transition back to rearfoot striking (even in the short term). In this case, the running has to be cut back to level that is tolerable and a slow and gradual build up to allow the tissues to adapt to the load (ie adapt to those higher forefoot dorsiflexion moments). I happy to work with them on this, but they have to realise that in some people the moments are so high, that the tissues may never be able to adapt to the load and changes to the running form or gait. In this case other interventions will be needed if they want to get over it. I also point out that it will be harder and take longer to get better without the use of heel striking and/or foot orthotics.

• b. If they not so ‘purist’ then I will get them into foot orthotics and, if they, can get them back to heel striking in the short term. Once they are better and back to their normal training routine we then decide what to do in the longer term. Ideally they will transition back to forefoot striking (if that is there wish) and away from the foot orthotics. This has got to be a planned process and done incredibly carefully (as the previously injured tissues are very prone to re-injury) and gradually. In some, that forefoot dorsiflexion moment is so high, there is no way that it can be lowered with a gait change and so high that the tissues can adapt to that load. In which case the heel striking and/or foot orthoses are going to have to be a long term option

Just why are the joint moments causing this problem so high? I think the most likely reason is the variations that occur in joint exes positions and the lever arms the bones and tendons have to that joint axis.

‘Top of foot pain’ is common in forefoot strikers (barefoot/minimalist runners). Understanding the role that the higher joint moments play in it guides the short and long term management, as well as the attitudes to forefoot vs rearfoot striking and the role of foot orthoses as a short or long term option and the issue of the magnitude of the moments and if the tissues can adapt to those moments or not.

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Vibram FiveFingers

Vibram Five Fingers as an alternative footwear to ‘barefoot’ have been getting a lot of attention, especially from the barefoot/minimalist running community. The anecdotal evidence is accumulating that barefoot running is increasing the injury rate in runners. I have seen predictions and posts that say something like because of ‘barefoot running’ that podiatrists must be ‘shaking in their boots’ at the thought of barefoot running due to all the business they will lose. Well, where are the people that made those claims now? The opposite has happened. Barefoot running is turning into an economic stimulus package for anyone who treats and rehabilitates running injuries. If you do not believe me, just ask them. Here is a typical comment:

"I do not see many runners in my clinic, but lately over half the ones I have seen are barefoot or minimalist runners. Given that my impression is that barefoot runers make up less than 0.01% of runners, and if 50% of the runners I see with an injury are barefoot, then should not alarm bells be going off?" source

and these types of comments:
“We’ve seen a fair amount of injuries from barefoot running already, or from just running in the Vibrams,” says Nathan Koch, PT, Director of Rehabilitation at Endurance Rehab in Phoenix, AZ. Vibrams are the barely-there “foot gloves” that have become popular among barefoot running devotees.Steve Pribut, a Washington, DC podiatrist and one of America’s most respected running injury specialists, says he has experienced a recent influx of barefoot runners at his office as well. And, asked by email whether he could confirm a barefoot running injury trend in his clinical experience, Lewis Maharam, a.k.a “Running Doc,” replied with two words: “Oh, yeah!” source

There is no doubt that some are getting less injuries after taking up barefoot running and there is no doubt that there are some that are getting more injuries.

There is even a rumour going around about a class action law suit against Vibram Five Fingers because of all the injuries that are occurring, but it may be just a rumour as I have seen nothing concrete on this. Certainly some running speciality shops have been asking customers to sign disclaimers to waive legal responsibility when the buy the Vibram Five Fingers.

There was even an insight into the sort of people who buy Vibram Five Fingers - they are being reported as being annoying people by the San Francisco Weekly!

See:
Why are barefoot runners getting so many injuries?
The Barefoot Running Injury Epidemic
Vibram FiveFingers Cause Metatarsal Stress Fractures?

While barefoot running or the Vibram Five fingers is certainly turning out to be not all they are touted as being, there is nothing wrong with barefoot running drills as part of balanced running program. Just don’t believe all the hype and propaganda that is being sold.

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More on barefoot running

I have previously blogged about barefoot running and how bad research on barefoot running gets reported. Now we have a publication in Nature that has been widely reported in the media and touted by the barefoot running community. The interpretation and use of this research has been so bad, that the authors took the unusual step of posting this disclaimer on their website:

There are many discrepancies in the way the press has reported our paper “Foot strike patterns and collision forces in habitually barefoot versus shod runners” (Lieberman et al., Nature, 463: 531-565) .....Please note that we present no data on how people should run, whether shoes cause some injuries, or whether barefoot running causes other kinds of injuries.

Now we have an anti-barefoot running website that has been set up to critically analyse the claims made. It appears to have touched a raw nerve in the barefoot running community. They do not like it when they get criticised, but think it is acceptable for them to criticise others ... don't figure! Even a Fench running website is highlighting the barefoot running debate.

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Barefoot running and BAD research

I just do not get how the media react and create headlines from research (well actually, I do get it ... they want to attract readers and sell papers), but they just have to be more responsible. A lot of bloggers fall for the same trap.

A few days ago there was some research published that looked at joint torques when running barefoot vs running in running shoes. Some of the headlines that accomapanied news and blog reports about this research were:
Running Shoes are Still Bad
Running Shoes may cause damage to knees hips and ankle
Running may be good for you, but running shoes aren't

What I do not get is that there was absolutely nothing in the research that actually showed this! Let alone the flaws in the study do not allow any conclusion to be drawn, let alone the above ones. Also, it turns out the lead author has a vested financial interest in a barefoot running product that was NOT disclosed!

The barefoot running fanatics and irrationalists have jumped on this research as supporting the barefoot running movement. The fact that they blindly accept this research without any form of critical analysis of the flaws, just confirms how fanatical and irrational they are!

Why can't the media and bloggers be more critical in what they report? At least Podiatry Arena could see through the problems: The Effect of Running Shoes on Lower Extremity Joint Torques

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Barefoot Running

I am not opposed to the barefoot running movement. It just some of the promoters of barefoot running that I have a problem with. They are like religious zealots that are fanatical about the whole concept of barefoot running. They use nonsensical non-scientific mumbo jumbo to support what they do. They twist research to make it sound like it supports their cause. They dismiss research that is anti-barefoot. They take any research that is anti-running shoe as evidence that proves running barefoot is better (huh?).

At the end of the day, there is no evidence that running barefoot is even ideal, let alone beneficial. There is also no evidence that its not. I blogged about this here and see Podiatry Arena: Barefoot Running for a balanced discussion on the pros and cons of barefoot running. For a bit a fun check out the zealotry on some of the running forums when it comes to discussing this. Trying to be rational with these people is like trying to argue a religion - not going to win that one.

I have no doubt that the research will show that there will be some benefits to running barefoot; I have no doubt it will also show that there will also have some risks. What we need is better evidence of who and when it should be used. I have no doubt that barefoot running should be a part of a balanced running program for all those who can tolerate it, but it should be used in moderation.

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