With the push of the barefoot/minimalist ideas over the last several years, there has been attacks from either sides.  Barefoot/minimalist proponents disregard, disrespect and generally don't believe what podiatrists have to say.  On the other hand, podiatrists are not very open to this new trend, and frankly most think this group a bunch of nutters.  Though I fully support the barefoot/minimalist (B/M) movement and live it myself, in practice I use tools from both sides depending on the patient's specific situation.
Here are some thoughts for both sides:
1.  B/Ms:  You're not a doctor!!  Podiatrists are highly trained! (4 yrs med school, 3 years of surgical residency.)  We don't do internet research on your job and then tell you how you should be doing things!   A good sports medicine podiatrist will be your best friend when things go wrong!
2. Podiatrists:  No need to judge and cling to preset ways!  There is plenty of research emerging that supports midfoot striking for decreased injury rate, and much anectdotal evidence from the barefoot running community.  In addition, the evidence showing traditional running shoe design and fit (neutral/stability/motion control) can be potentially harmful is so overwhelming, it should have already pointed us all away from making certain shoe suggestions.  In all other areas of the body, clinicians prescribe physical therapy after an acute period, but why do we put people in orthotics for life?  (We all know specific diagnoses/situations for which we definitely do need permanent bracing, but not EVERY person needs to be in orthotics permanently, and just because they're a runner with overpronation, doesn't mean they need orthotics)
3. B/Ms:  Yes, there is some good research pointing towards certain running styles/footstrike, low incidence of foot problems in habitually barefoot populations (see all of these in my LIBRARY section), but there is also (GASP!!!) good research on using orthotics for running injuries--it's why podiatrists use them so much!!  Here are just two that show effectiveness of orthotics for runners specifically.  (Readers: search in google scholar and you can read the abstracts):
Effectiveness of orthotic shoe inserts in the long-distance runner. 
Gross,M et al. 1991 
Clinical effectiveness of customized sport shoe orthoses for overuse injuries in runners:
a randomized controlled trial.  Hirschmuller, A. 2011.
(Fellow Podiatrists:  Yes, I have cherry picked my reference section.  This website is meant to be about promoting good research and analytical thought on minimalist and barefoot lifestyle, which is definitely not for everyone--or, frankly, most of the patient population we see!)
4. Podiatrists:  Please don't accuse people (biomechanic researchers, fellow podiatrists) of being in bed with certain shoe companies when many of you are part (or complete) owners with financial stake in using orthotics/bracing products. 

In summary:  Many B/Ms act like teenagers that "know it all" and there are many complexities and specific biomechanical conditions that podiatrists deal with on a daily basis.  Podiatrists, we need to be open to new research and even anectodal evidence from our own patients.  B/Ms, please seek out the help of a podiatrist who specializes in sports medicine (and is a runner him/herself) who will give you thorough attention.  Podiatrists, resist the urge for that "I told you so" moment when a B/M comes in with a stress fracture, but encourage moderation and slow transition. Let's continue to evaluate all the literature and be as critical as we can!

8/15/2012 03:35:06 pm

After reading this for the fifth time I cannot tell you how great this content is. I am blown away by your knowledge and writing skills presented in this work. You did an amazing job!


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