A recent vacation found me running barefoot on the beach.  After a crisp-paced warm up mile on the packed sand splashing as the waves rolled in, my feet began to ache.  Knowing what I know, I quickly altered my running style, which helped until the way back.  By the time I turned and headed back people were enjoying the surf so I was forced onto the soft sand.  Another mile and my legs and feet were cooked.  I reached a level of fatigue I rarely achieve at home.

What is it about running barefoot?

In the media, people seem to be all for it or completely opposed.  There doesn’t seem to be any middle ground.  At Desert Foot Surgeons, it is my job to educate you so that you can make the choice that best fits your needs.  Maybe you want to run barefoot and maybe not.  Let’s talk about it and see what you decide.

First of all, what are the benefits of running barefoot?  I will warn you that this is all theory!  No scientific evidence exists to date supporting these theories.  Running barefoot is said to increase the muscle strength of small (intrinsic) muscles in your foot.  By doing so it is thought that your foot will become more stable with the added strength thus help prevent injury and possibly even deformities such as bunions, hammertoes, and plantar fasciitis.  A study has shown that collegiate female track athletes who trained barefoot suffered fewer injuries.  Similar high level athletes have shown the same results such as volleyball players.

Here’s the catch with running barefoot…

There is a level of genetics involved in becoming a collegiate level athlete.  Of course there are your 5’6” guys who can dunk a basketball and a 5’9” football player who runs a 4 second 40, but for the rest of us we are not fortunate enough to have the same gifts as these people.  I’m not saying hard work and excellent coaching can’t make someone a collegiate athlete, I’m trying to keep the topic real.  A collegiate level track athlete has been coached for years and puts in significant miles with this coach.  These athletes know how to alter there stride length, change posture, modify their arm swing, go from heel strike to toe strike for different reasons.  Even in the famous book, “Born to Run” by Christopher McDougal, he was coached before he could accumulate any distance running barefoot.  So that leaves one question:  do you have a coach?

I’m not going to tell you that running barefoot is good or bad for you, that’s not my job.  My job at Desert Foot Surgeons is to examine your feet sitting, standing, walking, and even running.  With that information I can help you achieve your goals, but it might take some work.  If you want to run barefoot we are going to have to work on some things. Stretching programs, strengthening, balance and running in shoes with or without orthoses might be the first few steps before you ever step out there barefoot.  You might need help from a coach or trainer.  I can get you to the right people.  I don’t want you to be injured and the number of stress fractures in my practice has tripled this past year solely due to barefoot running.  To review injuries while training review my previous blog about marathon training.

In the foot people can have unsightly problems and what’s worse pain.  A bunion is a lump on the inside of the foot behind the big toe.  The size can vary and the toe can begin to move closer to and even under the 2nd toe.  When the smaller toes are buckled that is a hammertoe.  Here’s the key:  because we wear shoes, bunions and hammertoes hurt much sooner than if we went barefoot all the time.  Let me make this perfectly clear, wearing shoes does not cause the deformity, but wearing shoes does make a deformity hurt sooner than it otherwise would.

Bunion and hammertoe surgery can be cosmetic, which in my opinion means the deformity will look better after corrected so that you feel better since pain will be gone.  That’s a little bit different from other forms of cosmetic surgery.  When I perform bunion surgery or hammertoe surgery I always keep in mind the fact that you will be walking on the end result for years to come.  Because the bunion and hammertoe develop in an unstable foot I have to make sure the problem does not return.  Face lifts, tummy tucks, or breast augmentation have their long term considerations, but honestly you will not be walking, hiking, or running on these parts of your body.

There are people who want to fit into those 4” spiked heels at any cost.  They want their wide foot narrowed and long toe shortened.  I’m not talking about business executives who have to maintain a specific style of dress in order to advance their career and suffer horrible pain in these shoes.  I’m talking about people who would otherwise have no pain, but insist on wearing these heels for social purposes.  I caution those people who do not have pain!  Foot surgery can result in scar within the joint leading to stiffness and arthritis.  There is no true preventive surgery for arthritis.

One final word.  Recently a Beverly Hills Podiatrist coined the term “Cinderella Surgery” for correcting a bunion, long 2nd toe, and bunionette (on the outside of the foot) so that women can wear their high heels.  He did a very nice piece on the television show, The Doctors.  My problem is this:  I always say, feet are like snowflakes no two are alike, well here is a podiatrist telling women he can perform the same procedures on their feet in every case so they can walk immediately after surgery and their feet will fit into their stilettos.  That is just not possible without making some sacrifices.  To read about these sacrifices that might be made check back every few days for my new articles on cosmetic bunion surgery and cosmetic hammertoe surgery.  

Because your bunion involves an unstable foot, surgery to correct the bunion has to take into consideration this issue of stability.  There are many different surgeries for correcting a bunion ranging from simply removing the lump, correcting the bone in various places, or fusing the joint at the base of the metatarsal.  Planning bunion surgery requires a thorough evaluation of your foot at rest, standing, and walking.  At Desert Foot Surgeons, I perform video gait analysis on all patients with bunions.  I am currently involved in a research project that will show other foot surgeons how to determine exactly where to correct a bunion for the most stable result.

Bunion surgery is very complicated because of the stability issue.  Other surgeons promoting aesthetic bunion surgery state that their surgery will work to, “maintain or enhance the mechanics of the foot”.  Many of these aesthetic foot surgeons also tell patients they can walk immediately after surgery.  That means that they are either just removing the bump or correcting the bone near the lump.  Medical research has shown that this approach to bunion surgery makes the big toe less stable leading to further loss of a stable 2nd toe causing a hammertoe and those other problems we talked about above.

My approach to bunion surgery is to use science and apply to your problem.  You and I will talk about the best surgery to correct your problem.  If you cannot cooperate with the recovery I will work with you to get to the point that you can manage the rehabilitation or suggest alternatives.  It is these alternatives that you  need to understand.  When alternatives are chosen you are making sacrifices.  In the case of a bunion you are usually sacrificing stability.  Think of the table with one broken leg.  If you repair the table leg with duct tape the table is still unstable and will eventually tilt and possibly break completely when objects are placed on the table.

As far as cosmetic bunion surgery, the placement of the scar has to allow the surgeon to clearly see the bone being worked on.  I don’t want you to have an ugly scar, so whenever possible I will hide the scar.  But fair warning, the bigger the bunion the less likely it will be to hide your scar.

When considering cosmetic surgery, remember the goal is to make your lump or bump look better and relieve pain.  If the scar can be hidden it will, but the key to correcting your problem is choosing the correct surgical procedure based on a thorough exam including gait analysis.  Performing an alternative surgery requires sacrifices be made on your part and the part of your surgeon.  When all is said and done, a scar, time off your foot, having to perform physical therapy are reasonable things in order to make pain go away and prevent the problem from returning.

The big toe can develop a lump or bump on the inside of the foot. This prominence initially becomes painful in shoes from pressure, but if left untreated arthritis will set in. The lump on the inside of the foot at the base of the great toe is called a bunion. Often mistakenly referred to as a growth of bone, the cause of a bunion is really the result of an unstable joint. The loss of stability in the big toe joint causes the bone behind the big toe to drift inward leading to the lump or bump. The more the bone drifts, the more your big toe falls toward the second toe.

How the joint becomes unstable is related to the way your foot hits the ground when you walk. A detailed examination of your feet while standing and walking is needed to determine why your foot is unstable. If caught early custom molded foot orthoses can restore stability to the joint and prevent further damage.

If painful, damage to the joint has already occurred. Custom molded foot orthoses will restore stability to the joint, which can improve pain, but usually therapy involving anti-inflammatory medication is needed as well. When pain does not respond to stabilizing the foot, surgery is needed. The goal of surgery is to provide stability to the joint from within preventing further damage. This is accomplished by moving the bone that has shifted back into line with the big toe. The more the bone needs to be shifted, the longer the recovery. So getting treatment early is always recommended.

Dr. Stephen Geller, DPM , AZ Podiatrist