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Cushioned shoes aren't good for your feet

More and more research points to a serious mistake we made in how biomechanics works.

Photo: Spencer Platt/Getty Images
  • A new study from Helsinki found that the more you cushion your feet, the more likely you'll get injured.
  • This follows previous studies showing that cushioned shoes leave you more susceptible to pain and injury.
  • A few million years of evolutionary design has been usurped by shoe marketing campaigns.

A lot happened to our feet in the transition from being quadrupeds to exclusively bipedal. While the upright organization of our limbs and organs resulted in many benefits in our communication skills and ability to breathe, for example, it greatly decreased the strength and flexibility of our feet, which once needed bendable toes that could grasp tree branches and a healthy dose of keratin, the protein that forms calluses, which protected us from sharp objects on the ground.

For most of the millions of years we've been evolving we didn't wear shoes; during the 45,000 years we've been wearing some form of footwear they've been minimal. More aesthetically complex (and biomechanically questionable) fashion-forward shoes and sandals are a few thousand years old, though finding a society that championed elaborate footwear took time. The decision to confine our feet in tighter spaces higher up off the ground was one of status, not anatomy—only"savages" didn't properly protect and adorn their feet.

It's been a decade since the (slightly) controversial Born to Run was published, and so it's been a decade that the minimalist versus cushioned shoe debate has been raging. (The argument for both has existed far longer, but that book brought it to the forefront of the growing running community's consciousness.) When Vibram was sued for making false health claims, cushioned shoes advocates rejoiced, even if the lawsuit focused on to inflated claims, not the utility of going "barefoot."

Besides, citizens of economically-advanced societies are not going to go full barefoot. While our feet would likely grow calluses as they (painfully) became accustomed to hard surfaces, what really matters to runners is impact peak. When walking, this force is equal to your body's weight, but when running that forces triples in weight. Despite constant debate about best running form, some people naturally heel strike, which is easier on your calf muscles and Achilles tendon and allows you to lengthen your stride more easily. When walking, we mostly heel strike first.

But as Christopher McDougall wrote in Born to Run, running is more like jumping than walking. Right now if you jump while barefoot, you're going to land on your forefeet. Cushioned shoes won't allow you to forefoot strike naturally; they also cushion the impact peak so that you don't feel the weight of each strike. While running shoe companies have marketed this as a bonus, Daniel Lieberman points out the downsides:

Runners who generate higher, more rapid impact peaks are significantly more likely to accumulate repetitive stress injuries in their feet, shins, knees, and lower back.

Research he conducted on the Harvard cross country team discovered that heel strikers were twice as likely to be injured than forefoot strikers. Minimalist footwear decreases the likelihood you'll heel strike, thus decreasing the risk of injury.

Now a new study published in Scientific Reports backs this up—sort of. The Helsinki-based team points out that while seemingly advanced technologies in cushioned shoes keep appearing, rates of injuries do not. Their study notes what Lieberman discovered years ago: the more you pad your feet, the more intense the impact peak, thus the higher the injury rate:

We found that highly cushioned maximalist shoes alter spring-like running mechanics and amplify rather than attenuate impact loading… We attribute the greater impact loading with the maximalist shoes to stiffer leg during landing compared to that of running with the conventional shoes. These discoveries may explain why shoes with more cushioning do not protect against impact-related running injuries.

This small study of twelve men (average age: 27) compared conventional-cushioned shoes with maximally-cushioned shoes, so it's impossible to use it in making an argument for minimalism. That said, if you consider that impact peak will be reduced with less cushioning, we can extrapolate to confirm what Lieberman (and others) have advocated: the more you swaddle your feet in what biomechanist Katy Bowman calls "foot coffins," the more likely you're going to injure yourself.

Feet are amazingly complex structures. We often forget that—until they hurt, which happens more often in modern societies. Each foot has 26 bones and 33 joints that connect over 100 muscles, ligaments, and tendons. Everything we do depends on the health of our feet, yet every day most people slide them into small, padded spaces with little room for movement, and we haven't even touched the ankle joint yet. But Bowman does:

The ideal footwear is "none" for any human. A shoe will weaken the function of the musculature within the foot (intrinsic) by limiting the motion to the ankle.

Arch support atrophies the muscles up the chain dependent on strong arches; lack of ankle flexility has system-wide effects. Instead of strengthening those muscles, most responses to problems like plantar fasciitis—a condition I see often in my role as fitness instructor—are to continually baby the feet. Fascia needs lubrication to work effectively. Further padding the feet in an attempt to reduce inflammation is the exact opposite path to successful healing, but by the time you've acquired this particular ailment, the harder it's going to be to move without pain, creating a tragic feedback loop that severely restricts movement.

What seems like progress is often regressive, especially when we choose aesthetics over form. Squatting, for example, is the means by which our bodies were designed to defecate. Toilets were a societal advancement that was (and still is in many countries) indicative of class, yet the ninety-degree angle of that seated arrangement does more harm than good to our ability to "go."

So it is with cushioned shoes. Given the bacterial playground that is the ground, going completely barefoot is not in our best interests. But common sense is. Millions of years of evolving design do not surrender their anatomical wisdom without severe consequences.

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Stay in touch with Derek on Twitter and Facebook.

Hints of the 4th dimension have been detected by physicists

What would it be like to experience the 4th dimension?

Two different experiments show hints of a 4th spatial dimension. Credit: Zilberberg Group / ETH Zürich
Technology & Innovation

Physicists have understood at least theoretically, that there may be higher dimensions, besides our normal three. The first clue came in 1905 when Einstein developed his theory of special relativity. Of course, by dimensions we’re talking about length, width, and height. Generally speaking, when we talk about a fourth dimension, it’s considered space-time. But here, physicists mean a spatial dimension beyond the normal three, not a parallel universe, as such dimensions are mistaken for in popular sci-fi shows.

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A new hydrogel might be strong enough for knee replacements

Duke University researchers might have solved a half-century old problem.

Lee Jae-Sung of Korea Republic lies on the pitch holding his knee during the 2018 FIFA World Cup Russia group F match between Korea Republic and Germany at Kazan Arena on June 27, 2018 in Kazan, Russia.

Photo by Alexander Hassenstein/Getty Images
Technology & Innovation
  • Duke University researchers created a hydrogel that appears to be as strong and flexible as human cartilage.
  • The blend of three polymers provides enough flexibility and durability to mimic the knee.
  • The next step is to test this hydrogel in sheep; human use can take at least three years.
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Predicting PTSD symptoms becomes possible with a new test

An algorithm may allow doctors to assess PTSD candidates for early intervention after traumatic ER visits.

Image source: camillo jimenez/Unsplash
Technology & Innovation
  • 10-15% of people visiting emergency rooms eventually develop symptoms of long-lasting PTSD.
  • Early treatment is available but there's been no way to tell who needs it.
  • Using clinical data already being collected, machine learning can identify who's at risk.

The psychological scars a traumatic experience can leave behind may have a more profound effect on a person than the original traumatic experience. Long after an acute emergency is resolved, victims of post-traumatic stress disorder (PTSD) continue to suffer its consequences.

In the U.S. some 30 million patients are annually treated in emergency departments (EDs) for a range of traumatic injuries. Add to that urgent admissions to the ED with the onset of COVID-19 symptoms. Health experts predict that some 10 percent to 15 percent of these people will develop long-lasting PTSD within a year of the initial incident. While there are interventions that can help individuals avoid PTSD, there's been no reliable way to identify those most likely to need it.

That may now have changed. A multi-disciplinary team of researchers has developed a method for predicting who is most likely to develop PTSD after a traumatic emergency-room experience. Their study is published in the journal Nature Medicine.

70 data points and machine learning

nurse wrapping patient's arm

Image source: Creators Collective/Unsplash

Study lead author Katharina Schultebraucks of Columbia University's Department Vagelos College of Physicians and Surgeons says:

"For many trauma patients, the ED visit is often their sole contact with the health care system. The time immediately after a traumatic injury is a critical window for identifying people at risk for PTSD and arranging appropriate follow-up treatment. The earlier we can treat those at risk, the better the likely outcomes."

The new PTSD test uses machine learning and 70 clinical data points plus a clinical stress-level assessment to develop a PTSD score for an individual that identifies their risk of acquiring the condition.

Among the 70 data points are stress hormone levels, inflammatory signals, high blood pressure, and an anxiety-level assessment. Says Schultebraucks, "We selected measures that are routinely collected in the ED and logged in the electronic medical record, plus answers to a few short questions about the psychological stress response. The idea was to create a tool that would be universally available and would add little burden to ED personnel."

Researchers used data from adult trauma survivors in Atlanta, Georgia (377 individuals) and New York City (221 individuals) to test their system.

Of this cohort, 90 percent of those predicted to be at high risk developed long-lasting PTSD symptoms within a year of the initial traumatic event — just 5 percent of people who never developed PTSD symptoms had been erroneously identified as being at risk.

On the other side of the coin, 29 percent of individuals were 'false negatives," tagged by the algorithm as not being at risk of PTSD, but then developing symptoms.

Going forward

person leaning their head on another's shoulder

Image source: Külli Kittus/Unsplash

Schultebraucks looks forward to more testing as the researchers continue to refine their algorithm and to instill confidence in the approach among ED clinicians: "Because previous models for predicting PTSD risk have not been validated in independent samples like our model, they haven't been adopted in clinical practice." She expects that, "Testing and validation of our model in larger samples will be necessary for the algorithm to be ready-to-use in the general population."

"Currently only 7% of level-1 trauma centers routinely screen for PTSD," notes Schultebraucks. "We hope that the algorithm will provide ED clinicians with a rapid, automatic readout that they could use for discharge planning and the prevention of PTSD." She envisions the algorithm being implemented in the future as a feature of electronic medical records.

The researchers also plan to test their algorithm at predicting PTSD in people whose traumatic experiences come in the form of health events such as heart attacks and strokes, as opposed to visits to the emergency department.

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