This is an ultra-long version of my Hindustan Times column ‘Re-Solution: Solution to move optimally well lies within you’ published on 5th January 2019.

Just a couple of days back multiple running mates shared an article with the headline, ‘This Indian startup wants you to stop buying expensive running shoes’.

I was keen to know more about the underdogs who like David had just openly announced their duel with Goliath, the sports shoe industry with the market size bigger than GDP of more than a hundred countries on planet earth.

Before delving deeper, a disclaimer — from 2014 to 2017, I was Principal Technical Consultant and Head Coach for running for adidas India. Before taking on the role, my only condition was that I would not promote running shoes but running itself. That, yet again, is my intent here.

Let us start from the very beginning. The oldest footwear ever found were woven from twine made of sagebrush bark. They date back to over 10,000 years, when our ancestors were gatherer-hunters. Back then it would take an enormous amount of time and effort to make those sandal like shoes. As soon as we had the know-how, we were busy making them, with the emphasis on protecting the feet from cold and rough ground. Looking at the effort that went in, I would imagine them to be more a necessity, than a luxury, unless of course, it was our forefathers and foremothers favourite pass-time. 

Below is a video of mine from a decade ago demonstrating how to wear Tarahumara Huarache Running sandals.

Imagine your body being a state-of-the-art car and the best feature being what your bumpers are like. So when you do hit the other cars or they hit you, how much impact will those bumpers be able to absorb and reduce the injury to you. Even in the eccentric car designs, we don’t see crazy amount of cushioning or stiffness in the super large bumpers. You can have the best car, but if you don’t know how to drive, you are better off driving the cheapest car to start with. 

For that reason, first learn to drive that car, or in this case, your one and only very precious body. As soon as your driving skills start getting better, running in this case, almost like transformers, your car, i.e. your body will start upgrading to better specs. And you’ll be able to do justice to all the tech in your amazing body. In this whole story, bumpers aka running shoes play almost no role. As was the case 10,000 years ago, the running shoes’ role is to reduce injuries from cold or thorns.

Running shoe prescription is a newer phenomenon in India. The problem is that current research has shown that when it comes to injuries, shoes don’t make much of a difference.

I too prescribe shoes, but slightly differently. I, like a matchmaker, look at the horoscope of your feet and running, and then I match it to the shoes that are available in the market. If you over-pronate, i.e. your foot arches collapse while walking or running, then you are looking for stability shoes to start with. If not, you are looking for neutral shoes. Across all decent brands like Asics, New Balance, Adidas and Nike, you will find these kind of shoes. 

For over 40 years now, these over-cushioned and stability shoes have been promoted by the running footwear industry but the incident of running injuries hasn’t got any better. That itself should make you wonder what is going on here.

As if not enough damage had already been done, here is yet again an industry talking about all the science that in its eagerness to provide more stability to the foot, is dumbing down this masterpiece of engineering. 

They are trying to correct flat weak foot arches that actually don’t need static support but dynamic. No amount of stability whether in-built in running shoes or insoles (orthotics) are going to give you a long term solution. Only when you move and load those foot arches, similar to rest of the human body and even mind, will they become strong. Besides starting to walk and eventually graduate to running, you also need to focus on strength training.

One muscle that we all have massively abused, besides the brain, are the ones we have been sitting on forever, gluteus maximum, also known as the butt muscles. It’ll surprise you that exercising that muscle helps your foot arches, which seem miles away. 

After reading the NDTV Gadget 360 article that got me started in this, I had a few questions for the Nitin Gandhi, the co-founder of Shapecrunch who was quoted in that article. Below are his responses to my queries.

Question 1: Measuring two feet differently is a great idea. But again the feet will be in same set of shoes with identical size. Thoughts?

Nitin Gandhi: They are measured differently and insoles are also different in many cases. There are also cases, where feet length is different where we provide filler in front. There are also cases of leg length discrepancy in that case we increase height of insoles of one insole by the difference. Also, there are cases in which case one feet is highly pronated and other isn’t so wedging angle is provided different.

Question 2: Your assessment is static for a dynamic activity. Thoughts?

NG: Dynamic assessment is done by physio there. They provide their observations in the prescription.

Question 3: Whether stability shoes or insoles haven’t been shown to make a difference, at least not in the long run, so why then?

NG: Because there are several studies which show how feet affect biomechanics of body. Just to give one example - One of the most common problem – Flat Feet. People with Flat feet are 50% more likely to have osteoarthritishttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5403611/
Knee OA is a costly surgical intervention.

Question 4: You start off by standing up against shoe companies making expensive shoes but then your own insoles can be as or more expensive than those shoes themselves.

NG: We are medical service provider- where insoles are part of the treatment, what we charge includes this-

1. Assessment by physio

2. Measurement and Scan by our tech and generation of report.

3. Design and different corrections provided by sole which are described in (e).

   These corrections are provided based on recommendation of Physio and Orthotist.

There are cases where insoles can’t solve the problem, and surgery is required. So we can’t provide them the insoles.

Question 5: Feet are state of the art engineering. How are you helping them get smarter or are your solution is just doing more of the same as a stability shoes?

NG: Most of the people we have seen have multiple problems. Even in case of over or underpronation angle is different in both feet

These are some of the modifications we do:

1. Custom Arch support based on calculated foot parameters

2. Medial Heel wedging – different angular calculations are done and medial wedging is

   provided by calculating pronation angle in each foot. It can be different.

3. Lateral Heel Wedging

4. Metatarsal pad or metatarsal bar depending on problem

5. Offloading for corn or ulcer

6. Customizable density of insole based on BMI and other parameters

7. Heel cup or extra heel cushion if required

8. Different thickness of insoles for each foot in case of cases where there’s difference

   limb length

9. Toe filler in cases where there is discrepancy in foot length.

   There can be one modification or combination or multiple modifications

What I’ve done above is addressed the responses I had from that new start up making customised orthotics.

Studies have shown that there is large amount of differences in how runners respond to orthotics whether it be for performance or injuries, from no response to helping to some extent. If at all, non-customised orthotics have been shown to have better motion control of the foot. Customised orthotics have shown to reduce loading rate & vertical impact force, which are attributed to running injuries. 

So far we have been trying to fit into shoes, or at best getting orthotics to stand on. We moved to be born, we need to keep moving and running. We just need to figure what works for us rather than being told by others what to do.

Below is an interview of mine with Rajiv Makhni on the show ‘Contrarian’. People want things to be black and white, when it all is shades of grey.

Below are links to a few of my running articles on running form and shoes.

• Running: Losing My Religion: Running without a good technique or a good pair of shoes is like driving a car without a bumper

• Focus on running form: Running is probably the best hobby you could have ever picked: It’s poor running form, not running, that is going to hurt you. And improving your form and focusing on exercise can greatly reduce those injuries

• The science of selecting shoes: Most people assume that any shoe from the top brands will work for them. But you need to understand what would be a good match for you and your feet

• Run better, reduce injuries, with strength training: Some exercises that can be done anywhere for strength training, will help runners of all levels to run better and avoid injuries

• To run effortlessly, don’t resist: Remember some basics and run daily to stop resisting

• The shoe that fits: Buying the right pair is a decision that needs to be dictated not just by your wallet, but also the kind of runner you are

• Relearn Running: Shoes are simply a tool—they don’t do a thing unless you start moving in them. If you know how to run well, you’ll do amazing things, but if you don’t, you’ll get injured

Also, all the experts are trying to change your running form to get it to that ideal gait. Like your finger prints, you have a unique way of moving. Your best running form is the way you moved as a 2-3 year old when no one had yet told you how you need to be running. That is your goal. To move without a care for the world or time or distance.

British Journal of Sports Medicine

BJSM is a multimedia portal for authoritative original research, systematic reviews, consensus statements and timely debate in sport and exercise medicine (SEM) as well as clinical education and implementation success stories.

AlI that I mention above and also in last 11 years of writing isn’t about my way, but what scientific evidence, esp. research published in BJSM, today suggests.

My intent is always to reach out to masses by simplifying the message as I personally have always struggled with complex explanations.

Thanks a million miles BJSM for bearing with my eccentric ways.

Keep miling and smiling.

REFERENCES

1. Glasgow P. Simplicity: the ultimate sophistication. Br J Sports Med 2014;48:345.

2. McKeon PO, Hertel J, Bramble D, et al. The foot core system: a new paradigm for understanding intrinsic foot muscle function. Br J Sports Med 2015;49:290.

3. Napier C, Willy RW. Logical fallacies in the running shoe debate: let the evidence guide prescription. Br J Sports Med 2018;52:1552–1553.

4. Napier C, Cochrane CK, Taunton JE,et al. Gait modifications to change lower extremity gait biomechanics in runners: a systematic review. Br J Sports Med 2015;49:1382–1388.

5. Clinghan R, Arnold GP, Drew TS, Cochrane LA, Abboud RJ. Do you get value for money when you buy an expensive pair of running shoes? Br. J. Sports Med. 2008;42;189-193

6. Nigg BM, Baltich J, Hoerzer S, et al. Running shoes and running injuries: mythbusting and a proposal for two new paradigms: ‘preferred movement path’ and ‘comfort filter’. Br J Sports Med 2015;49:1290–1294.

7. Davis IS, Bowser BJ, Mullineaux DR. Greater vertical impact loading in female runners with medically diagnosed injuries: a prospective investigation. Br J Sports Med 2016, 50 (14) 887-892.

8. Smoliga JM. What is running economy? A clinician’s guide to key concepts, applications and myths. Br J Sports Med 2017;51:831–832.

9. Malisoux L, Chambon N, Delattre N, et al. Injury risk in runners using standard or motion control shoes: a randomised controlled trial with participant and assessor blinding. Br J Sports Med 2016;50:481–487.

10. Nielsen RO, Buist I, Parner ET, et al. Foot pronation is not associated with increased injury risk in novice runners wearing a neutral shoe: a 1-year prospective cohort study. Br J Sports Med 2014;48:440–447.

11. Franklyn-Miller A, Roberts A, Hulse D, et al. Biomechanical overload syndrome: defining a new diagnosis. Br J Sports Med 2014;48: 415–416.

12. Ryan M, Elashi M, Newsham-West R, et al. Examining injury risk and pain perception in runners using minimalist footwear. Br J Sports Med 2014;48: 1257–1262.

13. James AM, Williams CM, Haines TP. Effectiveness of footwear and foot orthoses for calcaneal apophysitis: a 12-month factorial randomised trial. Br J Sports Med 2016;50:1268–1275.

14. Bonacci J, Saunders PU, Hicks A, et al.Running in a minimalist and lightweight shoe is not the same as running barefoot: a biomechanical study. Br J Sports Med 2013;47: 387–392.

15. Kong PW, Candelaria NG, Smith DR. Running in new and worn shoes: a comparison of three types of cushioning footwear. Br J Sports Med 2009 43: 745-749

16. Barton CJ, Bonanno DR, Carr J, et al.Running retraining to treat lower limb injuries: a mixed-methods study of current evidence synthesised with expert opinion. Br J Sports Med 2016;50:513–526.

17. Richards CE, Magin PJ, Callister R. Is your prescription of distance running shoes evidence-based? Br. J. Sports Med. 2009;43;159-162

18. Altman AR, Davis IS. Prospective comparison of running injuries between shod and barefoot runners. Br J Sports Med 2016;50:476–480.

19. Bonacci J, Vicenzino B, Spratford W,et al. Take your shoes off to reduce patellofemoral joint stress during running. Br J Sports Med 2014;48:425–428.

20. Theisen D, Malisoux L, Genin J, et al. Influence of midsole hardness of standard cushioned shoes on running-related injury risk. Br J Sports Med 2014;48:371–376.

21. Tam N, Astephen Wilson JL, Noakes TD, et al. Barefoot running: an evaluation of current hypothesis, future research and clinical applications. Br J Sports Med 2014;48:349–355.

22. The Foot Collective on Instagram :)