Doc’s Talk 06-24-2012

Dr. Scaff talked about knee pain and why shoes are bad for you.

Note:  This is a talk Dr. Scaff gives without a finite answer because he doesn’t have “The” answer.  He is just telling you what the problems are.  It is up to you to try things and discover what works for you.

The book “Born To Run”, by Christopher McDougall, is about the Tarahumara Indians who live in Mexico’s Copper Canyons.  They do open trail running of 200 to 400 miles at a time and never get injured.  It is a very good book, worth reading.  Some of the premises as to why these people run McDougall got wrong, but the parts on running and endurance he got correct.

If you have not read this book, you can probably get it online.  Dr. Scaff says to forget all of the information about the Tarahumarans, just read Chapter 25, which is an entire chapter on running injuries with good documentation from the American College of Sports Medicine.  The interesting thing is that every study that is referenced showed that running injuries, plantar fasciitis and everything else, did not occur until we started wearing shoes.  Dr. Scaff recalled that back in 1972-73 when the shoes did not have mid-soles and were made of canvas on the sides, which would fall down, that none of the runners ever got hurt.  

Running and Shoe Mechanics
Normally when you runyou are supposed to land on your mid-foot (the ball of your foot) and then your foot adapts.  Today’s shoes make your heel come down first and you cannot do anything about that.  The higher the heel the harder it is to get your toe to come down before the rest of your foot.  You usually land on the outside of the heel, which is why it wears down, then you have to repair it because the shoe starts to pronate, and you don’t want to pronate (It turns out you actually Do want to pronate, but then there would be no reason to sell all the shoes).

The knee is the least flexible joint in the body, it can only bend 90 degrees.  All of your other joints can move more than one way.  Thus, when you are running, all the shock and trauma of your foot-plant goes to your knee and usually it goes to the lateral tibial plateau.

When people have come to Dr. Scaff with running injuries, he looks at their shoes.  Even if, for example, their shoulder is hurting, he may discover that they have low back pain, in which case they have accommodated the low back pain by fixating the shoulder.  When they ask why he is looking at their shoes when it is their shoulder that hurts, Dr. Scaff tells them that virtually all of our running problems are in our feet and in our shoes.  That is something for you to think about as well.

In Chapter 25 of “Born To Run”, the author recounts a time when his shoes wore down to the point that he would normally throw them away, but he decided to see what would happen if he put the left shoe on the right foot, and the right shoe on the left foot.  In doing this he discovered that he could get 4,000 miles out of a pair of shoes without any further injury, …suggesting that maybe when your shoes wear out you’ve got to start wearing them backwards!

Pain, Orthotics, and Wedges
So what do you do if you have lateral tibial plateau or patellar tracking pain, or medial plateau pain?  If you go to a running store that sells shoes, they will sell you a $300 pair of orthotics.  In a lot of ways this just furthers the process of when we have one problem, we keep adding things on.  But normally just cobbling the shoe a little bit will help (see “Shoe Repairing” page 32 of Your First Marathon – The Last Word In Long Distance Running, by Jack H. Scaff Jr., M.D., F.A.C.S.M.).

One thing you can get that will help is a prescription item called Thomas Wedges.  Thomas Wedges raise the heel of the foot just a little bit on one side to change the foot strike, which works quite well.

The bottom line is you can try little experiments on yourself.  Something might look foolish but it could work.  Of course, if none of the things you try work you may have to see a doctor.

Barefoot Sports Shoes
Dr. Scaff says that if you find all of this to be very confusing, it is! 

We cannot get rid of shoes so we will just put up with their disadvantages.

And while he is still not ready to make a statement about the barefoot sports shoes (e.g. “FiveFinger” shoes), at this point Dr. Scaff is starting to move toward the notion that if you have a running problem, it’s your shoes.

It can take up to a year to get used to the new barefoot sports shoes because your feet have to expand.  A lot of people give up before making the transition.  Author Christopher McDougall recommends that we learn to run barefoot, and suggested we should be running barefoot on grass a half hour, 3 or 4 times per week, and then slowly work into a pair of barefoot sports shoes.  Dr. Scaff’s feeling is just change the brand of the shoes and try to change your foot strike a little bit.

Dr. Scaff recently saw someone who had found a beautiful pair of barefoot sports shoes for only $65, sold at REI, a sporting equipment store, in Portland.  The Vibram FiveFinger shoes cost about $150.

Parting Thoughts
Shoes are our nemesis.  Nevertheless we need to put up with them.

In all of this Dr. Scaff is not suggesting you need to go purchase barefoot sports shoes.  If your shoes are fine and you are not getting injured, then continue.  Dr. Scaff ran the first 26 Honolulu Marathons, most of them at a sub-3:30 pace, and never missed a day due to an injury.  So no matter what shoes you have you can train properly.

Incidentally, in “Born To Run”, McDougall also found out that the cheaper the shoes the lower the rate of injury.  This fact was published by good scientists.  It turns out that the people who bought the $12.95 shoes from K-Mart experienced fewer injuries.

So don’t throw your shoes away and get totally discouraged, just keep an open mind.

You can find more information on repairing shoes and picking a good pair or running shoes in Your First Marathon – The Last Word In Long Distance Running, by Jack H. Scaff Jr., M.D., F.A.C.S.M., available for purchase at the Honolulu Marathon Clinic on Sundays and online at:

Next Sunday Dr. Scaff will talk about low-back pain.



For some good reading on nutrition, Dr. Scaff recommends everyone check out the daily postings on Dr. Alan Titchenal’s “Got Nutrients?” web site:

Here is a recent posting:

June 20, 2012
The nutrients in a food are only as good as the amount of those nutrients that are absorbed into the body. A Purdue University study showed that adding various oils and fats to the diet increased the amount of fat-soluble carotenoids absorbed.

Consumer Link
Study: No-Fat, Low-Fat Dressings Don’t Get Most Nutrients out of Salads

Research Link
Molecular Nutrition & Food Research, 2012; 56 (6): 866-877