NEW POSTING - August 2012
HOW RUNNING SHOES WERE TRANSFORMED FROM UNSAFE TO PROTECTIVE DEVICES THROUGH DECEPTIVE ADVERTIZING
For 250,000 years humans were active - weight-bearing most wakeful hours until Europeans became the first large population to begin wearing footwear during the Renaissance. Prolonged standing wearing shoes caused discomfort resulting leading to extensive use of chairs for the first time in human history in an teempt to advoid this discomfort. All others societies that are shod and extensively use chairs owe it to European colonization and cultural imperialism.
There were negative health consequences associated with this change from an active lifestyle involving extensive weight-bearing humans evolved with to being sedentary. This website addresses them. Visitors interested in footwear related health issues are advised to visit stevenrobbinsmd.com.
The following article appears also onstevenrobbinsmd.com. It deals distance running - an activity often used to reduce sedentary behavior in health conscious individuals. It tells the story about the modern running shoe, which lead to distance running for a large population - the first mass participation activity oriented at improving health through aerobic exercise. The frequent injuries associated with this activity was caused by deceptive footwear advertizing which promoted unsafe shoes as a protective devices.
On March 29, 2012, the media became inundated by articles reporting a class action lawsuit that was filed against Vibram, manufacturer of Five Fingers shoes. This lawsuit is the resulted from a spectacular numbers of injuries reported with Vibram Five Fingers shoes, compared to few reports indicating injury from true barefoot running which Vibram claimed their pruduct emulated.
This website has reported for two years about the danger of deceptive advertizing of products often referred to as “minimalist shoes” or “barefoot shoes.” They resemble existing footwear in terms of protection in that frequent injury should be anticipated by their use. However, they are advertized as protective through allowing inherent protective mechanisms humans use when barefoot. I predicted that the additional false sense of security imparted via this advertizing would result in a specacular injury frequency, which has happened. This creates an opportunity to review the history of the marketing of the modern running shoe. Deceptive advertizing of athletic shoes did not begin with this new shoe category. It began when the modern running shoe was found to be associated with frequent injury decades ago.
HOW RUNNING SHOES WERE TRANSFORMED FROM UNSAFE TO
PROTECTIVE DEVICES THROUGH DECEPTIVE ADVERTIZING:
Summary:The modern running shoe was first advertized as simply a device that allowed foot comfort when running on pavement to everyone regardless of fitness level and previous running experience. Frequent injuries followed, which created public perception that running with modern running shoes was unsafe. By 1980, running shoe manufacturers decided to improve sales through advertizing their products as protective devices to hide the inherent injury risk with their use. They accomplished this through promoting unproven notions advanced by the pseudosciences of podiatry and chiropody, which consider the foot as an inherently delicate object that require the protection of shoes. By 1990, these ideas were refuted and a plausible mechanism was available to explain how athletic footwear cause injuries in runners that would not occur if they were barefoot. Despite this, athletic footwear continued to be falsely advertized as protective devices until 2000, when footwear protection claims became less emphasized. This followed a scientific report indicating that false advertizing of athletic footwear as protective devices in itself could be injurious. This changed a few years later when footwear manufacturers recklessly began falsely claiming that their new “minimalist shoes” and “barefoot shoes” allowed users to retain the protection inherent in barefoot locomotion. This advertising exploited the public's scepticism regarding footwear protection but also only superficial understanding of science explaining how footwear cause injuries. Vibram, one manufacturer of “minimalist shoes” particularly known for making false health claims is now the subject to a class action suit demanding damages for those injured from the false sense of security that their deceptive advertizing created.
1970's - The magic years
Prior to the advent of antibiotics in the second quarter of the twentieth century, infectious diseases accounted for most deaths, and scientific research was directed at understanding and treating them. After just two decades of antibiotic use human life expectancy at birth in economically advanced countries nearly doubled from near 30 years, where it had been for perhaps much of human existence, to near 60 years. Heart disease and cancer soon overtook infections as the major cause of death and research was re-directed to the cause and prevention of these more important afflictions. The “fitness boom” that commenced in the 1970's, and continues presently, resulted from scientific reports indicating that vigorous exercise improved myocardial infarction survival and moderated obesity, a major risk factor of coronary artery disease.
Distance running became the first voluntary mass participation activity involving physical exercise in economically advanced countries directed at improving health. This movement became possible because of a footwear design change that occurred just prior to interest in distance running consisting of incorporation of large amounts of expanded polymer foam in the midsole of these shoes. This allowed foot comfort when running even in individuals with a low level of overall fitness. Advertizing of running shoes during the early years of the “running craze” consisted of honestly stating features that promoted shoe durability and comfort.
1980 -1990 – unsafe product transformed to protective device
Vast numbers of injuries followed the use of these new running shoe from all manufacturers which lead to the general perception that there was an inherent flaw in the shoe design. This was further reinforced by the perception that injuries were infrequent in countries where barefoot locomotion was the norm, and the evolutionary notion that humans required a robust foot to survive as hunter-gatherers for some 250,000 years. This health problem became so large that it could not be ignored by scientists. Solutions were approached from two distinct directions – application of presumptions of the pseudo-sciences of chiropody and podiatry by biomechanists, and traditional basic health science involving hypothesis and experimentation. Biomechanists were impatient to create protective footwear, however because of their engineering rather than health science background, were incapable of contributing to a basic understanding of why humans were so frequently injured wearing these shoes. They chose to accept the available empirical notions of the pseudo-sciences which indicated that the foot is inherently delicate thus requires external protection, ignoring both lack of scientific support for these ideas nor fear of incorporating self-serving empirical notions from a group with no scientific credentials. Specifically, biomechanists never questioned the underlying assumption that the foot is inherently delicate, nor that footwear might be the cause rather than the solution of these injuries. This “original sin” of biomechanists eventually resulted in their total body of work becoming irrelevant once scientific reports indicated that the foot is inherently robust and footwear likely account for most running related injuries.
Running shoe manufacturers faced with public concern about frequent injuries when running with their shoes found it impossible to market running shoes based only on comfort and improving fitness through running as they had done previously. They now incorporated the ideas of the pseudo-sciences of chiropody and podiatry to sell running shoes to the now injury wary public. This was accomplished through creating the illusion that the problem with running injuries was not their shoe, but rather their shoes were “protective devices” that aided the inherently fragile human foot. This false advertizing was made easier because few people had contact with barefoot populations so they were unable to ascertain for themselves that injuries were frequent only in those that wore shoes when running.
Although the direction of advertizing was consistent empirical notions of the foot pseudo-sciences, manufacturers decided to avoid direct association with podiatry and chiropody because of their poor scientific credentials. Rather they aligned themselves with biomechanists who were university based therefore more credible despite promoting the same empirical notions. Manufacturers hired and supporting applied research of biomechanists so long as they behaved as surrogates of the foot pseudo-scientists through not interfering with their deceptive advertizing campaign. Running shoes began being falsely advertized as effective protective devices with biomechanists providing the scientific legitimacy to support their claims. From this came the unsupported and refuted ideas that thick-soft layers underfoot would protect against excessive impact during running, and excessive pronation and supination result in injuries.
Contemporaneous with entry of biomechanists into injury prevention, in 1980 I began a methodical systematic scientific research using traditional scientific methods into the cause of foot injuries in runners wearing modern running shoes. Initial work was based on what I thought was the sensible notion that the foot of humans is inherently robust because it was essential to survival of Homo sapiens during their 250,000 years as hunter-gatherers. By this evolutionary analysis, I hypothesized that footwear must make an inherently robust foot susceptible to injury. By 1990, my colleagues and I had published a series of scientific reports supporting the notion that tactile information emanating from SA II mechanoreceptors results in behavior that moderates impact during locomotion. Also footwear act as an interface that attenuate mechanical transients that would normally occur when locomotion is performed barefoot, thereby exposing shod individuals to excessive impact during locomotion. The foundation of our current understanding of running related injuries with footwear had been laid.
1990 -2000 – the age of denial
The notion that the running shoe is a protective device scientifically died by 1990 via publication of reports explaining how footwear use when running causes frequent injuries from chronic excessive impact, yet athletic footwear manufacturers continued to irresponsibly advertise products as protective devices mainly because the public was slow to become aware of these new scientific developments. Running shoe manufacturers together with their biomechanist entourage who they financially supported orchestrated a decade long futile battle to delay the advancement of science in this area (see the exchange of letters to the editor-in-chief of a scientific published in Medicine and Science in Sports and Exercise (MSSE) that appears on this website). Despite efforts by biomechanists' sometimes hysterical approach of claiming that the bare foot is fragile thereby needing footwear, they were eventually abandoned by the footwear manufacturers they had tried so hard to please and the number of biomechanists employed directly by footwear manufacturers collapsed. The few that remained were used simply to create a public image of a scientific approach to product design and to perform mundane tasks such as durability testing. Similarly, footwear manufacturers reduced funding of university based biomechanists. This resulted from concern of product liability claims following my 1997 report published in the British Journal of Sports Medicine entitled. “Hazard of deceptive advertizing of athletic footwear.” It indicated that advertizing footwear as protective gives users a false sense of security that induces them to land with amplified impact, thereby accounting for a greater than 200% increase in injury frequency associated with the use or more expensive running shoes that was found in Marti's earlier epidemiological report.
From 2000, running shoe manufacturers began moderating claims regarding protection against injury in their advertizing out of concern of legal liability risk. With this de-emphasis of safety claims based on empirical notions. Advertizing of modern running shoes of traditional design now is based now almost exclusively on fashion of the brand, cosmetics and athlete endorsement.
The age of living dangerously
By 2000, most athletes had lost any hope of being protected by athletic footwear, and knowledgeable individuals (mainly serious runners and experienced coaches) became convinced about the importance of barefoot locomotion in prevention of injury and rehabilitation following running injuries of shod runners. Many individuals tried running without them. Fears of frequent injury promoted by biomechanists and foot pseudo-scientists proved unfounded. The only resistance to more widespread barefoot activity were implicit and explicit social norms.
By 2005, safety claims returned as athletic footwear manufacturers began their attempt to recapture the market of runners who became sceptical about their earlier safety claims by introducing thin-soled shoes which later were termed “minimalist shoes” and later “barefoot shoes.” These products were an attempt to cash in on the interest in barefoot locomotion in those individuals who were too timid to attempt confronting social norms regarding barefoot locomotion in public, with a product that was knowingly falsely advertized as allowing protection inherent to the bare foot. This advertizing was obviously reckless considering the known risk between deceptive advertizing and injury in runners. Initially this misleading advertizing message was soft in that it suggested that these new products were less dangerous than traditional shoes because it simply consisted of less shoe material. Some smaller manufacturers of these thin-soled products were more bold about claims by boldly stated that the foot changes with their shoes to closely resemble the foot of barefoot runners. No manufacturer was as bold as was Vibram in making these false claims. It seems appropriate that the frequent injuries associated with use of Vibram products initiated the first class action lawsuit regarding misleading advertizing of athletic footwear, holding them responsible for frequent injuries that have been associated with their products that can be accounted for by the false sense of security produced by their advertizing claims.
The modern running shoe that originated in 1970 was originally advertized honestly as a device that allowed most individuals, regardless of their fitness level, to run comfortably on pavement. By 1980, footwear manufacturers responded to public concern of frequent injuries when running with modern running shoes by transforming this hazardous product into a protective device through deceptive advertizing. This was achieved by promoting self-serving empirical notions of podiatrists, chiropodists and biomechanists. By 19990, a series of reports explained why athletic footwear cause chronic overloading when running through neutralizing forces required by plantar SA II mechanoreceptors to produce behavior that moderates overloading. Manufacturers continued to deceptively advertize their products as protective devices despite this information until a report indicated that the advertising in and of itself can account for injuries. Athletic footwear manufacturers moderated their claims out of fear of legal liability.
Health claims remained modest until 2005, when particularly smaller manufacturers recklessly began falsely marketing a niche product now called “minimalist shoes” or “barefoot shoes” as not interfering with protective mechanisms inherent with barefoot running. Frequent injuries followed the use of these products due to the false sense of security that the advertizing created with users expecting protection. A recent class action suit against Vibram, a manufacturer of these products that perhaps most aggressively and recklessly made these false claims, demands damages to those injured. According to this review, the athletic footwear manufacturers have never hesitated to use false health claims to sell products even when endangering the public. Only fear of legal action or litigation itself has ever resulted in moderating false and misleading advertizing used to sell athletic shoes.
The origin of obesity in humans (March 2012)
The solution to the present obesity epidemic lies in recognizing its evolutionary origins. Obesity defined as excess body fat sufficient to impair mobility, could not have existed in hunter-gatherers of the genus Homo, because ineffective mobility would have impaired survival. The sole extant member of this genus, Homo sapiens (humans), lived as did its ancestors with a keen sense of hunger so as to maintain energy reserves required for mobility and survival in relative famine, and constrained by impairment of survival imposed by excessive weight. This changed when the “Black Death” ravaged southern Europe. During this period, to avoid contact with the substrate that was presumed to be contaminated, all social classes in Europe adopted the habit of wearing shoes. The associated discomfort of standing when using footwear caused avoidance behavior through extensive use of chairs for the first time in human history – a sedentary lifestyle and subsequent obesity for many, because unlike when humans were hunter-gatherers, technology now allowed less mobile humans to survive. Consideration of this perspective suggests that highly restrictive diets will typically fail to curb obesity, and instead, increasing daily weight-bearing time is essential. This will require avoidance of footwear whenever possible.
All members of genus Homo are descended from a common ancestor who must have lived in the Sub-Saharan savanna, and was likely a nomadic hunter-gatherer with a vertical posture.1 These early humans spent most of their wakeful hours weight-bearing – mainly standing but also walking and running.2 The development of a behavioral adaptation to prevent plantar skin ulceration resulting from prolonged standing was a precondition to this emergence. More specifically, all members of this genus rely upon a relatively small area of skin as a heavily weighted interface between their body and support surface. It is notable that plantar skin is durable when walking and running but loses protective value with prolonged standing without the addition of a behavioral protective mechanism, because glabrous skin (skin type of palms and plantar surface) though more resistant to mechanical forces than other skin types is susceptible to ischemic necrosis (death from lack of blood supply) arising from persistent loading.3-5 This plantar surface sensory mediated behavioral mechanism involving constant repositioning of plantar loads is likely ancient, considering that it was a precondition to the emergence of the upright stance characteristic of the genus.6-8
Obesity is defined here as excess body fat capable of impairing mobility. Sub-optimal mobility likely would have compromised survival of members of genus Homo from their emergence up until the time Homo sapiens developed adequate technology in animal husbandry and agronomy that would have allowed departure from nomadic life (c. 10,000 years ago).1,2 Natural selection optimized their nutritional balance via their sense of hunger. Onset of hunger commenced when easily available stored energy in muscle and liver began to be depleted. Sense of satiation was probably always weak as will be discussed later.
Even humans that gave up their nomadic life remained weight-bearing, since there is no evidence of widespread use of seating until modern times.9 This is explained by adaptation over time leading to inherent comfort of barefoot weight-bearing in humans. But it also suggests weight-bearing is inherently more comfortable than sitting because humans voluntarily remained weight-bearing for thousands of years after chair technology was known and living conditions allowed a more sedentary life.9
This changed suddenly when Renaissance Europeans became the first society in human history where all classes (particularly the less affluent masses) began wearing footwear. Pain from the feet of shod humans attempting to stand for long periods forced avoidance behavior via seating.9 The result was that Renaissance Europeans became the first sedentary population in history. This is the only available explanation of why chairs were rare prior to the Renaissance but common thereafter.9 The present worldwide use of footwear and sedentary lifestyle outside of Europe can be traced to European colonization and cultural imperialism.
The effect of this sedentary change on human energy requirements was massive. The MET (Metabolic Equivalent of Task) scale is used to simplify discussion of average energy consumed by a population of humans performing activities. One MET is defined as the oxygen consumption of 3.5 ml O2·kg−1·min−1 , which approximates the energy consumed when subjects are sitting quietly. Simply maintaining stable equilibrium in the upright position for short periods requires 1.8 METs, but performing minimal upper body work for prolonged periods upright requires considerable additional work to protect plantar skin from necrosis. This raises energy expenditure to about 3 METs – near the cost of walking slowly (3.5 METs).
From the emergence of genus Homo some 2,500,000 years ago, until the time when humans in Europe began using chairs at home and in the workplace, hunger had to become intense when energy intake was near 3450 kcal daily for a 70 kg human (the prototype in the discussion that follows). This is consistent with standing for all wakeful time (16 hours). Satiation probably was never fixed because of the variability of energy requirements with work, and the need for energy stored as body fat to be used when work intensity was great and/or food was scarce. Further, excessive body fat was constrained because it reduced mobility, making food gathering more difficult and less successful.
Contemporary obesity is the result of elimination of historical constraint on adiposity imposed by the need to be mobile, combined with an innate sense of hunger that drives humans to consume at least 3450 kcal daily and a poor sense of satiation. We will never return to a time when humans survived as hunter-gatherers. On the other hand, as intelligent animals, once informed, people would choose the healthier path if it does not disrupt their ability to work, travel and perform other required tasks of contemporary life. There are presently many practical ways that even the sedentary office worker can easily achieve the goal of 3450 kcal daily calorie consumption through exercise. For instance, it could be half met by working upright rather than in the seated position (remarkably, energy equivalent to competitive running for one hour). Remaining upright during transportation would be of further benefit. The goal could then be reached simply by adding a few intense exercise sessions weekly as is required for cardiovascular health. Obviously, most of this increase in energy utilization results from amplified weight-bearing time. Since much of any practical solution involves amplifying time standing, it will become necessary to wear shoes much less – e.g., being barefoot in the office and outside it when climatic conditions permit. The only obstacles to this are implicit and explicit social norms commencing with the European Renaissance that now force and encourage, respectively, footwear use.
People must be informed about the importance of eating only enough to satisfy hunger unless preparing for prolonged multi-day strenuous exertion as relying on the sense of satiation will surely lead to obesity. Once informed about the necessity of more exercise, most persons would be receptive so long as it is achieved without interfere with daily life imperatives. The alternative of hunger control through chemical means in presently unsafe. Even if improved pharmaceuticals become available, hunger suppression is a poor approach because unlike exercise, it does have secondary positive benefits on almost all organ systems.
Science is continually evolving though not linearly. Renaissance Europeans applied scientific principles considered advanced by the standards of their time by using footwear in a failed attempt to deal with contagious diseases that were devastating their society.10 This solution never resulted in disease control but was only proved ineffective by Koch near the beginning of the twentieth century. Data has suggested onl recently that footwear use is a major source of morbidity and mortality through causing our sedentary lifestyle and damaging our feet.6,11-14 This progression should not be used to support the argument that traditional practices must be sustained at the expense of scientific advances. Rather it argues for hesitation in incorporating new ideas that seem attractive in theory until they have been proven in practice. If this had been the standard of proof in the European Renaissance, footwear would have remained an ornament signifying social class as it had been for thousands of years prior to its general use in Renaissance Europe.
We have been slow in integrating scientific research in our daily lives via eschewing footwear, despite the recentness of developments in this area. This is in large part accounted for by resistance from groups that benefit from selling footwear and others that profit from the misery that shoes create. Nevertheless, ideas that improve health seem to get integrated into daily life rapidly in this age of electronic communication.
Dunsworth, H. and Walker A. (2002). Early genus Homo. The Primate Fossil Record. (ed. W. Hartwig), 419-435. Cambridge: Cambridge University Press
Fleagle, J. (1999). Primate Adaptation and Evolution. Second Edition. New York: Academic Press
Santos D, Carline T, Richmod R, Abboud R. A review of the effects of external pressure on skin blood flow. The Foot, 13 (4). pp. 185-189. 2003
Adriansen H Gybels J Handwerker H O Van Hees J. Nociceptor discharges and sensations due to prolonged noxious mechanical stimulation: a paradox. Hum Neurobiol 3:53–58 1984
Greenspan J D McGillis SLB. Stimulus features relevant to the perception of sharpness and mechanically evoked cutaneous pain. Somatosens Mot Res 8:137–147 1991
Robbins SE, Waked E, Krouglicof N. Improving balance. J Am Geriatr Soc 1363-70 1998
McCrory JL Chambers AJ Daftary A Redfern MS. Dynamic postural stability during advancing pregnancy. Journal of Biomechanics 2434-2439 2010
Alexander, N, Shepard N, Ju Gu, M Schultz ,A. Postural Control in Young and Elderly Adults When Stance Is Perturbed.Journal of Gerontology 79-87 1992
Illustrated History of Furniture: From the Earliest to the Present Time. Frederick Litchfield. 1893
J Nohl, The Black Death: A chronicle of the Plague (London: Allen & Unwin, 1926)
Robbins SE, Waked E, Krouglicof N. Improving balance. J Am Geriatr Soc 1363-70 1998
Robbins SE Waked E Gouw GJ McClaren J. Athletic footwear affects balance in men. Br J Sports Med 28:117-122 1994
Robbins SE Gouw GJ McClaren J. Shoe sole thickness and hardness influence balance in older men. J Amer Geriatr Soc 1089-1994 1992
Robbins S. Waked E McClaren J. Proprioception and stability: Foot position awareness as a function of age and footwear. Age and Ageing 24:67-72 1995