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Peter Attia MDPeter Attia MD

#128 – Irene Davis, Ph.D.: Evolution of the foot, running injuries, and minimalist shoes

Irene Davis is the founding Director of the Spaulding National Running Center at the Harvard Medical School. In this episode, Irene describes how her research of biomechanics and clinical work with running injuries, as well as research by others, has shaped her views on maintaining body alignment and foot health. Irene discusses her argument for the role of modern footwear in running-related injuries and how minimalist footwear helps resolve the subsequent biomechanical issues. We discuss: 00:00:00 - Intro 00:03:20 - Irene’s path to her Ph.D., her entry into physical therapy, and her interest in biomechanics 00:07:15 - How Irene’s thinking about the use of orthotics has changed 00:10:30 - The evolution of the human foot and the transition from walking to running 00:17:30 - The evolution of shoes and its impact on running injuries 00:26:00 - An overview of running injuries 00:29:30 - Cushioned running shoes, heel striking and impact forces 00:33:45 - Shin splints 00:35:30 - How heel strike patterns promotes knee stress through rate of loading 00:42:15 - The critical importance of exercise 00:45:45 - Impact forces and injury potential 00:49:00 - How shoe cushioning alters impact forces despite forefoot striking 00:52:30 - An overview of minimalist shoes 00:58:45 - Irene’s protocol for transitioning people out of orthotics 01:05:30 - Transitioning to minimalist shoes and a forefoot strike 01:07:00 - Foot muscle volume, minimalist shoes, and orthotics 01:09:45 - The recognition of the importance of foot strength in podiatry 01:12:30 - Minimalist shoes across the lifespan—from children to adults 01:20:00 - Why learning to forefoot strike on soft surfaces is not the best approach 01:21:45 - Knee valgus and factors related to knee injury 01:28:30 - IT band syndrome 01:33:15 - Physics and ground reaction forces 01:36:00 - Irene’s approach to retraining a runner’s gait 01:42:15 - Case study—How the transition to minimalist shoes decreased injury and improved performance 01:45:30 - Importance of proper movement patterns and the negative influence of our modern environment Show notes page: https://peterattiamd.com/irenedavis About: The Peter Attia Drive is a weekly, ultra-deep-dive podcast focusing on maximizing health, longevity, critical thinking…and a few other things. With over 30 million episodes downloaded, it features topics including fasting, ketosis, Alzheimer’s disease, cancer, mental health, and much more. Peter is a physician focusing on the applied science of longevity. His practice deals extensively with nutritional interventions, exercise physiology, sleep physiology, emotional and mental health, and pharmacology to increase lifespan (delay the onset of chronic disease), while simultaneously improving healthspan (quality of life). Learn more: https://peterattiamd.com/ Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on: Facebook: http://bit.ly/PeterAttiaMDFB Twitter: http://bit.ly/PeterAttiaMDTW Instagram: http://bit.ly/PeterAttiaMDIG Subscribe to The Drive: Apple Podcast: http://bit.ly/TheDriveApplePodcasts Overcast: http://bit.ly/TheDriveOvercast Spotify: http://bit.ly/TheDriveSpotify Google Play: http://bit.ly/TheDriveGooglePlay

Peter AttiahostIrene Davisguest
Sep 14, 20201h 53mWatch on YouTube ↗

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At a glance

WHAT IT’S REALLY ABOUT

Irene Davis on Evolution, Minimalist Shoes, Forefoot Striking and Running Injuries

  1. Davis describes her shift from prescribing orthotics and matched shoes to promoting foot strength, minimalist footwear and a more natural running pattern, prompted by research and evolutionary biology.
  2. She argues that footwear changes after the 1970s running boom, including cushioning and motion control, led runners to land harder on their heels, raising impact loading and shifting stress to the knee.
  3. The conversation covers the mechanics of ground reaction forces, loading rates, valgus, pelvic drop and IT band syndrome, showing how foot, hip and core function connect to injury.
  4. Davis outlines her clinic's protocol: gradually weaning from orthotics, foot strengthening, a one-to-three month pre-gait program, minimal shoes, then treadmill gait retraining over several weeks.
  5. Both speakers argue for a broader prevention approach, including minimal footwear for children, daily physical education, less chair sitting and multi-sport activity.

IDEAS WORTH REMEMBERING

5 ideas

Matching shoes to foot type did not reduce injuries.

Davis cites a military study of about 7,000 people in which those given shoes matched to foot type had no different injury patterns from those who all received the same shoe, which led her to rethink her own prescribing.

Cushioning can lead people to land harder.

Davis says studies show runners in cushioned shoes hit harder, and that heel striking creates a sharp impact peak with a high loading rate linked to running injuries.

Forefoot striking removes the impact peak but not the peak force.

Davis says the peak force stays the same, but landing on the ball of the foot removes the quick first impact, which matters across roughly a million foot strikes per foot per year.

Shoe type and foot strike interact.

Davis says transitioning to a forefoot strike in regular shoes often brings Achilles and peroneal tendon problems, so the change should be made in minimal shoes, while heel strikers should keep cushioning under the heel.

Orthotic support may weaken foot muscles, and strengthening is underused.

Davis describes research showing foot muscles grow in minimal shoes and an unpublished study showing a 10 to 17 percent reduction after 12 weeks in orthotics, and she notes that plantar fasciitis guidelines omit strengthening.

WORDS WORTH SAVING

5 quotes

We have to evolve in our relationships. Right? And we have to evolve in, in our spirituality. We have to evolve in our scientific thinking as well, and I've always believed that.

— Irene Davis

I believe that running is an activity of daily living. People talk about running being a skill. I don't think it is. We learn to run on our own. We're not taught.

— Irene Davis

The softer you land, the less your chance of getting injured.

— Irene Davis

So if you put someone in a neck brace for life, what's gonna happen to your neck muscles?

— Irene Davis

What we evolved to do was to squat. We really try to get people back into shoes that allow their feet to do what they were adapted to do and to run in a pattern that is closer to our evolutionary legacy.

— Irene Davis

Evolution of running and the human footHistory of running shoes and the running boomHeel strike versus forefoot strike and loading rateMinimalist versus partial minimal and cushioned shoesWeaning from orthotics and foot strengtheningKnee valgus, pelvic drop and IT band syndromeGait retraining and injury prevention

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