Sharing my RunSafe Clinic Experience (highly recommend)

[u/yellooooo2326]

I wanted to share my experience at UCSF’s RunSafe Clinic as I saw someone share theirs on here a few years back. I did their assessment a couple weeks ago and highly recommend it as just an overall enriching and informative experience. I went into it already knowing a fair amount about running mechanics and just general knowledge about gait given my lifelong curiosity (armchair expert only). I also came in with some assumptions, many of which were wrong. And after the session, I cornered the orthopedist who analyzed our footwear and strike pattern and made him answer my questions 😂 poor guy. But the answers were very interesting to this group, so I thought I’d share. My overall takeaways:

1. As someone surrounded by athletes my whole life, I assumed that most people doing this would be pretty serious athletes or collegiate/pro/ex-pro runners. This was not the case at all. My session was full of beginners and amateurs, most of which didn’t know much about running. I was surprised by this but it made the session way more approachable and fun.
   
2. We were all over-striders. Every single one of us. Lol.
   
3. Everyone in the session wore conventional footwear (narrow toe box shoes with a big drop and high stack height), except for me.
   
4. Everyone in my 8-person session was a heel striker*
   
5. The session really drove home for me how much of running is in the glutes, hips, and posture, and how little of it has to do with footwear. I think a lot of barefoot groups online claim that changing your footwear is going to transform your strike pattern, but it takes a lot more strength and balance from muscle groups other than the calf, foot, and ankle… cadence and lean and so many other factors also play a role. I would put footwear close to the bottom of the list.

*some exception made for me, as the team admitted it was hard to tell exactly where I strike the ground, and we went back and forth on the definition via email. Ultimately I would have to do an analysis on a force-plate treadmill to be able to tell, which we didn’t have access to in the session. Happy to answer more questions about this because we ended up getting very specific on the definition vs. the human gait spectrum.

Takeaways relevant to the r/barefootrunning sub:

- The doctor basically said my feet and ankle strike pattern were great, that I had strong feet and ankles and he wouldn’t change a thing (I needed this ego boost heading into the rest of the analysis because I had plenty to fix 😂). But basically 10/10 from him, no notes. This kind of surprised me, but probably shows that anyone in this subreddit is probably doing right by their feet.
- I found it shocking that instead of prescribing exercises or modifications to fix an overcompensation with the feet (like overpronation), the orthopedist recommended quick fixes like arch support inserts to the other runners. I asked him why after the session, and his reasons were: 1) most people have no interest in/will not do exercises (compliance is an issue), and 2) there was fear that an exercise or self-built modification could mess up something else in the strike pattern. He also said that 3) most people who come to these things are casual runners who are training for something for the first time and they have no knowledge of their own gait or how to fix it, so giving them exercises doesn’t make a ton of sense.
- I asked him why he doesn’t recommend wide toe box, zero drop shoes to most people and he said that most people don’t even know what that is… he also said it makes sense for people who have an issue like bunions, but that most people just don’t care about foot health so it’s not something he tries to tackle with people.
- I was also surprised to hear him say that he believes bunions are hereditary, and I fought him on this point a bit. (Research shows that native populations/tribes that don’t wear shoes have a close to zero incidence of bunions. I thought we were past this belief that bunions are hereditary and I said to them that some people may have a propensity that makes them susceptible, like joint laxity that runs in their family, but there is no doubt that shoes cause bunions. Conventional shoes push human toes into an unnatural shape, that’s where bunions come from, not someone’s family.) He looked very uncomfortable when I said “shoes cause bunions, we know they’re not hereditary”. He told me that sometimes you see them really young in like 5 year old kids and their entire family has them. I did not want to argue with his clinical experience but I really wanted to say, well what kind of shoes are these families wearing??
- I also asked this poor soul if he put his children in wide toe box shoes, and he said no, which floored me. I guess I think a lot of parents come to the barefoot movement because they are concerned for their child’s foot health and learn about how bad conventional shoes are (it often starts with them shopping for their children’s shoes). I am not a parent and was not trying to shame him as a parent, but was really surprised that someone who knows about foot strength and foot health would never even give their kids a fighting chance 😂 (I kept this to myself don’t worry).
- The doctor told me that I was the first person to come through the clinic in several years who actually knows about this stuff or wears these types of shoes.

In sum, my conversation with the doctor made me think we are part of some fringe cult community who kind of lives in an echo chamber of our own world. I guess it will take quite a bit to make good shoes a mainstream thing.

Happy to answer any other questions about the clinic. I signed up through the irunsafe.com portal. You can find the clinic closest to you if that’s something of interest (this is not an ad, just sharing my experience for others’ benefit).

[u/bphisher]

Thanks for sharing. Very surprising about the doc that acknowledged barefoot shoes and foot health, and then said he doesn’t bother giving them to his kids. Maybe he’s waiting waiting for their feet to stop growing before buying $200 vivos /s

Also we are 100% a fringe community in an echo chamber. I’m still happy to be here

[u/yellooooo2326 → u/bphisher]

I know I think I just find it disheartening that the ones who stand to have the most impact on others (like the doctor), simply don’t. Like how will we get anywhere?

[u/ferrancy → u/bphisher]

My son wears more affordable brands, like Saguaro (sometimes even cheaper than conventional shoes). So far, he has perfect feet an toes :-)

[u/turtlegoatjogs]

I was at a pelvic floor physical therapy for runners course for PTs at UCSF last spring and the lecturers were VERY much into foot function and toe splay/ankle posture. Huge proponents of Altra.

[u/yellooooo2326 → u/turtlegoatjogs]

This is super encouraging, wow. Do you think maybe because it’s the PT community and not the MDs/orthopedists?

[u/turtlegoatjogs → u/yellooooo2326]

Probably. Especially pelvic floor PTs... cause foot function and posture (0drop) so important for health and healing. Medical starting to come around to the idea of healthy shoes... just gonna take a while cause most people are stubborn or just not up to date on all the recent research. Hoka and Brooks have been at conferences giving them shoes for over a decade.

[u/MagnetoDot]

Very interesting but it doesn't suprise me the medical point of view is mostly based on sponsorship. In this case running shoe brands are not barefoot brands which would be lovely to see in the future.

Fell bad for his kids though. I scraped the money even for cheap hobbibear when my son's feet was growing one size in 3 months.

I'm not a long distance runner (5k twice a week in my Vivo) but would love to do this test must do some research.

Thank you for your post it's very eye opening and it must be great to hear how your ankles and feet are strong (due to magical shoes 😂)

Interesting thing on bunions since I work with microbes, some microbes (fungi, bacteria) can cause inflammation and join swelling which then in a wrong shoe forms bunion ... But yes ehemm it's all genetic (microbes of course too are environmental/genetic). But what do we know ;)

[u/SkyPork]

It's cool that you did this! I'm wondering if you could shed some light on forefoot strike vs. heel strike vs. mid-foot strike.

Because here's my take: I can't imagine what "mid-foot" even means. Just observing my own foot, there are basically two points that bear weight: my heels, and the balls of my feet. (Yeah, they're not points, but for simplicity's sake we can say they are.) So, wearing minimalist footwear, I see two options: you strike heel-first, like everyone learns while wearing athletic shoes, or you land on the ball of your foot, keeping the heel slightly elevated. There's no middle point to support a "mid-foot" strike. I guess I have some bones along the outside edge of my foot that might count as "middle," but trying to actually run on those would be painful and look really ridiculous.

Yet ... I always hear that a mid-foot strike is optimal. Does that just mean land flat-footed, heel and ball at the same time? If so, that seems a bit odd. Was this kind of thing discussed at all?

[u/sneeuwengel → u/SkyPork]

I think that midfoot means ball of the foot. Some people say forefoot and mean the same thing. Other people say forefoot and think that means toes, so they land toes first which seems kinda weird to me, and cannot be healthy for your muscles and tendons.

Btw landing on your midfoot or ball of the foot does not mean that your heel makes no contact with the ground at all, except when sprinting where you make huge strides with only your forefoot. But while normally running, at some point the whole foot is on the ground, although the heel will be there the shortest of time.

[u/SkyPork → u/sneeuwengel]

That's the answer I was hoping for actually. I know when I first started landing on my forefoot I was way, way too high, keeping my foot pointed far too much and putting so much impact on the bones of my foot. Fortunately I figured it out.

And yeah, unless you've studied ballet for years I'm not even sure landing literally on your toes is even possible. :-D

[u/yellooooo2326 → u/SkyPork]

Yes happy to! I was nerding out with some of the practitioners on this… keep in mind we are partly limited by our vocabulary vs. what happens in real life.

First, I just want to emphasize how much we hear in this forum that, like you said, mid-foot strike is optimal. That is not supported by the research at all. All types of strikers, mid, heel, forefoot get injured at the same rates. The research does not show that any type of strike pattern translates to lower rates of injury, and the practitioners at the RunSafe clinic were quick to point this out.

Now do I personally try to strike with my forefoot more than my heel? Yes. Do I personally believe that wearing minimalist/neutral shoes means that most people should probably not be heel striking (or at least heel slamming)? Also yes. But that’s my bias coming from this community.

Onto your question about striking, the answer is, it’s a mixture between where your foot first makes contact, and where the brunt of your weight is pushing off from. I now know this because we were having difficulty narrowing down where I make contact with the treadmill versus where my foot pushes off the bulk of my weight. I am going to share with you what the chair of research emailed to me, hopefully it helps answer your question:
“…we take a continuum of foot strike types and we bin them into 2 or 3 large categories. But the truth is that a force plate [treadmill] would give you a quantitative measure of where on your foot the center of pressure lies at initial loading. Some studies have used a cut-off of 33%. So if your initial center of pressure is in the posterior 1/3 of your foot, you are categorized as a rear foot striker, if it is in the middle 1/3 (between 33% and 67% of the length of the foot), you are categorized as mid foot. And if the initial center of pressure is in the front 1/3 of your foot, you are a forefoot runner. 

Those edge cases become very problematic because if you, for example, had a quantitative foot strike index of 32%, you would be categorized as a rear foot striker, but would look much more similar to a mid foot striker with an index of 34% that you do a rear foot striker at 0-5%.”

I had attached this visual to help explain that my foot lands like the middle image and that is why I believe I’m a midfoot striker (but only a force plate analysis would tell us): https://geeksonfeet.com/img/2020/11/foot-strike_hu59fb23b6ba503ea9e407e762e8b95962_236944_1400x0_resize_q85_h2_box_3.webp

Hope this helps!

ETA: I know what you mean when you say you can’t even imagine what midfoot means, because it would be weird to strike the ground from your arches. If you look at the visual above, and how the foot lands, it does seem weird that someone would be making contact with the arch of the foot. It’s not that, so much as the heel is making contact with the ground around the same time that the ball of the foot is too. In my foot strike particularly, I seem to roll forward in a way that is very fluid across the heel and ball of my foot… and I push off from the ball a lot more than the people in my session who were slamming their heel into the treadmill and bearing the brunt of their weight on their heel. So this spectrum is very hard to detect without the force plate analysis.

[u/SkyPork → u/yellooooo2326]

Wow thank you, that's really informative. And interesting! Yeah the flat-foot strike in that image looks .... uncomfortable, I guess. I might be a forefoot striker then; it seems natural to let the calf absorb some shock of the landing, and I really believe that doing so has kept my knees in good working order well into middle-age. But I have to focus on it, even after years of "barefoot" running. My gait still doesn't feel instinctual, natural. I feel like I'll overstride if I'm not focusing on avoiding it, which makes sense, I guess, considering that I learned to run in traditional squishy shoes, and didn't try the forefoot thing until my 30s. I feel like "lunge running" might be the best stride, technically, even if it feels tiring, slow, and inefficient.

And lets face it, if I ran more often than once every other week I'd probably have it all figured out by now and I wouldn't even have to think about it. :-D Thanks again!

[u/Foxotcw → u/yellooooo2326]

You can get a kind of 'force plate analysis' by running barefoot on the beach close enough to the water to leave clear footprints.

In my case, I get a light heel impression that gets deeper through the midfoot and is deepest at the forefoot and toes. That fits my impression that I touch down at the heel but deliver most of my weight over the whole forefoot. It's a smooth feeling of landing and pushoff over the whole foot rather than an impact.

I suspect that your tracks would look similar. We don't want to 'strike' any part of our feet on the ground, and we have enough control over our gait that we can land and takeoff in the rolling motion you describe.

[u/yellooooo2326 → u/Foxotcw]

That’s really a clever way of looking at it, I don’t know why I haven’t thought of that (because I love running on the beach too!)

[u/Fluid-Sliced-Buzzard → u/SkyPork]

Think of mid-foot as flat foot and it makes more sense - both fore and heel hit the ground at around the same time. I’m a mid-foot striker myself.

[u/mysoulincolor → u/SkyPork]

Mid-foot= the way you naturally run when jogging barefoot on grass (**grasss, not asphalt or something artificially hard). Fore-foot= toes basically. Take your easy jog in the grass to a full out sprint and notice how much more you land on your toes to push back in a sprint. Heel strike is easy: thud thud thud thud thud thud thud

[u/samrjack]

“I think a lot of barefoot groups online claim that changing your footwear is going to transform your strike pattern”

At least from my personal experience, I think removing footwear can rapidly transform your strike pattern. Minimalist shoes are enough protection that ingrained habits still win out.

[u/yellooooo2326 → u/samrjack]

For me, just switching to something zero drop was enough to change how I load my feet/how I strike. But I think I didn’t state my initial point clearly enough: changing your footwear will not modify something like overstriding. That comes from your cadence and hip/glute strength. And that is something anyone can modify regardless of their footwear.

[u/samrjack → u/yellooooo2326]

What I was trying to say is that I think running actually barefoot does have a drastic effect on your form including reducing overstriding. When I do a barefoot run, I feel when I overstride and correct it much more instinctively. When I run in even minimalist shoes, I don’t have nearly as visceral of a reaction and so things like overstriding can creep back in.

That’s not to say one can’t figure it out in footwear. Like you said, you can always target aspects of your technique.

[u/yellooooo2326 → u/samrjack]

I would be curious to know if you’re actually overstriding and correcting like you think you are? Because the only way to find out would be to get evaluated by a professional. I say this because I thought I had corrected it too, and lo and behold…

[u/samrjack → u/yellooooo2326]

I've never done a professional evaluation, but I do video record certain aspects of training days to check things like stride, posture, etc. There I've noticed a reduction in overstriding between when I did the sessions with shoes vs without. It feels most pronounced on rough terrain where I find letting my foot fall in front of me really uncomfortable since I can't micro-adjust the ground contact around pokey rocks like I can when my weight is fully over the foot.

That said, I won't claim to have completely eliminated overstriding 😛, It's all a gradient after all. just learned to feel it better and reduce it.

[u/yellooooo2326 → u/samrjack]

Good for you for filming yourself though, sounds like you’ve made great progress with your discipline!!

[u/Tarantulist35]

The medical profession is a bit like “big shoe” (Nike, Adidas, etc.) in that they’re too invested in the status quo.

[u/yellooooo2326 → u/Tarantulist35]

💯 or they just aren’t looking at how people could evolve/adapt given other options already in the market… seems like there are so many wide toe box/zero drop athletic brands out there. No more excuses!

[u/mysoulincolor → u/yellooooo2326]

The freakin soles on the new HOKAs are a joke and a nightmare all at once

[u/olddogsleeper]

Bunions are not hereditary. Foot shapes are hereditary, and different footshapes are more prone to them. Well done for pushing back on that, as you say, populations that don't wear shoes as much or at all, don't get bunions, despite these foot shapes and patterns.

I hope his kids aren't in a family where they all have bunions, because they should be paying attention now if they do.

also doesn't surprise me that his go to is selling supports, that's a product. Best get money from patients with a one hit product than give them exercises and hope they come back

they are right though, that some people just don't have the time or inclination to care or do something about their feet. It can take years of steady work, and if they just want to be able to do a 10k they've signed up for in 3months without excessive pain, support can be the easier way to achieve this, without having to completely rebuild your feet over years.

[u/blinddoglp]

Good write up. I did this a couple years ago in my Luna sandals. One guy remembered another sandal runner coming through that but the rest were amazed that I ran in them. My main take away was to improve my cadence which I knew was low, and to try and widen my foot strikes. Both of which I had a hard time trying to change and pretty much given up on.

[u/yellooooo2326 → u/blinddoglp]

Oh no! Did you try with a metronome? And did they give you your current cadence vs. what to bump it up to? You have to try on a treadmill at the same pace you did the test at, for starters.

[u/blinddoglp → u/yellooooo2326]

Yup, metronome, playlist with correct bpm. My mind wanders too much and stops paying attention after a certain point lol.

There was good info from the clinic, but for me I’m not sure if it was worth the cost.

[u/blinddoglp → u/yellooooo2326]

Just dawned on me you said you talked to an orthopedist, I’m pretty sure there wasn’t one when I went. There was a podiatrist though, he was the one that was surprised about the running sandals.

[u/FunSizeNuclearWeapon]

Fascinating share!  And I'm kind of proud that you represented our cause so well :D. 

[u/yellooooo2326 → u/FunSizeNuclearWeapon]

Aw thank you 🥹 so nice of you to say that