The barefoot paradox

Patrick T. Reilly

Farrier Services, New Bolton Center, University of Pennsylvania

Take-Home Message The choice of barefoot vs. orthotics in equine hoofcare cannot be made objectively based solely on the available scientific information. Any valid parallels with human podiatry and sports medicine suggest the use of orthotics that provide selected characteristics such as protection while minimally changing the barefoot stride characteristics.

Introduction Owing to the lack of definitive information regarding equine hoofcare and foot health, any management decision made by the attending veterinarian or farrier is a mostly subjective one, based on limited research and anecdotal accounts. The large amount of information available on the internet can be helpful in educating horse owners about different aspects of horse care, including hoofcare choices, but seldom is the information presented by its author in a way that makes plain what it actually is: opinion. How does one decide on which information to base a hoofcare practice? Which scientific papers and conclusions can be used as the basis for decisions about hoofcare? And how can we, as providers of hoofcare, justify our decision-making process to owners who have been told that,

as practitioners educated in the use of horseshoes, we have interests other than the best interest of the horse? Even a cursory internet search reveals the disparity of opinions regarding the barefoot ideal. One side of the discussion are the purveyors of horseshoes and those educated in the treatment of foot-related maladies for which shoes are used as a treatment modality. On the other side are those who firmly believe that the use of horseshoes is cruel, and that barefoot horses live longer, happier, less painful lives [1]. Interestingly, this debate is not limited to horses nor to equine health and performance. A similar debate is ongoing in the field of human podiatry, between bare feet and the use of orthotics in human health and performance. As with the horse, humans evolved without shoes until relatively recent times, evolutionarily speaking. But unlike the equine field, human podiatry research is well funded and it benefits from advances in technology that are largely unavailable to equine researchers. There are several limitations in translating research findings from humans to horses anatomical and biomechanical differences between bipeds and quadrupeds, to name just a couple of obvious ones. Even so, there are also some undeniable parallels. The book Born to Runa hidden tribe, superathletes, and the greatest race the world has never seen by author Chris McDougal tells of the Tarahumara Indians of Mexico, who can stride effortlessly for hours barefoot or in lightweight sandals. The scientific merits of this book have been debated, but it has nonetheless developed a following which has been described as cultlike or having a religious fervor [2]. It is telling that such disagreement exists in the field of human footcare, despite the financial and academic advantages, as well as direct feedback from the subject: the person wearing the

shoes or going barefoot. In light of the limited resources available to the equine practitioner, both farrier and veterinarian, an investigation of the human literature might provide a useful perspective on the equine barefoot debate and help in the decision-making processes of veterinarians and farriers.

Are there morphologic differences between shod and unshod feet? A comparison of hoof morphology between feral and domestic horses is an important topic of study. Selective breeding has, to some extent, changed the shape and structure of the horse, foot shape being one of the differences seen among different horse breeds. But might our hoofcare practices also change foot shape and structure? In its earliest form, human footwear consisted of biodegradable materials such as plant fibers, bark, and animal hides [3]. But it is thought that even these minimalist types of footwear changed the function of the foot, as the smaller toes would not dig into the ground during locomotion. This effect is thought to have led to a morphologic change in humans wearing shoes, as the metatarsal bones of the smaller digits were less robust compared with the corresponding bones of barefoot humans [4]. The larger issue, however, is establishing causation between this change in foot morphology and the likelihood of injury. This link has not been firmly established in either equine or human research.

What is the potential for elite performance without shoes? Not every owner requires athletic performance of their horse. It might even be argued that elite athletic performance is not in the best interest of the horse. Nevertheless, it is worth examining the question of whether shoes help or hinder elite athletic performance. The barefoot model has

been promoted by some as offering a biomechanical advantage over the shod hoof, both in terms of hoof function and for comfort and soundness [1,5,6]. If these assertions are to be believed, then the barefoot horse might be expected to outperform its shod competitors. That has not proven to be the case in the equestrian disciplines at the Olympic Games. While there is no official record of the footwear worn by horses competing in the Olympic Games, there appear to be no accounts of barefoot horses winning medals in any equestrian events. It is possible that some barefoot medalists have been overlooked. Even so, it would have to be considered exceptional for a barefoot horse to succeed at the highest levels of athletic competition. There are several accounts of endurance horses training without shoes; however, many of these horses are shod prior to some of the more difficult events such as the Olympic Games. When it comes to human athletes, there are several reports that document potential advantages to performing barefoot. Oxygen consumption has been measured to be 2% lower in barefoot runners than in runners wearing shoes [7], which may translate into ability to perform for longer before tiring. Also, individual impact patterns are more varied in barefoot runners, with lower impact force and the potential for decreased risk of injury, particularly among runners with a mid-foot, lateral foot strike [8]. In addition, human runners take a longer stride when shod than when barefoot, and they are more inclined to land heel-first when wearing shoes [9], which may increase the ground impact force. However, the potential for increased levels of performance is not supported by track records. Since 1960, only two runners have won Olympic medals barefoot. In 1960, Ethiopian marathon runner Abebe Bikila established a world-record time in winning the gold medal barefoot, and South African/Briton Zola Budd also won medals competing barefoot. Interestingly, both

athletes later turned to competing with shoes. Bikila competed in the 1964 Olympic Games wearing shoes and set a new world record when he won his second gold medal. Zola Budd, who trained and competed both in shoes and barefoot during her career, now states: I no longer run barefoot. As I got older I had injuries to my hamstring. I found that wearing shoes gives me more support and protection from injuries [10].

Is there sufficient information to justify the choice of barefoot over shoes? In the equine hoofcare field, the anecdotal evidence far outweighs the scientific data, and the anecdotal evidence could support either stance on the issue. Horses certainly evolved over thousands of years without orthotics; however, foot problems appear to have been present even before horses were domesticated. A study of fossilized equine remains suggests the presence of navicular disease long before the time of any human involvement with horses. Furthermore, the research indicates that the severity of lesions in the navicular bone were related to the size of the animal [11]. The United States Navy examined this question and concluded that there was some evidence supporting the efficacy and safety of barefoot-style running shoes, such as the Vibram FiveFinger shoes which allow the foot to function naturally without added support or cushioning. (These shoes were originally designed as boat shoes.) The list of pros for the use of minimalist shoes includes stronger feet, reduced impact force, heightened proprioception, and improved balance. The list of cons includes less overall support and protection for the foot, and the need for a transition period. Minimalist shoes are not recommended for those successfully using foot orthotics or for those with pre-existing foot problems. Ultimately, the Navy concluded that there is insufficient evidence to either support or refute the efficacy and safety of the barefoot-style

running shoes for military personnel.

Conclusions With all of the resources available in the field of human footwear research, there is no consensus as to what constitutes ideal footwear. Although there are many advocates of barefoot running, the use of minimalist-style running shoes is more common. Orthotics that provide selected characteristics such as protection while minimally changing the barefoot stride characteristics are now available from several different shoe companies. While many advocates of leaving horses barefoot are opposed to the use of any orthotics, in recent years there has been an increase in the use and availability of many nontraditional orthotics for horses, including various styles of hoof boot, molded urethanes, glue-on shoes, and hoof casts. Although the use of any of orthotic is, strictly speaking, not barefoot, it does represent an interesting middle ground. Future studies that investigate the effects of these orthotic devices on foot morphology, function, and athletic performance might lead to the development of new products designed to provide the horse with the mechanical necessities while limiting undesirable effects of hoof orthotics. So, where does all this science and anecdote leave the practitioner considering whether to ditch the shoes? The evidence is not concrete for or against barefoot or shod running, said Allison H. Gruber, a doctoral candidate at the University of Massachusetts. If one is not experiencing any injuries, it is probably best to not change what youre doing.

References [1] King M. Barefoot vs. shod. The Horse Magazine 2008; article: 12778.

[2] Reynolds G. Phys Ed: Is running barefoot better for you? The New York Times 2009; Oct 21. [3] Bedwell SF, Cressman LS. Fort Rock Report: Prehistory and environment of the pluvial Fort Rock lake area of south-central Oregon. Great Basin Anthropological Conference, Selected Papers, Aikens CM (ed), University of Oregon Anthropological Papers 1. Eugene. 1970; pp. 125. [4] Trinkaus E, Hong S. Anatomical evidence for the antiquity of human footwear. Journal of Archaeological Science 2008; 35:19281933. [5] Strasser H. Shoeing: A Necessary Evil? 2nd edn., Sabine Kells, Qualicum Beach. 2000. pp 46 48. [6] Teskey TG. The unfettered foot: a paradigm change for equine podiatry. 2006; http://www.easycareinc.com/TeskeyTrim.pdf [7] Hanson NJ, Berg K, Deka P, et al. Oxygen cost of running barefoot vs. running shod. International Journal of Sports Medicine 2011; 32:401406. [8] Lieberman D, Venkadesan M, Werbel W, et al. Foot strike patterns and collision forces in habitually barefoot versus shod runners. Nature 2010; 463:531535. [9] Wegener C, Hunt AE, Vanwanseele B, et al. Effect of children's shoes on gait: a systematic review and meta-analysis. J Foot Ankle Res 2011; 4:3. [10] Friedman S. After the fall: Zola Budds running story. Runners World 2009; Oct. [11] Thompson ME, McDonald G, stblom LC. Equine navicular syndrome in the fossil record. Hoofcare and Lameness, 76:3440.