Saturday, December 25, 2010

Vibrams Five Fingers Bikila

I usually buy new running shoes ever year or two. This time, I decided to try something different. A few weeks ago I bought a pair of Vibrams Five Fingers Bikila. What the heck are those? Shoes, socks, or something else? I guess 'something else' is most appropriate.

I have had a long and disappointing history with running shoes. You see, I have a normal but lowish arch in my left foot and a flat right foot. My legs also curve outwards from my knee before coming down to my feet - the term for this is 'bow-shaped'. My feet are also relatively big and wide. Put together, I don't have the ideal build for running. Yet, I do it anyways because I enjoy it. Despite my awkward build, I slowly clawed my way to the finish in the 2004 Boston Marathon, one of my proudest accomplishments.

In the last few years I have mostly bought Brooks Stability and Asics Motion Control shoes. These shoes, especially the latter one, are built for people like me who 'over-pronate'. The feet of over-pronators bend inwards at the moment the foot strikes the ground because the runner lacks an arch to counter-balance inward movement foot. This results in excessive pressure on the knee and meniscus. As a result of this pressure, I have torn the meniscus in each of my knees (although only the right foot is flat). This injury takes a long time to heal. A few years ago I started wearing Superfeet orthotics in my shoes to provide additional arch support.

While the orthotics and shoes have reduced pressure on my knees, they have taken the fun out of running. The arch support can be especially uncomfortable and can pinch my feet where I'm lacking an arch. So, after going on a run with a classmate who was wearing the Vibrams shoe, I decided to get a pair for myself.

Vibrams has historically made the soles of shoes. For example, my Merrill hiking shoes have soles made by Vibrams. In the last few years, they have ventured into shoes. Vibrams Five Fingers are meant to simulate barefoot running, the act of running without shoes. Proponents of barefoot running believe that humans were built to run and are quite capable of running without shoes. This is essentially the premise of Born to Run a book (which I hope to read) about the barefoot running habits of humans. However, years of wearing shoes have weakened numerous muscles that are no longer needed when shoes do the work. One example of a weakened muscle is the Achilles tendon, which grows shorter when people wear shoes with heels. Shoes have also changed the biomechanic motion of running. Because shoes contain significant shock absorbing material in the heel, runners can land on their heels (a heel strike) and take long strides without pain. However, this is not the correct /natural motion for running. Rather, the barefoot method of running involves striking in the midfoot and taking shorter strides.

The Bikila, which costs about $100, is the running model of the Vibrams Five Fingers. The shoes features five slots for the five toes, a strap for holding the shoe on, and light tread on the soles of the shoe. There is no lift in the heel. All of this means that running in the Bikila is pretty darn close to running barefoot.

City Sports in Philadelphia, where I bought my shoes, is a big believer in Vibrams and has figured the shoes prominently in the center of their shoe section. Traditional shoe manufacturers have taken notice as well - Nike, Adidas, and others have started making their own minimalist shoes. Vibrams has the potential to really shake up the shoe industry. As shoe technology gets more complex (Nike Air Max, Reebok air pump, Speva Asics sole, etc.), Vibrams says simple is better. I do believe that the barefoot running movement is symptomatic of the minimalist trend that is taking place in the world: 'raw' or 'organic' diets, increased privacy in computer software, etc. The minimalist movement says that we should get back to basics.

I have now run 6 times in my Vibrams: 2 miles on the treadmill, 3 miles on the treadmill, 7 miles outside on the Schuylkill river path, 3.2 miles on the Schuylkill path, 3.4 miles around my house, and 3.4 miles around my house. Here are my experiences so far:

  • Socks are needed. When I ran without socks, I got some chafing above my right heel and on the side of my foot just below my big toe. So I bought socks with toe holes and the chafing doesn't happen. The Bikilas are also a little hot so I like the thin socks/liners unless I'm running in the cold.

  • The shoes work a lot of muscles that I don't typically use, so there has been a significant adjustment period. I have had soreness in my Achilles tendon, lower calf, and in my right calcaneofibular ligament, which goes from the ankle to the outside of the foot. Because there is no arch support in the Bikilas, my foot does move inward, which is putting pressure on this ligament in my right foot. Hopefully all of this soreness goes away as the muscles get stronger.

  • I have had some arch pain in my right foot. This will need to be monitored.

  • I may have slightly injured my left knee. A few sessions ago, I tried to run fast and probably the landed the wrong way on one of my strides, causing shock to my left knee. Hopefully it's not a big deal and will heal with time. I'm continuing to carefully run though as there is no shooting pain.

  • So far I haven't had any issues with running over rocks. The soles dull the impact of most stones - I can still feel them but generally don't get any sharp pain.

  • I felt self-conscious wearing these odd-looking shoes the first few times, but not anymore.

  • My running form seems to be changing. I'm consciously avoiding the heel strike and am trying to take smaller slides, while lifting my knees.

  • Most importantly, it's a lot of fun to run in these shoes. I get valuable 'ground feedback' with these shoes. It's especially fun to run on soft surfaces like grass or mud. I am also able to run faster since my arches have an opportunity to expand and contract, giving me a bounce in my step. Also, I am able to push off my toes, something I can't do in regular shoes.

  • I've had a positive-enough experience with the shoes to want to get another pair of Vibrams. I have my eye on the black Trek-Sport model, which I can use for hiking.

So there you have it. I really like the Vibrams Bikilas. To be fair, I have had some issues, particularly the knee injury and soreness in my right foot. However, the best thing about the shoes is knowing that they haven't caused the injuries, so you can't blame them. If things heal up properly, I'd like to do a 10 mile run in the Bikilas when I get back to Philly. I think I'm only going to attempt this in 30+ weather, though.

Thursday, December 2, 2010

HCMG 890

I can safely conclude that HCMG 890 - a.k.a. Medical Device Seminar, is my favorite class of my first semester at Wharton. The picture to the left illustrates a transcatheter aortic valve replacement procedure. The Transcatheter Valve is possibly the most cutting edge piece of technology in interventional cardiology.

HCMG 890 meets once a week on Wednesday from 4:30pm - 7:30pm. During this time, we hear from various industry speakers on various medical device topics. The class has a good mix of science and business - in the end I am always more excited when the primary discussion is science, with some business mixed in.

The best thing about the class is the opportunity to have dinner with the speakers. So far, we have had entrepreneurs, venture capitalists, Medtronic VPs, medical device sales managers, medical device lobbying groups, etc. At these dinners, food, drink, conversation, and money flows freely. This class might be the best kept academic secret at Wharton.

There is an interesting conflict in the perception of medical devices. On the one hand, these devices are exceedingly simple - what are clips, stents, and catheters but clips, barbed wire, and tubes? Yet they cost tremendous sums of money, which insurance companies pay. Ultimately, slight differences in the geometries and materials of these products can have slight differences in clinical effectiveness. But this industry persists on slight differences. Because, in the end, how much would you pay to mitigate adverse reactions (like death) by 3%, or to increase blood flow by 2%? Apparently you would pay a lot (but that number is probably coming down).

Until we can elegantly solve these problems before they start using gene therapy, we'll have a need for devices.

If these devices excite you, check out some of the clips below. If they don't excite you, check out these clips anyway, and you might get excited:

Mitral Clip:

Transcatheter aortic valve replacement:

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