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Local doctor advocates minimalist running

By Staff | May 17, 2013

Two River Treads on West German Street, sells running shoes designed to offer the foot less support instead of more. The store, owned by Dr. Mark Cucuzzella, a professor at the West Virginia University School of Medicine, caters to runners embracing a practice called minimalist running

Cucuzzella, a nationally known advocate for minimalist running, opened the store in 2010 when there were very few running stores offering alternatives to traditional running shoes. He has been running since he was a boy. When he was 13, Cucuzzella entered a half-marathon (13.1 miles) and finished in one hour and 23 minutes, running at a pace under six and a half minutes a mile. Once he began high school, he started to run competitively.

“And that was probably the beginning of the running injury trail,” Cucuzzella said. “As soon as I became a runner I stopped doing other things and just started running, and running in one direction and one direction only.”

Still, Cucuzzella ran well enough to earn a scholarship to the University of Virginia, but he had mixed success because injuries kept piling up. At UVA, he met the team physician, Dan Kulund, one of the first running doctors. Kuland experimented with old shoes, and was even molding soles of sneakers using a toaster oven. After spending time with Kuland, Cucuzzella decided to enroll in medical school.

While barefoot running is self-explanatory, in the minimalist running movement, the shoes have little cushion, little-to-no heel-to-toe drop and little-to-no heel support. The shoe is supposed to simulate the feeling of being barefoot. There are also transitional shoes that help the process of going ultra-minimalist. At Two River Treads, they sell three different levels of shoes; transitional, minimal and ultra-minimal, but the goal it to have the foot become as flat to the ground as possible.

The movement became popular after Christopher McDougall’s book, Born to Run, was released in 2009. McDougall followed the Tarahumara Indian tribe in Mexico, where tribe members were known to run barefoot for hundreds of miles without injury. Prior to visiting Mexico, McDougall suffered many running related injuries. He then began to study the Tarahumara’s running style and their ability to avoid injury.

The Tarahumara also ran in sandals, called huaraches, which offered no heel support. After McDougall’s book became a New York Times best seller, the minimalist craze began.

Proponents of minimalist and barefoot running say the practice keeps the foot flat and causes less strain on the lower body. When running in modern running shoes, runners typically land on their heels rather than flat on the entire foot. When this occurs, it exerts a lot of force on joints from the waist down including the hips, knees and ankles.

“In essence what [the foot’s] designed to do is to be a spring,” Cucuzzella said. “When you land your foot is designed to collapse. You have a lot of muscles and tendons in the foot. It’s like you’re loading a spring. So when the foot collapses, which is normal, it will spring back off the ground. Whenever you brace the foot up, i.e. put a shoe on it, you’re restricting those ranges of motion.”

Two River Treads was one of the first running stores to offer minimalist sneakers exclusively. Aside from offering customers all the tools they need to adopt minimalist running, Cucuzzella’s staff is made up of trained individuals, who can help teach injury prevention and running technique as well as field any other questions about the practice.

Cucuzzella is quick to say that people shouldn’t just go out and start running barefoot or with the most minimal style shoe. There is a transition process.

“One problem with the recent trend of barefoot running is that many people do not follow the correct steps and jump right into it,” said Alex Gorenshtein, a podiatrist at Foot and Ankle Care in Martinsburg..

“What happens is the foot knows something is different and doesn’t like it, almost as if it knows the cushion is not there. In return, the foot fills with fluid called marrow edema. While the foot is naturally supposed to have edema in it, too much can cause bruising the pain,” he said.

Earlier this year, a study published by Medicine & Science in Sports & Exercise was done by Dr. Douglas Brown, a radiologist in Utah, and Sarah Ridge, a professor of exercise science at Brigham Young University. In the study, 36 experienced runners underwent MRIs on their feet before and after a 10 week running and training session. About half of the runner stayed with a traditional running shoe, while the other half began to use an ultra-minimal shoe.

After the 10 weeks, the runners’ marrow edema levels were measured on a scale of 0-4. The runners using traditional running shoes averaged an edema level of 1. The majority of the runners in the minimalist shoe group averaged at least level 2. Two runners in the minimalist group even reached level 4, which indicates a stress fracture.

But Cucuzzella disputes the study.

“Any article that you see written about putting on different shoes for ten weeks is ridiculous,” Cucuzzella said. “It’s taken me five years-six years of running in flat shoes, and I’m still learning new stuff. Ten weeks, not even close.”

Martin Gross, a Shepherdstown native, is an example of what can happen if you jump into the minimalist movement to quickly. Gross, an avid marathon runner, read Born to Run, and from there he was convinced.

“I went out and got my leather sandals, which I would never run in, and ran in them instead,” Gross said. “I ran, and I was so surprised. This was the first time I had run in a couple months. I was able to run and not feel any pain in my quads.”

Within the first six months, Gross ran two marathons in minimalist shoes. He got through the first marathon with no problem, but after the second he developed planter fasciitis. That is when he met Cucuzzella at Two River Treads.

“Their suggestion was to lose the shoes and go completely barefoot, start all over again, which is what I did,” Gross said. “I did two things. I lost the shoes and started running totally barefoot and only did quarter-mile jogs the first day. After six months, I got up to 4-6 miles easily barefoot.”

Since Born to Run, many individuals have caught the minimalist bug, like Gross, but it is because of stores like Two River Treads that the movement has grown rapidly.

“When we opened this store, there were only three companies that made minimal shoes,” Cucuzzella said. “Now there are about 60 companies making these shoes. We opened this store before Born to Run, and now it’s crazy.”

In 2012, minimalist style shoes accounted for 10 percent of the $588 million United States running shoe market, according to Scott Jaeger, senior account analyst for the Leisure Trends Group in Boulder, Colo.