Barefoot Running

Answering patients’ questions about this growing trend.

By William Morgan, DC

Until recently, most of us considered athletic shoes an important and essential part of our athletic training gear. This belief has been fortified by the advent of the modern running shoe in the mid-1970s. Every year since the mid-1970s, the big running shoe companies have introduced new product lines based on shoes with increased cushion and support. Meanwhile, the public has been swayed by the marketing of new motioncontrolled shoes with high-tech shock-absorbing materials. But in recent years, there has been an uprising among subgroups of runners, cross-fitness enthusiasts and weight lifters: Less shoe is better, and no shoe is best. Those of us who work with runners and crossfitness enthusiasts have seen that the topic of barefoot running is gaining traction.

The premise behind the return to running barefoot is essentially that the intrinsic muscles, joints, ligaments and mechanoreceptors of the feet require stimulation to function properly.And this optimal function is inhibited by highly supportive and cushioned shoes. Intrinsic foot muscle atrophy and dampened mechanoreceptor activity combine to cause injury and reduced performance. Also, the thickly padded heels of running shoes have produced a world of runners who now strike heavily on their heels, producing a gait that is (reportedly¹) quite different from those who run without shoes.

Whether or not barefoot running is better for humans has yet to be determined scientifi cally, but advocates have made some very compelling arguments in Favor of barefoot running.²As we would expect, many podiatrists who have built their careers on prescribing rigid orthotics are opposed to the notion of running with less support. Can inappropriate shoes injure feet? You bet they can. Bunions, neuromas, plantar fasciitis and stress fractures can be the result of inappropriate shoes.I personally have suffered from a Morton’s neuroma that resulted from a dress shoe with inadequate shoe width.

To be fair, I must state that running barefoot can also produce its share of injuries. Barefoot injuries range from frostbite to tendinitis, metatarsal stress fractures, lacerations, puncture wounds, abrasions and stone bruising. Our ancestors invented shoes for a reason: to protect their feet from hostile environments as they migrated from regions of soft loam to more foreboding terrain.

The fact that the barefoot running craze has spread to shoe manufacturers, who are now ironically making shoes for the barefoot runner, indicates that this trend may be with us for some time to come. These shoe companies are making “minimalist shoes”— shoes that protect the foot from environmental injury but allow for a barefoot training effect. I should note that some of these minimalist shoes remind me of the racing flats that we wore in the early 1970s, in the days before the advent of highly cushioned and supportive running shoe designs. One type of minimalist shoe is the Vibram Five Finger shoe. I own a pair of Vibram Five Finger shoes, and I enjoy running short distances in them. But I should confess that I purchased them from a friend who sold them to me at a great discount after he developed metatarsal stress fractures shortly after he began running in them.

What advice can we share with our patients?
While running barefoot is most certainly what our ancestors did and our aboriginal cousins still do, we currently lack the knowledge to say irrefutably that it is more healthful than running with shoes. Since science has yet to decide this topic, I do not feel comfortable offering advice for or against running barefoot. But for patients insistent on running barefoot, I offer this advice:

Start with walking barefoot or in minimalist shoes, and gradually work into running.
Progress to short runs. Begin running only fi ve minutes per run, and gradually increase—and gradually means gradually!
Rather than going totally barefoot, use a minimalist shoe to protect your feet from thorns, glass, nails, stones and—dare I say—dog defecation.
Stop barefoot running at the earliest sign of pain.
Avoid running barefoot in freezing temperatures. Shoes protect us from frostbite if nothing else.
Be prepared for blisters and calluses to form as you transition to barefoot running.

Regardless of who is right in this dispute, if you switch from shoes to bare feet, you must allow time for your bones and soft tissues to adapt to the new stresses that barefoot running will place on the lower extremities. Achilles’ tendons are particularly susceptible to injury if there is a sudden change in their position of function.Most conventional running shoes place the Achilles’ tendon in a shortened position. So by suddenly switching to barefoot running you will place an unaccustomed strain on the Achilles’ tendon, making it more susceptible to rupture and strain. Use discretion and prudence in transitioning from supportive shoes to barefoot or minimalist shoe wear.

Horse Sense
Most people are surprised to learn that I have a background in horsemanship and was a trained farrier prior to joining the military, and subsequently becoming a chiropractor. We shod horses to protect their feet from the environment and stresses that humans imposed upon them. In the wild, horses would prefer to run on soft loam, but when humans domesticated them we placed them in rocky terrain, on roads, and forced them to work when they would normally allow themselves to rest.Some horses were gifted with amazing feet that never needed to be shod, regardless of the stresses placed on them. Other horses, less gifted, would pull up lame if they were not shod. Still other horses were lame unless we shod them with special corrective shoes. My belief is that we will find that people are much like horses. For the most part, our bare feet would work great if we stayed on soft, loamy soil or a sandy beach. People with the gift of optimal biomechanics will thrive with barefoot running regardless of where they run. But I feel that other people’s foot biomechanics will require shoes to prevent injury, and still others will require additional supportive or corrective shoes to function near normally. As further research uncovers the effects of shoes on our feet, I am sure that alterations and modifi cations in shoe design will continue. For now, I will continue to put on most of my running mileage in shoes, while running a mile here and there in my five-finger shoes to give my intrinsic foot muscles a workout.

References:

1. Lieberman DE, Venkadesan M, Werbel WA, Daoud AI, D’Andrea S, Davis IS, Mang’eni RO, Pitsiladis Y. (2010) Foot strike patterns and collision forces in habitually barefoot versus shod runners.Nature 463: 531-5.

2. Related Videos: http://www.youtube.com/watch?v=7jrnj-7YKZE

http://www.barefootrunning.fas.harvard.edu