Barefoot and Minimalist Running: What Do We Know?
Barefoot running and running in minimalist shoes have received much attention in the scientific literature and media over the past few years. However, only 25%-30% of runners have reported using minimalist footwear on a regular basis 1, 2, and only 2% run barefoot on a regular basis 1. In fact, only 20% have reported trying to run barefoot 2.
Advocates of barefoot/minimalist-shoe running suggest that changes in mechanics, foot strength, and impact have a direct relationship to injury reduction. A March 2014 article in the British Journal of Sports Medicine 3 reviews current research regarding barefoot running, and concludes that running injuries are the result of many factors, and running without your shoes is least likely to be the mitigating factor.
But research and debate on barefoot and minimalist running are likely to continue, in light of various reported benefits.
The most common justifications for barefoot running are:
Are these claims supported by evidence?
Let’s explore each one:
While it is likely that humans’ gait mechanics have evolved over eons, the evidence of the relationship between shoes and these changes is lacking. Shoes have been worn for thousands of years. More recently, the running boom of the 1970s resulted in distinct changes in shoes. Interestingly, since the change in shoe construction has changed dramatically over the past 40 years, the rate of injuries among runners has not. It would seem possible that this is due to 2 potential reasons 3:
These facts should not lead one to believe that no shoes are the answer.
The theory for how barefoot running will prevent injury are based on 2 primary findings:
Both of the above claims presume changes in mechanics occur with barefoot running, that running without shoes should result in a midfoot or forefoot strike pattern, rather than a heel strike gait. However, only 40%-50% of individuals who run barefoot adopt a midfoot or forefoot strike pattern.
Impact has been associated with stress related injuries to the tibia. By changing the strike pattern, the impact is potentially removed from the lower leg, but those impact forces are likely moved to the foot as a result. In fact, foot stress fractures have been related to increased loads.
While midfoot or forefoot striking reduces the impact forces at the knee, it concurrently increases the demand on the ankle muscles. If the logic is that reducing load in 1 structure will decrease injury, then increasing load in another structure should increase risk of injury. It is yet to be determined if either of these is true.
This appears to be a classic case of backwards logic. Runners adopt more of a midfoot strike pattern as they run faster. In fact, 73% of competitive runners in the 800 m and 1500 m events have a midfoot or forefoot strike pattern 11. However, during a marathon or half marathon, 88.9% of runners are rearfoot strikers 12.
It is often suggested that midfoot or forefoot striking is more economical (uses less energy) so therefore, you can run farther and faster. However, research suggests that forefoot runners and heel-strike runners demonstrate the same running economy at various speeds 13. So, faster runners are more likely to adopt a midfoot or forefoot pattern, but adopting a midfoot or forefoot pattern does not necessarily make you faster.
Evidence suggests that short foot exercises do increase the size of the foot intrinsic muscles; however, there is no evidence to suggest that barefoot walking or running has the same effect. There is little rationale given as to the reason for the foot strengthening 14.
It is also important to remember that there are muscles originating outside the foot (extrinsic muscles) that play a significant role in foot and ankle control during running and walking. These muscle are longer and have greater force-producing capabilities than the muscles originating inside the foot. Finally, recent findings suggest little change in foot intrinsic muscle activity after running (with or without shoes), and no difference between shoes on and shoes off 10.
Barefoot/minimalist running is a popular topic of discussion that is, in reality, not very prevalent among runners. There is little data to support its use as a training tool or treatment for injury. Continued study on the potential risks and benefits of this technique is necessary to determine its usefulness.
Access our Health Center for Runners for additional resources.
1. Goss DL, Gross MT. Relationships among self-reported shoe type, footstrike pattern, and injury incidence. US Army Med Dep J. 2012;Oct-Dec:25-30. Article Summary on PubMed.
2. Rothschild CE. Primitive running: a survey analysis of runners’ interest, participation, and implementation. J Strength Cond Res. 2012;26(8):2021-2026. Article Summary on PubMed.
3. Tam N, Astephen Wilson JL, Noakes TD, Tucker R. Barefoot running: an evaluation of current hypothesis, future research and clinical applications. Br J Sports Med. 2014;48(5):349-355. Free Article.
4. Trinkaus E, Shang H. Anatomical evidence for the antiquity of human footwear: Tianyuan and Sunghir. J Archaeol Sci. 2008;35(7):1928–1933. Article Summary.
5. Willson JD, Bjorhus JS, Williams DS III, Butler RJ, Porcari JP, Kernozek TW. Short-term changes in running mechanics and foot strike pattern after Introduction to minimalistic footwear. PM R. 2014;6(1):34-43. Article Summary on PubMed.
6. Hatala KG, Dingwall HL, Wunderlich RE, Richmond BG. Variation in foot strike patterns during running among habitually barefoot populations. PLoS One. 2013;8(1):e52548. Free Article.
7. Lieberman DE, Venkadesan M, Werbel WA, et al. Foot strike patterns and collision forces in habitually barefoot versus shod runners. Nature. 2010;463(7280):531-535. Article Summary on PubMed.
8. Dixon SJ, Creaby MW, Allsopp AJ. Comparison of static and dynamic biomechanical measures in military recruits with and without a history of third metatarsal stress fracture. Clin Biomech (Bristol, Avon). 2006;21(4):412-419. Article Summary on PubMed.
9. Ridge ST, Johnson AW, Mitchell UH, et al. Foot bone marrow edema after a 10-wk transition to minimalist running shoes. Med Sci Sports Exerc. 2013;45(7):1363-1368. Article Summary on PubMed.
10. Williams DS III, Green DH, Wurzinger B. Changes in lower extremity movement and power absorption during forefoot striking and barefoot running. Int J Sports Phys Ther. 2012;7(5):525-532. Free Article.
11. Hayes P, Caplan N. Foot strike patterns and ground contact times during high-calibre middle-distance races. J Sports Sci. 2012;30(12):1275-1283. Article Summary on PubMed.
March Madness is one week away. This month we thought we would highlight a common injury from our favorite basketball tournament of the year, ankle sprains. On a given day, more than 25,000 people will sprain their ankle. It can happen when you land the wrong way while you’re playing sports or participating in other physical activities, or even when you step on an uneven surface while walking. It can happen to athletes, non-athletes, children, and adults.
What Is Ankle Sprain?
Sprains are injuries to ligaments, the “bands” that hold joints together. Ankle sprains occur when the foot twists or turns beyond its normal range of movement, causing the ligaments to stretch beyond their normal length. If the force is too strong, the ligaments may tear.
An ankle sprain can range from mild to severe, depending on how badly the ligament is damaged or how many ligaments are injured. An ankle sprain is given a grade from 1 to 3 depending on the amount of ligament damage. A grade 1 sprain is mild, grade 2 is moderate, and grade 3 is severe.
Ankle sprains also are classified as acute, chronic, or recurrent:
With most sprains, you feel pain right away at the site of the ligament tear. Often the ankle starts to swell immediately and may bruise. The ankle area usually is tender to the touch and, when you move the ankle, it hurts.
In more severe sprains, you may hear or feel something tear, along with a “pop” or “snap.” You probably have extreme pain at first and are not able to walk or even put weight on your foot. Usually, the more pain and swelling you have, the more severe your ankle sprain is, and the longer it will take to heal.
How Is It Diagnosed?
At Advanced Motion Physical Therapy a physical therapist will perform a full evaluation. Manual tests are used to determine how unstable your ankle is. The therapist also will decide whether further tests are required or whether consultation with another health care provider is necessary. In some cases, x-rays might be needed to determine whether there is a broken bone. Occasionally, with severe sprains, magnetic resonance imaging (MRI) might be ordered to determine the extent of the damage.
How Can a Physical Therapist Help?
The First 24 to 48 Hours
For the first 24 to 48 hours after injury, ankle sprains usually are treated by resting the ankle on a pillow or stool, using elastic bandages or supports, and 10-minute ice treatments. A physical therapist can decide if you should use crutches or a cane to protect your ankle while it is healing.
As You Start to Recover
Your physical therapist’s overall goal is to return you to the roles you perform in the home, at work, and in the community. Without proper rehabilitation, serious problems—such as decreased movement, chronic pain, swelling, and joint instability—could arise, severely limiting your ability to do your usual activities.
Your physical therapist will select from treatments including:
Range-of-motion exercises. Swelling and pain can result in limited mobility of the ankle. A physical therapist teaches you how to do safe and effective exercises to restore full movement to your ankle.
Muscle-strengthening exercises. Ankle muscle weakness may cause long-term instability of the ankle and new ankle injuries. Your physical therapist can determine which strengthening exercises are right for you based on the severity of your injury and where you are in your recovery.
Body awareness and balance training. Specialized training exercises help your muscles “learn” to respond to changes in your environment, such as uneven or unstable surfaces. When you are able to put full weight on your foot without pain, your physical therapist may prescribe these exercises to help you return to your normal activities.
Activity-specific training. Depending on the requirements of your job or the type of sports you play, you might need additional rehabilitation that is tailored for your job or sport and the demands that it places on your ankle. Your physical therapist can develop a program that takes all of these demands—as well as your specific injury—into account.
Can this Injury or Condition be Prevented?
If you have sprained your ankle more than once in your life, you might be at risk for re-injury in the future if the ligaments did not heal properly or if your ankle never returned to its normal strength. And, if you returned to sports or activities too soon after injury, your ankle might give you persistent pain or might easily or frequently sprain. A physical therapist can help you resolve these problems.
At Advanced Motion Physical Therapy we can help you get back to life and work quicker than ever.
Current research shows that: ten days after injury, patients in an early ankle mobilization group (physical therapy) were more likely to be back to work and had less pain 3 weeks after the injury.
Icing started within 36 hours of injury reached full activity in 13.2 days as compared with an average 30.4 days for those initiating ice more than 36 hours after injury.
If you or anyone you know is experiencing ankle pain or recurrent sprains, come in and see us at Advanced Motion Physical Therapy. We can help you regain your mobility and your life.
Remember this information is not meant to take place of medical treatment. Consult your doctor or physical therapist if needed.
Have a great March Madness and tell your friends to “like” us on Facebook to receive healthy tips through the year.
Lance Dougher DPT, MTC