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Barefoot Running, Minimalist Running Shoes and all that jazz .....

 
 
 
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For some time now we have had many patients asking us about barefoot running.  It has been touted as the ‘natural’ way to run by many proponents that recommend techniques such as Pose Method or ChiRunning.  Shoe manufacturers, keen to cash in on this new fad, have brought out a mind boggling range of so-called ‘minimalist’ footwear and they are still bringing out more!

 

Firstly there is no scientific or industry standard definition for a minimalist shoe.  If you trawl the reviews and forums there is a vast amount of opinion and anecdote about what constitutes a minimalist shoe.  Some suggest they are defined by weight - perhaps under 8oz or by depth of cushioning material.  We come across terms like 'zero drop', "promotes forefoot strike" but is there any scientific evidence that forefoot running is good for us when compared with heel striking?

 

If barefoot running is so good, why do so many of us heel strike even when wearing a so-called minimalist shoe?  Interestingly, of the participants in the men's 10K US Olympic trials finals (all wearing racing flats) the majority of participants ran with a heel strike pattern - these are all elite athletes finishing within 2 minutes of each other (see below) (1).

 
 
 
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There has been some interesting recent simulation data collected by Miller et al (2) that suggests heel-striking is 6.2% more energy efficient than mid-foot strike running at 4.0m/sec (6:42 mile pace).  So why do some people heel strike and some forefoot strike?  A lot has to do with speed.  As a general rule, slow runners heel strike; as we pick up speed we'll mid-foot strike and sprinters tend to forefoot strike.  Most people who run for fitness fall into the slow runner category. Other factors may be at play such as not achieving an ankle dorsiflexion above 10 degrees - naturally if you can't lift your toes up to achieve heel strike you will autoselect a mid-foot strike.  The human body is very efficient and adept at finding its own most efficient way of locomotion, which begs the question ..... should we be teaching our bodies to run in a different way?

 

 
 
 
 
 
 
 

If a person is asked to run up a street barefoot a large number will choose to run on the forefoot - the reason for this is probably to avoid injury.  Not an overuse injury (like the ones we see in our clinic) but to avoid the heavy impact of soft tissues on a potential sharp or hard object.  Running barefoot reduces Ground Reaction Force [GRF] (how hard the foot pushes into the gournd - Newton's 3rd Law).  On heel strike there is increased GRF compared with forefoot strike.  Landing on a sharp object on heel strike would be very painful, there would be less pain on forefoot strike and greater ease of reduction of GRF by flexion of the knee - does this mean forefoot running whilst barefoot is protection against injury?  If shod however we do not need to run on our forefoot, we naturally switch to heel strike. 

 

The bones of our legs are well adapted to absorb GRF and whilst there is less GRF in forefoot running the GRF will be aborbed by soft tissues (tendon, muscle, ligament, periosteum) which is less well adapted to absorb GRF and so possibly more prone to damage.  There is currently no scientific evidence that reduced impact on the heel reduces injury rate.

 

 
 
 
 
 
 
 
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Many barefoot proponents quote Lieberman’s article (3) that suggested there is less impact force during barefoot running but in 2000 in the Journal of Biomechanics (4)  a study found a significant increase in the external loading rate and an increase in leg stiffness, plus a recent US study looked at natural heel strikers and then looked at them shod and in racing flats and then racing spikes  (5,6) – the results showed higher loading and peak vertical impact forces in the flats and spikes (considered to be minimalist by most).   These studies did not look at injury however so we are no closer to understanding if there is a link between impact and injury.

 

One of the biggest problems with the barefoot running versus traditional running shoe debate is the lack of evidence - or worse spurious tests and observations that are then spouted as evidence.  There is a lot of nonsense out there, for example the quoting of Adebe Bikala barefoot win of  the Rome Olympic Marathon ..... wow, sounds great but then the barefoot evangelists fail to mention that he later ran faster and broke a world record in the next Olympics in shoes, and yes ..... he was heel striking!

 

So is there less reported injury in barefoot runners?

Well the simple answer is we don't know.  There hasn't been any research published on this and designing a scientific paper would be almost impossible because of the problem in defining a minimalist shoe in the first place.   We certainly know shoe design does effect foot function (7).  We certainly see injuries from barefoot runners as we do from traditional running shoes but usually they are different injuries.  For example, there are well documented incidence of metatarsal stress fractures after wearing Vibram Five Finger shoes and greater incidence of Dorsal Midfoot Interosseus Compression Syndrome (top of foot pain).  It would seem logical to expect more metatarsal and calf injuries in barefoot running and more shin pathologies in traditional heel strikers.

 
 
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Likelihood of injury more likely lies in a runner's lack of preparedness, poor training and poor running form.  This applies to both barefoot and traditional running shoes.

 

So where does this leave us?  We know for sure that barefoot running does suit some people and there are truths that it can improve foot strength, proprioception and balance but barefoot running certainly is not a panacea that will cure you of your chronic running injuries. If you want to give barefoot a go the best advice we can give is:

 

1.     Work out if you are naturally a forefoot runner or heel striker, then if still wanting to try barefoot technique follow the rules below;

 

2.     Make this change gradually

 

3.     Change your heel height by degrees - don't dare to go zero drop straight away; progress from neutral/transition => minimalist => barefoot

 

4.     Work on your calf, hamstring and achilles tendon stretches because these are the main areas where injury occurs - if possible also work on your hip and core stability

 

5.     Add distance gradually - establish a comfortable distance where you are just beginning to feel sore then increase by 2 minute increments until desired distance is achieved

 

6.     And shoe choice?                    

 

       This is purely subjective - trial and error - find one that suits you and is comfortable.  Comfort is scientifically linked to injury reduction.  Then ideally have two pairs and wear on rotation.  Bear in mind  traditional running shoe can last for up to 500 miles a barefoot shoe probably less due to lower shore value materials (like EVA) and other factors such as running style and body wight will effect durability.

 

FINAL THOUGHT:   If you look back at the photos of the Olympic 10K athletes: firstly and most notably none of them are barefoot and secondly in sptie of being shod in minimalist footwear these top athletes feet did exactly the hell they wanted to!

 

 
 
References:
 
1.     biomechanics.by.u.edu/footstrikesmens10K
2.     Miller RH, Russell EM, Gruber AH, Hamill J, Foot-strike pattern selection to minimize muscle energy.  Running: a computer simulation study.  American Society of Biomechanics
        Annual Conference, State College (PA); 2009
3.     Lieberman DE, Venkadesan M, Werbel W, A et al (2010) Foot strike patterns and collision forces in habitually barefoot versus shod runners.  Nature, 463,531-535
4.     DeWit B, De Clercq D, Aerts P (2000) Biomechanical analysis of the stance phase during barefoot and shot running.  Journal of Biomechanics 33, 369-278
5.    Wiegerinck J, Boyd J, Yoder J, C et al (2009), Differences in plantar loading between training shoes and racing flats at a self selected running speed.  Gait & Posture, 29, 514-519
6.     Logan S, Hunter I, Hopkins J, T et al (2010) GRF differences between running shoes, racing flats and distance spikes in runners.  Journal of Sports Science and Medicine 9, 147-153
7.    Payne C, Zammitt G, Patience D, Predictors of a response to windlass mechanism enhancing running shoes, Dept of Human Biosciences, La Trobe University, Australia
8.    Further acknowledgment to contributors of www.podiatry-arena.com and Ian Griffiths Sports Podiatry
 
 
Leah Claydon
BSc pod, DpodM, MChS
Podiatrist, betterNOW! Healthcare
 
 

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