Is barefoot best?
Barefoot and minimalist running is growing in popularity across the world, with Americans spending $59 million on minimalist running shoes last year alone! It has been hailed as the natural way to run and as a saviour to those plagued by running injuries. However, Doctors and new research agree that running without traditional running shoes may actually increase the risk of foot injuries.
A study published in last month’s Medicine and Science in Sports and Exercise looked at foot bone marrow edema after a 10 week period of running in Vibram Five Finger minimalist shoes. Twenty-six experienced runners were split into control and test groups, underwent an MRI scan and were instructed to continue running as normal. The test group were instructed to gradually transition to the minimalist shoes.
After the 10 week period, both groups were scanned again. The results indicated that of the 19 in the test group, the majority had developed at least grade 2 bone edema which indicates early bone injury. Three individuals had level 3 edema which the authors state to be ‘an actual injury’ and 2 runners had grade 4 edema – indicative of a stress fracture. Virtually all in this group had also spontaneously reduced their running loads, according to author Dr Ridge, “probably because their feet hurt”.
Running barefoot (or in minimalist shoes) has been shown to reduce the body weight impacted on the heel by up to 3 times the person’s weight. This and the change in biomechanics brought on by a mid or forefoot strike can contribute to a reduction in shin splints, tibial stress fractures and knee pain to name just a few.
However, the reduction in heel strike must increase the weight distribution anteriorly, which clearly increases in the bones of the forefoot. Barefoot runners could therefore expect higher rates of metatarsal stress fractures, calcaneal stress fractures and achilles tendonitis.
Whilst running barefoot was the way of our ancestors who ran to survive when hunting (and being hunted!) we should not compare our modern lifestyles to those of cavemen and tribes hundreds and thousands of years ago, or even those in the present day.
For a start, most of us pound the pavement, or at best tarmac for the majority of our runs. Cavemen and tribes certainly don’t (didn’t) do this! They would be (or would have been) running on softer, more forgiving grass and earth which allows far more shock absorption and less bone stress.
Secondly, they are more active populations who use their bodies as intended! For those with desk and driving based jobs especially, who spend large portions of their days in one position, muscle imbalances tend to develop. Weaknesses in some muscle groups and reduced flexibility in others results in altered movement patterns and increased stresses on joints and tendons etc. This leaves us more prone to injuries when we start to perform repetitive movements like running. For this reason, I don’t think we should be placing all the blame for running injuries at the door of footwear manufacturers and citing cavemen as reasons to run barefoot! There are plenty of other culprits out there!
The authors of this study state that:
“Runners interested in transitioning to minimalist running shoes, such as Vibram FiveFingers should transition very slowly and gradually in order to avoid potential stress injury in the foot.”
Substituting a mere mile per week of normal running at the start with one in minimal shoes “was probably too much,” Dr Ridge says.  Running in this way may have been normal for our ancestors, but it is entirely new for most of our feet and requires a lot of adaptation and development of intrinsic foot strength.
There are also certain individuals who are advised not to transition to barefoot or minimalist shoes at all. Those with poor foot structure or clear biomechanical problems may not be suited to the stresses involved and so should stick to their running shoes. Dr Ridge is now looking in more detail at the runners who participated in her study, to determine if mileage, running form or body weight have more of an impact. The results of this are expected in the summer.