Considerations on Barefoot Running and Injuries

August 3rd, 2010

Recently, I have been asked many times by my patients in clinical practice what my recommendations and thoughts are regarding barefoot running.  I have seen running injuries associated with barefoot running, but there is a complexity and individuality to each and every specific injury.  I hope to share some insights as a runner and as a clinician.  The book, Born to Run, which I am currently reading, by Chris McDougall, has recently popularized barefoot running in the U.S.  The book is about a tribe of runners in Mexico, who run for extremely long distances efficiently without shoes, barefoot.  In the book, McDougall interviews many prominent researchers analyzing gait with shoes (shod) and barefoot.

 In the past few years, I have witnessed more people running races without shoes and it’s always a curious observation for me.  I tend to stop what I am doing to analyze their stride, gait pattern and foot structure.  I can’t help it, I am fascinated by human locomotion and biomechanics.

I recall the days running cross country as an adolescent.  I recall my first pair of “real” running shoes; they were the blue and yellow Nike Waffle Trainers that were produced in the 1970’s.  In my college years, our coach had us running on the local golf course by special permission and track workouts while barefoot.  For me, there has always been something deeply satisfying about running fast on sand or grass. It just feels really good…did you know there are as many sensory-touch receptors in your feet as in your hands and lips?

 My high school and college coaches were always careful to protect our feet.  We did a lot of our speed work in minimal footwear and barefoot to work on our running form.  College Coach Red was a big promoter of barefoot and running drills back then, and those were the days when we were running 90 miles a week.  I was fortunate to learn how to run with minimal shoes.  I learned proper gait with mechanics with forefoot strike and a lighter gait.  Red advocated wearing our bulkier training shoes with our longer runs and for our quicker speed work, we ran barefoot or with spikes.

Some of the minimal shoes that are available today for protection with barefoot running are the Vibram Five Toes Web Shoes below and the Nike Free’s.  (I personally wear the Nike Free’s to strengthen my foot during the day when I am working in the clinic, but I do not wear these when I am running on hard surfaces or for longer runs.  I have gone through 4 pairs and love them!

 

Some Facts on Barefoot Running:  

  1. It does change gait.  Take a look at these videos to educate yourself on the differences with and without shoes. 
  2. The main difference is that usually no heel strike occurs with barefoot running.  Barefoot runners have lower passive peak in vertical torque.  With running shoes on,  there is more heel strike causing more shock, load to the knee, especially if the stride is longer, causing a stop or “braking” on heel strike.
  3. It is important to keep in mind that there are no randomized prospective studies providing evidence of increased injury rates in running shoes versus barefoot.  This is still to be determined.  Any claims that barefoot running will help prevent injuries is just not accurate.     
  4. Many runners do tend to over stride with shoes on.  It is noted that a shorter stride and a quicker turnover occurs with barefoot running. Coaches recommend stride cadence (foot turnover) to be 170 to 180 per minute for efficient running– elite runners demonstrate this.

My Top Ten Recommendations for Barefoot Running: 

  1. Do not assume that barefoot running will solve your lower extremity injuries.  Be mindful of the increase load in the achilles tendon, calf muscles and plantar fascia regions.  If you have experienced these types of injuries in the past, it is important for you to strengthen these areas.  Ease into barefoot running extremely carefully.
  2. Be careful with any history of foot pain or major foot deformities.  Barefoot running increases the load on the lower posterior calf muscles, tendons, and forefoot.  Be mindful if you have a very flexible forefoot, this is for people who have splayed feet, capsulitis, excessive flat feet (hyperflexible or hyperpronation). 
  3. Do not assume that barefoot running is the miracle cure for your running.  Be mindful; start slow, with the recommended 1-minute intervals, do not increase this more than 10 percent a week.
  4. Consider using barefoot running as a tool to improve your running gait if you are blessed with good structure.
  5. Keep shoes on with hot weather and in possible areas where there can be dangerous rocks, glass, or nails.  Protect your feet with any hard asphalt and potential areas of uneven, unpredictable debris such as rocks, glass, nails or shards. 
  6. People who have aberrant motion (poor stability) and are prone to over supinate or excessively overpronate should be extremely careful. 
  7. Keep in mind that not everyone is built to run efficiently.  There are different body types and heavier runners may be biomechanically disadvantaged with valgus alignment (knocked knees) or varus alignment (bowlegged).
  8.  I do like the idea of having my patients and clients ease into a more flexible shoe and very cautiously with the barefoot drills (only if they do not have foot deformities and “broken down” feet).  As with most indulgent pleasures, everything in moderation!  It is wise not to get overzealous.  My advice if you are over 40 years old like me and you have some instability and/or deconditioned muscles; it would not be advised to attempt too much barefoot running.
  9. Here’s why: As we age, our feet age too.  The human foot has 26 bones, 33 joints, and more than 100 tendons and ligaments.  Unfortunately, as a part of the aging process, our ligaments and tendons become looser and weaker.  The feet become flatter and wider and the ligaments stretch out.  We can develop foot deformities.  Ligaments and joint capsules hold the bones together at the joints. Tendons are the tough fibers that connect muscles to the bones and allow the muscles to work.  They do weaken as we age  and become less resilient.  Looser ligaments and tendons cannot hold bones and joints together in their proper alignment.  Our fat pads also give us less padding and get thinner especially on the heel and at the ball of the foot.  (I was not blessed with good ligamentous integrity; I have splayed toes, a collapsed forefoot, so I need to be very careful of too much barefoot running, but I can do it, and I love it!)
  10. It is recommended you get a good running evaluation with muscle testing to see what areas you need to work on in terms of stability and balance.  This can be addressed through a physical therapist who works with runners and has a good understanding of lower extremity biomechanics. 

 Enjoy your ability to run, be safe and happy trails!

A big thank you to Brian Hoke, PT for providing much clarification regarding lower extremity biomechanics and the current research on barefoot running: Separating Myth from Fact, http://www.theptproject.com/.

 

 

Posted by Tammara Moore, DPT at 1:58 pm: 2 comments

2 responses to “Considerations on Barefoot Running and Injuries”

  1. Larry writes:

    Hey Tammara,

    I’m currently a DPT student at Loma Linda University and I stumbled upon this website on a friend’s facebook. I guess I just want to say that the website is a very clear introduction to the concept of barefoot running and especially the cautions of barefoot running. I did Track and Field in high school and coached some as well and have always ran with the “barefoot running” gait, I just thought that running with a forefoot strike first was always the most efficient way to run. I’m just glad that it’s picking up a lot of momentum here in the states.

    @ August 31st, 2010 at 23:36
  2. Tammara Moore, DPT writes:

    Glad you enjoyed the article, Larry! Best of luck with your studies, and thanks for reading!

    @ September 1st, 2010 at 14:44

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