Barefoot and Minimalist Shoe Running

Disclaimer: this is not meant to replace medical advice. Before beginning a running program discuss it with your doctor. When deciding on running shoewear visit your local running store for a gait analysis to provide the best shoe for your running pattern. 

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That’s me in the red shirt, during the 2018 Chicago Marathon.

As of late there has been a surge of people running barefoot or in minimalist shoewear. The argument that I have heard in favor of minimalist/barefoot running is that it most mimics the way we would run if never having invented shoes. As in, the way cavemen or indigenous people would run. There is also an argument that it allows for more forefoot striking (which will be broken down later) which individuals believe is a better form of running. I get questioned often when I am working with patients on if minimalist shoes are better for them, since it is becoming more prevalent in the running world. Especially since the release of the 5 finger minimalist shoes. When I am working with well-practiced runners, most have an opinion on what shoe works best for them, and I am not here to persuade anyone to one side or the other. I’m here today to break down barefoot/minimalist running compared to traditional shod running (traditional running shoe) as it relates to current evidence in the field.

Running patterns

Before discussing the running shoes, I am going to break down the types of running patterns for you, since this will be a topic of discussion. There are 3 different types of striking patterns during running. Striking is referenced as the point in time when the foot contacts the ground. A striking pattern relates to the part of the foot that strikes the ground first.

  1. Forefoot strike: the ball of the foot hits the ground first followed by the foot flattening to the ground, so that the heel comes in contact prior to pushing off the ground.
  2. Midfoot strike: the center portion of the foot hits the ground followed by the heel prior to push off.
  3. Hindfoot (heel) strike: the heel hits the ground first followed by rolling onto the rest of the foot before pushing off your toes. This type is most similar to walking patterns.

In another post I will go over the various types of foot striking in more detail and the evidence behind which is “appropriate”. At this time the focus will be on shoewear.

The Benefits of Minimalist Footwear

When speaking specifically on the benefits of minimalist shoewear, there is little support in evidence over shod running. The one notable benefit is the automatic change in mechanics that is observed when people begin running minimalist. When an individual runs barefoot, they demonstrate increased running cadence (steps per minute), decreased stride length (distance of each step), and a tendency to forefoot strike (LeBlanc and Ferkranus, 2018). All of these changes tend to decrease the force from the ground during foot strike. Whereas running shod may not promote these same running parameters. The force at the moment your foot hits the ground may over time lead to injury due to the high impact that is sustained. Running can be as high as 2-3x your body weight in force with each foot strike. This means if a person weighs 150 pounds, each step they take running would be about 300 pounds of impact. If an average mile is about 2,000 steps that is 300,000 pounds of force through each foot per mile. When you think about it in that way, it’s easy to see how running is much more of a strength and muscle endurance sport than simply cardiovascular. If we are able to decrease the impact at each foot strike, it could potentially decrease the risk for injury over the long run (pun was intentional).

The Risks of Minimalist Footwear

There is a study from 2013 by Ridge et al that looked at an MRI taken before and after a 10 week running program in a group of runners. They were placed in either the shod running or minimalist running group. There was a notable increase in bone marrow edema (bone inflammation) in the minimalist running group in the post-training MRI, indicating that there was a stress reaction occurring. In fact, 10 out of the 19 minimalist group participants had edema that was considered concerning, while only 1 out of 16 shod runners had this outcome. Overall, the shod running group showed no significant changes on their MRI. Where this article lacked is that the minimalist runners in this study were previous shod runners and had no prior experience in minimalist shoes. This is important to note because usually when someone is transitioning into minimalist shoes they are educated on training into them slowly to prevent this type of reaction from occurring. If the authors had used trained minimalist runners and trained shod runners for their two groups, the MRI results may drastically different. This article demonstrates more so the importance of proper training into the minimalist shoes to prevent injury to the bones of the foot versus stating a risk of minimalist running altogether.

When running in minimalist shoes, the runner tends to use a forefoot striking pattern. This type of running pattern places a higher loading force onto the Achilles tendon because it absorbs the forces from the initial impact with the ground. When running with a heel strike pattern, it is the anterior tibialis (muscle on the front of the shin) that is absorbing the forces, as it is with normal walking. Individuals who run with a forefoot strike have a higher likelihood of developing Achilles tendon overuse injuries, as supported in research by Perkins et al (2013) and Bonacci et al (2013).

In one obvious statement of the risks of barefoot running, there is a huge potential of stepping on something that you may not want to be stepping on. When I was running the 2018 Chicago Marathon, a man ran past me barefoot. The only thing I could think was “running barefoot through Chicago seems like a terrible idea”. I saw hypodermic needles, broken glass, pot holes, rocks, and puddles of who knows what all along that course. So if you have a fear of sustaining a flesh injury from running barefoot, but still want the benefits of it, then I would suggest a minimalist shoe in this case.

My Recommendations

I, personally, would not make a recommendation in favor either running style. I usually say “stick to what you know works for you” to individuals who may be asking me if they should switch or not. Although, there are people who just want to try it out to see if it makes a difference for them and I am not against that. The research I have read through  does not tend to lean towards way one or the other, and there are few longevity studies that demonstrate what the difference overtime may be between either running type. If an individual is planning on running barefoot or with minimalist shoes I would absolutely be supportive. There are definite benefits of running minimalist and there is no known difference in terms of actual injury rate between minimalist and shod running at this time (Perkins et al, 2013). I would encourage anyone who is planning on running in a minimalist shoe to begin gradually so as to not lead to a stress reaction in the foot or lead to an Achilles overuse injury. As for me, I am a shod runner in a neutral shoe that naturally runs with a heel strike. It’s just who I am and how I run. This type of running works for me and until an issue arises I do not plan on changing it. Each runner has a different pattern and different needs, so what works for one person may not work for another. If I were to provide any recommendation to the runners that I work with, I would begin with addressing their cadence and stride length and see if that is enough to minimize risk for injury before changing footwear altogether. These topics will be covered at another time, so stay tuned!

 

Comment below if you are a shod, barefoot, or minimalist runner- I would love to hear some personal insight! What are your favorite running shoes?

What else do you all want to know about? Send me any suggestions you have for future topics!

-Katie PT, DPT

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