Barefoot Running - Have Podiatrists Been Giving the Wrong Advice?
Minimalist or Barefoot Running isn’t going anywhere soon. Some people want to feel the earth between their toes.
I’ll lay my cards straight out on the table: in a career of over 20 years in private practice and a sessional clinical facilitator in a university I have prescribed a lot of pairs of custom foot orthotics. I am also a 1/3 owner of an commercial orthotics laboratory.
I believe that I have done a lot of good with orthotics, the majority of the people I treated would tell me that I helped them to recover from an injury that was holding them back. So I wouldn’t change what I’ve done for a moment.
But the question would often come up in different circles about the merits of modern day shoes and inserts and whether they were in some way weakening feet and legs and leading to injury.
Science doesn’t really help us a lot in this area. It is very difficult to run Randomised Controlled Trials on orthotics. Any that have been conducted tend to have huge weaknesses.
So we are guided in clinical situations by our understanding of anatomy and biomechanics, and the experience we have of helping people in the past.
That gnawing question still persists: could some people be better off learning how to run either barefoot or in minimalist shoes that provide protection from sharp objects by don’t cushion or control?
Why Discuss Barefoot Running?
Barefoot running has been in and out of favour over the past 35 years and was a frequent topic in my role ss a podiatrist.
Running with shoes is still a reasonably new idea. Until the 19??s barefoot running was the preferred method for athletes competing from school carnivals to elite competition such as the Olympics
At the 1960 Olympic Games Abebe Bikila won the gold medal in the marathon and set a world record time in the process. A feat that seems impossible in the modern times where the 2 hour mark was beaten with carbon plated shoes and pacing runners.
Still, barefoot running is never going away. People will always seek a simpler, more pure form of exercise, and I think that’s why barefoot running has such a strong pull for people.
The fact that “running naked” means that you aren’t wearing a watch or phone to measure your run, you can tell that we feel very tied to technology, which of course includes running shoes.
In this article I’ll take a look at the arguments for and against barefoot running, and why some shoe companies have strode to embrace it at times, and why others have fought it so hard.
Looking for the right running shoe? Head to our blog post for some guidance here.
Why Do People Run Barefoot?
With all the technological advances in technical running shoes, there are always a percentage of people who want to run barefoot.
Being connected to the earth and being unrestrained seem to be the most common reasons barefoot runners give for enjoying the practice.
The most controversial of reasons is that there are health benefits in running barefoot. Especially that it will reduce impact, strengthen the intrinsic muscles (small muscles contained within the feet), and reduce the risk of injuries.
Controversial because it goes against a lot of the research that had previously been conducted by shoe companies, podiatrists, physiotherapists and other linked professions.
Has the conventional approach been wrong all along?
One of the big issues is that we know big shoe compaines have a lot to lose if more people started running barefoot. When money comes into the health industry, things always get a bit murky.
Conspiracy theories are thick on the ground and many people believe that very large companies (in this case shoe companies) have too mcuh say in our lives and out health.
Evidence FOR Running Barefoot
Two of the governing principles of anatomy and physiology are Wolff’s and Davis’ Laws.
Wolff’s Law states:
“bone will remodel and adapt to the mechanical loads it experiences over time.”
Davis’ Law states:
“soft tissues (like muscles, ligaments, and fascia) will adapt and remodel themselves along the lines of the mechanical stress placed upon them.”
What these laws mean is that as we increase load on soft and boy tissue in the body, it will adapt to accommodate that load. Remember that this will occur in a healthy individual, this is a crucial piece of information that I believe some people overlook.
So in theory, we should be able to build up the strength in the muscles, ligaments, tendons, and bones in the feet, ankles and lower limb in general, by working towards barefoot running.
These laws in themselves support barefoot running in athletes who are healthy and who build up to barefoot running slowly.
Are Othotics a Mistake?
Based on the two laws that mentioned above, you might conclude that by wearing orthotics and supportive shoes is the wrong thing to do for people.
What you’re not taking into account is that most of the people who come through our clinics are broken and in pain. The first thing we need to do is get control of their pain.
This is often best achieved by getting them into some form of support, i.e orthotics, supportive or cushioning footwear, basically whatever way of transferring stress from the injured area and get people active and enjoying life again.
What might be more relevant is, for how long should they wear them? This is something that has been a topic of interest among some podiatrists with some feeling that we should then see patients to help them transition back out of orthotics.
More about this in a moment.
Are you concerned that you may have flat feet? Check out our flat foot guide here.
Evidence AGAINST Running Barefoot
I often think of a lady who returned to my clinic one evening after a couple of years since I prescribed her orthotics and supportive shoes (Brooks Ariel from memory), which had helped her get back to running without pain.
One evening she presented to my clinic and told me she had been at a runners information night where a visiting podiatrist told her she should run in minimalist shoes without orthotics.
Basically just ditch exactly what had been working for her and go into the EXACT OPPOSITE.
So she bought a pair of minimalist shoes and didn’t wear her orthotics.
After a couple of days of exercise she described terrible pain throughout most of her body.
I think we can all see the lesson here.
This was a middle aged woman, who was de-conditioned and not used to running without significant support.
To tell her to go from what I’d prescribed to minimalist shoes is a massive shift that should be done:
- over a lengthy period of time, slowly increasing load on muscles, joints, tendons, and bones to allow them to adapt,
- supervised!
At the time I saw this case as a reason against barefoot running. In reality I think it is reason to use common sense!
It was totally irresponsible to tell someone to go from one version of training to one on the opposite end of the spectrum with no guidance and no follow-up.
A Case Study on Minimalist or Barefoot Running
I often think of a lady who returned to my clinic one evening after a couple of years since I orescribed her orthotics and supportive shoes (Brooks Ariel from memory).
She told me that a few months ago she had been at a runners information night where a visiting podiatrist told her she should run in minimalist shoes without orthotics.
So she bought a pair of minimalist shoes and didn’t wear her orthotics.
After a couple of days of running she described terrible pain throughout most of her body.
She presented back to my clinic with her story and told me that pretty much EVERYTHING HURTS.
I think we can all see the lesson here.
This was a middle aged woman, who was de-conditioned and not used to running without significant support.
To tell her to go from what I’d prescribed to minimalist shoes is a massive shift that should be done:
- over a lengthy period of time, slowly increasing load on muscles, joints, tendons, and bones to allow them to adapt,
- supervised!
At the time I saw this case as a reason against barefoot running. In reality I think it is reason to use common sense!
It was totally irresponsible to tell someone to go from one version of training to one on the opposite end of the spectrum with no guidance and no follow-up.
Scientific Evidence on Barefoot Running
Some of the claimed benefits of running either barefoot or in minimalist shoes is:
- reduced injuries (particularly knees and heels),
- improved performance and efficiency,
- Biomechanical improvements.
Unfortunately the evidence is very mixed.
Some studies showed some increase in injury in minimalist/barefoot running where others showed a decrease.
Some studies showed that there was more efficiency in minimalist/barefoot running.
A well know study from 2014 used MRI results on runners in “Neutral Shoes” and others in Vibram minimalist shoes.
The study showed increased bony oedema in the participants in the minimalist shoes.
Bony Oedema is swelling in the bone and can be a precursor to stress reactions and eventually stress fractures. Basically bones is being damaged faster than the body can restore it.
One of the issues with the above study is that it used a 10 week transition from neutral shoes to Vibram Five Fingers. We now know that the transition should be done more gradually.
You can find a link to the study here.
Another study in 2015 showed greater efficiency and less ground reaction forces when running in minimalist shoes or barefoot compared to running in traditional running shoes. You can find the results of that study here.
A systematic review of the evidence in 2014 found the following:
Conclusion:
Because of lack of high-quality evidence, no definitive conclusions can be drawn regarding specific risks or benefits to running barefoot, shod, or in minimalist shoes.
You can read their findings here.
Another study conducted my an old mate of mine (for transperency), Luke Kelly at The University of Queensland studied how much the arch was collapsing in barefoot and when in shoes.
The results went against the common wisdom and found that the muscles were more active in running shoes! They postulate that the brain and spinal cord are active in firing the intrinsic muscles to step up and work harder when presented with a soft surface (the running shoe).
So where does that leave us? I think it leaves us with a responsibility to be very cautious in this area, seek professional adivce on your individual circumstances, and to go slowly and gradually of you decide to transition to minimalist/barefoot running.
My Thoughts on Barefoot Running
Everyone’s got an opinion right? But I do believe mine comes from a place of significant knowledge and professional experience (not personal barefoot running experience though).
Based on Wolff’s and Davis’ laws, which are very much accepted as known evidence, a person who is healthy should be able to adapt to barefoot running.
You might say, “why would they need to adapt, we ran barefoot as children.” This is true, but then for most of us, once we started school we started wearing shoes for a majority of our weight bearing time. So adaptation is required.
I also believe that it was very irresponsible to tell a middle aged person who has run in trainers and orthotics for years, to suddenly go into a negative drop shoe and don’t wear orthotics.
If you want to run barefoot, and you are well, then I think you should do it!
But it must come with a caveat: DO IT SLOWLY!
If you’re already a runner in trainers then slowly reduce the pitch of your shoes. Do a mix at the start of running in your usual shoes and your lower pitch shoes.
A generally accepted rule of thumb is to go up in increments of 10%. You may not be able to get enough different shoes to increment this slowly so get the advice of a podiatrist who is happy to help you on your endeavour.
If you’re unable to access a podiatrist then follow the 10% rule. First week do 10% of your running in less supportive shoes and slowly work your way towards 100%.
Another important piece of advice is to not expect your progress to be linear. There will be times when your body will let you know that you’re progressing a bit too fast. DO NOT ignore your body. Ease back a little and if you have pain that isn’t purely muscular then stop running and see a professional.
IMPORTANT: I am an Australian podiatrist, but I not YOUR podiatrist. This advice is general in nature and definitely does not replace advice from a health professional.
Final Thoughts on Barefoot Running
I’m sure that barefoot running will continue a cycle of going in and out of favour.
But some people will always feel that pull to get closer to nature and to our ancestral roots.
As long as you work within your personal limits and seek professional advice as needed, best of luck to you.
I know that there will always be a place for orthotics and supportive shoes because a lot of people break down. Whether it’s from arthritis, or obesity or just over training, podiatrists will be required to help you on your way.