Barefoot Running - Fad or Your Ticket to Injury-Free Running?

Introduction

Barefoot or minimalist running has become somewhat of a “buzz” topic within the running community in recent years claiming to miraculously cure an array of overuse injuries that are attributed to poor running biomechanics. While there may be some truth to the concept and in theory, running barefoot or in a minimalist shoe makes sense for injury prevention, there are also disadvantages and several reasons that an individual may consider sticking with a traditional shoe instead. Moreover, there is a proper way to transition into running in a minimalist shoe that is imperative to follow, lest you be vulnerable to injury. To illustrate this, let’s take a dive into the history of the barefoot running concept and discuss what a minimalist shoe is as well as discuss the advantages and disadvantages of using one and tips for beginners. In addition, I’d like to offer my personal anecdote on barefoot running to assist you in making the decision for yourself.

History of Barefoot Running

Humans have been running barefoot or in minimalist footwear since the invention of the foot. Indeed, there are still tribes today running barefoot or in minimalist “shoes” (I use that word lightly), most notably in Kenya and the Tarahumara of Mexico. The rest of the world took a different path, so to speak. The first running shoe was introduced in approximately 1865 and were essentially a men’s dress shoe with spikes on the bottom. Since then, running shoes have evolved and have consistently added more padding to the bottom of the shoe.

While there were well known runners practicing barefoot running historically, the concept was most significantly introduced into the running world in 1960. The moment came when a previously unknown African runner by the name of Abebe Bikila from Ethiopia seized the gold medal at the Rome Olympic Marathon in an impressive 2:15:16.2 wearing on his feet, you guessed it, absolutely nothing at all. Following his victory, Abebe continued to win races running barefoot alongside a number of other prominent elite runners doing the same. However, it wasn’t until Christopher McDougall’s “Born to Run” was released in 2009 that barefoot running became more of a mainstream practice.

“Born to Run” asserted that the direct cause of running related injuries was due to the modern running shoe and that humans were designed to run barefoot. The book follows the Tarahumara and their unheard-of ability to regularly run ultramarathons (any distance greater than a marathon) in nothing more than homemade huaraches. Not only are the Tarahumara running obscene distances in thin sandals, but they’re doing it repeatedly and regularly without injury. Having read the book, the arguments are certainly convincing, and the world seemed to think so as well! After “Born to Run”, there was a substantial increase in the number of people running sans footwear or in a minimalist shoe as well as companies specifically touting a minimalist shoe design. Big players have also become involved with companies such as Nike, Adidas and Asics (among others) releasing their own version of a minimalist shoe.

So, what’s all the hype about?

Improved Foot and Ankle Strength

Proponents of barefoot running argue that minimalist running dramatically improves foot and ankle strength. To the frequent runner, this is an attractive adaptation. In this light, minimalist running presents itself as somewhat of a magical elixir promising that by indulging, your feet and lower limbs will somehow undergo a metamorphosis from flimsy and injury prone to solid steel; I’ll drink to that! But, as always, we must consult the literature. A study conducted by Herje et al (2017)1. The aim of the study was to assess foot structure, foot function, injury and physical activity levels in habitually barefoot Kenyan children and adolescents some of whom run up to 20km per day to and from school. This population was specifically looked at due to their elevated activity levels alongside habitual barefoot practices. What the research alluded to were distinct differences in foot parameters, injury prevention and general foot health when compared to the general population of habitually shod individuals.

This has of course great implications for the general population however, an important point to note is that the participants of this study would have gradually built up to high activity levels while going barefoot. The point being, over the course of several years, the participants feet and lower limbs would have adapted slowly. This is in stark contrast to your running buddy who just came across barefoot running and decided to pick up a pair of minimalist shoes and run a 10k (guilty as charged).

Enhanced Sensory Feedback

Another prominent argument in favor of barefoot or minimalist running is enhanced sensory feedback, which of course conversely implies that wearing shoes diminishes proprioception and sensory feedback. But why is this important? A meta-analysis by Lieberman (2012)2 argues that plantar proprioception is crucial for the central nervous system to make decisions that aim to stabilize our bodies during running and avoid injuries. He hypothesizes that this feedback mechanism is effectively blunted when running in a cushioned shoe and that the absence of such feedback is one of the direct causes of repetitive motion injuries in runners. In theory and from an evolutionary perspective, this makes perfect sense.

Interestingly, plantar proprioception is immediately noticeable in the absence of cushioned shoes while running. I myself have experienced such a phenomenon during my brief experiment with barefoot running (actual barefoot running I might add; straight up barefoot, no socks, running like a madman through my suburban neighborhood). Now the ultimate question is: does having this feedback correlate directly with a reduction in overuse injuries in runners? Unfortunately, the conclusions that can be drawn from the existing data are mixed and further research is needed.

Potential Reduction in Impact Forces

During my anecdote indicated above, not only did I experience an immediate sense of previously absent plantar proprioception, but also an immediate shift in stride length and gait. This was something I found truly fascinating as the shift seemed to come about effortlessly and without thought. Specifically, what was noticed was a shortened stride length and a shift to a forefoot – midfoot strike which is consistent with findings in existing literature.

A study conducted by our dear friend Lieberman (man this guy likes barefoot running) and company (2010)3 sought to determine the striking pattern of habitually barefoot runners versus habitually shod runners and if this had any consequence on impact forces to the bottom of the foot. What was discovered was that indeed, barefoot runners mostly run with a forefoot strike or occasionally a midfoot strike as opposed to shod runners that mostly heal strike. What about impact forces? Intriguingly, kinematic and kinetic analyses demonstrated that even on hard surfaces such as asphalt and pavement, “barefoot runners who forefoot strike generate smaller collision forces than shod rearfoot strikers. The difference results primarily from a more plantarflexed foot at landing and more ankle compliance during impact, decreasing the effective mass of the body that collides with the ground.” Smaller collision forces = less stress on the body = less opportunity for injury.

Not only do barefoot supporters tote this as the holy grail of injury prevention in running, but a significant portion of the general running community would argue that a running pattern of this style is less prone to repetitive strain. Again, the data are mixed here; which brings me to the caveat of barefoot/minimalist running and the argument against frantically attempting to switch up your running style.

Increased Risk of Overuse Injuries

The issue with running au naturale, which is completely counter to the entire purpose of switching to a barefoot or minimalist running style, is that barefoot runners are still getting injured! And, in some cases, getting injured more often. Even Lieberman himself cautioned in his 2012 review that “barefoot running raises more questions about injury than we have answers at the moment… we simply do not yet know if experienced barefoot runners have fewer injuries than habitually shod runners.”

Let’s evaluate some alternative research. Injury rates in barefoot runners were examined prospectively by Altman and Davis (2016)4 with the purpose of comparing incidence and rate of injuries between shod and barefoot runners. Specifically, the number of injured runners, number of injuries per runner and injury rates were compared between the two groups. As you might have guessed, injury rates were not statistically different between groups! Statistical analysis of the types of injuries determined that barefoot runners were experiencing a greater number of calf injuries, but a lower number of knee and hip injuries and reportedly less plantar fasciitis.

Here's the kicker; in the aforementioned study, barefoot runners were putting in 24 km/week (as an average) versus 41 km/week (as an average) for the shod runners. So, what is the implication? Barefoot runners had similar injury rates to shod runners AND were putting in almost less than half the mileage. So much for the holy grail..

There have been additional studies since that I will reference for further reading (Fuller et al. 20175 and Udofa et al. 20196) that continue to mount evidence against the argument for barefoot running.

My Two Cents

Like many, I too drank the barefoot running kool-aid with all its promises of injury free running. My start with barefoot/minimalist running began almost two years ago when I incurred my first real running injury. I suffered from some acute hip injury due to a massive increase in mileage against the advice of my fiancé (fellas, listen to your lady, she knows what she’s talking about) that just never seemed to go away. Rounds of physio, prehab, rehab, ice, rest, rinse and repeat nothing seemed to work. The concept of barefoot running wasn’t new to me, but I had read that running barefoot or in a minimalist shoe altered foot striking patterns and could help reduce load on the hips and knees. So, I gave it a shot. I gave it a REAL shot. As I mentioned above, the shoes were cast aside and so were the socks and I did a pain-free 2km lap around my neighborhood. I WAS CURED.

Of course, you simply can’t “run” around barefoot everywhere so the logical next step was a pair of minimalist shoes. I was pumped and fully ready to go after so much downtime. As you can imagine, I dove right in and began ramping the miles up each week. The only issue was, I had this nagging pain in my right foot that seemed to get worse with each run. Noting of course that there is supposed to be a break-in period for minimalist shoes during which unfamiliar aches and pains can be expected, I brushed it off. Then came race day; a 25k trail run through the snow in the downtown river valley. That race seemed to push it over the edge. Fast forward 5 months later and I am still working towards relieving this particular injury to which both my physio therapist and podiatrist attribute to my experiment with barefoot running and minimalist shoes. Safe to say, the minimalist shoes were promptly donated to the local Goodwill!

All that being said, I am not particularly against barefoot running or minimalist shoes. There is such variety in foot shapes and lower limb structure between individuals that I firmly do not believe there is a one-size fits all approach to running and running shoes. There is nothing wrong with experimenting to find what works for you. I will say, however, the old adage “if its not broken, don’t fix it” is particularly applicable here. If you are not trying to manage an injury and are generally pain free when you run in typical running shoes, why switch? Cause it’s a fad and someone told you that you would be able to run faster and farther in a pair of minimalist shoes? If that were legitimately true, elite runners all over the world would be snatching up minimalist shoes faster than they could be manufactured!

I am obligated to say, if you do attempt the switch to a minimalist shoe, please do so with caution and ramp up your mileage extremely slowly (even if you are running high mileage weeks already). There’s a legitimate chance you’ll be running vastly different in these shoes and your body will not be accustomed to the unfamiliar running pattern. Approach your runs as a new runner would, slow and steady, incremental increases in mileage and you’ll do just fine. Or, maybe this is a concept you should just forget about entirely and continue running in your typical running shoes 🙃.

References:

1. Herje et al. Foot Structure and Function in Habitually Barefoot and Shod Adolescents in Kenya. Current Sports Medicine Reports 16(6):p 448-458, 11/12 2017. | DOI: 10.1249/JSR.0000000000000431.

2. Lieberman, Daniel E.. What We Can Learn About Running from Barefoot Running: An Evolutionary Medical Perspective. Exercise and Sport Sciences Reviews 40(2):p 63-72, April 2012. | DOI: 10.1097/JES.0b013e31824ab210.

3. Lieberman DE, Venkadesan M, Werbel WA, Daoud AI, D'Andrea S, Davis IS, Mang'eni RO, Pitsiladis Y. Foot strike patterns and collision forces in habitually barefoot versus shod runners. Nature. 2010 Jan 28;463(7280):531-5. doi: 10.1038/nature08723. PMID: 20111000.

4. Altman AR, Davis IS. Prospective comparison of running injuries between shod and barefoot runners. Br J Sports Med. 2016 Apr;50(8):476–80. PubMed 2613069.

5. Fuller JT, Thewlis D, Buckley JD, et al. Body Mass and Weekly Training Distance Influence the Pain and Injuries Experienced by Runners Using Minimalist Shoes. Am J Sports Med. 2017 Jan:363546516682497. PubMed 28129518

6. Udofa AB, Clark KP, Ryan LJ, Weyand PG. Running ground reaction forces across footwear conditions are predicted from the motion of two body mass components. J Appl Physiol (1985). 2019 May;126(5):1315–1325. PubMed 30763160