Minimalist Shoes And Injuries: Keys To Diagnosis And Patient Education
Footwear News reports that the emergent category of minimalist shoes represents between 10 and 20 percent of the business of runner specialty stores.1 Through July 2011, minimalist shoe sales have already totaled $30 million, up nearly twofold from the year-ago period. What this means to podiatrists is the trend toward minimalist shoe purchases is not a temporary flash in the pan phenomenon but rather a groundswell of change, at least for now.
As a result of this, it is incumbent upon podiatrists to familiarize ourselves with the history, major players and potential injuries associated with running in these types of shoes, and educate our patients accordingly.
History. Nike Free debuted in 2004 and Vibram FiveFingers debuted in 2006. However, it was not until the book Born to Run was published in 2009 that barefoot running took off. According to Footwear News, currently 19 distinct brands in the running shoe category offer minimalist styles.1 In addition to Nike Free and Vibram FiveFingers, other popular brands include Saucony ProGrid Kinvara, Saucony Mirage styles and New Balance’s Minimus line.
Players. In addition to retail stores, running clubs, personal trainers, gyms and even physical therapists are jumping on the bandwagon, touting the benefits of minimalist running. Unfortunately, few of these sources are sufficiently knowledgeable to properly evaluate or definitively recommend this type of running. As a result, more serious injuries are occurring than I have previously seen with traditional running shoes.
Injuries. At least once a week, a runner new to minimalist shoes presents to my sports medicine clinic with an insidious onset (usually three to four weeks) of osseous injury. The most common fractures involve the metatarsal bases (see photo at left) or the calcaneus. More severe than typical overuse stress fractures, these injuries almost always require non-weightbearing immobilization with crutches to heal. In 50 percent of the injuries, radiographic findings are unremarkable and magnetic resonance imaging is required for definitive diagnosis (see photo at right). The problem with these injuries is they start out as an annoyance and slowly build from discomfort to pain without a specific inciting event, causing the runners to continue training in spite of injury.
If you treat runners, it is important to know how to talk to them about minimalist running, especially since patients look to us as the experts.
In regard to the scientific research on barefoot versus shod running, Kevin Kirby, DPM, gave a great lecture on this topic and you can view this in four parts on YouTube with the following links:
1. Beaudry JE. How barefoot is changing retail. Footwear News, Sept. 19, 2011. Available at http://www.wwd.com/footwear-news/retail/how-barefoot-is-changing-retail-... .