Should Podiatrists Embrace Barefoot Running?

Hey, Doc, what is your position on barefoot/minimalist running?

Unless you practice under a rock, then it is likely that you have noticed more and more people getting involved in the barefoot running movement. You do not have to be a sports medicine focused podiatrist to have treated patients who have tried minimalist running. Chances are that these particular patients are seeking your medical advice to a treat a foot problem "related" to this method of running. Perhaps you have treated patients who have developed plantar fasciitis, cuts and blisters, or perhaps even stress fractures.

You have likely developed a firm position on barefoot/minimalist running. Otherwise, you may not seem up to date or modern when probed by patients. The American Podiatric Medical Association released a statement on barefoot running in 2009
(https://www.apma.org/MainMenu/News/MediaRoom/PositionStatements/Barefoot-... ).
I am sure patients have even brought these minimalist shoes or "foot gloves" into your office. Do you shrug this off as a fad? Do you discount the running movement and redirect patients back into more conventional running shoes (and maybe an orthotic)? Do you support the running movement and provide tips on how to avoid injury?

It is my opinion that most foot specialists do not embrace barefoot running. Why?

First, medical opinion and education on biomechanics of the foot largely favor supporting the foot — something that cannot be accomplished with barefoot running. Hyperpronation = Bad. I am sure our biomechanical expert colleagues will provide commentary here. I am also one who believes that the foot needs support in general.

But I am not sure that all feet need this support. I recognize that I see a small subset of the population who seek out my opinion because they have structural foot problems, and these patients particularly benefit from the support or ultimately corrective surgery.

Second, barefoot running lacks protection (or a barrier) to the dangers lurking in the environment and there is concern that a person will sustain a puncture wound or perhaps step on the theoretic (but still realistic) hypodermic needle. This is indeed a logical argument and I have treated my fair share of serious limb threatening infections that started from simple abrasions. We all know patients with diabetes are at particular risk.

However, I am not aware of a specific running barefoot puncture wound tragedy. Should people get a puncture injury while running barefoot, then at least they may be spared from developing a Pseudomonas infection that occurs with puncture wounds in sneakers. Clearly, patients should have their tetanus up to date.

Third, there is a thought that barefoot runners are more likely to get musculoskeletal injuries. This is also a logical consideration as sneakers provide a cushion and without this cushion, more stress is theoretically placed on the foot and one can sustain an impact injury. However, it is not clear that this is true. Barefoot runners do have musculoskeletal injuries but so do runners who wear conventional sneakers. Experienced barefoot runners tout fewer injuries and perhaps this is due to the fact that barefoot running is centered on midfoot strike (rather than heel strike with sneakers).

It is clear that the barefoot running movement is here to stay a while, especially since athletic shoe companies have embraced the concept and now sell minimalist running shoes. Is it time we embrace the minimalist running movement or perhaps even offer patients minimalist orthotics?

So, Doc, I ask again, what is your position on barefoot running?

Dr. Blitz is the Chief of Foot Surgery and Associate Chairman of Orthopaedics at Bronx-Lebanon Hospital Center in New York City. Dr. Blitz can be reached at nealblitz@aol.com .

Editor¹s note: For a related article, see the recent Point-Counterpoint feature, "Barefoot Running: Is It Here To Stay Or Just A Passing Fad?," (see https://tinyurl.com/6kqw2pn ) from the April 2011 issue of Podiatry Today.