Should Podiatrists Embrace Barefoot Running?

Neal Blitz DPM FACFAS

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
(http://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 http://tinyurl.com/6kqw2pn ) from the April 2011 issue of Podiatry Today.

Comments

I currently run in a minimalist shoe and also have healed an injury of 8 years duration by running this way. This is not a fad and is also nothing new. Evidence-based medicine has not revealed that running in a running shoe, or even an orthotic, can prevent or reduce injury. Current literature supports the theory that there is reduced stress on impact by landing on your forefoot and midfoot as opposed to the heel.

I have recently collaborated with Vibram FiveFingers and will be lecturing nationally on this topic. We also have several studies under way demonstrating positive outcomes by strengthening intrinsic musculature which is the basis for running this way.

I have been implementing this in my practice and am seeing positive results with numerous pathologies, not just in runners.

I gladly welcome any comments or questions to my email and if Podiatry Today is interested in an article on my opinions and experience, I can do so.

Thanks,
Dr. Campitelli

Dr. Campitelli,

Since you mention evidence-based medicine, I'm sure that the studies underway are focusing on non-biased, double blind trials to prove (or disprove) the theories that the Vibram shoes profess, especially since they are funded by the Vibram company. Are you showing an unbiased view of your findings since your collaboration and when lecturing, will you be discussing the risks and benefits of using this running method?

If you do a Pubmed search, there are a few articles indicating that the proper running shoe for the foot type is useful in reducing but not preventing injury. There also are some data analyses that show orthotics do indeed reduce running stresses.

After spending some time discussing these issues with a Vibram company rep, it became clear to me that unless you are a midfoot striker with a neutral foot type, the Vibram shoes may cause more issues than they help. I personally saw two stress related injuries the last half marathon I worked medical at that likely were directly attributed to training in these shoes. They are NOT for everyone. Don't forget, we are not trying to correct any pathology with these shoes, but offering a different approach to exercising.

markcucu's picture

Neal,

Thanks for opening up the conversation. I am a family doc, do a lot of barefoot running, and promote and teach a barefoot running STYLE. Doing some total barefoot running helps one learn the softer landing. We have loads of articles and education on our site www.trtreads.org .

We opened the first store selling only minimal and level shoes ... and out of thousands of customers now, we have not had one saying they prefer the rigid, beefy elevated heel shoe. It is a progression though and the runner must listen to his or her body.

For fun and learning, we posted a video too showing the barefoot style. Learn evolve, run….
http://www.youtube.com/watch?v=kpnhKcvbsMM&feature=mfu_in_order&list=UL

Take your shoes off, get thinner shoes, and decide yourself. Agree that certain specific conditions need corrective footwear but the normal foot is the perfect invention and needs NO correction.

Mark Cucuzzella, MD
Professor of Family Medicine
West Virginia School of Medicine

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