Why Minimalist Shoes Are A Boon For My Practice

Doug Richie Jr. DPM FACFAS

I am fascinated by the postings on this Web site in which colleagues argue about the merits of barefoot running as well as the superiority of minimalist shoes over traditional running shoes. I have been one of many who have challenged the barefoot/minimalist advocates but now I wonder why I should go through any effort at all.

The fact is that my own clinical practice has blossomed with new patients presenting with injuries directly attributed to this new type of footwear.

Having practiced podiatric sports medicine for more than 30 years, I have a pretty good understanding of the frequency and types of injuries in my office on a daily basis. Without question, the number of injuries attributed to the use of minimalist shoes has risen significantly over the past two years. The popularity of this type of footwear has also grown astronomically in the Southern California area where I practice.

How do I know when to attribute an injury primarily to wearing a minimalist shoe? I admit that I cannot prove this conclusively but often patients have already made the connection when they come into my office. Many times, these are experienced runners with a long history of injury-free participation. Within weeks of changing to a minimalist shoe, they experience symptoms of plantar heel pain syndrome, Achilles tendinopathy or a stress fracture of a metatarsal.

Another trend I have noticed is patients, particularly women, using minimalist shoes for casual day-to-day activity and they suddenly come down with a raging case of plantar fasciitis. While Nike originally marketed the Nike Free® as a training tool for elite runners, it is now a hot fashion item sold in virtually every department store in the country.

Minimalist shoes are now extremely popular in gyms and fitness studios. Participants in many forms of impact exercise, including cardio kickboxing and Zumba, are also wearing minimalist shoes. I see just as many injuries from these forms of exercise in which the use of minimalist shoes is more popular than among pure runners.

Should I enjoy this surge of new patients to my practice or follow my ethical responsibility and continue to lobby against the use of these flimsy shoes for high impact fitness activities?
Of course, I will do the latter, just as I did almost 30 years ago when aerobic dance exercise was beginning a surge in popularity in this country. My colleague Steve Kelso, DPM, and I published the first ever study of the frequency and cause of injury in this new activity in Physicians and Sportsmedicine in 1985.1 Many consider it to be a monumental paper. Our survey of more than 1,200 participants of aerobic dance showed with a high level of statistical significance that barefoot exercisers had a 30 percent greater rate of injury in comparison to those who wore shoes.

The aerobic dance industry made a major shift towards recommending the use of supportive cross trainer shoes after our study and other subsequently published papers showed the same findings.2,3 Anybody involved in the aerobics/fitness industry can attest to the fact that injury rates dramatically dropped after the condemnation of barefoot participation.

Now colleagues of mine who were probably in elementary school when my study was published are suddenly advocating barefoot or minimalist shoes for running presumably because these shoes supposedly promote an injury-free and natural environment for the foot.

Let me pose the following questions.

Do we have to reinvent the wheel again?

Should we throw everything we learned back in the early 1980s out the window?

Are we going to have to go through another period when almost half of the regular participants in high-impact exercise get injured?

If so, I may need to start looking for another associate to help handle the increased volume in my practice.

1. Richie DH, Kelso SF, Bellucci PA. Aerobic dance injuries: a retrospective study of instructors and participants. Physician Sportsmedicine. 1985; 13(2):130-40.
2. Francis L, Francis P, Welshons-Smith K. Aerobic dance injuries: a survey of instructors. Phys Sportsmedicine. 1985; 13(2):105-111.
3. Garrick JG, Requa RK. Aerobic dance: a review. Sports Med. 1988; 6(3):169-79.


Dr. Richie,

I am new to a foot care specialty in nursing and I am enjoying adding new information to my professional knowledge base. Clear, direct articles like this are especially helpful. Primarily, I have enjoyed becoming a more informed referral source for our local podiatrist and having information regarding foot care to impart to patients. As I read your post, I could only shake my head. Just last weekend, I saw a minimalist shoe in a local footware specialty store. I can't even imagine this shoe's lack of protection for heel strikes in running or walking, and the lack of overall foot stabilization. The price tag suggests the "perfect" shoe! Thanks again!

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