December 2009

Volume 22 - Issue 12 - December 2009
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Other Perspectives On The Barefoot Running Debate

In regard to specific brands of shoes that simulate barefoot running, Jenny Sanders, DPM, says the Nike Free shoes provide a soft, non-supportive cloth upper with a wide, cushioned midsole and deep grooves to enhance flexibility.

However, the few patients she has that use barefoot running shoes prefer the Vibram Five Fingers shoes as they believe these shoes “simulate the true feel and biomechanics of barefoot running shoes.”

“Nike Free and Newton Running seem to be losing ground in the battle of barefoot running shoes,” notes Dr. Sanders.

Doug Richie, Jr., DPM, FACFAS, FACFAOM, says he has a few cases of non-runners who benefitted from the Nike Free, “only in terms of improved shoe fit over severe deformities of the toes.

“The non-confining, stretch upper of this shoe is definitely an advantage for individuals with toe deformities and bunions where conventional shoe fit has failed.”

Dr. Richie says some athletes may receive benefits from using minimalist shoes but only if they use these shoes “intermittently as a training tool.”

Dr. Sanders concurs.

“Based on most of the patient pathology I see coming through the door, few would benefit from this as a primary treatment,” emphasizes Dr. Sanders. “In fact, I have taken quite a few runners out of these styles of shoes because they caused injury.”

Dr. Richie says he would definitely caution against using the minimalist shoes for any patient with a previous history of plantar fasciitis, stress fracture, Achilles tendinopathy or calf muscle injury.

In addition to the introduction of more barefoot running shoes, Dr. Sanders says the recently published book, Born To Run, by ultra runner Christopher McDougall has fueled the debate over the merits of barefoot running. While the book reportedly questions running shoe companies, orthotics, podiatrists and sports medicine specialists, Dr. Sanders appreciates the book’s historical perspective on barefoot running and ultra running.

“This book will definitely shake up the podiatry community but I do not necessarily think that is a bad thing,” says Dr. Sanders. “I also think it will stimulate conversation and better scientific research into the question, ‘Is there an optimal running form and is it the same for everyone and every foot type?’”

Is Barefoot Running Beneficial Or Detrimental?

By Lauren Grant, Assistant Editor

With the emergence of new research and more footwear that simulates barefoot running, the debate seems to be intensifying in the podiatry community about the merits of barefoot running.

In a recent study, published in the Journal of Sports Medicine and Physical Fitness, researchers assessed eight experienced barefoot runners and found that barefoot running led to more plantarflexion at the ankle, which facilitated a reduction in impact forces and shorter stride length. The study authors also found that a lightweight shoe (FiveFingers, Vibram) was “effective in imitating barefoot running conditions while providing a small amount of protection.”

Another recent study, which appeared in the Journal of Biomechanics, found increased eversion of the forefoot with barefoot locomotion. The study authors also noted that shoes “restrict the natural motion of the barefoot” and “impose a specific foot motion pattern” during the push-off phase.

Assessing The Biomechanical Strengths And Potential Drawbacks

Could the emergence of shoes that simulate barefoot running have an impact? Two podiatrists see pros and cons with these shoes when it comes to biomechanics and the training regimens of athletes.

“Increased torsional motion of the foot will likely stimulate activity of the intrinsic musculature of the foot,” explains Doug Richie, Jr., DPM, a Past President of the American Academy of Podiatric Sports Medicine. “Stronger intrinsic muscles in the human foot could conceivably improve foot function and efficiency in running gait. However, this has not been proven in any credible scientific study.”

Jenny Sanders, DPM, says barefoot running shoes are designed to promote forefoot contact over heel contact.

“This does two things. It reduces the impact of heel strike, which improves shock absorption throughout the rearfoot and midfoot,” notes Dr. Sanders, who is in private practice in San Francisco. “(These shoes) also alter the center of gravity forward with the feet being centered below the hip, which is a much more stable alignment.”

In terms of potential weaknesses of these shoes, Dr. Richie says a lack of cushioning may increase the risk of certain injuries. In his clinical experience, he has seen many running injuries that were “impact-related and could be related to shoes with poor cushioning.” However, Dr. Richie concedes that the literature is inconclusive on the cause-effect relationship between impact and running injury.

He maintains that the lack of torsional stability in minimalist shoes will likely put strain on the plantar aponeurosis and increase the risk of plantar heel syndrome. Dr. Richie adds that the lack of heel elevation in these shoes will cause eccentric loading of the Achilles tendon and calf musculature. “In runners who have not adapted to this footwear design, the risk of Achilles tendon injuries could be expected to increase,” notes Dr. Richie, an Adjunct Clinical Professor of Biomechanics at the California School of Podiatric Medicine at Samuel Merritt University.

Dr. Sanders says a significant concern is the possibility that runners may see these shoes as a new fad and train without proper conditioning or assessment.

“If the running shoe is not a match to your foot type and running biomechanics, injuries will occur,” notes Dr. Sanders. “In addition to shoes, I think too many runners have not been adequately coached in proper form. The best running shoe design in the world coupled with poor running form has little chance of benefitting a runner.”

In Brief

The “Podiatric Success” interview series features regular interviews with podiatric legends as conducted by Bret Ribotsky, DPM. For information on upcoming programs and access to archived interviews, visit www.podiatricsuccess.com.