Point-Counterpoint: Minimalist Running Shoes: A Significant Advance Or Injuries Waiting To Happen?
Whenever I encountered runners who were not responding to orthotics, shoe gear changes and physical therapy treatments, I educated them on these principles. Obviously, there is more to a running injury than just the aforementioned treatments but my thinking was to introduce the patients to a natural form and make them realize how easily obtainable that form is when they are not in a shoe. I have been scrutinized for telling individuals to run barefoot as they may “step on glass or a rock” or even “cut their foot,” which misses the point. By running without shoes, it becomes very hard to run incorrectly. I realize that is a big assumption but taking long strides and heel striking barefoot becomes extremely difficult because it will hurt. I like to use the phrase “Shoes should allow you to run, not enable you to run.”
Over the past two years, I have helped numerous runners who have been plagued with injuries that did not respond to conventional treatment. Why? It’s not the minimalist shoes directly, it is the gradual adaptation in running form that has been key in my experience.
Can Switching To Minimalist Shoes Help Address Recalcitrant Plantar Fasciitis?
Not only have I incorporated the minimalist shoe for runners but I have also instituted it as part of my regimen in treating recalcitrant plantar fasciitis. When patients present with plantar fasciitis that has not responded to conservative treatment over the timeframe of three to six months, I suggest to these patients to begin functioning barefoot at home in the house for 30 minutes a day and gradually increase the time weekly.
In my experience, I have found that many times, individuals can benefit from changes to their shoe gear. Progressing to a flatter, more flexible shoe allows the foot to be parallel to the ground without compromising a natural gait.
I teach patients with plantar fasciitis to avoid long strides and not accentuate a heel strike with the thick rubber heel attached to their shoe. Many times, the stride people carry, especially men, is a direct result of their shoe gear. Some patients are reluctant initially as they have been told not to go barefoot and that they need orthotic devices. While I agree that the use of orthotics is an acceptable treatment option for acute plantar fasciitis, I do not agree with it for chronic situations. It is also pretty evident if patients have been treating their plantar fasciitis for six months or more with cushioned shoes and orthotics with no success, it is not working.
It has been said that minimalist shoes may work for some but not for everyone. This is partly true. I will say that the thinking among our profession, as well as our society, needs to shift from what we put on our feet to how our feet should be functioning and working as they were intended to.
Dr. Campitelli is an Adjunct Professor at the Kent State College of Podiatric Medicine. He is in private practice at North East Ohio Medical Associates.
Dr. Campitelli writes a monthly DPM Blog for Podiatry Today. To access the blog, visit http://www.podiatrytoday.com/blogs/1413 .
1. Richards CE, Magin PJ, Callister R. Is your prescription of distance running shoes evidence based? Br J Sports Med. 2009; 43(3):159-62.
2. Root ML, Weed JH, Sgarlato TE, et al. Axis of motion of the subtalar joint. JAPA. 1966; 56:149.
3. Kirby KA. Subtalar joint axis location and rotational equilibrium theory of foot function. J Am Podiatr Med Assoc. 2001; 91(1):465-87.
4. Cauthon DJ, Langer P, Coniglione TC. Minimalist shoe injuries: Three case reports. Foot (Edinb). 2013 May 10 (epub ahead of print) doi:pii: S0958-2592(13)00018-7. 10.1016/j.foot.2013.03.001.
5. Giuliani J, Masini B, Alitz C, Owens BD. Barefoot-simulating footwear associated with metatarsal stress injury in 2 runners. Orthopedics. 2011 7;34(7):e320-3.
6. Dreyer D. How to avoid injuries when transitioning to barefoot shoes or minimal running. Available at http://www.chirunning.com/blog/entry/how-to-avoid-injuries-when-transiti... . Published Nov. 23, 2011. Accessed July 30, 2013.