Point-Counterpoint: Minimalist Running Shoes: A Significant Advance Or Injuries Waiting To Happen?

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Author(s): 
Nicholas A. Campitelli, DPM, FACFAS, and Kevin A. Kirby, DPM

   In other words, these racing flats that myself and thousands of other distance runners wore from the 1970s onward had nearly identical shoe construction to today’s “minimalist running shoes.” Therefore, minimalist shoes represent simply a renaming of a four-decade-old running shoe type, not a radical new idea in running shoe design.

   Likewise, over 30 years ago, it was not uncommon for many collegiate long-distance runners, including myself and many of my college distance running teammates, to run workouts while barefoot as a way to vary the stress on our bodies during our intense workout and racing schedules. Therefore, the notion that running barefoot or running in “minimalist shoes” is a significant advance or is something new that just began a few years ago is not only a ridiculous idea but also fails to acknowledge the long history of barefoot running and the evolution of running shoe design within the distance running community over the past four decades.

A Closer Look At The Research

As a result of this misinformation that the barefoot running and minimalist shoe enthusiasts are promoting, it is very important for podiatrists to be knowledgeable of the research on minimalist running shoes in order to determine whether the claims that the minimalist running shoe advocates make are supported by the scientific literature.

   Ridge and colleagues recently conducted one of the best research studies to investigate the question of whether minimalist running shoes do indeed prevent running injuries.3 These researchers studied 36 experienced recreational runners split into two groups: a control group of 17 patients who ran in traditional thicker-soled running shoes and a minimalist shoe group of 19 patients who ran in Vibram FiveFingers minimalist running shoes for 10 weeks. The runners wearing FiveFingers shoes transitioned into these shoes using the same 10-week transition protocol that was published on the Vibram FiveFingers Web site in 2010.

   The runners in the study by Ridge and colleagues had magnetic resonance imaging (MRI) scans both before and after the 10-week period to monitor bone marrow edema and any other bone stress-related changes within their feet and ankles.3 Various authors have previously shown that MRI scans are able to detect bone stress injuries of the feet and ankles weeks before radiographs can detect any abnormalities.4-6 Even though pre-training MRI results were not statistically different between the two groups, the post-training MRI scores showed that more runners in the FiveFingers group (10 of 19) showed increases in bone marrow edema after 10 weeks of running than did the control group. In fact, of those who ran in the FiveFingers shoes, one of the runners developed a calcaneal stress fracture while another runner developed a second metatarsal stress fracture. No runners in the traditional running shoe group developed stress fractures during the 10-week training period.

   Within the medical literature, there are also reports of runners developing stress fractures and other injuries from running in minimalist running shoes. In a retrospective case series from Salzler and colleagues, 10 runners developed injuries when they switched from traditional running shoes to minimalist shoes.7 These injuries included eight metatarsal stress fractures, one calcaneal stress fracture and one plantar fascia rupture.

   In 2011, Giuliani and coworkers also reported two cases of second metatarsal stress fractures in experienced runners when they started running in Vibram FiveFingers shoes.8

   The increase in injuries that occurs with minimalist running shoes is possibly due to the more anterior foot strike, greater ankle plantarflexion moment in early stance, greater eccentric plantarflexion muscle involvement and greater impact peak loading rate found in people who run in minimalist shoes. Paquette and colleagues showed this in a recent study that compared the biomechanics of minimalist shoe running to traditional shoe running.9

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