Have we forgotten about pronation? With all the hype surrounding minimalist shoes, the concern has shifted from controlling motion to simply avoiding minimalist shoes. This has happened not because minimalist shoes don't control motion but plain and simple because they allegedly cause injury.
The naysayers of minimalist shoes focus their argument on the fact that these shoes are not supportive and offer no motion control for runners. Yet a majority of the recent literature that has been published in regard to minimalist shoes and injury does not focus on pronation or foot structure. These studies demonstrate no direct link between foot type and excessive pronation or lack of motion control. The three articles I have referenced below all suggest overuse injury leading to possible stress fractures or bony edema.1-3
In their case reports involving minimalist shoe injuries, Cauthon and coworkers noted that all three patients “switched immediately to the minimalist shoes with no transition period.”2 In the study of 36 experienced recreational runners by Ridge and colleagues, they noted that 10 out of 19 runners who gradually transitioned to Vibram FiveFinger running shoes over 10 weeks had increases in bone marrow edema in at least one bone.1 I believe the increased bone marrow edema is a normal response to the gradually increased stress on the foot. I would expect to see bone adaptation over time.
(Often, when we’re working up patients with a suspected stress fracture, we don’t see bony callus formation on X-ray but subsequently get a MRI, see bony edema and call it a stress fracture. We need to question whether we are truly seeing a stress fracture on MRI or perhaps recognize that the MRI findings are just a normal response to increased stress on the midfoot. Should we be treating these cases more from a clinical standpoint as opposed to a radiographic standpoint?)
I see runners in my practice with all variations in foot types: flat feet, high arches and normal foot types. These patients have overcome injury without orthotics or motion control shoes.
The focus on footwear has become very misconstrued. I regularly see patients with a normal arch coming to see me wearing orthotics and motion control running shoes, and they are still experiencing pain. Unfortunately, many physicians do not discuss form and training patterns with a runner.
In my experience, inadequate form and training regimens are often the cause of minimalist running injuries. I realize other variables can play a role but we could significantly lower the yearly injury rate among runners if we could divert our focus away from shoes. Too often, patients in my practice admit to switching shoes to fix an injury and this yields no positive results.
I have transitioned numerous runners to minimalist shoes safely. These runners have not suffered injuries that were directly related to shoe gear or lack thereof. Readers of my blog (www.drnicksrunningblog.com  ) have shared many success stories with me of their safe switch to a minimalist shoe and reduction in pain or injury. I believe the change in form and a renewed focus on training patterns can be helpful in reducing injuries.
1. Ridge ST, Johnson AW, Mitchell UH, Hunter I, Robinson E, Rich BS, Brown SD. Foot bone marrow edema after a 10-wk transition to minimalist running shoes. Med Sci Sports Exerc. 2013; 45(7):1363-8.
2. 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.
3. 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.