Tackling The 10 Myths Of Barefoot Running
As I noted previously, we know that ground reactive forces are greater with heel strike in comparison to unshod or barefoot runners who adapt a more forefoot strike pattern.6 Numerous studies have demonstrated higher ground reactive forces and mechanical stresses to the knee while running in traditional running shoes as opposed to barefoot.12-13 A recent study published in the British Journal of Sports Medicine looked at patients with knee osteoarthritis over 12 months and found no difference between wearing a lateral wedge orthotic versus a control flat insert.14 Similarly, a systematic review of literature demonstrates that external knee adduction moment and pain associated with knee osteoarthritis is higher in individuals wearing sneakers in comparison to those who do barefoot walking.15
How Do Orthotics And Plantar Fasciitis Come Into Play With Barefoot Running?
I can't do barefoot running because I need to wear my orthotics. Orthotics have become more overutilized in the practice of podiatry then ever before. It is very common for me to see runners present in my office with plantar fasciitis, a normal arch, cushioned running shoes and orthotics they have worn. When running barefoot or in a minimalist shoe, we do not need to control motion at the rearfoot because heel striking is not occurring and “excessive pronation,” as described by Root, does not occur. While we have numerous studies that do not support the use of orthotics for running injuries alone, it becomes a challenge to convince the patient they are not needed.16-20
I have plantar fasciitis so barefoot running would be too painful. This article was not intended to discuss the pathomechanics or treatment options of plantar fasciitis. However, we are anecdotally seeing resolution of symptoms in those who adopt this style of running. One potential explanation is the development in strength we see to the intrinsic musculature, specifically the abductor hallucis muscle, which is a primary supporter of the arch.21-25
Another overlooked phenomenon is the fact that the majority of running shoes place your ankle into plantarflexion. This forces the body to compensate by increasing lumbar lordosis and increasing pressure to the heel as opposed to having more even distribution throughout the foot.
Addressing Other Perceptions About Barefoot Running
An atrophied fat pad would prohibit barefoot running. This is another common myth that patients acquire from various sources, including medical professionals. Most, if not all, of us have treated a patient who complains of forefoot pain or calluses, and then simply blames the problem on a lack of adipose tissue or cushioning below the metatarsal heads. While this seems to be a possible etiology, there is no evidence to date that the fat pad of the sole of our foot actually atrophies on the forefoot or the heel region.26,27 With common forefoot pathology such as hammertoe deformities, we do see the fat pad migrate distally producing more prominent metatarsal heads but typically, this is in severe cases, such as rheumatoid arthritis.28 Patients at this stage of a deformity are typically not runners.
Barefoot running causes severe calluses. Calluses on our feet form as a result of shear force on the plantar surfaces of the skin that produces excess friction. Shear force that occurs in the horizontal plane is the key to understanding this concept. Direct pressure does not produce calluses or we would see a high preponderance of heel calluses in runners as the majority of runners heel strike.
Root discussed the formation of forefoot calluses secondary to shearing forces associated with propulsion as well as to the central metatarsals due to increased loading for an excessive period of time and abnormal shear.29 Root's observations hold true for someone who heel strikes when running as we see increased force placed upon the forefoot during what he described as the propulsion phase. Observation of the gait of a barefoot runner or one who strikes with the forefoot/midfoot demonstrates that the propulsion phase as described by Root becomes very minimal in existence, if it even occurs at all.