When Patients Ask About Barefoot Running And Minimalist Shoes

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Author(s): 
Moderator: Jenny Sanders, DPM Panelists: Richard Blake, DPM, Bill Johncock, DPM, Kevin Kirby, DPM, Doug Richie Jr., DPM, FACFAS, and Nicholas Romansky, DPM, FACFAS

Chances are that you have had a patient or two ask for your opinion on barefoot running or minimalist shoes. Accordingly, these panelists share their perspectives on the recent surge of interest in these topics, review pertinent keys to patient assessment and discuss common injuries they have seen.

   In an intriguing roundtable discussion, these accomplished sports medicine podiatrists (including a couple of longtime runners) discuss various issues related to barefoot running and minimalist footwear. Does barefoot running have a role in the training regimen of elite athletes? What do you say to non-elite athletes or beginning runners who want to try minimalist shoes? How critical is a gradual transition to minimalist shoes? Is there sufficient research to validate the hype or do common injuries like metatarsal fractures suggest otherwise? Without further delay, here is what the panelists have to say.

Q:

When patients ask about your opinion on barefoot running and whether or not it may be appropriate for them, what do you tell them?

A:

The majority of the panelists agree that this depends on several factors. Bill Johncock, DPM, says it depends on the type of injuries runners have had in the past, whether they have any current injuries, the types of surfaces they run on, their age, etc. Jenny Sanders, DPM, and Nicholas Romansky, DPM, also ask these patients if they have already tried barefoot running, and whether they had a favorable or unfavorable response. Drs. Johncock, Romansky and Sanders all concur that it is important to determine the patient’s motivation for wanting to run barefoot. Is it fueled by hype, a history of chronic injury or some other factor?

   “Understanding a runner’s motivation to want to run barefoot is key to making an informed decision,” points out Dr. Sanders. “Many runners don’t know why they think they should run barefoot and have no plan whatsoever as to how or why to adapt to a new form.”

   Richard Blake, DPM, assesses the patient’s biomechanics in order to determine if his or her feet are stable enough to handle barefoot running. However, he notes that “many feet are so unstable that it is hard to recommend such an activity.”

   Dr. Romansky says he rarely recommends barefoot running or minimalist shoes for patients or athletes starting to exercise or restarting an exercise program after a layoff. Similarly, Kevin Kirby, DPM, is not likely to recommend barefoot running to beginning runners as he believes it may increase their risk of injury at a time when their body is not quite ready for the extra stress that it will place on their feet and lower extremities.

   However, as a sports medicine podiatrist and longtime distance runner, Dr. Kirby does tell runners that barefoot running is “certainly a reasonable way to train for running on a part-time basis as long as it is performed on a safe surface.” He reminds patients there is an extra risk of stepping on sharp objects with barefoot running. Dr. Kirby also notes that he is “more likely” to recommend occasional barefoot running to more experienced runners to allow more training variety and as a method to help them refine their running form.

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Brian Fullem, DPMsays: May 6, 2013 at 2:25 pm

Excellent discussion with many salient points. I have seen a lot of minimalist and even a few true barefoot runners here in Tampa. I think the injury rate is similar to those runners in traditional shoes but different areas - cuboid, sesamoid and metatarsal stress fractures are the most common. I have noted in the last 6 months a decrease in those using Vibrams or other similar shoes and an increase in the use of shoes such as the Brook Pure series or New Balance Minimus, which as Dr Kirby correctly pointed out are not much different from the road racing shoes of the 1960s-1980s.

Brian W. Fullem, DPM
Tampa, FL

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Kevin A. Kirby DPMsays: May 20, 2013 at 11:30 am

Brian:

Thanks for your comments.

As an older runner with 40 years of distance running under my belt, probably one of the most bizarre things I have seen in this "barefoot-minimalist shoe fad" is the claim by the barefoot-minimalist shoe advocates that they have somehow created a new shoe: the minimalist running shoe.

During my high school and college years of competing in cross-country, track and road races from 1972-1979, myself and many other runners in Northern California often wore racing flats that were thinner soled and lower heeled than today's "minimalist shoes." This was over three decades before the barefoot crowd proclaimed that they had invented a new type of running shoe ... the minimalist shoe. Amazing!

I am all for more running shoe selection for the public but I just hope we can put down this nonsense that minimalist shoes are anything more than a return to racing flats for training ... something which many of us were regularly doing back in the 1970s!

Nothing new under the sun.

Cheers,

Kevin A. Kirby, DPM

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Patrick Johnsonsays: June 14, 2013 at 6:27 am

Most advocates of barefoot running are advocating a change in form as much as they are advocating throwing away the shoe. One basic characteristic of this form is that the foot strikes the ground under the body rather than in front. It is difficult to strike under the body with the heel, thus the change to the midfoot or forefoot strike. The biomechanical evidence supporting this form and foot strike is very compelling. This way of coming down with the foot eliminates a sharp impact peak that is present with the heel strike in front of the body.

If you run barefoot, you feel this impact peak more so you naturally change your form to avoid it. Alternatively, you can learn this way of running with a regular shoe and practice.

Then there is the second very interesting discussion about the anthropological history of running barefoot (I.e. were we meant to wear shoes with big heels?).

These are logical arguments from both a scientific and common sense perspective, and should be taken seriously.

Of course, if you are changing your form and your shoes, you need to build up slowly. Most people have very little sense of what building up slowly means. I personally switched to minimalist shoe running over a period of two years starting with short 2-5 minute runs during my lunch break. My calves and Achillies were often sore at the start and needed to be built up. I wouldn't recommend any other approach. My motivation was that I could not previously run due to knee injuries.

Running barefoot and/or minimalist shoes are not new ideas. That is the point. Often an old idea gains popularity for new reasons. The new reasons are those mentioned above.

I find the whole discussion extremely interesting and more than just a fad. This is a debate that has engaged elite runners, Harvard scientists, anthropologists, as well as bloggers and everyday joggers.

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