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

   Doug Richie, Jr., DPM, says the vast majority of his patients have “no interest in running barefoot and look at the movement as a silly fad with potential dangers.” Alternately, he has had many patients ask him about possibly switching from stability running shoes to minimalist running shoes. Dr. Richie says these inquiries are fueled by one of the following reasons: boredom with their current level of training; boredom with their current running shoe; getting swayed by advertising; getting swayed by Internet chatter about the barefoot/minimalist craze; an interest in improving performance; or a nagging injury that isn’t getting better.

   Dr. Sanders cautions her patients that definitive scientific evidence (via prospective, randomized, controlled studies) either for or against barefoot running “is still lacking.”1

   “Barefoot or minimalist running is neither the savior nor the apocalypse to running injuries,” maintains Dr. Johncock. “The late, great George Sheehan, MD, (a running philosopher and accomplished runner himself) was frequently quoted as saying, ‘We are all a study of one.’ I feel barefoot running is absolutely a subject where this is true.”

Q:

How do you evaluate a runner to determine whether he or she is a candidate for barefoot/minimalist running?

A:

Dr. Kirby has observed that runners who are more experienced in distance running, younger, of normal body weight and are frequently barefoot while walking are “much more likely” to tolerate barefoot running than those who are beginners, older, heavier or habitually shod. Dr. Kirby feels that any runner can run barefoot or in minimalist shoes on an intermittent basis. He believes that the main question for the podiatric physician is whether the runner will derive benefit or possibly become injured from running barefoot or in minimalist shoes on a regular basis. Dr. Richie counters that when it comes to giving advice to runners on what biomechanics or characteristics of the feet are better suited for barefoot running, there is insufficient evidence from which to make such recommendations.

   When patients ask Dr. Richie about switching to minimalist shoes, he points out that the origin of the movement was among elite runners who sought new methods of improving performance and that running barefoot was proposed as a training technique used once a week to supposedly strengthen the feet in elite runners. Then Dr. Richie will ask inquiring patients if they consider themselves to be truly elite runners and whether they have a specific goal of dropping a few seconds off their 10K time. He also asks these patients if their body frame is similar to the Kenyan runners leading the pack at the New York City or Boston marathons. Dr. Richie then reminds them that the Nike Free (Nike) shoe was designed for elite runners.

   Dr. Romansky also emphasizes candor about fitness level. He says many patients are not as fit, functional or efficient in using their bodies as they think they are in multiple forms of exercise including running, cycling, Zumba, gym workouts, spin class, etc. Accordingly, Dr. Romansky emphasizes performing a quick but in-depth functional movement screen to evaluate the athletic patient. This evaluation should focus on the patient’s core, balance, proprioception and single leg raise exercise, and compare the right side to the left side. He also asks patients if they’re going to use the minimalist shoes only for running or for other activities such as gym workouts, daily errands or housework. Dr. Romansky also tries to find out what shoes patients have worn in the past.

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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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