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

Q:

Have any of your elite running patients switched to barefoot or minimalist running? If so, what was the outcome?

A:

Dr. Richie notes that one patient, a veteran Ironman triathlete, decided to switch to total barefoot running last year so he could “run faster.” He had bilateral cavus feet and had run injury-free for over four years in traditional shoes. Within three months, the patient developed a calcaneal stress fracture, according to Dr. Richie. He notes that this was not just a stress reaction but a complete fracture through the tuber of the calcaneus that was visible on computed tomography (CT) and magnetic resonance imaging (MRI). Dr. Richie says two other patients switched to barefoot running over the past year and have had no problems, but they both mix barefoot running with shod running during their weekly training.

   Dr. Johncock notes he has only had one elite athlete who attempted to make the jump to total barefoot running and extreme minimalist shoes (Vibram). He ended up in Dr. Johncock’s office with a metatarsal stress fracture. He does note that a number of his college runners and high-level athletes do a portion of their training on grass barefoot or in minimalist shoes, but this “typically accounts for 10 percent or less of their total training.” Dr. Johncock adds that he has seen a general trend of more elite athletes going with a lighter, less supportive shoe for their training.

   Dr. Romansky reports that many of his patients have switched but very few exclusively use minimalist shoes. He says they may alternate with a zero drop shoe type or a lower profile shoe. He adds that some may use minimalist shoes for gym use, daily use around the house, daily errands and light trail walking. Regardless, Dr. Romansky says the use of minimalist shoes or barefoot running “must be a progressive and well thought out plan.”

   Over the past 28 years of being a sports medicine podiatrist, Dr. Kirby says all of his elite running patients were already running in “minimalist shoes” as these shoes were called “racing flats” up until a few years ago when the barefoot running fad began. He adds that during his collegiate long-distance running days in the late 1970s, “many of us occasionally ran barefoot as a way to vary the stresses on our feet and lower extremities.

   “Therefore, the notion that running in ‘minimalist shoes’ or running barefoot is a new idea is not only false but frankly is comical to anyone who is knowledgeable of the long history of distance running in the United States and other countries around the world,” says Dr. Kirby.

   He notes that currently, no barefoot runners hold world records in any track events or long distance running events. Dr. Kirby says elite runners don’t want to increase their risk of injury by running barefoot so they instead wear thin-soled, lightweight racing flats to run their races in, just as they have done so for at least the past half-century.

   Dr. Sanders says none of the elite runners she treats have changed from shod running to a minimalist shoe or barefoot running style. If Dr. Blake is treating an elite runner, it is usually due to a foot, ankle or leg injury and “the last thing we are thinking about is changing shoes and technique.”

   While Dr. Johncock says he is far from an elite runner, he runs two to four ultra-marathons a year and has seen more of his friends in these ultra-marathons run barefoot or in true minimalist shoes. He notes that has yet to be beaten by any of his barefoot friends in distances over a marathon.

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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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