When Patients Ask About Barefoot Running And Minimalist Shoes
Shoes come into play with gait assessment in the majority of the runners Dr. Sanders sees. She evaluates every runner she sees by first having the patient run barefoot on a treadmill and then having him or her run shod on the treadmill. In some cases, the runner will look better barefoot. However, in most of these cases, Dr. Sanders says it’s not because a midfoot or a forefoot strike is more efficient, it’s because the runner’s shoes are incompatible with his or her alignment.
“In these cases, I get the patient into a more appropriate shoe and repeat the running analysis. If there is no difference between the patient running barefoot or shod, I see no reason why the patient cannot include barefoot running in his or her overall training regimen as long as the runner takes it slow,” notes Dr. Sanders. “If the patient’s running gait is better in shoes or if he or she has a barefoot running injury, I strongly recommend that the patient avoids barefoot running entirely.”
When it comes to assessment, Dr. Blake says one of the easiest factors to consider is joint flexibility.
“If the runner is loose in various foot joints — and you can imagine a sport like running in which you have to handle two and a half to three times your body weight and high pronation/supination moments — then you have to be very cautious,” explains Dr. Blake.
Dr. Kirby asserts that “so-called minimalist shoes” are far from a new idea as these shoes have been continuously available in running shoe stores as “racing flats” for at least the past four decades. If runners want to wear “thinner-soled shoes with less cushioning and thinner heels,” he doesn’t try to talk them out of it. However, Dr. Kirby does tell them they are more likely to develop Achilles tendinitis, metatarsal stress fractures and/or plantar forefoot injuries as a result of regularly training in those shoes.
Other orthopedic issues may also come into play when assessing whether a patient is a candidate for minimalist shoes or barefoot running, according to Dr. Romansky. He tries to ascertain whether the patient has sufficient glute and leg strength, whether the quadriceps and hamstrings are working efficiently or effectively, whether the patient has total joint replacements and/or whether there are any issues with the lumbosacral spine.
Dr. Johncock emphasizes the importance of the runner’s past injury history. He notes that certain areas of the body appear to have decreased stress in response to barefoot running while other areas have increased stress. One of the key differences between barefoot/minimalist running and “traditional” running shoes is that you land more on the forefoot, according to Dr. Johncock. He says it is interesting to look at the differences between the power absorption and eccentric work done at the knee and ankle when landing on the forefoot versus heel strike.2 Dr. Johncock says landing on the forefoot creates decreased stress to the knee, which is where a significant percentage of people seem to achieve relief.3 However, he emphasizes that stress does not disappear as there is increased stress to the ankle, specifically in the Achilles, and increased impact to the metatarsals.
“As time moves on, I think we’ll find more and more data demonstrating that certain injuries such as knee pain may be reduced and other injuries such as Achilles tendinitis and metatarsal/forefoot injuries will increase with minimalist shoewear,” posits Dr. Johncock. “I inform my patients who have had chronic knee pain that minimalist shoes are something they may wish to consider. If they have had chronic Achilles tendinitis or repetitive metatarsal stress fractures, they may not be good candidates.”