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

   Dr. Johncock says it is “ill-advised” for podiatrists to vilify barefoot runners just as he feels it is wrong for barefoot running advocates to attempt to make podiatrists villains for prescribing orthoses that they feel will benefit their patients. Dr. Romansky concurs, noting that many individuals have blamed current injury patterns on a shoe type or a shoe company. He feels answers will come through ongoing research on the subject.

   “With time, we will (and have already begun) to build a new injury database noting the pattern, type and severity of injuries associated with barefoot running and/or the minimalist shoe movement,” notes Dr. Romansky. “We would be shortsighted or narrow-minded not to think so.”

   Drs. Kirby, Romansky and Johncock says there are other silver linings to the recent barefoot running/minimalist shoe movement.

   “Overall, the whole barefoot running fad has been a valuable lesson for many runners and many sports medicine podiatrists in that it has clearly demonstrated that popular books and shoe company-sponsored research are no match for the hard facts that come from good science,” notes Dr. Kirby.

   “The barefoot running debate has forced me to rethink my perspective on what’s good and what’s bad,” concedes Dr. Johncock. “Let us reexamine the available data. Let us create new studies to look at the risks and benefits of new running techniques, shoe types and barefoot running. Do minimalist shoe wearers need orthotics or do these shoes change the type of orthotic which would be beneficial? Will minimalist shoes give better results for those with a neutral gait pattern versus an overpronator?”

   Dr. Romansky agrees that the minimalist footwear trend has forced physicians and healthcare providers to “revisit, revamp and reevaluate” current perceptions, and consider what the future holds for shoe technology, shoe design, training habits, training routines and programs of athletes.

   “It is a work in progress and an evolution to find the ultimate shoe but we should continue to look at the total athlete,” emphasizes Dr. Romansky. “Certain shoe types will bring out the individual athlete’s weaknesses, muscle/joint imbalances and compensation mechanisms of multiple body parts.”

   Dr. Blake is a Fellow and Past President of the American Academy of Podiatric Sports Medicine. He is affiliated with the Center for Sports Medicine at the St. Francis Memorial Hospital in San Francisco.

   Dr. Johncock is a Fellow of the American Academy of Podiatric Sports Medicine and is board-certified by the American Board of Podiatric Surgery. He is in private practice in Hickory, N.C.

   Dr. Kirby is an Adjunct Associate Professor within the Department of Applied Biomechanics at the California School of Podiatric Medicine at Samuel Merritt University in Oakland, Calif. Dr. Kirby is board-certified by the American Board of Podiatric Medicine, and lectures nationally and internationally on barefoot and shod running biomechanics. He is in private practice in Sacramento, Calif.

   Dr. Richie is an Adjunct Associate Professor within the Department of Applied Biomechanics at the California School of Podiatric Medicine at Samuel Merritt University in Oakland, Calif. He is a Fellow and Past President of the American Academy of Podiatric Sports Medicine. Dr. Richie is a Fellow of the American College of Foot and Ankle Surgeons, and the American College of Foot and Ankle Orthopedics and Medicine. He is in private practice in Seal Beach, Calif. Dr. Richie writes a monthly blog for Podiatry Today. One can access his blog at www.podiatrytoday.com/blogs/301 .

   Dr. Romansky is a Fellow of the American College of Foot and Ankle Surgeons, and is a Diplomate of the American Board of Podiatric Surgery. He is the team podiatrist for the United States Olympic and World Cup Men’s and Women’s soccer teams. Dr. Romansky is in private practice in Media and Phoenixville, Pa.

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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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