by Meaghan Harwood, DPT
The best runner leaves no tracks. – Tao Te Ching
In late 2009, my mother sent me the National Best Seller Born To Run by Christopher McDougall in which the author’s own difficulties with running injuries led him to ask a seemingly simple question, one that I hear from runners frequently, “Why do my feet hurt?” It is not a simple question at all, but at the time my graduate studies got in the way of a deeper appreciation of the topics raised in this book including the idea of barefoot running. However, in early 2011, I attended the American Physical Therapy Association’s (APTA) Combined Section Meeting and the issues raised in this book resurfaced as one of the “hot topics” and I was hooked again. Since that time, I have had many patients inquire about my thoughts on barefoot running in general as well as whether they should adopt the minimalist approach. I have even tried it myself. Unfortunately, there is not a straightforward recommendation.
Recently, there has been increased media awareness and attention in the literature about barefoot style running as well as an uptick of enthusiasm for minimalist movements in many running circles, increased discussions in sporting communities, and people trying to find a way to respond to their orthopedist’s recommendation to give up on running and “buy a bike” to stop their foot pain or save their knees. In turn, there has been a spirited debate about the pros and cons of barefoot style running.
As the APTA titled their 2011 symposium, Barefoot Running: So Easy a Caveman Did It, supporters believe that the human body was designed to run without shoes in the most primitive sense. Proponents suggest that modern shoes interfere with our natural abilities and the natural process of human evolution and thus increase the risk for injury. Many propose that the deconditioned musculature of the foot is the greatest issue leading to injury and we have allowed our feet to become badly deconditioned over the years with the transformation of footwear. On the other hand, some argue that the cushioning and stabilization provided by modern running shoes are needed to protect the foot against overuse injuries. The controversy has been longstanding, dating back to the 1970s when there was opposition by college running coaches to the movement toward the modern running shoe spearheaded by major shoe companies. However, the controversy is still unresolved over four decades later.
There is a lot of information regarding the mechanics of foot strike patterns in both barefoot style running and shod running as well as the effects of each on the musculoskeletal system. Previous studies have suggested that runners wearing the newest and most expensive shoes are more likely to get injured than runners in cheaper or more worn down shoes. However, a study published last month showed that barefoot style runners (all wearing a popular minimalist shoe) were more likely to have a reactionary inflammatory response (early bone injury) in the bones of their feet.
So what does it all mean? Unfortunately there is no consensus. However, there are several important takeaways from all the discourse to date. First and foremost, a transition period is crucial if you decide to try barefoot style running. Secondly, you must be cautious during this transition period. Like most activities, moderation and a gradual progression is key. It may also be helpful to have a gait analysis performed by a physical therapist to address any issues that may accompany your transition to a more minimalist approach. Your physical therapist can also provide advice for developing a transition program to optimize your running goals while minimizing your chance of injury. Running barefoot might have been natural for our ancestors but it is a new experience for most of our feet.
Dr. Harwood is a Physical Therapist at Boston Sports Medicine