Minimalist Shoes: Do they work?

by Justin Wu, DPT

“What are minimalist shoes and what do they hope to accomplish?” is a question that I ask myself every time I see someone using them. Well here’s a simple gist of what this specific type of shoe hopes to achieve: reduce the amount of stress on legs and lower the incidence of running injuries by mimicking running mechanics of a barefoot runner. With the frequency of injuries in runners ranging from 19.4%-79.3%, this concept is definitely appealing.

The theory behind the minimalist shoe is that barefoot runners, or users of the minimalist footwear, land with a fore-foot or mid-foot strike which generates less impact force. Therefore, this concept decreases the risk the runner would sustain a stress fracture, plantar fascia involvement, and obtain other running-related injuries…but does it work? A case-series1 that was done here in Boston shows interesting results.

This study looked at ten experienced (25.9 miles/week for an average of 18.9 years) runners, aged 21-57, who transitioned from using traditional running shoes to minimalist running shoes. Here’s a look at a set of data table obtained from the article:

Now you can see a couple things going on with this data table. 1) There is no control group for this study so you can’t compare the effectiveness of the experimental group, which is the minimalist group, successfully against traditional running shoes. 2) Not all patients were the same. As you can see, 2 of the 10 patients did have injuries prior to the minimalist transition which skews results. 3) The transition length from which they either immediately switched to a minimalist shoe to a traditional shoe (which is signified as a 0) or gradually worked themselves into a minimalist shoe varied.

So is there an explanation as to why injuries still occurred? One theory is that although the amount of impact generated with a minimalist shoe is lower than a traditional shoe, the impact force may be directed at a different location: the metatarsals rather than the heel, which may explain the amount of metatarsal stress fractures. Another theory is that minimalist runners’ connective tissues are conditioned differently. Therefore, a safer and more effective way to transition from wearing traditional running shoes to minimalist running shoes must be found so that runners can adapt safely. Again, these two points are only theories at this given time.

Overall, with the 3 facts/issues about the article in consideration, these results can be seen as speculation as to what the minimalist really does. Is it really effective in decreasing the amount of injuries that could occur in runners in comparison to traditional running shoes? Perhaps, and perhaps not! There is still room for a more controlled study (specifically, a randomly controlled trial) which could provide more concrete results. But, interpret from what you will from the data table as above: you can still sustain an injury using minimalist shoes!

Dr. Wu is a Physical Therapist at Boston Sports Medicine