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What’s Better? Running Barefoot or with Shoes? Here’s what the research says

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By Michael Hall,

Let’s face it, with all the claims and counter claims that go with barefoot running, it’s difficult if not impossible to know who or what to believe. Runners, especially barefoot runners are passionate people and passionate people tend to be biased people. Discovering the truth however is important as the stakes are high. If you are a runner, the chances are that you have had or will have a running related injury. Running is the 4th most popular activity by participation1 and runners tend to be at high risk of injury. Yet, despite the millions of dollars poured into running research, shoe technology and advanced training programs, the incidence of running related injuries has remained remarkably consistent over the past 40 years.

Up until now, the approach used to prevent injury and tackle running related problems is called Running Shoe Theory (RST), or the prescription of running shoes based on your foot type. Unfortunately this theory has never been adequately tested and is now being called into question by many in the running shoe community.

The barefoot running phenomenon

In recent years, barefoot running (Barefoot Running Theory or BRT) has been proposed as being the answer to reducing running injuries as it allows the foot to work in a way that nature intended it to – something that can’t occur when the foot is put in a running shoe.
Analysis of barefoot running versus running in running shoes reveals that barefoot runners tend to run with a mid or forefoot ground strike (where the mid or ball of the foot hits the ground first) as opposed to shoe runners who land on their heel first in a heel - toe fashion.

Barefoot running – the Pros and Cons

It has been found that using a mid or forefoot strike pattern reduces the impact forces of when your foot hits the ground. However, it also results in a reduced step length and therefore an increase in the number and frequency of steps per given distance.4 So whilst the intensity of the impact stress might be reduced, the frequency and number of these forces actually increases, meaning that the overall effect might be the same.

The impact forces are much greater in heel strike runners being typically 1.5 – 3 times a person’s body weight. Cushioning in the heels of shoes reduces this impact force by about 10% making it more tolerable. Barefoot foot running and using a heel strike pattern actually produce a 7 fold increase in impact forces, thereby placing these runners at much greater risk of injury.

Another difference is that in heel strike runners, much of the impact forces are absorbed through the hip and knee joints as opposed to barefoot and forefoot runners where more of the forces are absorbed through the small mid foot bones and muscles as well as the ankle joints. Whilst a structurally sound and conditioned foot might be able to tolerate these forces, feet which are not biomechanically correct and habituated are more likely to be injured.

Other disadvantages of barefoot running include damage to soles of the feet from running on sharp, jagged, hot or even cold surfaces. To address these problems, running shoe manufacturers have developed minimalist running shoes (or barefoot shoes) which allow the foot to move as naturally as possible whilst offering some protection.

However, a possible advantage of walking or running on grass or at the beach is that of “earthing” where negatively charged electrons are absorbed through your feet providing an anti-inflammatory effect on your body.

Running in bare feet or minimalist shoes also enables better sensory feedback from your feet, thereby facilitating improved body awareness and dynamic balance reactions potentially leading to a reduction in injuries.

However, more recent research is less positive. One study that evaluated claims that minimalist shoes can improve running efficiency and economy found that compared to standard running shoes, minimalist shoes did not decrease running expenditure or improve running economy.

Two other studies have shown that when experienced recreational runners have transitioned to minimalist footwear, there was an increased incidence of injury and of stress reactions in the foot bones.These studies suggest that even despite a careful, slow transition to minimalist footwear, there may still be an increased risk of stress fracture injuries.

Different people have different needs and therefore need different solutions

As can be seen from this article, there is much conflicting evidence as to the advantages and disadvantages of barefoot running. Perhaps this is a reflection that the people unique structural and running styles have not been addressed. If you are overweight, are de-conditioned, have poor core, gluteal, quadriceps and / or calf strength or you have reduced hip, knee and / or ankle mobility, you will be at risk of injury even before you start. Some people have flat feet whilst others have high arched feet. High arched feet tend to needs extra cushioning to absorb shock, whereas flat feet tend to need support to prevent “over stretching” of the foot ligaments and muscles. Therefore, prescribing a generalised, one size fits all approach is inappropriate and fraught with risk. It is therefore advisable that if you are going to take up or increase your running demands, that you get a physical assessment so that you can identify and address potential problems before they become an issue.

For a FREE physical health check or injury assessment, please call Bodywise Health on 1 300 263 994 (BODYWISE).

Precautions and Advice

On balance, the evidence suggests you need to be wary when trialling minimalist footwear for running. If you have a previous history of plantar fasciitis or stress fractures, you should avoid barefoot or minimalist footwear when running. If you are absolutely determined to run with bare feet or minimalist footwear, you must avoid hills (with the associated greater impacts) and transition from short distances and time periods over a period of at least 3 months. Also, you must acquire a mid or forefoot ground strike pattern.

But does your physiology, biomechanics and speed predispose you to a “best” running style?

Most people run with a heel strike pattern11 which might be a reflection of the speed of ambulation. We are adapted to walk for long distances in a heel strike manner. Underneath the heel of your foot is a fat pad that is designed to absorb shock. Also, the lower calf muscle (soleus) is a postural muscle, which means that it can contract for long periods of time without getting fatigued.

Gradually as our speed ambulation increases, we move to a mid foot landing pattern and then to a forefoot strike pattern with sprinting.12 As the bones of the feet are small and the upper calf muscle (gastrocnemius) is a phasic (powerful but easily fatigue able) muscle, we are adapted to running on the balls of our feet for short amounts of time (e.g. sprinting). Because of these adaptations, running for long distances on your forefeet therefore might be putting you at risk of stress fractures and / or upper calf strains.

Having said this, if you run with a heel strike pattern and have weak gluteal, quadriceps, calf and foot muscles as well as stiff hips and ankles, your legs will tend to move excessively inwards, flattening out your feet (pronation) and setting you up for facet joint syndrome (back pain), gluteus medius tendinopathy (buttock pain), iliotibial fasciitis (outside knee pain), Achilles tendinopathy, ankle sprains and plantar fasciitis (underneath foot pain).

Possibly the best advice is to have a physical and / or running assessment and then once cleared to introduce a small amount barefoot running into your training. We know that repetitive activity can cause injury and running is certainly a repetitive activity. So having been cleared to barefoot run, start slowly and progress slowly at a rate that feels almost too easy for a 6 to 12 week conditioning period.

Following this time, start your sessions with a 5 minute warm up and then begin to gradually build up to 10, 20 second barefoot run throughs on grass or sand at about 80% effort (or more but within comfort limits). Then slow down to an easy jog and get your breath back before beginning the next run through. Do this twice each week and mix your sessions up at least monthly with different rest periods, tempos and drills.

When you run, focus on landing with your knee over your foot (2nd toe to be exact) and contract your buttocks as you push off your toes to stride forward. This will challenge and strengthen your body, helping you to avoid injury and perform better. Alternatively, go for a walk in bare feet at the park (on grass) or at the beach (on sand). It might be just one of the greatest discoveries of sensory stimulation, stress release and freedom that you experience all year.

For a FREE physical health check or injury assessment, please call Bodywise Health on 1 300 263 994 (BODYWISE)

For more information on how Bodywise Health can help you to recover from or prevent running injuries, please call Bodywise Health on 1 300 BODYWISE (263 994).

Please note:

• Rebates are available through your private insurance extras cover;

• For complex or chronic conditions, you may qualify for the EPC (Enhanced Primary Care Program) allowing you to receive 5 allied health services each calendar year with a referral from your GP. For more information, please call Bodywise Health now on 1 300 263 994.

References

1. ABS data, Australian Health Survey, Participation in Sport and Physical Recreation, Australia, 2011-12

2. Jenkins DW, Cauthon DJ. Barefoot running claims and controversies: a review of the literature. JAPMA 2011; 101: 231

3. Lope A. Hespanhol C. Yeung S. Pena Costa L. What are the main running musculoskelatal injuries: A systematic review. Nature.2010 Jan28;463(7280):531-5

4. Proceedings ISB XXth Congress, America Society of Biomechanics. 29th Annual Meeting Cleveland.2005:553

5. Oschman JL. Can electrons act as antioxidants? A review and commentary. Journal of Alternative and Complementary MedicinE. 2007 Nov; Nov13(9):955-67

6. Squadrone R, Gallozzi C: Effect of a five-toed minimal protection shoe on static and dynamic ankle position sense. J Sports Med Phys Fitness 51: 401, 2011.

7. J Sci Med Sport. 2013 May 24 pii: S1440-2440(13)00102-3

8. Med Sci Sports Exerc.2013 Jul 19.

9. Foot Ankle Int. 2012 Apr; 33(4):262-6

10. Med Sci Sports Exerc: 2013 Jul;45(7):e320-23

11. Sahrmann SA and Associates. Movement System Impairment Syndromes of the Extremities, Cervical and Thoracic Spines. Elsevier Mosby 2011.

12. Brukner P, Khan K And Collegues. Clinical Sports Medicine. McCraw Medical. 4th Edition, 2012.

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