Less is More?

The popularity of “barefoot running” is on the rise. Vibram Five Fingers and other minimalist shoes, including New Balance’s Minimus and the Nike Free have been a hot topic among both the running and medical communities. Companies have certainly been able to capitalize on the greener movement despite a lack of consensus regarding the true benefit of them among fitness and medical professionals.

So, the question is: Will these shoes benefit me? I have my professional opinion which I will present briefly. However, first I will discuss what a couple of professionals have said. At a recent running expo I had the opportunity to speak with “The Running Doc”, Dr. Lewis Maharam. He stated that he is against the usage of these minimalist shoes as he has noticed a rise in injuries in people who have used them. He prefers traditional running shoes supplemented with an orthotic for those who have injury issues. Another opinion presented in “Running With Joy” by Ryan Hall (4th in the 2011 Boston Marathon and fastest American marathoner ever) stated that while it is argued that running barefoot is more natural, Americans face unnatural barriers such as running on hard surfaces and increased incidence of obesity.

Now, let’s explore the arguments of those who are in favor of barefoot running. It is argued that running barefoot creates increased midfoot and forefoot striking which reduces stress on the heel and allows for improved strength of the foot flexors. It is also argued that supportive running shoes have increased the incidence of foot and ankle injuries such as Achilles tendonitis and plantar fasciitis by not allowing the foot to move naturally and the muscles to build strength. Lastly, those in favor of barefoot running state that there are spiritual and psychological benefits to running more naturally as purported in the bestselling book “Born to Run”.

From a physical therapist standpoint when I assess the efficacy and benefit of barefoot running I have to gather information from my background both as a physical therapist and as a runner. Years ago, when barefoot walking and running were more mainstream, the foot muscles and subsequently the other muscles of the lower extremities and core were able to adapt to the natural biomechanics of the gait pattern. However, things have since changed. Roads are blacktop, many running paths are concrete, and the floors we work on are hard surfaces. Also, casual shoewear, especially high heels, has certainly increased the incidence of foot and ankle injuries. Given the fact that we wear shoes from the moment we first learn to walk, our bodies have adapted to shoewear. Undoubtedly, this has resulted in a weaker foot and consequently less structurally supportive foot thus requiring more supportive shoewear. Increased injuries associated with minimalist shoes are likely to happen if a person immediately starts to perform all exercise in them. The injury does not necessarily have to occur at the foot either. It could result in knee, hip, or back pain due to the change in the rotation of the lower extremity with gait.

Given the aforementioned information, are minimalist shoes right for me? The answer is complicated and should be considered on an individual basis. To generalize that every runner needs to experience barefoot running is a gross overstatement. As with other things, in moderation minimalist shoes could be of benefit. However, the key words are “in moderation”. As with any new exercise, you want to start out slow and build yourself up. The same should be applied with minimalist shoes. If you want to try them first start using them for no more than 5% or so of your running. Also, start on softer surfaces. This will allow for strengthening of the foot without overtraining and causing stress fractures or tendonitis. In other words, the body needs time to adapt. Special situations to consider would be a previous history of injury, osteoporosis, arthritis, etc.. If you have any prior medical history you should consult a medical professional first. In summary, if you feel the need to be free, make an educated decision and consider all the variables. If you do your homework the risk of injury will be less and the likelihood of positive outcomes will be much higher.