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Saturday, May 29, 2010

Barefoot running and injuries

Barefoot running - it was a stimulus plan for physical therapists after all

About four months ago, we did a lengthy series on barefoot running, which began with this post on the latest research from the Harvard lab looking at how habitual barefoot runners' mechanics different from shod runners'.  That was followed up by a six-part series, done in Q & A format, where we looked at the evidence for barefoot running as a means to prevent injury.

In that very first post, looking at the Harvard study, we made mention of barefoot running being a "stimulus plan for physical therapists".  This was entirely predictable, because the media jumped all over the Harvard study and reported it as "proof" that running barefoot was less likely to cause injury as a result of the lower impact forces it caused.  This was despite the paper actually reminding people that it had NOT shown this at all.  Its final sentence was "controlled prospective studies are needed to test the hypothesis that individuals who do not predominantly RFS either barefoot or in minimal footwear, as the foot apparently evolved to do, have reduced injury rates"

This research came along into a "market" that was increasingly moving towards barefoot running.  The book "Born to Run" described the feats (pardon the pun) of a tribe of Mexican Indians, and gave legs to the movement that was picking up followers all over the world.  Barefoot was suddenly the way of the future.  It inspired our series, and much debate on the issue.  All the while though, people were trying to advocate caution, warning that simply going from shoes to barefoot would guarantee injury.

Increased injury rates - the stimulus plan is working

It should come as no surprise that medical doctors and physical therapists are now beginning to pick up on a potential fall-out from the "Born to Run" movement.  Our friend (and book co-author) Matt Fitzgerald has hunted a few down, and his report details of a sudden increase in injuries caused by barefoot running. According to those he interviewed, the nature and number of injuries has changed in recent times.

There is however a missing piece of the puzzle here.  First, the increase in the number of people running barefoot would produce more barefoot injuries even if the relative risk was the same.  Imagine that in a community, 100 people run, 80 of them in shoes and 20 of them barefoot.  If the injury rate is equal for both at 10%, therapists will treat 10 patients, 8 who run in shoes, 2 who run barefoot. 

But if a book or research studies plus the media inspires 40 people to switch to barefoot running rather than shoes, the split would now be 40 in shoes, 60 barefoot.  Now, even if the injury risk stayed the same, they'd suddenly treat fewer injuries from shod runners (4) and more from barefoot runners (6).  Has barefoot running caused more injuries?  Or has running caused the same injury rate, regardless of what is on the foot?  That's why properly controlled prospective studies are still needed. 

However, one of the doctors who Matt interviews is still of the opinion that the barefoot running is responsible for specific injuries.  He explains how plantar fasciitis injuries are on the rise, and attributes this not to overuse, but to barefoot running.  He also pins down why those who swtich to barefoot running often don't report injury.  His words: “There are a fair amount of people who have tried it but have stopped pretty quick, just because they realized that it was not going to work for them,” he says.

The spike in injuries - the stimulus plan

The potential spike in injuries is similar to that which I once saw reported as a result of Pose.  I recall reading how therapists always saw increased patient numbers about two weeks after a Pose running course had been held in the city.  Runners, armed with a new, injury-preventing running technique, were going away to implement what they had learned without due caution, and breaking down at either the calf, foot or Achilles tendons.

The same will happen for barefoot running, unless the runner is a) very, very careful to manage the transition slowly, and b) mechanically able to do it.

I raise point b) because this is something we don't fully understand yet, but I am convinced that there are individuals who simply cannot get away with barefoot running.  I may yet be shown to be incorrect, but only evidence will convince me of this, not the anecdotes of the few who are successful at making the transition.  Those who fail rarely speak out - they just switch back to shoes.  Those who are successful tend to be vocal, and I believe this is why the risk has been under-recognized.

Having said all this, I don't believe that barefoot running is without its merits.  And please, before I get slated for selling out to shoe-companies, take some time to read the series we did on barefoot running (especially Part 5).  I know it's long, but it lays out all the thoughts, and ultimately concludes that there is merit, but that caution must be used, and if you advocate that barefoot is the only way to go, you're making the same 'extremist' error that shoe-companies are being accused of making.  I don't want to rehash all the same arguments again - they're in that series. 

Conclusion - universal truth doesn't exist

But bottom line - don't buy into the hype.  Try it out, with caution.  See if you enjoy it (it is a lot of fun), see if you feel different and then build it slowly into the programme. But if it doesn't work, don't believe the 'criticisms' that it's your fault.  I've heard these re both Pose and barefoot running - if you run Pose and get injured, you may be told that it's because you've failed to do it right.  If you run barefoot with injury, you will be told that it you haven't made the transition gradual enough, or that you're landing with a stiff ankle, or pointing your toes, or some variation which ultimately boils down to "It's you, not the concept".

It is not true.  It may just be that you cannot do it.  One-size-fits-all fits exactly no-one.  So rise above the generalization and hype!

Ross

56 Comments:

heidi said...

Excellent article. Much appreciate the wise input.
BTW: Any thoughts on Newton running shoes and their forefoot running philosophy?

Lindy said...

Good article! I ran high school and college cross country and tore up my knees. Now, after surgery on one knee, I run pain free using a midfoot strike- no Achilles problems. I wear flat racers on trails and NB 800 midfoot strike shoes for the road. The focus should be body position and what feels comfortable to the individual. Save barefoot running for the beach!

Ken Schafer said...

I suspect that many of the injuries from barefoot running are the result of people jumping in too enthusiastically, and without proper preparation. I've seen people try to start minimalist running who don't even know that they need to learn how to land on their forefoot. I also see a lot people try to force a forefoot landing without learning the proper mechanics.

Ross Tucker and Jonathan Dugas said...

Hi Folks

Thanks for the comments.

To Heidi:

I've written quite a bit on forefoot running - if you click on the link in this post for that barefoot series, it comes up a lot there, because "barefoot" has kind of incorrectly been used interchangeably with "forefoot". They have certain similarities for sure, but not technically the same.

But I have discussed it at length in that six-part series, the Q & A. I haven't looked specifically at the Newton shoes though. I don't know enough to speak about them without speculating. My principle remains, however, that if you are going to change the running style, be it through equipment or training, you have to do so very, very gradually, and also accept that it's not guaranteed to work for everyone.

To Ken:

I've no doubt you're right. But, and this is the key point in the post, I'm not convinced that everyone can run barefoot successfully, even if they do adapt very gradually. In that article by Matt Fitzgerald, you'll note that he says that his barefoot running attempt started with a run of 1 minute. And Matt is a clued up guy, he would have built up very gradually indeed. Yet he still got injured.

So did I, and I started very, very slowly. Much slower than I would wearing shoes. So I don't believe that anyone can do it provided they do it with proper preparation. I believe there are people for whom it would work, and people for whom it can't work.

And I think people make a mistake by saying "if you only do X,Y or Z". Some things can't be avoided, and for some people, barefoot running injuries is one of them.

Regards
Ross

Ken Schafer said...

Maybe some people can not convert to barefoot running. I believe that most people with proper preparation and a little common sense could convert if they wanted to. However, for those who can't, is their inability caused from a life time of wearing shoes or it just the way they are put together? In other words, is it nature or nurture? In the absence of much evidence either way, I'm leaning toward nurture.

Ross Tucker and Jonathan Dugas said...

Hi Ken

Thanks for the follow up.

Good question. I don't know. I'm leaning neither side, because I honestly don't know. If the answer is "nature", I guess it implies that some people are just not meant to be distance runners - they break down with injuries at a certain point (lower than most) because of a mechanical or structural problem. I find that pretty reasonable to accept. We're not all cut out to be rugby/football players, we're not all cut out for sprints, we probably aren't all designed for distance. IN general, perhaps, but some people simply cannot run.

I also find it reasonable to accept that "nurture" in the form of our shoes as children and the terrain we walk on all our lives strongly affects that mechanical/structural factor. The result is that by the time you have a 35 year old runner, you cannot distinguish where nature ended and nurture began!

However, I also wonder what difference it makes? If it's nature, then you're 'beaten'. That group who can't adapt to barefoot running is never going to get it right, so back to shoes. If it's nurture, then I guess the argument can be made to very gradually untrain years of 'conditioning', but I'm not sure that's possible either. At some point, it's defeating to try. I don't know where that point may exist.

All I know is that some people probably can't get it right! Or, if they could, they would have to start by jogging 200m a day for a week, increasing by 0.1% per week to avoid the "too much, too soon" problem. By the time they've been doing it for just over a year, they'll be running 10km! It's a tough ask. theoretical only, practically, better to go in shoes, but more sensibly...

Ross

Anonymous said...

Thanks for the posts and usually agree. In this case though, I struggle to read without comment. You are not running POSE if you are getting injured. In other words, you are trying to run Pose and not allow your heal to hit etc. Bottom line, I have run POSE for years AFTER going to a clinic to learn how to do it properly. I haven't had a running injury in yeras.

Lyn said...

@ Anon: "you are not running POSE if you are getting injured."
--This is just the kind of circular reasoning that Ross and Jonathan are discussing.It's the logic of true believers.

Ross Tucker and Jonathan Dugas said...

HI Anonymous, and Lyn

I agree with Lyn. The argument is circular. Pose positions itself as "injury-free" running, and so anyone who is injured, is, by its own definition, not running Pose. Or so the thinking goes, it's a perfect circle.

I think you've found success with Pose, which is great for you. You're one of many, I'm sure, you has tried it, with success. I've said many times that there are people out there who do succeed, and good luck to them. However, I think it would be fair (and wise) to acknowledge that there are many (maybe more) who try it and fail.

To say that they've failed because they've failed to run the technique is to say that the technique is insufficient. It's like buying a medicine that you have to make work. It simply doesn't work for me.

So the point, there will those who treat injuries by changing their technique. There are those who will fail. And there are those who will cause injuries by learning it.

Ross

Steve Magness said...

Barefoot running is a tool, not a means in and of itself. It should be used to teach proper mechanics and strengthen the feet. In those terms, it serves as a supplementary exercise. Use barefoot strides to teach proper footstrike and increase awareness of what the lower leg is actually doing via increased proprioception/feedback.

If you want to run barefoot, it's not just about taking it gradually. You have to strengthen the foot, especially the achilles, to prepare for the increased load it's going to take up, since it's been dormant all these years when protected by a shoe.

Additionally, a lot of people make the switch to barefoot/VFF running without trying to alter their mechanics to suit barefoot running. They hope/think that just by running barefoot the decades of motor programming will go away.

Look at the data from Lieberman's studies, among others, that clearly shows that some people still heel strike when barefoot running, and that a heel strike barefoot running produces similar ground reaction forces as a heel strike in shoes. In other words, you don't get the change in GRF unless the footstrike changes. That means, when you switch from shoe heel striking to barefoot heel striking the foot/calf/achilles complex is doing a whole lot of muscle tuning that it wasn't doing with the shoe on. It's no wonder injuries occur.

The bottom line is that there is no magic cure-all so don't expect one. There is also a high degree of individualism, like with anything.

But from what I've seen, the people who get hurt barefoot/VFF running are those who do not strengthening work for the lower leg, are not gradual in implementation, and/or do not alter their biomechanics.

Jaime said...

Matt's article is, to say the least, terribly tendentious. His talk on the "developing barefoot running injury epidemic" based on anecdotal evidence from a few PT he's talked to, his dismissal of Lieberman's anthropological theories on the basis that "it is quite obviously not the case that every human individual is meant to run," make up for what he aptly describes as "a classic fallacy of faith-based versus evidence-based belief."

I enjoy your blog greatly, because of the rational, scientific approach you give to controversial issues. It definitely has been the norm in you former approach to barefoot running and many other issues. And hey, there's plenty to criticize of the barefoot running movement. And it's great to have people like yourselves stirring up the debate. Not for the sake of the debate, but because it may eventually lead to actual research that settles it. But honestly, neither your post, nor Matt's article stand up to that challenge...

Ken Schafer said...

Ross,

Well stated, and I agree that on a practical level it doesn't matter if the cause is nature or nurture. If someone needs (or wants) to ware shoes to run, then, by all means, they should ware shoes.

For me it's a more of a philosophical debate until we have more facts. I just find it hard to believe that it is necessary for most people to ware something invented in the early 1970's to do something that people have been doing for millions of years. I also believe that most of the problems many people have with running are the result of modern living and not from an innate structural deficit. However I am perfectly willing to concede that I may be proven incorrect as more research is done.

Steven Sashen said...
This comment has been removed by the author.
Steven Sashen said...

I participated in a panel discussion about barefoot running where all the medical participants (physical therapists, pedorthists, doctors) also said they *BELIEVED* that barefoot running was or would be the cause of more injuries.

Not doing too much too soon, before you've built up the strength to run barefoot, but barefoot running itself was the culprit. And it didn't matter to them if you ran 5 miles a week or 100.

They suggested that you transition to more and more minimalist shoes, then that you run on grass, then on dirt, then, maybe, just maybe, you'll be able to handle pavement.

Meanwhile, only Danny Abshire from Newton and myself (from http://www.InvisibleShoe.com) suggested that:

a) The issue is not being barefoot, but doing more than you're ready for, and;
b) You can't "transition" to barefoot. You have to simply go barefoot WAY slower and WAY shorter than you want to (think of it like adding weight lifting to your existing running program rather than something you do to replace your current program).

And then it hit me. I asked each member of the panel, "Have you ever run barefoot on pavement for at least a mile?"

Not surprisingly, without exception, everyone who warned about the dangers inherent in running barefoot had never done it.

Their opinions were based on anecdotal information like, "I'm seeing more Achilles issues from people who say they run barefoot."

I tried to point out that unless they knew the number of barefoot runners who were NOT coming in to see them with problems, that they had new patients complaining of self-diagnosed barefoot-caused injuries was meaningless.

Clearly, there's a lot of excitement about barefooting. And there are more than a few vested interests (one could argue my interests fall into that category). But the bottom line, pointed out repeatedly in this thread, is that:

1) We need some real research to replace anecdotal claims, and;
2) Due to the excitement factor, it's going to be a little messy (arguments, name calling, and the like), until we do, and;
3) No conclusion from any research will silence those whose livelihood requires the opposite conclusion (if studies showed unequivocally that barefoot is best for recreational runners, no shoe company will ever say, "Oops, sorry. We're closing our doors tomorrow.")

aluchko said...

According to that article as someone with very flat feet I'll need to be careful. I've done 20K+ without ill-effects though my stride still doesn't feel completely natural.

I'd be curious to see after how many total kilometres people are showing up in the doctors office. Clearly a lot of injuries are going to occur in the first 100K as people transition, but what happens to the injury rates after 500K, 1000K?

Sharene said...

@ Lindy....."The focus should be body position and what feels comfortable to the individual. Save barefoot running for the beach!"

So we should do what is comfortable for us an individual, as long as it isn't barefoot running? That is only suitable at the beach? Or did I misunderstand you?

Ross Tucker and Jonathan Dugas said...

Hi Jamie

Thanks for the comments and debate.
I'm not 100% sure what part of this post you believe doesn't stand up to the challenge.

My impression of Matt's article is that he is very much against barefoot running. My post is not. In fact, I devote a full section and example of why the testimony of the therapists may be 'flawed' in the sense that they don't have data, only anecdote and that their testimony, even if accurate, has not established an increased rate of injuries.

I've also pointed out at the bottom of this piece that barefoot running WILL work for some people. In fact, this post is not at all a deviation on anything I've written on barefoot running in the past.

I also feel that you may have misread a few things. One is Lieberman's theory. He is certainly arguing that humans did evolve as distance runners. He has most definitely called us the best long distance athletes. However, if you ask Lieberman about this, he'll agree with Matt that not every single person is meant to do it. Especially not today, in 2010. He's a very cautious, very prudent and good scientist, and he would avoid making sweeping statements like "we should all be barefoot". I don't want to put words into his mouth, obviously, but I have no doubt at all that his take will be that barefoot running won't work for everyone for a variety of reasons.

But the point is, Matt has not dismissed Lieberman's anthropological theories at all. He's making the same argument I did in that series when I pointed out that in a group of 100 people, perhaps 10 will have to be fisherman, because they simply cannot run well enough to hunt like the rest of the village.

So Matt's article is an extreme dismissal of barefoot running. I wouldn't go that far, but I also do think that those advocating for it are making a grave mistake to think that what works for them works for everyone. This is what Nike did when their shoe was promised as the solve-all, and that clearly didn't work either. So I'm for moderation. I'm sorry this post didn't say that.

Ciao!
Ross

MichaelMc said...

Thanks for another interesting and entertaining post Guys. You are certainly getting some serious interactions with your latest topics!

I am a moderately high mileage runner myself, own a pair of "five fingers" shoes, and do a little coaching: just to establish where I'm coming from.

I find it interesting that whenever the shortcomings or injury rates of minimalist running comes up, the defense is that the injuries are due to "too much too soon", or poor form. In other words "operator error". I actually think that is largely true, but would add that I find the exact same thing to be true for shod runners.

I have consistantly been able to coach runners from 35-45km/week to >100km/week by simply laying out a program with gradual increases. Many were runners who "couldn't run high mileage", who "weren't built for it". If we take "operator error" out of the injury statistics I wonder how many injuries there would be to study?

Carry on the good work: enjoy the topics, ESPECIALLY the controversial ones.

Anonymous said...

Thumbs up to the comments on Pose. I tried it for a couple years and quit due to recurring injuries.

Before trying forefoot-style I ran heel or mid-foot striking like most folks and was injury-free from 1982 to 2005, with about 12 races a year from 95 - 01. Used padded shoes and ran 10+ miles per run, 3 times/wk for 23 years.

I tore my lateral meniscus pretty bad in a volleyball accident in 2005, so the cushioning in my knee was shot for a long while (bone-on-bone pain when I tried to jog even a few feet, and could not straighten knee 100 percent). No surgery, just high-volume elliptical and leg motions got my cartilage eventually remolded.

Meanwhile after I could straighten my knee I tried Pose running -- presto, no knee pain!!! However, once I got up to 7 mile runs after about 11 months, I got a stress fracture in my hip (less trochanter stress reaction). Based on running videos analyzed, it appears I had a 3 to 4 inch vertical bounce with my forefoot stride, while my normal stride was less than 2 inches.

After 8 months rehab, I resumed running, trying Pose again. After about 2 months, hip pain returned. By this time it had been a couple years after the knee injury, so the next time I came back to running, it was back to the old thick-soled shoes and heel/mid-foot strike. I've been running without hip or knee injuries my old style for the last year and a half.

Forefoot adaptation may not be possible for longer distances for some runners, myself included.

Anonymous said...

Just another anecdote...I've been running pretty consistently for about 30 years. I gave running shoes (motion control, cushioning, orthotics) a really fair test; I figure to the tune of 35,000 miles or so. Basically, a "front of the middle of the pack" type runner (qualified for Boston once), but was getting slower and slower faster and faster. I had signed up for the 2009 NYC marathon (it was my 13th marathon), and was pretty well resigned that it was my last, if I made it at all. My legs were dead, I had painful heel spurs the size of golf balls (well, maybe half a golf tee) and Achilles tendinitis so bad that I could barely walk down the street. I bought VFFs in August, ran a 20K in them 5 days later, and (in November) took 15 minutes off my previous marathon. I'm running times that I haven't seen since 2004 and walking down the street has gone back to being an enjoyable way to get around the city. Does this make me a "true believer" and "over-enthusiastic"? Well, the data is working for me, and as Bobby D said in The Untouchables: "Enthusiasms, enthusiasms...a man has to have his enthusiasms."

IMHO, the good thing that's come out of all of this in terms of the overall running population is this: There are a lot of people out there who can't run in running shoes (Chris MacDougal and Barefoot Ted, among others). For THAT population (and I "truly" believe that I almost joined their ranks), this is now seen a viable option (along with other legitimate ways of leaving the beaten path, such as POSE and chi running).

Cheers, and thanks for your considered and balanced treatment of this topic!

Tuck said...

Re: Mr. Fitzgerald's article: A fellow on Barefoot Ted's Google group pointed out this problem with his logic:
“It’s totally misleading to tell people that when they get injured running in shoes, it’s the shoe’s fault, and when they get injured running barefoot, it’s the athlete’s fault. It makes no sense. You’re going to have injuries either way. It’s running.”

When you're running shod, you can blame the shoes, or the athlete. When you're running in bare feet, who else is there to blame but the athlete?

McDougall has pointed out in recent posts on his blog that what is really the issue in running injuries is form. Sneakers predispose you to bad form, therefore they predispose you to injury. Bare feet provide you the feedback to allow you to avoid bad form (heel striking hurts!).

I'm happy to report that I am currently suffering from my first injury encountered as a result of running a half marathon in FiveFingers. I think I pulled a muscle or ligament in my right foot. Why am I happy about this?

Prior to running in Vibrams, I was astonished at the notion of running a marathon. What pain! How could people run so far? They must have an incredible endurance for pain! I could run only 5 miles or so in sneakers, due to the pain in my shins and joints.

Now that I've learned to run with better form, thanks to running in Vibrams, the notion of a marathon seems like nothing more than a matter of muscle conditioning.

Why am I happy that I got injured running my first half marathon in Vibrams? Because I never would have imagined attempting a half in sneakers. This injury would never have happened in sneakers, that is true; because I would never have tried to run a half in sneakers: it would have been too painful.

So are there people for whom running barefoot-style is not a good idea? Sure, people with club feet, or some other deformity.

But if you believe in evolution, and believe that we are evolved to run, and buy the evidence that there is very little genetic variation in the human species; than the statement that some of us cannot run as we evolved to run, and can only run in a device that was invented in the last 40 years; holds very little weight from a scientific perspective.

The unfortunate truth is that the weight of the scientific evidence is that running in modern shoes is not a great idea. It deforms our feet, it alters our gait, and the race results suggest that it makes us slower.

Three other thoughts: quoting Dr. Pribut, who touts the many benefits of now-discredited motion control sneakers, is like quoting an advocate of using leaches to cure, well, pretty much everything.

Second thought: critics of barefoot-style running make the straw-man claim that barefoot running will prevent all injuries. The only place I've heard this claim is from critics of barefoot-style running. All the material I've read in the barefoot-style running community provide much advice on how to avoid injury, which implies that it can happen, obviously.

Third thought: the notion that you should wait for a scientific study to determine if you should run one way or another, given how the medical and scientific communities have mislead us to date, is the height of foolishness. That study may never even occur.

Use your common sense and make your own judgement.

You might as well wait for the scientific evidence that running in shoes is of any benefit. ;)

Chris said...

Where the heck is the "science" in this recap or in the referenced article? A few chats with a few doctors?

Anonymous said...

Here's the problem with your conclusions.

"I pointed out that in a group of 100 people, perhaps 10 will have to be fisherman, because they simply cannot run well enough to hunt like the rest of the village."

From this idea that one out of ten cannot run, you conclude that we should NOT tell everyone to try running barefoot! That would be like telling elementary teachers to NOT teach reading to everyone, because some students might fail at it! Barefoot is and always has been the evolutionary norm, the burden of neccesity lies with the shoes. I think it's far more dangerous, after a half century of false information, to NOT tell everyone about the LIKELIHOOD that they could run better, with less pain, if they give up their motion-controlled shoes. Sure, a few people might not find success, but like you yourself said, that's the exception, not the norm.

Ray said...

To Chris:

As Rafiki said to Simba: "Lo-o-ok ha-a-arder...".

Barefoot running is inextricably linked to human physiology, inarguably a science.

The root of all this discussion is a Harvard study by Lieberman published in "Nature".

Our scientists point out that Matt Fitzgerald (who is not a scientist, but a journalist/athlete/coach, but nevertheless well respected), "unscientifically" concluded an injury trend, and that we need more science: "Has barefoot running caused more injuries? Or has running caused the same injury rate, regardless of what is on the foot? That's why properly controlled prospective studies are still needed."

Our scientists also remind us that more science is still needed to support barefoot running: "because this is something we don't fully understand yet, but I am convinced that there are individuals who simply cannot get away with barefoot running."

So to ask "where is the science" is simply reinforcing what our scientists said: we need more science both to support barefoot running, and to conclude significant injury rates caused by barefoot running.

Ray said...

To anonymous:

I thought they concluded that you should try it, with caution.

Ray said...

My experience suggests me to believe that a strong shoe makes a weak foot.

I'm inclined to agree with Steve Magness when he talked about barefooot running as a tool, to strengthen underused muscles, and help improve your mechanics.

I wouldn't ever see it as a goal itself, but admittedly this may be based in large part, on an irrational fear of getting cold feet, or unwitting finding some broken glass or rusty nails.

sports articles said...

I have been BFR for 5 months now. My right tibia seems to rotate out. I struggle between trying to keep my feet straight v/s letting it splay (externally rotate).
sports articles

Michael McBeth said...

It is one thing to discuss what evolution did, another to discuss what is best for us as individuals. We can debate whether a 'tool' like a shoe can augment our ability to run longer/faster or whether evolution is more clever than we are. It is a different question whether idividuals who grew up a certain way could change at this point (even if 'barefoot' proved to be optimum).

Many barefoot proponents talk about how shoes "malform" feet. Anyone who has seen the feet of adults who have walked shoeless most of their life will attest they are certainly different than our own. I don't see any amount of gradual transitioning turning my feet into theirs, even if I wanted to.

I don't see the "burden of proof" being on shoes, since that is the status quo (for me) and they work really well. I am keenly interested in (unbiased) studies.

What I don't find very interesting is people suggesting running barefoot MUST be better because it is "natural", or suggesting a shoe company conspiracy. Like all conspiracy theories, I think it gives far too much credit to the powers of organization and marketing. If humans were capable of organized conspiracy on such a scale, you'd think we'd be able to organize world peace or the eradication of poverty.

Shoes arrived well before mass media marketing hype, and everything since then is a variation on a theme. Proof (or evidence at least) is needed on all sides.

Ken Schafer said...

@Michael McBeth

I think you over-stating most of what the minimalist and barefoot running communities are saying about shoe companies. I've heard very little about conspiracies. Most people think that the shoe companies were well intentioned, and that the running boom that started in 1970's would have been impossible without modern running shoes, but now that more is understood about the biomechanics of running, it's time for the shoe companies to rethink running shoe design. Something it appears they are reluctant to do.

Also, I find it odd that anyone would say that since running shoes represent the status quo, the running shoe companies don't have the burden of proof. Runners have an incredibly high injury rate. Clearly, the status quo is not working out very well.

Matt said...

Come on guys..... you bash the barefoot movement...but why don't you show that injuries have stayed the same with people running with the most updated shoes for many years

Tuck said...

@ Michael McBeth

It's true that there's a difference between what's correct given evolution, and what's best for us as individuals.

It may be the case that growing up shod (as I have) so damages you that you cannot return to the evolutionary norm. I grew up shod, and I'm now attempting to return to the norm. I've noticed that my feet have made dramatic adaptations so far. But will I be able to go all the way? Probably not.

I suspect that growth is permanantly altered by growing up shod.

I plan on finding out if it is possible to return to a point functionally equivalent to that of the habitually unshod. The improvements I've made to date make me want to continue.

I'm certainly now able to do more that I was able to do in sneakers. Plus it feels much better.

I'm certainly not going back to sneakers.

Diana said...

Great article from a great series. Thank you for the balanced view - and this was my favorite line:

One-size-fits-all fits exactly no-one

Exactly. Too bad evangelists on both sides of this debate, and the media always seem to forget this.

Tony C. said...

"...not every single person is meant to do it."

Yes, well, I doubt that any reasonable person would disagree. But the inference that an increase in injuries stems from an intrinsic problem with the mechanics of forefoot/midfoot strike running is highly questionable for reasons that have already been stated above.

Obviously there is a profound distance between a person who has grown up running with a forefoot/midfoot strike and those of us who adopt such a style late in life. The true test of the mechanics (i.e. advantages/disadvantages) would be found studying those who have been using such styles for a long period of time, not those who have recently (and often poorly) transitioned.

What I can discern, and quite clearly, from my experience thus far, is that using a forefoot/midfoot strike, along with the 'natural' gait adjustments, markedly reduces pressure on knees and ankles.

I have not suffered from joint problems, but the difference between how my joints feel after running in a conventional style versus a forefoot/midfoot strike is pronounced, if not profound.

The mechanics of this are obvious, as the body's natural shock absorption mechanisms are not fully engaged when striking heel first, and the energy is much better dispersed when avoiding a heel strike. Much like the commentator above who mentioned his changed attitude towards marathons, I now look forward to running further and longer than ever before. The simple reason is that I am more energized, and feel better before, during and after running when soft tissue, rather than joints, are taking the lion's share of the pounding.

Anonymous said...

Right now, our current knowledge is only clear on the following two facts:
1) some people are able to reduce injuries by running barefoot instead of shod
2) some people are able to reduce injuries by running shod instead of barefoot

The problem with Matt Fitzgerald's article and research is that it does not clarify what percentage of runners fit into either of these two groups. I'm glad you recognize that barefoot running can work for many people. It's disappointing that you fail to emphasize that Fitzgerlad's research relies on anecdotal evidence that is no more conclusive than evidence provided by successful barefoot runners.

Lastly, we forget that nearly all runners grow up in supportive, structured shoes that are a historical novelty. There are some large-scale studies that demonstrate that growing up in shoes does, in fact, permanently alter the shape and proportion of your feet. Perhaps if we grew up without shoes (or in nothing more than leather slippers), which was the norm on several hundred years ago, the success of barefoot or minimalist running would be different for the general population.

Matt Fitzgerald may be your friend, but his articles have shown personal animosity towards barefoot runners. Read the last paragraph of his first article on this issue for Competitor.com. It's downright mean-spirited.

Please try to remain objective 'scientists' on this issue, unlike Matt Fitzgerald. Neither side will benefit from the type of personal animosity that Fitzgerald has shown.

Anonymous said...

Good thing we are all born with shoes.

JP Kab said...

Question for Ross and Jonathan:

Do you think that it may be easier for non-runners to start from zero mileage with barefoot/minimal than for habitual shod runners? As a person who had stopped running for a long time due to injuries, I didn't have to worry about "going too far, too soon." I also wasn't as predisposed to the muscle memory associated with heel striking(which my old running shoes greatly encouraged due to a thick heel and thin front).

I like your articles, and agree with your view that we should wait for the evidence. I just felt that this was a valid point, because the pattern I've noticed with my friends who have bought VFF's is that the one's who are high mileage runners (plagued with injuries) end up trying to run 5 miles the first time they go out, despite my warnings. This is anecdotal obviously, but it would be interesting to see a real study conducted on success rates of injury reduction in switching runners with shin/knee/hip problems from conventional to minimal running shoes.

Joe Garland said...

Saucony has just come out with the Kinvara, with the major selling point of a dramatically reduced heel-to-toe drop, which is a major pitch for Newton. New Balance has also come out with low-drop shoes, and I'm sure others are/will as well.

It would seem that the shoe companies are expanding the range of shoe options.

Matthew said...

I just completed my first marathon. I ran in VFFs and I had a really hard time due to a cramp at 9K in a calf. I have about 300km training in the VFFs and my knees and shins are great but I did not have a lot of time running at race pace. I need more mileage to get better at landing softly and I need better conditioning to get faster. Overall, two days after the race I am not limping much more than my shod friends.

melissa said...

Another excellent post and lively discussion. I will state upfront- I have tried both and have been successful barefoot and shod, although I prefer shod because I run faster and I hate the feel of wet grass on my feet. A couple thoughts on running-

As for evolution, we do not run now how we ran then. When hunting, the pace is stop and go, not a consistent tempo for the duration. So, in my opinion, may not be the strongest argument for an approach to running in today's running culture.

All of the 'talk' about how you should run takes the enjoyment out of it. Personally, I cannot stop thinking about how I should be running while out for a run. It has been driving me nuts ever since the series on Pose running! I prefer the wear what makes you happy approach. I appreciate the hot topic aspect, but maybe a new physiological or biomechanical topic soon so I can maintain my running sanity!

Ross Tucker and Jonathan Dugas said...

Hi All

Thank you for the lively discussion on the post. Much appreciated. I haven't been able to respond adequately, because I've been flying from Scotland back to SA, so in transit.

Just a few comments.

First, to Matt:

That's a very frustrating comment you've made. I tried really, really hard to emphasize in the post that you need to read previous posts. I hardly ever do this, but I made a point of linking back not once or twice but three times and imploring that you read them, because I know that people will take things out of context. Yet somehow you have still arrived at the conclusion that we "bash" the barefoot movement. You clearly have read neither this post nor any of the others that I linked to.

And as Ray has said, we did in fact conclude that barefoot running has merit, so I really am at a loss to respond to your comments. I love debate, but you seem to have missed the conclusion and drawn out one or two sentences.

Then to Anonymous at 6:58, who wrote "Matt Fitzgerald may be your friend, but his articles have shown personal animosity towards barefoot runners. Read the last paragraph of his first article on this issue for Competitor.com. It's downright mean-spirited. Please try to remain objective 'scientists' on this issue, unlike Matt Fitzgerald. Neither side will benefit from the type of personal animosity that Fitzgerald has shown."

This again is frustrating. I gave two distinct paragraphs to pointing out that Fitzgerald's article was based on anecdotes. As Ray has pointed out, I've even stated that prospective studies are needed to answer the questions, and I think you actually have the same take as we do.

This is why your criticism of remaining "objective" is, i feel, unwarranted and unfair. Again, I implore you, please read the series we did on barefoot running, where I believe I did the best objective job possible given the lack of evidence (which you yourself point out). I can only think that you haven't read it.

I'm with you on the animosity, but I also would ask that you need to understand that Matt has tried barefoot running (he has tried many things) and it hasn't worked. Rightly or wrongly, he has thrown out the concept, perhaps too soon, but he's as entitled to do that based on trying it as you are to support it having tried it.

And this goes to everyone on the forum. There are a lot of people who are very scathing of people who criticize barefoot running. Even we've been on the receiving end of that for this post, which is not even critical of barefoot running! It is cautionary, not critical.

But to those who dismiss the criticism so disdainfully, it pays to remember your positive experience is matched by the negative experience of others who have tried it but failed. And often, they have good reason. Some dismiss it out of hand, having never tried it. And I just have to emphasize again that if you adopt the position that says "shoes are bad, and you must run barefoot to avoid injury", then you are doing the same as the companies and doctors you so vocally criticize. If shoes have worked for some, and not for others, the prudent approach is to first acknowledge their possible benefits, and then seek improvements. Not to dismiss anyone who has anything but praise for barefoot running.

I await the research eagerly, if it is ever even possible to do the study that will provide the evidence we're all after. But until then, I feel that if you advocate a "must follow" approach, you're guaranteed to be wrong. Never a good position to be in!

To Michael, Ken, Tuck, Tony C, thank you for your accounts and thoughts on the issue. They've certainly improved the post.

Regards
Ross

Anonymous said...

The "us against them" industry meme for barefoot runners doesn't really exist.

1. Best case scenario for barefooters is slow and steady growth in adoption, then a big boom, then a new trend after bare feet.

2. There is plenty of time and customers for shoe companies to change existing product to capture some facet of the barefoot trend. Look at the 'new' flatter shoes.

3. At some point, the major shoe companies will come out with a barefoot style of their own until the next trend is identified.

Thanks for the blog!

aluchko said...

A question about the plantar fasciitis injuries. Are those injuries typically due to impact or overuse? I've noticed that when going barefoot my heel hits harder than I think is proper, which could conceivably cause injury on those grounds. Another possibility is the tendon getting injured through overuse.

Anonymous said...

"...somehow you have still arrived at the conclusion that we "bash" the barefoot movement."

I do have a problem reading your full post---because of your headline. Your headline and opening material is !CLEARLY! biased against barefoot running, therefore what reader would assume that you aren't "bashing"? If you don't want the negative criticism, change the opening and headline to reflect a more neutral, unbiased opinion.

Ross Tucker and Jonathan Dugas said...

To anonymous:

No, it doesn't. You are basically saying that you read the headline, arrived at a conclusion, and then failed to read the rest of the post. That is poor. I find it very frustrating that you have clearly failed to follow through and read the rest. Then there is the matter of a whole series on barefoot running, which I really did implore you to read. That too went by the wayside.

I'm sorry you disagree with the headline, but in the post, I explained the context, the history behind where that headline came from. I don't believe it bashed anything - it had a historical context, which was explained, and then clarified in the post.

If you're not prepared to explore the subject matter, then quite frankly, you will arrive at random conclusions.

Ross

Ross Tucker and Jonathan Dugas said...

To aluchko:

Both, probably. There's a bit of debate and uncertainty around this when it comes to injuries, but the general consensus is that they interact. If impact goes up (per footstrike), then the overload "threshold" comes down, meaning that you may say, pick up the injury running 5km a day. If the impact is lower, then the volume increases to produce the same injury.

So the two are linked very closely.

Ciao!
Ross

Ray said...

One more comment:

I just re-read Matt Fitzgerald's "Brain Training for Runners", the part where he talks about modern shoes. One of his points, is that runners develop bad form, and injuries, (in part) because of modern shoes, pointing to an article by Dennis Bramble and Daniel Lieberman.

He recounts his positive experience with the Nike Frees (3.0, 4.0, and 5.0) and the Vibram Five Fingers, and he is fully convinced that minimalist shoes are less likely to cause injury. Nevertheless, he likewise recommends that a formal scientific evaluation is required, and gives a cautious and qualified recommendation for minimalism (including not recommending it if you are fine now, or you try it and it doesn't work).

So it is interesting now, taking the extra step (shall we say) to barefoot running, that Matt talks negatively about it, citing injury increases, and that it's not for everybody for bio-mechanical reasons.

Ross Tucker and Jonathan Dugas said...

Hi Ray

Good point, and this is what I'm also getting at when I say that Matt is someone who won't simply dismiss it. In fact, he's someone more likely to embrace the barefoot running concept than anyone is, but he hasn't.

He alluded in that article to his own struggles with injury, despite his careful approach, and that is why I'm inclined to really take heed of what he says, as I've written in the very latest post.

I'd really be listening. My own experience, for what it's worth, is that barefoot running didn't work for me, despite trying to be very careful. I was much more careful running in Vibrams than in shoes, but still got injured, and it was a new injury, never had before. So I'm with Matt on the cautious approach, not the outright dismissive one.

Cheers
Ross

Erik Backes said...

This is an excellent article and should be required reading, along with your longer series, for anyone considering barefoot, minimal, pose, chi (the list really does go on) running. Unfortunately, we seem to be a quick fix society and jump into anything that promises to cure all of our ailments without considering the requirements. I first started Pose running a couple years ago after picking up the book and can admit that there was some initial soreness from the change. I have recently started barefoot and minimal running in Vibrams and am following the advice of many experts to transition into these activities EXTREMELY slow. Some may not realize the patience it can take and I think it may be best to start with barefoot over vibrams because at least you realize very quickly how tender your skin is before building up the needed pads and thickness and you turn around and head home before doing internal damage. I had this same benefit when I started Pose because I had just come off of knee surgeries and an extended period off running so I had to start small and work my way up. With barefoot I am only doing a half mile tops every 2-3 days which can be frustrating when you are a runner who is used to going 10 miles plus shod. So, I mix it up and do my long runs in Pose acceptable footwear and save the short run training, no speed and no ego for the barefoot and Vibrams.

Farid said...

I'd first like to applaud Ross for his Malcolm Gladwell-esque point "that most who switch to barefoot and fail would end up switching back and not saying a thing while those that succeed will tout it loudly." (gladwell is a bestselling author in the U.S. that approaches social issues with a more empirical point of view). While anecdotal evidence has its place, it by no means should be used as any sort of proof and should be reserved for the bedside when it comes to updating fundamental knowledge.
That said, the mounting evidence that homo sapiens developed long distance running as a parallel skill and NOT as simply a different version of walking should be evidence enough that running barefoot is at least possible for us as a race. But, let's not forget, early humans learned to run and grew up in much different conditions. There has been anthropometric work that shows that being shod our entire lives changes our foot anatomy and those who remain unshod throughout their younger years develop different foot dynamics.
The argument that running wear is a personal fit (pun intended) is the crux of this argument.
We need to understand how feet adapt to shoes and the mechanisms of injury for running in general, and for people who switch between gear or lack of it. In today's world, the right combination will probably be different based on how that person was brought up, their physical characteristics, their environment, and how plastic their anatomy is.

Rob Claus said...

I don't find these evolutionary arguments convincing. Take a look at your average Inuit (eskimo). His ancestors, like everyone else's, came from Africa at some point, but that was a long time ago. The Inuit have evolved in an environment that rewards conserving body heat, not running down antelope. They tend to be short and thick in comparison to other ethnic groups. Are they "born to run"?

The Inuit are an extreme example, but this applies to some degree to anyone whose ancestors lived in an agricultural society, or a cold climate. If you're a slow antelope, you die young, but it's been a long time since that was true of humans in general.

Ken Schafer said...

@Rob

Not a long time in evolutionary terms. In any case, out of necessity the evolutionary argument is presented in an over simplified version on a form such as this. But that does not invalidate it. Also most people think they understand evolutionary theory, but are really very ignorant on the subject. So that only adds to the confusion.

Matt Metzgar said...

In Matt's article, it said he tried to run in Vibrams. This is NOT barefoot running. If he went barefoot on pavement it might have been a different story.

Barefoot running means the bare foot, not minimal shoes. There is a huge difference.

Ross Tucker and Jonathan Dugas said...

Hi Matt

I agree with you...partly. If you start talking about pure barefoot running though, then you introduce all kinds of factors that this debate hasn't even covered.

What I will say is that the barefoot movement has mostly embraced Vibrams as their "tool", and so for all intents and purposes, the marketing has set it up as barefoot. In this sense, perception is reality. And, there are studies that find no mechanical differences between Vibrams and barefoot running. The only difference will be the sensory feedback from the foot. So I agree on that basis.

Mechanically, though, the science says otherwise. So does the marketing. Perception is often reality - scientifically, in this case, it is too....

Ross

Matt Metzgar said...

I agree this is slightly off-topic from your debate, but it all started with Matt saying he couldn't run barefoot (when he was actually running in shoes).

As far as the science, Christopher McDougall recently met with Dr. Ireve Davis and they found that even minimal shoes cause problems:

http://www.runcolo.com/content/220-interview-christopher-mcdougall.html

"I had this conversation with Dr. Davis recently, and I tried to make the case that minimalist shoes (racing flats, water shoes, moccasins, whatever) were as good as bare feet. She shot me down. She said that once you cover up all those nerve endings in the foot, you’re taking a step backward. You’re losing ground awareness, stability, balance, all kinds of key input that you can only get from a naked foot. Then, she proved it to me. She had me run three tests on her force-impact treadmill: first in bare feet, then in fivefingers, and finally in the Nike Free 3.0 (the thinnest Frees on the market)."

This isn't published research, but I assume it will be at some point. I think research will eventually show huge differences between barefoot running versus using any minimal shoe.

Tache said...

I really enjoyed this article because it gave a really unbiased and purely objective view on barefoot running. Which, I must say, is terribly hard to find on the web, and is much appreciated.

I do have one question though. As far as barefoot running or minimalist running are concerned, where do cleated sports (Soccer, Ultimate Frisbee, Football, etc.) fall? Are they considered minimalist? Shod? or what?

If you excel in cleated sports, should you train for them in bare feet? with shoes? with cleats? or just whatever works? Has there been any research on the similarities or differences between cleats, feet, and shoes?

aluchko said...

According to that article as someone with very flat feet I'll need to be careful. I've done 20K+ without ill-effects though my stride still doesn't feel completely natural.

I'd be curious to see after how many total kilometres people are showing up in the doctors office. Clearly a lot of injuries are going to occur in the first 100K as people transition, but what happens to the injury rates after 500K, 1000K?