Ask a Podiatrist: Myths About Barefoot Running

Mar 5th, 2010 by Amanda Strouse | 23 Comments So Far

This new “barefoot running” fad is blowing up. Articles and web sites regarding this “new and healthy” way of running can be found all over the Internet. So I interviewed Dr. Jeff Hurless, a foot and ankle surgeon, podiatrist, partial owner and medical director of HealthyFeetStore.com, to get the facts straight about barefoot running.

woman running barefoot at the beach

A study published in PM&R: The Journal of Injury, Function and Rehabilitation showed that running on a treadmill in the Brooks Adrenaline shoes increases stress on the knee joints up to 38% compared to those who ran barefoot on a treadmill.

Why do you think the study found that?

It would be dependant on the subjects. Who were the subjects? Those kinds of studies have so many variables. What type of treadmill? What pace? Was it inclined? Did the subjects have pre-existing conditions? What were their foot types? Did they ever have surgery on their feet, knees, back? You can pick apart that study so fast. How many subjects were there? It’s a meaningless study in my mind. Anybody who has any interest in research or does research knows you can pick apart those studies in the first paragraph. The downside is that the average person doesn’t know that.

The whole basis behind barefoot running in my opinion – I don’t advocate it or anything – from what I know about it, there were reasonable studies that did show an increase of efficiency of the lower extremity, with barefoot running as opposed to shoe running. I’m not going to debate that – I agree with that. What it comes down to is when you have a shoe on, there is more of a heel strike as opposed to a non-shoe runner, where you strike more in your forefoot. When you heel strike, a lot of the energy you built up in a run gets taken away with a vertical heel strike. Opposed to if you’re landing on your toes, that energy isn’t as absorbed, it gets put back into to propel you forward. I would agree barefoot running is slightly more efficient than running with shoes. A slight amount.

However, barefoot running isn’t for everybody. If you look at the mechanics of it, not everyone can handle it. It’s a very small percentage of the population. The percentage who can run barefoot and not create problems, that’s great. It’s very few and far between.

There’s absolutely no study currently that has shown that a heel striking contributes to more injury than forefoot striking. Who cares if you have more force on your knee if it doesn’t cause any trouble?


You can never make a broad statement that barefoot running is better for you – not today. There are just too many variables. It may be better for that 2 percent – they might have a more efficient stride. We can never blanket that statement.

 

What types of people can run barefoot?

It has to do with muscle type, slow twitch/fast twitch mussels, reflex efficiency, connective tissue, stability of tissue, bone density of foot. Tissue type and foot function make a difference. There’s no way that the patients I see with collapsed arches could run barefoot. A flat foot is a severely unstable foot. We rely on adding support back to that foot so they can function better. That type of person would never be able to be a barefoot runner. And body weight matters. You’re not going to have a 250 pound person out there running barefoot. Body type, foot type, tissue type – that is what selects the type of people that can run barefoot.

 

The doctor from the study attributes the increased stress to the characteristic design of the majority of running shoes, including an elevated heel and increased material in the midsole arch. She suspects the cushioning in the heel counteracts the body’s natural response to compensate for the torque associated with impact.
Is there some truth in that?

Those numbers may be correct. It boils back to if you look at people running with shoes and without shoes. You do have more of a heel strike when you’re in a shoe- so that vertical force that gets absorbed through the heel goes up the leg, but I really can’t debate that. I’m not saying that added force is bad. Did it translate into knee problems? The stress doesn’t necessarily mean it’s a bad thing. Comparing the shoed-running to the non, there is more force that does get absorbed through our heel, ankle, knee and hip. However, our mind changes the foot position when you run barefoot, and its been shown they spend more time on their forefoot, which overall is slightly a more efficient way to run, but again not everyone can do it.

There are very few individuals who can withstand barefoot running. In today’s society, everyone wears shoes, it’s expected. You can’t go from wearing a shoe 98% of your life to running barefoot. Our society will never be without shoes. We can’t fight that. People with foot problems and foot pain- the worst thing they can do is run barefoot.

The doctor running the study said she isn’t advocating that runners take up barefoot running- just that her findings may be a reason to redesign running shoes.
What do you think makes a healthy athletic shoe?

I’m more for support. The population I’m dealing with, I’m always recommending support. For the 90 percent of the population who can’t run barefoot, the characteristics would include: a more slightly elevated heel than the forefoot, it takes tension away from Achilles tendon and plantar foot structures. The mainstream athletic shoe now has a thicker heel, because when the heel is slightly higher than your forefoot, it does relieve some of the stress of the Achilles tendon and plantar foot structures. A ridged sole with an appropriate flex point – it should only flex at the toe box not anywhere else. Because our toes need to flex there but we don’t need it anywhere else. A firm heel counter that goes around the back of our heel. It needs to be ridged. Adjustability is an important part of an athletic shoe- being able to fit the shoe well to your foot makes, the shoe will then provide better support. Uggs are very loose and sloppy, so they’re not supportive. It’s great if you can tighten the shoe around your foot. Also shoes that are durable, absorb shock.

 

There is a growing barefoot running community. Why do they say running barefoot feels better than in shoes?

Probably – for that few select group who can handle it – it boils down to it is a slightly more efficient stride. You’re avoiding that heel strike; that loss of vertical force that happens when we heel strike that is absorbing that energy isn’t there in the barefoot run.

 

What types of foot or joint problems will these people develop later?

If somebody new to barefoot running starts doing it, they can get plantar fasciitis. I have a patient who was a tri-athlete and started barefoot running and came down with plantar fasciitis. You can also get a variety of tendinitises or soft tissue injuries. If you’re already a slightly over-pronator, you’re going to really over-pronate and you can get tibial tendinitis. If we lived without shoes, we’d probably have more success at barefoot running. The bone density might be better and muscles would be stronger. But we’re not always on our barefeet – it’s our society and culture to live in shoes and that’s the way it’s always going to be. We’re not in the best position to run barefoot.

 

Is there any activity that people should do barefoot, besides showering?

Exposing our body to being barefoot is important to a degree. We rely on our feet for many other reasons other than propulsion – we use them to see what the temperature is of the ground, if the ground is level, if the ground is moving. We have all these nerves that give us feedback that we don’t even think about. To basically exercise that sensory input is best done barefoot. We do use muscles in the feet a little more – tiny intrinsic muscles in the foot, we use them more barefoot. Exposing ourselves to barefoot time is appropriate, but there is a balance.

 

Why is support in a shoe good for your feet?

Our foot needs to serve as a rigid lever so that we have that lever to propel ourselves forward. That’s why we got rid of that opposable big toe. We don’t climb trees anymore. So we use feet primarily to make us go forward. We need stability, we need our foot to be on the rigid side so it does its job, so we can contract our muscles so we can go forward. So support is imperative for our normal functioning foot. A good percentage of people are over-pronators: about 60 to 80% of people. Pronation is a normal motion in our ankle. Pronation is when the arch goes down. We don’t want to over-do anything. Over-pronation is absolutely not good for feet. It causes many problems in the feet. Adding support to prevent this over-pronation of the foot is important.

As we get older, we need more and more support around our foot. We lose our ability to support our feet. Gravity will slowly drop your arches, lose stability in your tissues of your feet. 

 

If you had the time and resources to do a study, what type of study would you do?

Something that has to do with women and high heels – because that’s a huge speed bump for us in foot medicine. Dealing with women with foot problems that need to wear high heels. I’d put some research into the ultimate high heel that’s good for the foot. There have been attempts.

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23 Comments on “Ask a Podiatrist: Myths About Barefoot Running”


  1. barbee said:

    very informative!!


  2. Mauricio Morales said:

    I used to suffer from both “overpronation” (almost flat feet) and plantar fasciitis, as well as shin-splints (among a whole other list of foot ailments) until I started going barefoot on a regular basis almost 20 years ago. I haven’t had such problems in nearly 18 years.

    In an effort to loose some weight, and inspired by numerous fellow barefooters from all over the globe, I’ve recently started power walking and light jogging in minimalistic footwear as well as barefooted and my feet, legs and back, are perfectly fine.

    I did notice, however, the shin splints came back as soon as I put a regular pair of “well supported” sneakers over the weekend. I got rid of them by doing some stretching and going for a 50 minute barefoot power walk/jog today. I think that in itself speaks volumes about how barefooting is a much more sensible way to go.


  3. Barefoot Josh said:

    Then surely you, as a podiatrist, would be fascinated to see my perfect feet! Check them out at http://barefootjosh.com

    Seriously, running barefoot is easy. I’ll train a 5’8″, 300 lb person to run barefoot. I don’t care who you are – if you have feet and working nerve endings in your soles, you can do it.

    And even more seriously, until podiatrists start speaking out against products like these:
    http://birthdayshoes.com/top-10-most-gimmicky-shoes
    I will consider any expression of concern for the health of their customers to be disingenuous.


  4. Lydia Adams said:

    My husband is a serious runner working toward his first half marathon. He’s got flat feet and overpronates so I know he could never run barefoot. He needs running shoes with serious shock absorption and support.


  5. Barefoot Johnny O said:

    Dr. Jeff,
    After you check out the perfect feet of Barefoot Josh, come check mine out at http://barefootjohnnyo.blogspot.com/


  6. Peter Bird said:

    Barefoot runners have attention seeking mental health issues. They are nutters that lie about research and twist research around to pretend it supports their case. They are irrational and not capabable of discussing issues. They criticise people making any negative comments about barefoot running, but are not capable of addressing the actual negative comments. They are so gullible that they fell for all the fiction in the book, ‘Born to Run’

    See this site:
    http://www.runningbarefootisbad.com


  7. Sam Harkin said:

    Agreed. They make up less than 0.0001% of runners so are nothing more than a vocal insignificant irrelevant minority.


  8. ~*~ Jennifer ~*~ said:

    If barefoot running is working for someone, why criticize? I think it’s great! If you are excelling while wearing running shoes, that’s great too! Do whatever works best for YOU. That is the bottom line.


  9. Girl Gone Primal said:

    Aw, I was taking this seriously until

    “If you look at the mechanics of it, not everyone can handle it. It’s a very small percentage of the population. ”

    Guess those hunter-gatherers who needed to run-down their prey sure could have used some shoes so that everyone could join in!

    Pronation issues are, as I’ve read and experienced through others, pretty much always caused by footwear. To say that someone now ‘needs’ shoes because of those conditions is like saying a baby with nappy rash needs to wear a nappy so that no one can see the inflammation.

    I don’t criticise any personal choices that people make, but manipulation of data (and logic!) to enforce an ideal is always wrong. I was intrigued to see if the barefooters were guilty of the crime of bias, but even if they are, this opponent is guilty of the same charge.

    Personally, I’ve always had short calf muscles, and used to have to perform torturous stretches every day to try and give myself a day of enhanced flexibility. I tried every kind of shoe to try and find a way to walk in comfort for long periods of time. I wanted to be able to drive, but I couldn’t lift my foot high enough to be able to sensitively operate pedals.

    Cure? Vibram FiveFingers. I wear them on my walks to and from work, and even though I wear high heeled boots for most of the day, my calves are supple and flexible. I can walk forever without calf stiffness. I’m not a runner, but I understand the logic and the science behind the ‘return to nature’ (ignoring the cultures that have always run barefoot).

    I guess we’ll hear about it if barefooters end up with the same ‘runner’s knee/hip’ as shoed runners, but until then, it’s working for people, so why bother with criticism and conjecture? Are you selling shoes? Does your livelihood depend on people having foot problems?

    Oh, right.


  10. John said:

    I like to add to the comment of Peter Bird above: http://runningbarefootisbad.wordpress.com/


  11. Jason said:

    If the good Dr. is going to provide anecdotal evidence to support the claim that barefoot running causes plantar fasciitis, “I have a patient who was a tri-athlete and started barefoot running and came down with plantar fasciitis.” I’d like to provide my own anecdote: I had plantar fasciitis in my right foot for 6-7 years. After 1 month of barefoot running, my plantar fasciitis was gone.
    Barefoot running cures plantar fasciitis!


  12. Daniel said:

    @Peter Bird

    I really enjoyed the irony of your post and how right after stating “Barefoot runners have attention seeking mental health issues. They are nutters that lie about research and twist research around to pretend it supports their case. They are irrational and not capabable of discussing issues.”, you say that “They criticise people making any negative comments about barefoot running, but are not capable of addressing the actual negative comments.” In case you didn’t pick up on it, you attack barefoot runners for twisting research and claim they have mental health issues (neither of which you have proven, you are just “twisting” things you have seen on the internet), but then attack them again because they criticise people (which you just did yourself). Irony.

    Note that I am not a barefoot runner, but I have nothing wrong with barefoot runners. ~*~ Jennifer ~*~ seems to be a barefoot runner, but she wasn’t a “criticising” “nutter”. In fact she made positive comments on shod running, you are making shod runners seem like a bunch of angry “nutters.”


  13. Jen said:

    GirlGonePrimal said, “Are you selling shoes? Does your livelihood depend on people having foot problems?

    Oh, right.”

    Girl, your comment completely sums it up. Since it was at the end of your post, I thought I’d bring it up again. The Dr. who comments in this article is: “a foot and ankle surgeon, podiatrist, partial owner and medical director of HealthyFeetStore.com”

    Yep. As Girl pointed out, he sell shoes (awful high-heeled running shoes mainly, it seems) and his livelihood depends on people having foot problems.
    Of COURSE he is anti-barefoot! People not buying shoes and having strong, healthy feet means Dr. Jeff would be out of a job!

    Me, I’ve been going barefoot for a year now. It cured my plantar fasciitis. Oh, and I’m not a “barefoot runner” because I don’t run. (Guess I’m just a “barefooter.”)


  14. hanapapa said:

    This article lost me immediately calling barefoot running a “fad.” This doctor sells shoes and other “devices.” If you don’t want to run barefoot, people, nobody’s forcing you. But some of the comments are so mean; people are getting a little weird about it. For many, like myself, BFR has enabled me to run farther and injury free. Granted, if people don’t start gradually they will get injured. I just ran 10 miles on pavement barefoot. Not bad for a 58 year old. Let’s stay open minded, people.


  15. TXwalker said:

    What I find irritating is this myopia on running as proof of barefooting good/bad. For the past twenty years I’ve participated in barefoot exercise with people of all ages who have no problem being barefoot: bellydancing, nia, yoga, martial arts, etc. That said I did wear sandals when I hiked the Rockies because I didn’t want to deal with pointy rocks. I cannot run a minute due to hip shape making me the most inefficient runner on the planet (imagine Marilyn–I’m curvier) so I gravitate toward dance as exercise. I was considering adding kick boxing but I’ve grown used to not wearing exercise shoes that the thought is unattractive.
    That said I totally believe in closed toed sensible shoes at work because we move furniture….


  16. Cat said:

    I was told by the experts at the local running store ( including an in-house podiatrist) that my feet over pronated too much and my joints were all too loose. Their conclusion for me was to sell the most expensive running shoes and recommend that I not run more than 5ks. Well many races and marathons later I got sick of the pain, twisted ankles and muscle imbalances of my pricey shoes and went back to the way I ran as a kid- barefoot. Guess what? A couple years later, I’m strong with stable feet no imbalances and am training for a marathon then ironman barefoot. It’s no big deal to take off for a 10 mile run. I started barefooting before born to run, but love the vast audience of supporters for this “fad”.


  17. Erwin said:

    I started wearing the five fingers about two months ago. I now have five pairs with my favorites being the leather lace up ones. I wear them three or four days a week. I don’t run in them but I enjoy hiking and hunting in them. I have started reading this article because I have noticed that my planters isn’t noticable any longer. Imagine that.


  18. Chris said:

    I’m flat footed. I run barefoot or in the Vibram fivefingers. I’ve run almost every day for nearly a year now. I haven’t had a single injury since.


  19. RENEE said:

    love this: “No stonemason worth his trowel would ever stick a support under an arch; push up from underneath, and you weaken the whole structure. Buttressing the foot’s arch from all sides is a high-tensile web of twenty-six bones, thirty-three joints, twelve rubbery tendons, and eighteen muscles, all stretching and flexing like an earthquake resistant suspension bridge.” ― quote from Christopher McDougall’s book Born to Run


  20. Jer said:

    Premise: Back braces cause atrophy in lower-back muscles.

    Premise: Arm slings and casts cause atrophy in the muscles that they prevent movement in.

    Premise: Artificial muscular support replaces the necessity of said muscles – subsequently atrophy occurs therein.

    Premise: The objective of the professional field of physical therapy is to grow muscles by using them correctly and incrementally.

    Rhetorically Phrased Logical Conclusion: Why then would arch supports work opposite to what anatomical science has determined to reverse musclular growth?


  21. Niklas said:

    Hey! Do you use Twitter? I’d like to follow you if that
    would be okay. I’m absolutely enjoying your blog and look forward to new posts.


  22. JennaG said:

    Yes, you can follow us on Twitter @gethealthyfeet.


  23. JennaG said:

    Yes we do! You can follow us @gethealthyfeet