HealthyFeetBlog.com

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.

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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