Beware of Barefoot Running Injuries

Posted by on Tuesday, June 15, 2010 @ 9:17 am | 19 Replies

by Danny Abshire, co-founder, Newton Running

People have been experimenting with barefoot running for a long time, but in recent years the activity has gained mainstream notoriety and science-based credibility.

Most coaches, elite athletes, physiologists and other medical experts agree that running barefoot in very small doses on soft surfaces can help improve your running mechanics and teach your body to land lightly at your midfoot, but they also agree that you should wear some kind of running shoes most of the time.

“Throw your shoes away for good? Sure, if you have perfect mechanics and you’ve been living barefoot all of your life,” says Dr. Mark Cucuzzella, a West Virginia University professor and 2:25 marathoner who has studied barefoot and minimalist runners in relation to running injuries. “But that’s not the majority of runners. Most runners absolutely need to wear shoes when they run.”

What Shoe Type is Best?

If you’re used to running in a traditional training shoe with a built-up heel, running barefoot can be a fascinating experience of freedom and can be the first step in developing natural running mechanics. Running unshod your foot naturally seeks out the ground by landing at the midfoot/forefoot, where it receives sensory interaction, or afferent feedback.

This sensory input immediately tells the rest of the body how to move efficiently with light footsteps, a high leg cadence, a relaxed but consistent arm swing, an upright posture and a slight forward lean from the ankles. This same feedback can be gained while wearing some types of lightweight shoes, but traditional trainers with thick levels of foam dampen the sensory interaction and make it much harder to interpret the ground, especially with the heel-striking gait those shoes promote.

How Run “Barefoot” in Shoes

Landing lightly at your midfoot and picking up your foot quickly to start a new stride is the most effective way your body knows to propel and protect itself while running. Conversely, your body generally doesn’t allow you to land on your heel if you’re running barefoot (especially on a hard surface) because it isn’t engineered to accommodate the blunt force trauma of repeated heel striking.

True, the calcaneus (heel) bone is a large bone, but it was designed to take the lower impacts of a walking gait and help balance the body as it rolls forward, as well as to help support and balance the body in a standing position as the rear point of a tripod.

Accepting large impacts on the heel bone from heel-strike running on the roads barefoot sends tremendous shockwaves (or impact transients) up your body. Those impact transients can have numerous negative affects upstream as your body tries to offset that force and remain balanced, including various forms of tendinitis, illiotibial band strains and adverse sheering in the pelvis and lower spine.

“It’s no different than somebody hitting you on the heel with a sledgehammer with 300 to 400 pounds of force,” says Dr. Daniel Lieberman, the Harvard University evolutionary biologist who concluded in a study released in January 2010 that running with midfoot footstrikes, either barefoot or in shoes, is better and less impactful than heel-striking. “So if you’re going to do that, it makes sense to wear shoes. A shoe makes that comfortable. A shoe essentially slows that rate of loading enormously — by about sevenfold in a typical shoe — and that’s what makes it comfortable and that’s why a lot of people can wear shoes and heel-strike.”

Is Running Without Shoes Bad?

Many proponents of barefoot running point to Ethiopia’s Abebe Bikila as the patron saint of barefoot runners. But even though he won the 1960 Olympic marathon through the streets of Rome, there’s much more to the story. Having run barefoot for much of his life, it wasn’t a huge leap for Bikila to consider running without shoes. What most people forget is he continued to run — and win — marathons while wearing running shoes, including the 1964 Olympic marathon in Tokyo.

Even though Lieberman’s study concluded that barefoot running with a midfoot stance was more efficient and less impactful than running with a heel-striking stance in shoes, he doesn’t mean you should run your next big city marathon barefoot. Nor should you train regularly without shoes or run on the roads without shoes, at least according to most doctors, podiatrists, physical therapists, coaches and elite runners. Running barefoot on the roads or running barefoot most of the time is just not practical or safe.

“I definitely feel like the risk of injury is a lot higher. People don’t know how to temper themselves and they get too excited about this new thing and trying something different without a building process,” says two-time U.S. Olympian Alan Culpepper, a 2:09 marathoner and owner of Solepepper Sports in Louisville, Colo. “I think to run exclusively barefoot or in minimalist shoes is more of a lifestyle thing and not really about performance running,” he says.

Some foot types cannot handle the impacts of barefoot running, such as feet with hyper-mobility, hypo-mobility or imbalances in the forefoot that need correcting by an orthotic. Also, tissue in muscle, tendon, ligament, skin and the fat pads under your feet can take a long time to adapt to hard impacts, contact with abrasive surfaces and the full range of motion that occurs when barefoot.

Drills Help Restore Proper Foot Function

Work boots, men’s and women’s dress shoes, cowboy boots and many other types of sneakers have elevated heels, which means most of us are accustom to a limited range of motion, dampened feedback, a layer of protection and a shortened Achilles tendon. Even small amounts of barefoot running (or walking) can leave feet sore and fatigued, but too much barefoot running can lead to injuries like plantar fasciitis, a inflamed Achilles tendon or strained calf muscles.

Most of America’s top professional and collegiate distance-running coaches utilize some form of barefoot running or barefoot strength and proprioception drills in small doses. Used properly these drills can improve balance, strengthen the small muscles in the feet and lower legs and maintain a runner’s form and, ultimately, individual running economy (oxygen cost at a given pace) to maximize race performance.

But if you’ve never done any kind of barefoot drills or running, it is important to transition into unshod exercising very slowly. Consider starting with barefoot lunges, barefoot squats or walking barefoot through sand with accentuated rolling from heel to mid-stance to toes. After a few weeks, you can start running easy acceleration strides or a few cool down laps on the soft grass infield after a long run or track workout.

The principle behind barefoot running makes sense, but even if you’ve got great mechanics and exceptional core strength, you should still run with shoes to keep your feet out of harm’s way and choose a lightweight, minimalist shoes with a low ramp angle to mimic the bare foot. Shoes will protect your feet from hazards like glass, gravel and debris, and they will provide thermal protection properties.

The bottom line: if you’re going to run barefoot, do it responsibly, sensibly and in small doses.

Danny Abshire is the co-founder of Newton Running, a Boulder, Colo.-based company that makes shoes that promote an efficient midfoot/forefoot running gait. He has been making advanced footwear solutions for runners and triathletes for more than 20 years.

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19 thoughts on “Beware of Barefoot Running Injuries

  1. David H.

    Nice write-up. It’s nice to see an alternative point of view on this issue (that I have not taken a stance on at all). Shoes or no shoes, runners have to battle foot injuries at some point.

  2. Fredbros

    I wore Newton for 4 months, including the Marathon de Paris. Then I went to Vibram and Terra Plana EVO (both are labelled minimalist shoes). This progressive approach was perfect : Newton helped me modify my stride from heel-striking to middle of the foot striking, which then helped me take benefits of minimalist shoes.
    I agree with your point of view. Coming to barefoot or minimalism has to be slow, progressive to allow the body to get accustomed.

  3. MG

    I enjoyed this column! I am new to barefoot running, but let me say that I am new to it in the same way I have been new to many things. The world is full of stuff, some stuff is fun and some will kill you. I like to have fun trying somethings that I think won’t kill me. I tend to do a little research if I am unsure of the fun-to-death ratio. The problem I have with barefoot running is the religious zealots who somehow think the shoe is the equivalent of a coffin or some Spanish inquisition iron maiden for your foot. They argue that we were born without shoes and therefor we should be shoeless in our lives. Do these same people throw away their eyeglasses and contacts? Disown their cars and TVs? Burn their underwear and live in caves? The reality is that they don’t. Humans are not born to run, but rather, born to invent. We are a unique species on this planet that can evolve not only biologically and socially, but technologically. The truth is that millions of us were not born to do anything, by all biological standards we should not have made it through our first year of life. But we did, and it was thanks to our cunning technological evolution. I am in no way against barefoot running. I own a pair of VFF Bikilas and they have introduced me to my soleus muscles. I have run in combat boots and running shoes for many years. I have a love-hate relationship with running and it is one relationship I intend to keep. The barefoot running and VFF crowd will tell you that shoes injure you, but if you ask them about an injury you sustain while running barefoot, they tell you that you must not be doing it right. Sounds a bit like global warming – if it is getting hotter, it is global warming. If it is getting cooler it is global warming (mother nature fighting back). I guess some people just need this antidisestablishmenterrianism in their lives. The bottom line is don’t throw away your shoes, wear a tin-foil hat and worship before a statue of a Carrot disdaining those who don’t; just do what you feel is good for YOU.

    BTW – I did 3.5M today in my VFF Bikilas!

  4. Sir Isaac Post author

    MG, you make some good points, and you won’t see us in any tinfoil hats. We believe that our shoes are the most technologically advanced, in that they simulate the barefoot movement while providing energy return and protection.

    Run Strong,
    Sir Isaac

    p.s. excellent use of the word “antidisestablishmenterrianism.”

  5. LC Ewing

    48 yr old male in decent cardio shape- 6’1, 195. Had not run with or without shoes for 25 yrs. Primarily did Elliptical and stair machine. Bought Born to Run, got amped. Bought VFF, ran 1 mile 4X/wk for 1 month. Progressed to 3 miles 4x/ week. Ran very slow (36 min for 3 miles.) Saw McDougall interviewed by Sanjay Gupta on CNN before my last and I do mean last run. Tried to replicate his forefoot strike and did not let my heel touch the ground for 1.5 miles before having tremendous outside heel pain. Could barely walk. Just got MRI result which indicatess a stress fracture of calcaneus. What should my running future hold?

  6. Sir Isaac Post author

    Hi LC,

    Thank you for your question regarding your running future. I’m very sorry to hear about your injury and despite this believe you should be able to recover and continue to run.

    It is highly probable that a quarter century not running and wearing modern shoes deconditioned and weakened the connective tissue, attachments and structure of your feet. You were smart to ramp up you mileage slowly, however strengthening your body to cope with the stress of running in VFF on hard surfaces could take many months or even years.

    By keeping your heel off the ground you are imposing an enormous and unnatural stress on you Achilles tendon and attachments. Normal and natural gait biomechanics allows you heel to settle on the ground. This loads your muscle and tendons, storing energy and engaging your body’s elastic recoil mechanism.

    You should still load you foot under center of mass and avoid a heel strike, but trying to keep your heel off the ground is difficult, unnatural and often (as you found out), injurious. You can see detailed information and videos at http://www.newtonrunning.com/run-better/optimal-running-form < http://www.newtonrunning.com/run-better/optimal-running-form>
    I strongly suggest you take the time to fully recover and repair your injury, then gradually start walking and running again. Please study the natural running form videos and ideally attend a run form clinic with Newton, Chi, Evolution or Pose. Chi Running has an excellent book explaining how to run injury free and Evolution running sells a very good DVD demonstrating efficient running form.

    Appropriate footwear is also crucial. VFF protect your feet from sharp objects but provide virtually no cushioning. Ideally you should choose a shoe that is level to the ground so you can run with your natural gait. Firm cushioning will provide shock absorption and support on hard man made surfaces. My recommendation is to start with the Newton Sir Isaac which does all of the above, is very supportive and provides excellent energy return.

    Good luck and be patient, you can get back to running (slowly and carefully) in a few weeks.

  7. Mike Peach

    Just got in from a 13 mile barefoot run on tarmac and dirt roads. That is a barefoot run by the way, not a VFF run or any other minimal shoe. It is the furthest I have gone by about 2 miles having started barefoot running about six months ago.

    Whether it is good or bad for me really doesn’t matter, it is just such good fun. I hate running in shoes now.

    You just have to do what feels best for you, there is no right or wrong and your body will tell you when your technique is right so let it make the decisions for you.

    It really doesn’t need all the analysis, it is going out for a run with no shoes on, kids do it all the time and who doesn’t want to feel childlike all over again.

    But take it from a 46 year old guy getting fitter by the day, shoes are not crucial at all.

  8. Frank the Tank

    I just started running in my VFF Sprints for about a month. I’ve got a 10k run coming up in Omaha, NE and am planning to wear my new minimalists, but I’ve think I’ve been having some problems transitioning from my thick-cushioned Brooks. I’ve been trying to pay attention to my form and my strike, and have not been toe running. For some reason, however, the top of my right foot is in quite a bit of pain and my left calf muscle is always more sore than my right. Am I doing something wrong or do I some reason have a disposition to land on one foot harder than another?

  9. Andrew Guitarte

    I’m thinking of getting a minimalist pair of shoes like Newtons’ but have to hold back since I’m getting to like the idea of running in bare feet. Just started a week ago and I’ve logged a conservative 5K twice, once on the treadmill and another on asphalt in our neighborhood.

    I finished 22 marathons in the last 7 years and will finish an Ironman this November at Florida. My goal is to run a marathon in bare feet by late next year 2011 or early 2012. I’ve been injury-free all my running life and a neutral runner.

    So what’s my motivation for running in bare feet? Definitely not primarily to avoid injuries since shoes seem to work fine for me. It’s to improve my form and increase my stamina and endurance. We’re built by nature to endure long distance runs and that’s what I’m planning to do for the rest of my life.

  10. Justin

    male, mid 30′s, 6-2, 195, decent shape, run about 25 miles/wk & did half marathon about a month ago in my asics nimbus. After that, I bought a pair of newtons and scaled down my runs to no more than 5 miles at a time. I love the newtons (the nimbus feel like squishy bricks now), however my calves are screaming by mile 4. Like LC (above), I don’t seem to touch my heels too much at all during my stride, and the videos on the newton site don’t make it look like the heels hit the ground much either. Are my heels supposed to hit the ground & when will this assault on my calf muscles stop? Don’t see how I can ever run long distances with this stride, my calves would never last. I must be doing something wrong. I am worried about my achilles if I keep going on this way. any advice appreciated, thanks.

  11. Sir Isaac Post author

    Hi Justin,

    It sounds like your calves are sore because you aren’t letting your heels touch the ground at all. You should allow your heel to settle onto the ground after you land midfoot. This will take the stress off of your calf muscles. Let us know if you have any other questions.

    Cheers,
    Sir Isaac

  12. Mike

    I recently bought a pair of Sir Isaac shoes, wide version and I enjoy the runs. My quads and knees are do not ache after a run and I seem to have better breathing control. After my last run, I developed a sharp pain on the top of my left hip bone. It’s not the joint but actually on top/center. it hurts when I press on it or twist to the right. I’ve tried to make sure I’m landing on my midfoot and then letting my heel settle briefly before lifting off, also taking smaller strides.
    Any idea what this could be? I think I started running too far with the new shoes. I’m going to let it settle down before I run again.
    Thanks
    Mike

  13. Sir Isaac Post author

    Hard for us to diagnose, so I’d recommend seeing a doctor if the problem persists. What it most likely is a case of is “too much, too fast.” We always tell people to only run 15-20 minutes in the shoes for the first 2-3 weeks. Give it time to rest and I hope everything improves!

    Cheers,
    Sir Isaac

  14. Erskien Lenier

    The article you posted here declaring that barefoot running is dangerous and that shoes are the only logical solution to running safely is misguiding to those who have not decided to commit to mastering the discipline needed to run barefoot safely.
    I am a 53 yr. old former International Racing Cyclist who transitioned to Barefoot Running about 3 1/2 yrs ago. I too went the Vibram route for the 1st few months but only as a bail out shoe after I had gone as far and fast as I could Barefoot each run first. Eventually, I only used the minimalist shoes as “Bail Out Shoes” when I encountered terrain to bruising or contaminated with jagged rocks or thorns and then they went back into my hydration packs pockets for the rest of the run.
    Now a days I run over 125 mpw on all kinds of terrain and rarely need to break out any kind of sole covering.
    Your decision to push shoes because it is your enterprise and your belief is respectable only if you let others know that these are your reasons for the stand you take.
    For those of us that have stuck with our dedication to mastering step by step control of strike forces your view point is a slap in the face for no other reason than the promotion of technology over innate responsibility for ability to adapt to hard, hot and cold surfaces not respecting the appropriate use of sole coverings when the physics of functionality.
    There is room for everyone in the running community to express running in the manner that suits their values, limitations or lack there of without speaking condescendingly about how or why others interface with the land or surfaces they run upon.
    I have no problems with any of us offering someone an option if they find themselves wanting to improve performance or longevity in running. To each their own. Take a higher road than dissing others to make your product sell. There are no limits to what a runner can do except the ones he complains about instead of learns from.

  15. Lshaw

    I started running in VFF’s in August of 2010 and was 12 at the time. I have tried to change my technique to landing on the forefoot and keeping my heel off the ground. It was going absolutely fine. I ran a 5k on tarmac in 16:55 in the VFF’s’ Then in early November i got an injury on the front of my right foot when running on pavement, as my club had switched venue for the winter about three weeks in to the training. I was out for 5 weeks and did strengthening exercises before going back to running. Four days later and it came back although not very painful, more niggly. I left it for a week then did a short interval session, fine. Three days later i went out for a run and 6 minutes in, the side of my left foot and up under and around the outside ankle bone. I walked home, extremely annoyed. The day after i went out again, as the pain stopped a minute after i stopped running. Four minutes in it went again although now it was only around the bottom and back side of the lateral malleolus (the outside bony bit of the ankle).It went away and 30 minutes later i tried with my trainers (still with the same technique) but not too long in it niggled again. Later on in the day i jogged a few steps before it nigled again niggled again. Please note i never run on tarmac except at the club and i haven’t gone there since i was first injured 7-8 weeks ago now.

    Pleas help i wan’t to run again!

  16. Flintstone

    Everybody will make up their own mind. I’ve been running barefoot since 2001, including 3 marathons and countless halfs and 10ks, without injury or significant incident (occasional shard of glass). Had lots of injuries in shoes before that. Two observations: first, about calf pain, that’s natural. When you run properly, the eccentric muscles of your calf absorb the impact that used to be absorbed by the inch of rubber. So your calves will fatigue first, and your endurance will be limited mostly by the endurance-strength of your calves, plantar and (to a lesser extent) quads and glutes. That will steadily improve, but it won’t happen overnight. The second point is just to take exception with this idea that barefoot running is just for the biomechanically gifted. I think the opposite: it is only the truly gifted who can overcome the many problems of stability and desensitization presented by shoes. Most shod runners are injured at least once a year. Consider this: genes that restricted our ability to run naturally would not have lasted long in the evolutionary process. Our hardware and software has evolved over 2 million years to compensate for any surface or biomechanical imperfection. We were, as MacDougall put it, ‘Born to Run’.

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  19. Jimbob

    I was up to 5.8M with my VFF’s and don’t ever wish to go back to full cushioned running shoes. I go barefoot on the local track, just to keep my form up. However, my VFF’s have cost me – I was on a local trail on Memorial Day friday, and stepped on a few rocks, and let me tell you, it hurts. A lot. The bruise went away, but there’s a small lump by the sematoids on my left foot. Just today, my podiatrist gave me the ‘boot’ to wear for 3 weeks until the inflammation goes down. X-rays were inconclusive. Not painful, but I could tell the foot wasn’t right. This won’t change my beliefs, nor am I a candidate to win any race, any distance. I just have fallen in love with the ‘ground feel’ of minimalist shoes. – J – ‘Pequa, NY

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