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Keyword: barefoot running

Guest Post by:
Kathleen Choate
Athletic Trainer
MUSC Health Sports Medicine

We all remember running barefoot in our yard with our friends when we were young.  Minimalist shoes play into the desire to run barefoot, but with the added foot protection from hazards like glass and sharp rocks. Barefoot running enthusiasts claim it can help with both an improved running economy and a decrease in injuries. While they typically have significantly less padding and support than traditional shoes, minimalist shoes have been shown to help prevent several common running injuries. Vibram Five Fingers is the most recognized brand of minimalist shoes on the market, but just about every brand that makes shoes has come up with their own version as well. 

Typically, when we wear traditional running shoes, we heel strike first. Then our weight then shifts to the middle of the foot, and then to the front of our foot before we push off. When we run barefoot, striking the ground with our heel would be painful, so it's more natural to put your forefoot or mid-foot down first to help absorb shock. In order to wear minimalist shoes safely, it's necessary to learn to change your running style in order to absorb shock safely. This is not just a matter of learning this new running technique; your muscles will also have to get use to this new way of running.  

To transition as safely as possible, start by running very short distances, such as 100 yards to a quarter mile, with a strong focus on proper technique. This technique should involve teaching yourself to forefoot strike first. Build on this gradually and patiently until you are able to run comfortably at your desired distance. If you feel pain at any time, either while you are running or in between runs, rest until the pain subsides.

This new running technique is very demanding on the calf muscles. In an effort to prevent injury to the calves and related structures, I recommend stretching the calf muscles at least once daily and to do calf raises for strengthening every other day. 

While there's still a lot of research needed, minimalist shoes have the potential to help with a variety of injuries including patellofemoral syndrome, iliotibial (IT) band syndrome, as well as injuries related to “flat feet.” The difference in running mechanics helps with shock absorption and also forces your hip muscles to work harder. One research study also documented an increase in muscle thickness of the abductor hallucis muscle, which helps to support the medial longitudinal arch of the foot*. This increased shock absorption, increased muscle strength, and overall change in biomechanics could be what has led minimalist and barefoot running enthusiasts to claim that it has helped their injuries.

Minimalist shoes are not for everyone, and research has yet to clearly define all risks and benefits. It’s not unusual to develop injuries quickly from wearing these shoes. In fact, your chances of developing an injury could potentially increase while running barefoot or in minimalist shoes than in traditional running shoes. Typical injuries can include, but are not limited to, stress fractures, plantar fascia injuries, and achilles tendinopathies. With that said, there is also no proven performance benefit to running barefoot or in minimalist shoes.

There's still a lot of research to be done in this area to get more clear and definitive answers on risks and benefits. Until then, if you decide to jump on the minimalist or barefoot running bandwagon, please do so cautiously. As always, consult with your physician, physical therapist, or athletic trainer if you are thinking about using minimalist footwear or experience new aches or pains along the way.  

*Campitelli, DPM*, N. A., Spencer, DPM*, S. A., Bernhard, DPM*, K., Heard, DPM*, K., & Kidon, DPM, A. (2016, September). Effect of Vibram FiveFingers Minimalist Shoes on the Abductor Hallucis Muscle. Journal of the American Podiatric Medical Association, 106, 344-351.

Guest post by:
Emily A. Darr, M.D.
Assistant Professor of Physical Medicine and Rehabilitation
Department of Orthopaedic Surgery

Deanna Roberts, MS ATC
Department of Orthopaedic Surgery

So you've been training hard for an upcoming race and you're starting to feel an aching pain in your knee. Or maybe you're a new runner that's been increasing your mileage at the expense of a sharp pain in both your shins. Running injuries are a common part of the sport, and unfortunately, up to 82% of runners will experience one at some point in their training. Given this alarming rate of injuries, awareness of such injuries can be important in prevention, diagnosis, and treatment.

Bridge RunThe knee is arguably the most common site of injury with patellofemoral pain syndrome, AKA “runner’s knee”, affecting around 40% of runners. This is characterized by pain around and under the kneecap. Other common injuries include medial tibial stress syndrome, AKA “shin splints” which is an inflammation of the muscles and tendons of the lower leg characterized by a sharp pain, usually on the inside of the shins, Achilles tendonitis, plantar fasciitis, and IT band syndrome, which is pain on the outside of the knee that is caused by repetitive rubbing of the IT band against the outside of the knee.

Sometimes risk factors have a clear link with a particular injury, and sometimes there is a less clear link. Risk factors for which there is clear association with injury include:

  1. Increasing your mileage. Injury is more common when running over 20 and then 40 miles per week.
  2. Recent increase in training intensity
  3. Being new to running

Some risk factors which have a more loose association with injury may include:

  1. Changing your footwear or wearing improper footwear
  2. Running on harder surfaces
  3. Poor habits of warming up prior to running and stretching soft tissues
  4. Muscle imbalance and compensatory patterns

When dealing with an injury, it is best to listen to your body. Be sure to schedule rest days during your training, and take a few days off if your pain is worsening. If you are dealing with an injury that requires a few weeks of rest, pencil in some cross training days to maintain your cardiovascular conditioning. 

Pay attention to your training plan. If you notice a flare up in pain when running on the road, stick to a surface with more give like a turf field or soft track. Run on the side of the road that feels more comfortable and stick to flat courses if running up and down hills exacerbates your pain. When returning from a rest period, increase your training volume by 10% intervals to avoid overtraining and re-injury.

Can I run through an injury?

Dr. Bob Wilder’s Rules for Runners can quickly assess whether you should continue through pain.

  1. On a 10-point scale, pain during the run should be no greater than 0-3.
  2. Pain should not be severe to the point where you limp during or following the run.
  3. The long run should not be more than half the regular weekly volume.

Make sure to warm up before your run with dynamic stretching exercises that warm up your muscles and increase your heart rate. Include a cool down with gentle stretching exercises that focus on the main muscle groups worked during your run.

Running footwear has been a hot topic in recent years including minimalist shoes and barefoot running. Every foot is unique and every running style is different therefore a visit to a running store where a professional can assess your feet and help you decide on the best running shoe for you is well worth it.  Interestingly, studies have shown that when runners wear more expensive shoes promising more cushion or support, they suffer more injuries than runners who opt to wear cheaper footwear. There are no studies that show that running shoes actually prevent injury. Remember that the most important factor in finding a shoe that fits is to make sure it is comfortable when running, not just when placing it on your foot at the store.

If an injury continues to linger or worsen, see a sports medicine physician for further evaluation. He or she can provide you with a proper diagnosis and appropriate rehabilitation plan to get you back on the roads!

Running is a great form of exercise to engage in, whether it be in sport, with a running group, or participating in a color run with friends. These days, the possibilities are endless and so are the opportunities! With the proper training, equipment and rest, you too can have fun and be pain free during your run!


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