Injuries and Barefoot Running

Michael Warburton, PT, MSc, found in his review of research literature that although clinical research is lacking, there is a lower risk of lower leg injuries in the barefoot running population when compared to shod runners. He suggests that an increase in the number of injuries in modern running shoes is due to decreased sensory feedback provided from the foot and ankle. Foremost among these injuries are plantar fasciitis, shin splints, and iliotibial band friction syndrome.

Are Shoes Really Necessary?

It is believed that by running barefoot on firm surfaces, you naturally adjust your foot placement so that you land on your midfoot and thereby make a softer landing. This midfoot striking allows the arch of the foot to flex and absorb shock while allowing the musculature and support structures of the foot to control motion and lessen impact forces. This results in less damaging strain on tissue from your foot up to your lower back.

Are we destined to be injured?

Some experts believe that since very few runners are biomechanically perfect, most will need some sort of corrective or supportive shoes to prevent or reduce the risk of injury. Other experts say that the rate of running injuries is essentially unchanged since the introduction of the modern running shoe in the 1970s, and that some injuries, such as those involving the knee and Achilles tendon, may have increased in the past forty years.

Maybe the human foot was not meant to have a shoe that forces it to heel-strike, controls its pronation, blunts its sensory feedback, or provides cushion for its landing. Proponents of barefoot running believe that reliance on the external support, protection, and correction provided by the long-term use of footwear prevents the natural response of the well-functioning foot.

Arch supports and orthotics added to the shoes may interfere even more by blocking the natural deflection of the arch. Granted, some of the less biomechanically gifted runners will need all of the things that the modern running shoe provides. Perhaps these runners are not well-suited for barefoot running. For others, less is better.

Give Yourself Time

Matthew Walsh, PT, advances the principle of “tissue adaptation time.” When you remove the support of the running shoe, you place the control of motion for the foot and leg in the structures of the foot itself. Any tissue that operates at an extreme condition (shortened, lengthened, compressed, or torsioned) is less capable of controlling motion and adapting. This makes its adaptation time longer.

During this time of tissue adaptation, secondary structures such as bone, cartilage, and tendon will be absorbing more load or stretch. Therefore, during this vulnerable period while you are transitioning to barefoot running, patience and time are necessary to prevent overload and breakdown of tissue.

Essential

Many symptoms that occur following an injury, such as pain and inflammation, are part of the body's adaptation process and should be expected.

Those runners blessed with good technique and mechanics will adapt easiest to barefoot running, while those with poor mechanics/alignment may have more trouble and need more time to transition to barefoot running. Practically speaking, if you possess the extremes of a high, rigid arch or a flat foot, you will likely need a longer time for tissues to adapt. The progressive loading and stress to this tissue needs to begin with short bouts of exposure that very gradually increase as they are spread out over a long period of time (weeks or months).

Consult an Expert

According to Vibram USA's Georgia Shaw, the majority of injuries associated with minimalist shoes and barefoot running in general are due to training errors and overuse. Keep in mind that by overloading tissue that is not accustomed or adapted to new demands, strain on bones and stress on connective tissue may lead to an increased risk of injuries such as stress fractures, plantar fasciitis, and tendonitis.

If you are struggling with pain or are not able to progress with your barefoot running, you may need to consult a physical therapist or a physician who specializes in sports medicine for a thorough foot examination and assessment of your running mechanics.

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