What Every Runner Needs to Know About Barefoot Running and Minimalist Shoes

Video: Is There a “Best” Running Shoe for Your Feet?

In our Seattle foot and ankle clinic, we treat many runners including those that run in traditional shoes, minimalist shoes or run barefoot. A question that is commonly asked is how injuries compare between barefoot and minimalist shoe running versus traditional running shoes. The truth is that it is not clear. There is not much research indicating that barefoot running decreases injuries in runners or that traditional shoes decrease injuries either.

But there have been some good studies on barefoot running and the following is what we do know: Barefoot running shoes

  • Barefoot running decreases stride length
  • Barefoot running decreases force on the heel and increases force on the forefoot
  • Barefoot running decreases load on the knee but increases load on the ankle
  • Barefoot running is more metabolically efficient – you use less energy. If you are trying to run as far as possible without hitting the wall, this is beneficial. If you are trying to burn more calories in the shortest time, then this is a negative aspect.
  • Barefoot running increases the risk of stress fractures of the metatarsal bones

Expert Opinions on Barefoot Running

Craig Payne, an Australian podiatrist and a top biomechanist, provided an excellent summary of the issue on the Podiatry Arena forum. We agree with his take on barefoot running. Here is what Dr Craig Payne wrote on Podiatry Arena on the subject:

“We were created to run barefoot to survive, so we can move camps, can hunt for our food, etc. But that was before concrete got invented and we started to run for fitness, recreation and competition rather than survival (but given the obesity epidemic we may need to run for survival in the near future!). Because of the invention of concrete, we needed another invention – the running shoe.

Running barefoot comes in two forms. Those that do it in moderation as part of a balanced running program and those that use it as a philosophy that underpins their running. It is this later group I have a problem with. They are like religious zealots that are fanatical about it. They use nonsensical non-scientific mumbo jumbo to support what they do. They use any piece of evidence that is negative about running shoes as “proof” that barefoot running is better. They grasp at straws to misrepresent other research and dismiss any anti-barefoot research. They claim there is research for it, but when you look at the research, it does not support it – they misrepresent what the research is showing (…and even when you point that out to them, they continue to claim it supports them).

At the end of the day, there is not one piece of evidence that shows barefoot is even ideal, let alone beneficial. Yet do an internet search for barefoot running and look at the extraordinary range of claims being made for the benefits of it. HOWEVER, there is no evidence that it is not beneficial either. Yet the fanatical supporters of barefoot running quote a wide range of research to support their cause. When I read the reference list for the claims, not one piece of the research says what they claim it says. Trying to discuss rationally with these people is like trying to argue a religion – you never going to win that argument.

They also like to be dismissive of claims by Podiatrists that running barefoot is not good as Podiatrists have a vested interest in foot orthotics. That is just silly nonsense. Podiatrists will, generally, always be motivated by what is best for the patient and if the evidence says that barefoot running is beneficial, then they will be recommending it. There are even Podiatrists who are barefoot runners! I love the way the fanatics claims that Podiatrists are anti-barefoot running because of the orthotic $. They need to come up with some better evidence and data than that silly argument.

There have been some very balanced discussions on Podiatry Arena on barefoot running; certainly more balanced that the fanaticism and zealotry seen on some running forums to do with barefoot running.

I am not opposed to barefoot running; it is just I want good evidence to guide me as to what runners should and should not be doing it; it probably should be done in moderation as part of a balanced running program; and the zealots need to get over it.”

Dr. Kevin Kirby is an international expert on foot biomechanics, orthotics and barefoot running. He recently gave a lecture which runners who are considering barefoot running will find useful. In the videos below, Dr. Kirby discusses the scientific research on barefoot versus shod running and his personal experience as a competitive long distance runner, biomechanics professor and sports podiatrist.

Some Injuries May Increase with Minimalist Shoes and Barefoot Running

Our experience is that barefoot and minimalist runners get injured at the same rate as those that wear regular shoes, but they are trading one group of injuries for another. In our practice, we’ve observed that those who choose traditional running shoes are more likely to develop Runners’ Knee and shin splints while those who use minimalist shoes are more likely to develop forefoot problems such as Morton’s neuroma and metatarsal stress fractures. In fact, we have seen more metatarsal stress fractures in the last year than in any previous year in our more than 20 years of practice because of the trend in toward minimalist shoes.

Anyone that is considering transitioning to minimalist running shoes should be aware of some recent studies on the types of injuries most likely to increase with barefoot running or minimalist shoes.

  • Runners Over 30 Have Increased Barefoot Running Injury Risk

A 2015 study shows that runners over 30 should be extremely cautious in transitioning to barefoot running in order to avoid injury1. A study of 30 runners with at least 10 years running experience found they did poorly when transitioning to a forefoot strike pattern favored by the minimalist shoe. Researchers tested the runners at various speeds, in both standard running shoes and barefoot capturing the foot strike pattern by video as they ran.

Researchers found “There was persistence of the heel strike in the adults, regardless of speed” and “43 percent of the adults continued to heel strike barefoot at the highest speed, compared to about 12 percent of the adolescents.” This is indicative that runners must take a much longer time than is currently assumed to transition into barefoot or minimalist shoes for running.

  • Metatarsal Stress Fractures Increase Dramatically with Minimalist Shoes and Barefoot Running

A 2013 study published in Medicine & Science in Sports & Exercise2 found that runners who transitioned from standard running shoes to minimalist shoes were more likely to suffer a stress fracture in their metatarsal and tarsal bones than runners who chose shoes with more support. We have seen this in our practice as well. In the first two years of the minimalist shoe trend, we treated more stress fractures than in the prior 10 years combined. As the minimalist trend has died down over the past couple of years, the number of stress fractures we treat has dropped back to normal levels.

Custom Orthotics Work in Minimalist Shoes but must be made Specifically for the Minimalist Shoe

Trends develop with every human activity – some as a style choice, some in an attempt to improve performance. A trend that began several years ago in running apparel was minimalist running shoes. These are designed to closely duplicate a barefoot running experience while still protecting the foot. Minimalist shoes have become very popular in recent years for both dedicated and casual runners but can be problematic for some people.

For instance, runners with a biomechanical imbalance may suffer discomfort, pain, and injury from the use of minimalist running shoes. And patients with common running injuries may exacerbate the problem by choosing minimalist shoes due to a lack of support and stability. This is not to say that these shoes are necessarily bad for you, but that care must be taken when wearing them. If you believe you may have suffered a foot injury from running, see your podiatrist immediately for help in determining if your shoes are a contributing factor.

A biomechanical imbalance will commonly cause gait problems for runners, leading to pain and possible injury. In most cases, the imbalance can be corrected and the pain relieved through the use of custom foot orthotics. These are orthopedic shoe inserts designed to improve support and stability. Orthotic therapy is common for running injuries and very effective in the vast majority of cases. However, minimalist running shoes commonly lack the room for a standard orthotic. We can make orthotics that fit in minimalist shoes, but like the shoe, they must be smaller than standard orthotics. We also often recommend specific over-the-counter arch supports that can fit in minimalist shoes.
Still other patients with no biomechanical problems will develop foot problems once they switch to minimalist shoes. In these cases, the use of the shoes should be discontinued. If you have only recently developed foot pain despite having worn minimalist running shoes for years, it is unlikely that the cause of your pain is the shoes and it is some other problem that needs attention. In other words, if you’ve been wearing minimalist shoes for running without problems, feel free to continue doing so.

Since most of your time is spent not running, using custom orthotics in your work and casual shoes may likely resolve the problems you’re experiencing without changing your running shoes. Orthotics improve the support and stability of your feet which can improve your foot mechanics even if you don’t have orthotics in your running shoes.

Contact the Foot and Ankle Center About Your Runner’s Foot Pain

If you are a runner experiencing foot pain, contact Dr. Huppin or Dr. Hale. The Foot & Ankle Center of Washington has a national reputation for the conservative treatment of running injuries which are one of our primary specialties. We work daily with runners that choose standard running shoes, minimalist shoes and a few truly barefoot runners.

It is not our goal to limit or stop your running, but to help you improve your running and make it pain free. If your shoes are the issue, we will let you know. If not, other therapies will be recommended including custom made and personally fitted orthotics where appropriate. We are well known for building the best orthotics for runners.

If you are considering moving toward barefoot running or minimalist shoes, make an appointment to see us prior to beginning your program. We can help you develop a plan that will minimize the risk of injury. If you are unsure whether you would be better off wearing traditional shoes or minimalist shoes, we can analyze your gait, examine your feet and help you determine which is likely to be the best choice for you. Be sure to bring all of your running shoes to your appointment.

1 S. Mullen, University of Kansas Hospital Sports Medicine and Performance Center in Kansas City, Presented at American Academy of Orthopaedic Surgeons, March 2015.

2 ST Ridge, AW Johnson, et al, Foot bone marrow edema after a 10-wk transition to minimalist running shoes, Medicine & Science in Sports & Exercise, 45(7): 1363-8, July 2013.

Dr. Larry Huppin
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3 thoughts on “Minimalist Shoes and Barefoot Running

  1. I did go and look at the papers that showed that running shoes correlate with injuries and they seem decent B grade evidence. Retrospective, small number of subjects and not repeated yet. But that doesn’t mean that barefoot is necessarily safer as you say.

    I’m starting with a careful walk run on a treadmill and what I’m finding is that
    my Achilles don’t hurt and my knees don’t hurt where heel striking in running shoes irritates both and thus limits me.

    And I’m walking around in minimalist shoes without pain. The orthotics were great for me but I don’t like the loss of balance in them due to the rounded heels. And I’m now pain free without them.

    However, I’m probably a bit of a special case in two ways: arthritis and weight training. Most of my arch pain was from arthritis which is nicely controlled. And I’ve spent the last three years since starting with your orthotics in the gym and have strengthened the heck out of my calfs before starting this. I can lift the entire calf stack on multiple machines without strain.

    1. Actually, I didn’t say that barefoot shoes were safer. For most people there is more evidence that they are safer wearing traditional running shoes. Some people, however, do well with the minimalist shoes. You are doing the right thing by working into them slowly.

  2. This is very interesting. I am surprised to read that wearing minimalist shoes increases cases of Morton’s Nueroma. This condition is what landed me in such shoes. I am not fanatical about the FiveFingers or the minimalist/barefoot craze, or even running. I just need to be able to walk and stay active and FiveFingers and ToeSox shoes are the footwear that support my mobility due to terrible neuroma in my left foot. I have tried everything but surgery (that my excellent Podiatrist said he doesn’t recommended for me) and those funny looking shoes work best for me. Any ideas why they would alleviate my pain when it sounds like the research would suggest otherwise? I found this site because I am online looking for trail shoes. I was reading about Newton’s and OESH and found your article. Any suggestions about Newton’s? Thanks for the rabbit hole, er, info!

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