Is bare better?
If you read magazines like Runners World, you might be inclined to think so. Barefoot running, or at least the idea of running with minimal support, has gained bucket-loads of media attention, with claims of better foot stability, and enhanced muscle development, this movement has inspired a die-hard following, and in practice, more and more inquiring patients want to know - which is better to run with - my shoes or just my feet?
First, you should know that the barefoot running technique is slightly different than the way we run with shoes. In barefoot running, you start off by touching the ground with the balls of your feet (called the forefoot), and you work backwards to the heel. This is very different than the way we run in shoes, where the heel is the first thing to touch the ground, and our forefoot makes contact with the ground at a later point in the running cycle.
Why this is important is it changes which bones, joints, and ligaments that have to deal with the initial impact on the ground, and then later, how these forces move through the foot, and up into the body.
To date, there has only been one paper on barefoot running (Lieberman, D. et al (2010): Foot strike patterns and collision forces in habitually barefoot versus shod runners. Nature Vol 463 P 531-536.). Not exactly an overwhelming abundance of data. However, in this study they conclude that the initial strike forces the body has to deal with are approximately are up to 7x lower in barefoot runners vs running with shoes. Sounds impressive, right?
Before you chuck your trainers out the nearest window, the initial forces in running are not the only thing we need to consider.
One important issue that this study was not able to address is how do the forces move from the forefoot, through the rest of the foot, and then up into the body? Meaning, how does this running pattern effect the rest of bones in our skeleton?
And, this is where barefoot running, in my opinion, falls flat. There have been, unfortunately, lots of reports on barefoot runners that have a tendency to develop metatarsal stress fractures. Meaning the metatarsal bones (the long, finger-like bones in your foot) have to take a ton of impact, and they develop hairlike fractures in them because these bones don't have the bending ability that our heels do when they hit the ground. The other nasty thing that can happen when you start increasing the forces in the forefoot is a condition called Dorsal Interosseous Compression Syndrome. Which, if you are an avid runner, is the equivalent of Kryptonite, and will continually reappear when using the forefoot running pattern.
I think the reason why the Barefoot running movement has gained so much popularity is because people may associate this kind of running with being more 'natural', and therefore 'normal' for the body. And hey, I am a doctor who's bread and butter is about healing naturally, so no need to sing the praises of natural vs. artificial intervention to me!
However, I do take issue with some of the parameters and claims that the barefoot-philes seems to have.
In particular, there is really no evidence that running barefoot is better than running in shoes - it is just a different way of running. Claims of "increased stability" and "enhanced muscular development in the foot" are marginal at best, and there is simply not enough data (one study) to support the idea that it is better than running with shoes.
Now, having said that, I do have some very dedicated runners in my practice who have adopted this running style, and swear by it. Which, if it works for you, then keep at it!
My rule is simple: if you are running in shoes without injury, keep running in shoes. If, no matter what shoes or orthotics
you try, you are chronically injured, then you might want to try barefoot running. Although there is no guarantee that it may work for you, *and* you will need to be trained to start landing on your forefoot - please don't go out tomorrow and run a 10K with nothing more than these:
Like anything, and especially with running, you need to gradually get used to the different forces your body is now being subject to, and there is a learning curve associated with it. Be nice to your feet!! They are literally the foundation of your body. If they go, everything else falls out of place, too.
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