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Saturday, July 3, 2010

Barefoot Running Controversy

     Many have asked me my opinion on Barefoot Running that has seemed to catch everyone's attention. Marc Evans, world renowned Triathlete Coach, asked this of me recently and this was my quick reply:
Marc Evans said..
Dr. Blake,
Do you have an opinion on minimalist running trends? I have read many of the studies and am impressed with the research, but mostly in terms of how running shoes may contribute to some over use injuries. In my case, running with shoes causes sharp pain (immediately) in the low back. Whereas without shoes there is none.

April 2, 2010 9:17 AM

DrRichBlake said...

Marc, since I have spent my entire podiatric life making feet more stable and more protected, this concept is a new paradigm. However, biomechanics is the basis of most problems and solutions in some many activities like running, cycling, swimming, etc, where there is repetitive motion. Running shoes in general have around 1/2" heel height, increasing low back curve (lordosis), and, in some patients, producing low back pain. The high heel effect also can cause many runners whom land on the lateral (outside) border of the running shoe to either excessively supinate (lateral instability), or rapidly pronate (arch collapse). Both of these problems can cause foot/ankle/knee/hip/low back pain. Both of these problems also get worse with as little as 200 miles of shoe wear. I will have a later post dealing with the weakest link in the chain syndrome. Serious, if not all, runners need to link up with a good running shoe store, and/or knowledgeable sports medicine practitioners, whom can evaluate the function of an athlete shoe purchased or possibly causing problems. I will also have a post on generalizations in choosing the right running shoe.

So, yes, shoes can produce problems. I have mentioned only a few. But, does the answer lie in a minimalist approach to foot wear? For some, definitely. For others, a fatal running mistake. Who will help them decide? My best advice with any new device, shoe, technique, is to listen to your body (Golden Rule of Foot). Go gradual, and use common sense on what surfaces to wear them. Avoid pain. Any thing that causes pain weakens the body. Will feet get stronger with this type of shoe? I hope the physical therapist/runners out there will tell us. Is the answer more in prescribing foot strengthening exercises for every pair of stable running shoes and/or foot orthotic devices purchased or prescribed. I hope this helps. Dr Rich Blake
April 2, 2010 10:19 AM

Marc Evans said...

Thanks for the advice...I believe we'll see ever more shoe options which should help those with special biomechanic and musculoskeletal needs...In my case, the elevated heel in running shoes causes a heel strike where forces collide...without running shoes (and I've video taped both) I land on the foot pad with a more reactive strike and quicker turn over...Love the Golden Run of Foot...great advice...
April 2, 2010 10:38 AM
     Marc's comment on heel strike causing problems is definitely worth noting. I have found the most smooth and effective running styles involve full foot strike or fore foot strike, not heel strike. When you land at your heel hard, too many problems can arise. For years, cross country and track coachs have known to minimize over striding as a way of running faster. You can run faster by either lengthening your stride (emphasizing harder heel strike) or by increasing stride rate (moving your muscles faster and more efficient). Over the last 10 years or so, I have heard more and more patients told to emphasize in gait a heel to toe motion. Supposedly, this makes a smoother, less jarring gait to ease the stress on your muscles, tendons, and joints. But, this is very hard to learn, and not necessarily the best for most patients. I prefer a solid full foot or forefoot land, based on you speed of walking and a de-emphasis on heel strike. For 5 years our clinic did video analysis on our biomechanical patients, both walking and running. The running gait cycle was so much smoother than the walking cycle. I felt it was the elimination of heel strike in running that smoothed the gait out. Smoother gait should mean less stress on the body overall. So I think some running shoes if they force unusual heel strikes because of their heel lifts or their out flares or their outersole bumps should not be used. The athlete, with the help of the running shoe store, and perhaps with the help of the personal trainor, coach, health care provider, should make sure the gait is smooth. At least in the big cities, it is common practice for running shoe store personel to be runners, and to watch the athletes run to check for this before purchasing a shoe.
     As podiatrists, we look at people with very weak structural feet everyday. These feet can/may be helped with a progressive foot strengthening program over the course of 2 to 3 years, if they choose to spend that effort. I find this the hardest part of rehab, restrengthening, since patients normally don't hurt much in this phase. The motivation goes out the window. And this will only help some. Many patients with weak foot structure, very sensitive nervous system, loose ligaments, auto-immune deficiencies, to name a few, would have their feet ruined by attempting to run/walk without good shoe protection. Unfortunately, I have seen too many patients injure themselves so far that there is permanent damage. No health care provider would ever want to take that risk with their patients. Therefore, this minimalist shoes/barefoot trends will never get a medical endorsement.
     So, what to do? Here are some recommendations:
  1. Make sure your shoes allow you to run smoothly. Work with experts to insure your gait is smooth.
  2. Do not emphasize a heel to toe walk/run, land more flat footed for stability.
  3. Change your gait pattern gradually, and only if you are forced because of injury. It is a very hard process to accomplish.
  4. If you wear motion control or stability shoes, and orthotic devices, make sure that 3 times a week you are doing a foot/ankle strengthening regimen. The regimen should be progressive from month to month to make sure you gradually get stronger feet and ankles.
  5. If you have strong feet, no history of any problems in feet, ankles, knees, hips, or low back, and you decide to run barefoot or with minimalist shoes like Vibram Five Fingers, progress very slowly, and listen to your body. Choose soft safe surfaces. Get the advice from a running coach on how to start slow, and then go even slower and shorter.
  6. If you develop pain with any new trend, stop immediately, make sure the pain has resolved, and think extra hard if this is really worth the risk.



  1. Love your perspective on the controversy Dr.Blake. The 6 points at the end have definitely stood the test of time. I will be writing an article about the same on my blog - Please feel free to check it out.
    Jason Hughes


Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.