Barefoot running


Introduction:[edit | edit source]

Barefoot running.jpeg

Running has become increasingly popular over the years and provides numerous health benefits including improved cardiovascular health and healthy weight maintenance[1]. Running also has psychological benefits such as decreased depression and anxiety, it promotes self-esteem and prevents mood changes. [2] Despite its popularity and many benefits runners still experience a high injury rate. Among runners, the most common musculoskeletal injuries are anterior compartment tendinopathy, patellofemoral pain syndrome, and Achilles tendinopathy [3]. There are biomechanical risk factors for running-related overuse injuries [4]. Thus, runners have sought numerous strategies in hopes of reducing injury and running faster. One strategy is to run without any shoes at all: Barefoot[5]

Despite the benefits of footwear, interest in barefoot running has increased among the running community, with proposed benefits including a decreased injury rate. Advocates tout the evolutionary success of man as a barefoot bipedal runner. There is also speculation that the development of modern footwear and the associated altered running gait patterns have contributed to injuries seen in runners[5]. A minimalist shoe provides "minimal interference with the natural movement of the foot, because of its high flexibility, low heel-to-toe drop, weight and stack height, and the absence of motion control and stability devices"[6]. Transitioning with a minimalist shoe may be beneficial to some runners as it enhances performance, however, it is important to highlight that recent studies show that running in minimalist shoes is linked to higher running-related pain in the ankle, knee, calf and shin [7].

In some respects, humans are maladapted to wearing shoes, which can contribute to specific types of injuries:

  • Shoes limit proprioception: The sensory input received from the plantar side of the foot serves as an adaptation for detecting various ground characteristics like hardness, roughness, and potential hazards such as sharp rocks. Plantar proprioception triggers reflexes, aiding the central nervous system in decisions that enhance stability and prevent injury. When running barefoot, this sensory input enhances postural stability and refines control over subtle movements. [5]
  • Modern shoes designed with raised heels, rigid soles, cushioning, and arch support might promote a distinct running style compared to what habitual barefoot runners typically adopt. Opting for barefoot running could potentially restore a natural foot arch by enhancing the intrinsic strength of the foot. [5]
  • Running in conventional running shoes may increase asymmetry in vertical instantaneous loading rates.[8]

What do we know about Barefoot Running?[edit | edit source]

The majority of studies on barefoot running involved instructing regularly shod runners to remove their shoes within a laboratory setting. However, relying solely on habitually shod runners for studying barefoot running poses limitations. These subjects may lack the musculoskeletal adaptations and movement habits characteristic of habitual barefoot runners. When simulating barefoot running, runners modify their running mechanics, yet not all aspects align with habitual barefoot runners. While simulating barefoot running, the stride length remains the same as in shod running, but the foot strike mirrors that of habitual barefoot runners [9]. It is also important to emphasize that all runners, barefoot and shod, vary in their form depending on a wide range of conditions such as speed, surface texture, surface hardness, and fatigue. There is evidence suggesting significant differences in morphology between different ethnicities[10].

Barefoot running may play a role in injury prevention, however, it seems to be affecting running stability in a negative way. "Local dynamic running stability is the ability of a dynamic system to compensate for small perturbations during running." Based on a study exploring running stability, it was lower among barefoot runners compared to shod runners even after a long period of time. [11]

Foot Strike patterns in barefoot and shod runners:[edit | edit source]

  • Barefoot runners typically adopt a fore-foot strike as their primary pattern of landing. Given the reduced tendency to adopt a rear-foot strike while barefoot, athletes aiming for better performance might find value in training using minimalist running shoes. Such footwear could potentially encourage a foot contact pattern that avoids a rear-foot strike, potentially benefiting high-performance runners.[12]
  • Barefoot runners decrease stride length while running[9].
  • At touchdown, barefoot runners have a plantarflexed ankle, while the ankles of shod runners are dorsiflexed[9].
  • Running barefoot affects the muscle properties as well, it influences the changes in stiffness of the peroneus and vastus lateralis muscles[13].

Evidence about Barefoot Running:[edit | edit source]

In the systematic review conducted by (Hall et al .,2013)[14], an analysis was performed on the biomechanical variances between running barefoot and wearing shoes. The aim was to assess the available evidence quality, intending to offer insights into barefoot running for the running and sports medicine sectors. The results of this study indicated that:

  • Moderate evidence suggests that barefoot running correlates with a decrease in peak ground reaction force (GRF), increased plantarflexion of the foot and ankle, and increased knee flexion upon ground contact when contrasted with running in a neutral shoe.
  • Moreover, there's limited evidence suggesting that barefoot running is linked to reduced impact GRF, lowered peak knee flexion and varus joint moments, along with a higher stride frequency compared to running in a neutral shoe.
  • Very limited evidence suggests a decrease in power absorption at the knee but an increase at the ankle during barefoot running. Furthermore, the impact of barefoot running on loading rate seems to rely on the chosen strike pattern: adopting a fore-foot strike pattern reduces loading rate, whereas a rear-foot strike pattern increases loading rate.

However, certain methodological weaknesses in this study should be addressed in future research.

Additional effects of Barefoot Running:[edit | edit source]

  • In a study examining the effects of following a barefoot running plan in children, it was observed: that children engaging in a daily 10-minute barefoot running routine at school for a minimum of four years demonstrated distinctive changes: they exhibited reduced contact time while running, extended flight time, adopted an anterior foot-strike pattern, and displayed improved performance in the fast stretch-shortening cycle compared to the control group.[15]
  • Barefoot running may facilitate running ability by enhancing power generation at the ankle in children with cerebral palsy, GMFCS level I. However, the long-term effects based on higher loading rates still have to be examined in future research to avoid injury. [16]
  • Running barefoot on grass could be a better option for runners with plantar fasciitis as it is observed to ease pain associated with this condition. [17]

Transitioning to Barefoot Running:[edit | edit source]

Transitioning successfully to barefoot running depends on anatomical and biomechanical characteristics. In a study exploring this subject, over 70% of the participants were able to transition within a 20-week period. Rear-foot strike pattern and higher midfoot mobility were in connection with failing to transition. The number of failures, however, could be reduced by using a minimalist shoe as an intermediary step. The transition causes new stress to the body which has to be tolerated, therefore the amount of time needed for transitioning should be considered respectively since for some runners, the 20-week period may be too short. [18]

In injury prevention foot strike pattern is more important than the footwear, switching to a more anterior strike is the key. Shifting to barefoot running does result in a more anterior strike, still, the abrupt change may cause injuries. [19] As shod runners switch to fore-foot strike, energy absorption and generation requirements are increased at the ankle and foot. [20]

To examine these factors more deeply, further research is needed in this area.

References:[edit | edit source]

  1. Kozlovskaia M, Vlahovich N, Rathbone E, Manzanero S, Keogh J, Hughes DC. A profile of health, lifestyle and training habits of 4720 Australian recreational runners-The case for promoting running for health benefits. Health Promot J Austr. 2019 Apr;30(2):172-179.
  2. Markotić V, Pokrajčić V, Babić M, Radančević D, Grle M, Miljko M, Kosović V, Jurić I, Karlović Vidaković M. The Positive Effects of Running on Mental Health. Psychiatr Danub. 2020 Sep;32(Suppl 2):233-235.
  3. Kakouris N, Yener N, Fong DTP. A systematic review of running-related musculoskeletal injuries in runners. J Sport Health Sci. 2021 Sep;10(5):513-522.
  4. Willwacher S, Kurz M, Robbin J, Thelen M, Hamill J, Kelly L, Mai P. Running-Related Biomechanical Risk Factors for Overuse Injuries in Distance Runners: A Systematic Review Considering Injury Specificity and the Potentials for Future Research. Sports Med. 2022 Aug;52(8):1863-1877.
  5. 5.0 5.1 5.2 5.3 Francis P, Schofield G. From barefoot hunter gathering to shod pavement pounding. Where to from here? A narrative review. BMJ Open Sport Exerc Med. 2020 Apr 21;6(1):e000577.
  6. Knapik JJ, Orr R, Pope R, Grier T. Injuries And Footwear (Part 2): Minimalist Running Shoes. Journal of special operations medicine: a peer reviewed journal for SOF medical professionals. 2016;16(1):89-96.
  7. Knapik JJ, Orr R, Pope R. Update on Minimalist Running Shoes. J Spec Oper Med. 2021 Fall;21(3):107-110.
  8. Kim J, McSweeney SC, Hollander K, Horstman T, Wearing SC. Adolescents running in conventional running shoes have lower vertical instantaneous loading rates but greater asymmetry than running barefoot or in partial-minimal shoes. J Sports Sci. 2023 Jun;41(8):774-787.
  9. 9.0 9.1 9.2 Leblanc M, Ferkranus H. Lower Extremity Joint Kinematics of Shod, Barefoot, and Simulated Barefoot Treadmill Running. Int J Exerc Sci. 2018 Jun 1;11(1):717-729. PMID: 29997724; PMCID: PMC6033505.
  10. Shu Y, Mei Q, Fernandez J, Li Z, Feng N, Gu Y. Foot morphological difference between habitually shod and unshod runners. PloS one. 2015 Jul 6;10(7):e0131385.
  11. Hollander K, Hamacher D, Zech A. Running barefoot leads to lower running stability compared to shod running - results from a randomized controlled study. Scientific reports. 2021;11(1):4376.
  12. Mosqueira-Ouréns M, Muñoz-Pérez I, Luis Tuimil J, Saleta-Cobos M, Varela-Sanz A. Well-trained Endurance Runners' Foot Contact Patterns: Barefoot vs. Shod Condition. Int J Sports Med. 2023 Sep 22.
  13. Saeki J, Shiotani H, Kawakami Y. Effect of shod and barefoot running on muscle mechanical properties. J Sports Med Phys Fitness. 2022 Jul;62(7):883-889.
  14. Hall JP, Barton C, Jones PR, Morrissey D. The biomechanical differences between barefoot and shod distance running: a systematic review and preliminary meta-analysis. Sports Medicine. 2013 Dec 1;43(12):1335-53.
  15. Mizushima J, Keogh JWL, Maeda K, Shibata A, Kaneko J, Ohyama-Byun K, Ogata M. Long-term effects of school barefoot running program on sprinting biomechanics in children: A case-control study. Gait Posture. 2021 Jan;83:9-14.
  16. Tinker M, Betten A, Morris S, Gibson N, Allison G, Ng L, Williams G, Chappell A. A comparison of the kinematics and kinetics of barefoot and shod running in children with cerebral palsy. Gait Posture. 2022 Oct;98:271-278.
  17. MacGabhann S, Kearney D, Perrem N, Francis P. Barefoot Running on Grass as a Potential Treatment for Plantar Fasciitis: A Prospective Case Series. Int J Environ Res Public Health. 2022 Nov 22;19(23):15466.
  18. Mills K, Collins NJ, Vicenzino B. Transitioning to Barefoot Running Using a Minimalist Shoe Intermediary: A Prospective Cohort Study. Med Sci Sports Exerc. 2023 May 1;55(5):787-793.
  19. Connors G, Mathew J, Freeland E. Biomechanics and Injury Prevention for Barefoot/Minimalist Running. JBJS Rev. 2023 Nov 7;11(11).
  20. Kelly LA, Farris DJ, Lichtwark GA, Cresswell AG. The Influence of Foot-Strike Technique on the Neuromechanical Function of the Foot. Med Sci Sports Exerc. 2018 Jan;50(1):98-108.