Barefoot running: Difference between revisions

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===Introduction:===
===Introduction:===
Running has become increasingly popular over the years and provides numerous health benefits including improved cardiovascular health, decreased risk of stroke and hypertension, increased bone mass<ref>Wilks DC, Winwood K, Gilliver SF, Kwiet A, Chatfield M, Michaelis I, Sun LW, Ferretti JL, Sargeant AJ, Felsenberg D, Rittweger J. [https://www.sciencedirect.com/science/article/pii/S8756328209012125 Bone mass and geometry of the tibia and the radius of master sprinters, middle and long distance runners, race-walkers and sedentary control participants: a pQCT study.] Bone. 2009 Jul 1;45(1):91-7.</ref> and psychological benefits such as decreased depression and a positive effect on mood state. Despite its popularity and many benefits runners still experience a high injury rate, with up to 79% of runners incurring an injury annually<ref>Hreljac AL, Marshall RN, Hume PA. [https://www.researchgate.net/profile/Patria_Hume/publication/283517551_Evaluation_of_lower_extremity_overuse_injury_potential_in_runners/links/56415b5808aec448fa607cb0/Evaluation-of-lower-extremity-overuse-injury-potential-in-runners.pdf Evaluation of lower extremity overuse injury potential in runners]. Medicine & Science in Sports & Exercise. 2000 Sep 1;32(9):1635-41.</ref>. 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'''<ref>Hanson NJ, Berg K, Deka P, Meendering JR, Ryan C. [https://pdfs.semanticscholar.org/8ef9/5b1868ce0f780777cc92983cd64902660793.pdf Oxygen cost of running barefoot vs. running shod. International journal of sports medicine]. 2011 Jun 1;32(6):401.</ref>
[[File:Barefoot running.jpeg|right|frameless]]
Running has become increasingly popular over the years and provides numerous health benefits including improved cardiovascular health, decreased risk of stroke and hypertension, increased bone mass<ref>Wilks DC, Winwood K, Gilliver SF, Kwiet A, Chatfield M, Michaelis I, Sun LW, Ferretti JL, Sargeant AJ, Felsenberg D, Rittweger J. [https://www.sciencedirect.com/science/article/pii/S8756328209012125 Bone mass and geometry of the tibia and the radius of master sprinters, middle and long distance runners, race-walkers and sedentary control participants: a pQCT study.] Bone. 2009 Jul 1;45(1):91-7.</ref> and psychological benefits such as decreased depression and a positive effect on mood state. Despite its popularity and many benefits runners still experience a high injury rate, with up to 79% of runners incurring an injury annually<ref>Hreljac AL, Marshall RN, Hume PA. [https://www.researchgate.net/profile/Patria_Hume/publication/283517551_Evaluation_of_lower_extremity_overuse_injury_potential_in_runners/links/56415b5808aec448fa607cb0/Evaluation-of-lower-extremity-overuse-injury-potential-in-runners.pdf Evaluation of lower extremity overuse injury potential in runners]. Medicine & Science in Sports & Exercise. 2000 Sep 1;32(9):1635-41.</ref>. 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'''<ref>Hanson NJ, Berg K, Deka P, Meendering JR, Ryan C. [https://www.researchgate.net/publication/51031900_Oxygen_Cost_of_Running_Barefoot_vs_Running_Shod Oxygen cost of running barefoot vs. running shod. International journal of sports medicine.] 2011 Jun 1;32(6):401.</ref>


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 (including a hindfoot strike versus the forefoot or midfoot strike typical of unshod runners) have contributed to injuries seen in runners<ref>Giuliani J, Masini B, Alitz C, Owens LB. Barefoot-simulating footwear associated with metatarsal stress injury in 2 runners. Orthopedics. 2011 Jul 1;34(7):e320-3.</ref>. The term('''minimalist shoe''') is one that 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." Most studies indicate that running in minimalist shoes results in a lower physiological energy cost than running in conventional shoes, likely because of the lower weight of the minimalist shoe.<ref>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.</ref>   
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 (including a hindfoot strike versus the forefoot or midfoot strike typical of unshod runners) have contributed to injuries seen in runners<ref>Giuliani J, Masini B, Alitz C, Owens LB. Barefoot-simulating footwear associated with metatarsal stress injury in 2 runners. Orthopedics. 2011 Jul 1;34(7):e320-3.</ref>. 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." Studies show that running in minimalist shoes has lower physiological energy costs probably because of their light weight.<ref>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.</ref>   


Humans are maladapted to wearing shoes in some ways that contribute to certain injuries. From an evolutional medical perspective, three novel consequences of wearing shoes may be relevant to injury:<ref name=":0">Altman AR, Davis IS. [https://pdfs.semanticscholar.org/6443/5c128b22e6af1b1f76618fff056610384aca.pdf Barefoot running: biomechanics and implications for running injuries]. Current sports medicine reports. 2012 Sep 1;11(5):244-50.</ref>   
Humans are maladapted to wearing shoes in some ways that contribute to certain injuries. From an evolutional medical perspective, three novel consequences of wearing shoes may be relevant to injury:<ref name=":0">Altman AR, Davis IS. [https://journals.lww.com/acsm-csmr/fulltext/2012/09000/barefoot_running__biomechanics_and_implications.9.aspx Barefoot running: biomechanics and implications for running injuries.] Current sports medicine reports. 2012 Sep 1;11(5):244-50.</ref>   
* '''Shoes limit''' '''[[proprioception]]:''' Sensory feedback from the plantar surface of the foot works as an adaptation for sensing characteristics of the ground including hardness, roughness, unevenness, and the presence of potentially dangerous objects such as sharp rocks. Plantar proprioception activates reflexes and helps the central nervous system make decisions that help increase stability and avoid injury.   
* '''Shoes limit''' '''[[proprioception]]:''' Sensory feedback from the plantar surface of the foot works as an adaptation for sensing characteristics of the ground including hardness, roughness, unevenness, and the presence of potentially dangerous objects such as sharp rocks. Plantar proprioception activates reflexes and helps the central nervous system make decisions that help increase stability and avoid injury.   


* '''Modern shoes''' with elevated heels, stiff soles, cushioning, and arch support may either facilitate or encourage a different running form than appears to be common among habitual barefoot runners.   
* '''Modern shoes''' with elevated heels, stiff soles, cushioning, and arch support may either facilitate or encourage a different running form than appears to be common among habitual barefoot runners.   
*  '''Shoes''' can contribute to weak and inflexible feet, especially during childhood when the foot is growing.<ref name=":0" />
*  '''Shoes''' can contribute to weak and inflexible feet, especially during childhood when the foot is growing.<ref name=":0" />
*  '''Running in conventional running shoes''' may increase asymmetry in vertical instantaneous loading rates.<ref>Kim J, McSweeney SC, Hollander K, Horstman T, Wearing SC. [https://pubmed.ncbi.nlm.nih.gov/37571975/ 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.</ref>
*  '''Running in conventional running shoes''' may increase asymmetry in vertical instantaneous loading rates.<ref>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.</ref>


=== What do we know about Barefoot Running?<ref name=":0" /> ===
=== What do we know about Barefoot Running? ===
Most studies of barefoot running were conducted by asking habitually shod runners to take their shoes off in a laboratory. However, using only habitually shod runners to study barefoot running is problematic because one cannot expect such subjects to have developed the musculoskeletal adaptations and kinematic habits of habitually barefoot runners. Barefoot runners have more variable kinematics than shod runners because they experience more [[proprioception]] from their feet. 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<ref>Shu Y, Mei Q, Fernandez J, Li Z, Feng N, Gu Y. [https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0131385 Foot morphological difference between habitually shod and unshod runners]. PloS one. 2015 Jul 6;10(7):e0131385.</ref>.  
Most studies of barefoot running were conducted by asking habitually shod runners to take their shoes off in a laboratory. However, using only habitually shod runners to study barefoot running is problematic because one cannot expect such subjects to have developed the musculoskeletal adaptations and kinematic habits of habitually barefoot runners. Barefoot runners have more variable kinematics than shod runners because they experience more [[proprioception]] from their feet.<ref name=":0" /> 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<ref>Shu Y, Mei Q, Fernandez J, Li Z, Feng N, Gu Y. [https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0131385 Foot morphological difference between habitually shod and unshod runners]. PloS one. 2015 Jul 6;10(7):e0131385.</ref>.  


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. <ref>Hollander K, Hamacher D,  Zech A. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7902604/ Running barefoot leads to lower running stability compared to shod running - results from a randomized controlled study]. Scientific reports. 2021;11(1):4376. </ref>
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. <ref>Hollander K, Hamacher D,  Zech A. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7902604/ Running barefoot leads to lower running stability compared to shod running - results from a randomized controlled study]. Scientific reports. 2021;11(1):4376. </ref>


===Foot Strike patterns in barefoot and shod runners:===
===Foot Strike patterns in barefoot and shod runners:===
* '''Barefoot''' runners often land on the fore-foot (fore-foot strike) before bringing down the heel, but they sometimes land with a flat foot (mid-foot strike) or, less often, on the heel (rear-foot strike). However, '''shod''' runners mostly rear-foot strike, due to the elevated and cushioned heel of the modern running shoe. Kinematic and kinetic analyses show that even on hard surfaces, barefoot runners who fore-foot strike generate smaller collision forces than shod rear-foot strikers. Fore-foot- and mid-foot-strike gaits were probably more common when humans ran barefoot or in minimal shoes, and may protect the feet and lower limbs from some of the impact-related injuries now experienced by a high percentage of runners<ref>Lieberman DE, Venkadesan M, Werbel WA, Daoud AI, D’andrea S, Davis IS, Mang’Eni RO, Pitsiladis Y. [https://previa.uclm.es/PROFESORADO/xaguado/ASIGNATURAS/BTD/4-Apuntes/Tema01/Liberman_2010_Nature_foot%20strike%20patterns.pdf Foot strike patterns and collision forces in habitually barefoot versus shod runners.] Nature. 2010 Jan;463(7280):531.</ref>.
* '''Barefoot''' runners typically adopt a fore-foot strike as their primary pattern of landing, occasionally a mid-foot strike, and less frequently landing on the heel (rear-foot strike). '''Shod''' runners predominantly engage in a rear-foot strike due to the heel design of modern running shoes. Even on hard surfaces, barefoot runners employing a fore-foot strike experience lower collision forces compared to shod runners using a rear-foot strike. Fore-foot and mid-foot striking gaits were probably more prevalent during periods when humans ran barefoot or in minimal shoes, potentially offering protection to the feet and lower limbs from certain impact-related injuries observed among a significant portion of present-day runners.<ref>Lieberman DE, Venkadesan M, Werbel WA, Daoud AI, D’andrea S, Davis IS, Mang’Eni RO, Pitsiladis Y. [https://www.nature.com/articles/nature08723 Foot strike patterns and collision forces in habitually barefoot versus shod runners.] Nature. 2010 Jan;463(7280):531.</ref>
* Shorter stride length and high stride frequency for barefoot runners.<ref>Squadrone R, Gallozzi C. [https://pdfs.semanticscholar.org/5a42/3be315bfb3caeddd2fde5251810ebc6b76b5.pdf Biomechanical and physiological comparison of barefoot and two shod conditions in experienced barefoot runners]. J Sports Med Phys Fitness. 2009 Mar 1;49(1):6-13.</ref>  
* Shorter stride length and high stride frequency for barefoot runners.<ref>Squadrone R, Gallozzi C. [http://bands.ua.edu/wp-content/uploads/2015/07/Biomechanical-camparison-of-barefoot-vs-shod.pdf Biomechanical and physiological comparison of barefoot and two shod conditions in experienced barefoot runners]. J Sports Med Phys Fitness. 2009 Mar 1;49(1):6-13.</ref>
* A significant increase in leg stiffness (shod runners land in more dorsiflexion but had less ankle motion than when running barefoot)<ref>Bishop M, Fiolkowski P, Conrad B, Brunt D, Horodyski M. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1748411/ Athletic footwear, leg stiffness, and running kinematics.] Journal of athletic training. 2006 Oct;41(4):387.</ref><ref>Hatala KG, Dingwall HL, Wunderlich RE, Richmond BG. [https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0052548 Variation in foot strike patterns during running among habitually barefoot populations]. PloS one. 2013 Jan 9;8(1):e52548.</ref>
* A significant increase in leg stiffness (shod runners land in more dorsiflexion but had less ankle motion than when running barefoot)<ref>Bishop M, Fiolkowski P, Conrad B, Brunt D, Horodyski M. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1748411/ Athletic footwear, leg stiffness, and running kinematics.] Journal of athletic training. 2006 Oct;41(4):387.</ref><ref>Hatala KG, Dingwall HL, Wunderlich RE, Richmond BG. [https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0052548 Variation in foot strike patterns during running among habitually barefoot populations]. PloS one. 2013 Jan 9;8(1):e52548.</ref>
* Running barefoot affects the muscle properties as well, it influences the changes in stiffness of the peroneus and [[Vastus Lateralis|vastus lateralis]] muscles<ref>Saeki J, Shiotani H, Kawakami Y. [https://pubmed.ncbi.nlm.nih.gov/34609097/ Effect of shod and barefoot running on muscle mechanical properties.] J Sports Med Phys Fitness. 2022 Jul;62(7):883-889.</ref>.
* Running barefoot affects the muscle properties as well, it influences the changes in stiffness of the peroneus and [[Vastus Lateralis|vastus lateralis]] muscles<ref>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.</ref>.
===Evidence about Barefoot Running:===
===Evidence about Barefoot Running:===
The systematic review conducted by (Hall et al .,2013)<ref>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.</ref>  evaluated the biomechanical differences between running barefoot and shod, including the quality of available evidence to provide guidance on the phenomenon of barefoot running to the running and sports medicine communities. The results of  this study indicated that:
The systematic review conducted by (Hall et al .,2013)<ref>Hall JP, Barton C, Jones PR, Morrissey D. [https://link.springer.com/article/10.1007/s40279-013-0084-3 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.</ref>  evaluated the biomechanical differences between running barefoot and shod, including the quality of available evidence to provide guidance on the phenomenon of barefoot running to the running and sports medicine communities. The results of  this study indicated that:
* Moderate evidence that barefoot running is associated with reduced ''peak'' ground reaction force (GRF), increased foot and ankle plantarflexion and increased knee flexion at ground contact compared with running in a neutral shoe.
* Moderate evidence that barefoot running is associated with reduced ''peak'' ground reaction force (GRF), increased foot and ankle plantarflexion and increased knee flexion at ground contact compared with running in a neutral shoe.
* Limited evidence indicates barefoot running is associated with reduced ''impact'' GRF, reduced peak knee flexion and varus joint moments, and a higher stride frequency compared to a neutral shoe.
* Limited evidence indicates barefoot running is associated with reduced ''impact'' GRF, reduced peak knee flexion and varus joint moments, and a higher stride frequency compared to a neutral shoe.
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=== Additional effects of Barefoot Running: ===
=== Additional effects of Barefoot Running: ===


* In a study examining the effects of a school barefoot running program on sprinting biomechanics in children, the following was observed: children, who ran barefoot for 10 minutes every school day for a minimum of four years, ran with a shorter contact time, longer flight time and anterior foot-strike pattern while having a greater fast stretch-shortening cycle performance than the control group. <ref name=":1">Mizushima J, Keogh JWL, Maeda K, Shibata A, Kaneko J, Ohyama-Byun K, Ogata M. [https://www.sciencedirect.com/science/article/pii/S0966636220305749?via%3Dihub Long-term effects of school barefoot running program on sprinting biomechanics in children: A case-control study.] Gait Posture. 2021 Jan;83:9-14. </ref>
* 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.<ref name=":1">Mizushima J, Keogh JWL, Maeda K, Shibata A, Kaneko J, Ohyama-Byun K, Ogata M. [https://www.sciencedirect.com/science/article/pii/S0966636220305749?via%3Dihub Long-term effects of school barefoot running program on sprinting biomechanics in children: A case-control study.] Gait Posture. 2021 Jan;83:9-14. </ref>
* Barefoot running may facilitate running ability by enhancing power generation at the ankle in children with [[Cerebral Palsy Introduction|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. <ref>Tinker M, Betten A, Morris S, Gibson N, Allison G, Ng L, Williams G, Chappell A. [https://www.sciencedirect.com/science/article/pii/S0966636222005951?via%3Dihub A comparison of the kinematics and kinetics of barefoot and shod running in children with cerebral palsy.] Gait Posture. 2022 Oct;98:271-278.</ref>
* Barefoot running may facilitate running ability by enhancing power generation at the ankle in children with [[Cerebral Palsy Introduction|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. <ref>Tinker M, Betten A, Morris S, Gibson N, Allison G, Ng L, Williams G, Chappell A. [https://www.sciencedirect.com/science/article/pii/S0966636222005951?via%3Dihub A comparison of the kinematics and kinetics of barefoot and shod running in children with cerebral palsy.] Gait Posture. 2022 Oct;98:271-278.</ref>
* Running barefoot on grass could be a better option for runners with [[Plantar Fasciitis|plantar fasciitis]] as it is observed to ease pain associated with this condition. <ref>MacGabhann S, Kearney D, Perrem N, Francis P. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9741467/ 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.</ref>
* Running barefoot on grass could be a better option for runners with [[Plantar Fasciitis|plantar fasciitis]] as it is observed to ease pain associated with this condition. <ref>MacGabhann S, Kearney D, Perrem N, Francis P. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9741467/ 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.</ref>


=== Transitioning to Barefoot Running: ===
=== Transitioning to Barefoot Running: ===
Transitioning successfully to barefoot running depends on anatomical and biomechanical characteristics. In a research 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. <ref>Mills K, Collins NJ, Vicenzino B. [https://journals.lww.com/acsm-msse/fulltext/2023/05000/transitioning_to_barefoot_running_using_a.3.aspx Transitioning to Barefoot Running Using a Minimalist Shoe Intermediary: A Prospective Cohort Study.] Med Sci Sports Exerc. 2023 May 1;55(5):787-793.</ref>
Transitioning successfully to barefoot running depends on anatomical and biomechanical characteristics. In a research 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. <ref>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.</ref>


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.<ref>Connors G, Mathew J, Freeland E. [https://journals.lww.com/jbjsreviews/fulltext/2023/11000/biomechanics_and_injury_prevention_for.1.aspx Biomechanics and Injury Prevention for Barefoot/Minimalist Running.] JBJS Rev. 2023 Nov 7;11(11).</ref>  As shod runners switch to fore-foot strike, energy absorption and generation requirements are increased at the ankle and foot. <ref>Kelly LA, Farris DJ, Lichtwark GA, Cresswell AG. [https://journals.lww.com/acsm-msse/fulltext/2018/01000/the_influence_of_foot_strike_technique_on_the.13.aspx The Influence of Foot-Strike Technique on the Neuromechanical Function of the Foot.] Med Sci Sports Exerc. 2018 Jan;50(1):98-108. </ref>
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.<ref>Connors G, Mathew J, Freeland E. Biomechanics and Injury Prevention for Barefoot/Minimalist Running. JBJS Rev. 2023 Nov 7;11(11).</ref>  As shod runners switch to fore-foot strike, energy absorption and generation requirements are increased at the ankle and foot. <ref>Kelly LA, Farris DJ, Lichtwark GA, Cresswell AG. [https://journals.lww.com/acsm-msse/fulltext/2018/01000/the_influence_of_foot_strike_technique_on_the.13.aspx The Influence of Foot-Strike Technique on the Neuromechanical Function of the Foot.] Med Sci Sports Exerc. 2018 Jan;50(1):98-108. </ref>


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

Revision as of 00:42, 27 November 2023

This article or area is currently under construction and may only be partially complete. Please come back soon to see the finished work! (27/11/2023)
Original Editor - Shaimaa Eldib Top Contributors - Shaimaa Eldib, Zsofia Laszlo, Kim Jackson, Wanda van Niekerk, Sehriban Ozmen and Kris Porter

Introduction:[edit | edit source]

Barefoot running.jpeg

Running has become increasingly popular over the years and provides numerous health benefits including improved cardiovascular health, decreased risk of stroke and hypertension, increased bone mass[1] and psychological benefits such as decreased depression and a positive effect on mood state. Despite its popularity and many benefits runners still experience a high injury rate, with up to 79% of runners incurring an injury annually[2]. 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[3]

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 (including a hindfoot strike versus the forefoot or midfoot strike typical of unshod runners) have contributed to injuries seen in runners[4]. 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." Studies show that running in minimalist shoes has lower physiological energy costs probably because of their light weight.[5]

Humans are maladapted to wearing shoes in some ways that contribute to certain injuries. From an evolutional medical perspective, three novel consequences of wearing shoes may be relevant to injury:[6]

  • Shoes limit proprioception: Sensory feedback from the plantar surface of the foot works as an adaptation for sensing characteristics of the ground including hardness, roughness, unevenness, and the presence of potentially dangerous objects such as sharp rocks. Plantar proprioception activates reflexes and helps the central nervous system make decisions that help increase stability and avoid injury.
  • Modern shoes with elevated heels, stiff soles, cushioning, and arch support may either facilitate or encourage a different running form than appears to be common among habitual barefoot runners.
  • Shoes can contribute to weak and inflexible feet, especially during childhood when the foot is growing.[6]
  • Running in conventional running shoes may increase asymmetry in vertical instantaneous loading rates.[7]

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

Most studies of barefoot running were conducted by asking habitually shod runners to take their shoes off in a laboratory. However, using only habitually shod runners to study barefoot running is problematic because one cannot expect such subjects to have developed the musculoskeletal adaptations and kinematic habits of habitually barefoot runners. Barefoot runners have more variable kinematics than shod runners because they experience more proprioception from their feet.[6] 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[8].

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. [9]

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, occasionally a mid-foot strike, and less frequently landing on the heel (rear-foot strike). Shod runners predominantly engage in a rear-foot strike due to the heel design of modern running shoes. Even on hard surfaces, barefoot runners employing a fore-foot strike experience lower collision forces compared to shod runners using a rear-foot strike. Fore-foot and mid-foot striking gaits were probably more prevalent during periods when humans ran barefoot or in minimal shoes, potentially offering protection to the feet and lower limbs from certain impact-related injuries observed among a significant portion of present-day runners.[10]
  • Shorter stride length and high stride frequency for barefoot runners.[11]
  • A significant increase in leg stiffness (shod runners land in more dorsiflexion but had less ankle motion than when running barefoot)[12][13]
  • Running barefoot affects the muscle properties as well, it influences the changes in stiffness of the peroneus and vastus lateralis muscles[14].

Evidence about Barefoot Running:[edit | edit source]

The systematic review conducted by (Hall et al .,2013)[15] evaluated the biomechanical differences between running barefoot and shod, including the quality of available evidence to provide guidance on the phenomenon of barefoot running to the running and sports medicine communities. The results of this study indicated that:

  • Moderate evidence that barefoot running is associated with reduced peak ground reaction force (GRF), increased foot and ankle plantarflexion and increased knee flexion at ground contact compared with running in a neutral shoe.
  • Limited evidence indicates barefoot running is associated with reduced impact GRF, reduced peak knee flexion and varus joint moments, and a higher stride frequency compared to a neutral shoe.
  • Very limited to limited evidence also indicates power absorption at the knee is decreased while being increased at the ankle whilst barefoot running. Additionally, the effects of barefoot running on loading rate appear dependent on the strike pattern adopted, with a forefoot strike pattern found to reduce loading rate, whilst a rearfoot strike pattern increases loading rate when running barefoot compared to shod.

However, there was some methodological weakness in this study that needed to be covered 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.[16]
  • 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. [17]
  • 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. [18]

Transitioning to Barefoot Running:[edit | edit source]

Transitioning successfully to barefoot running depends on anatomical and biomechanical characteristics. In a research 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. [19]

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.[20] As shod runners switch to fore-foot strike, energy absorption and generation requirements are increased at the ankle and foot. [21]

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

References:[edit | edit source]

  1. ↑ Wilks DC, Winwood K, Gilliver SF, Kwiet A, Chatfield M, Michaelis I, Sun LW, Ferretti JL, Sargeant AJ, Felsenberg D, Rittweger J. Bone mass and geometry of the tibia and the radius of master sprinters, middle and long distance runners, race-walkers and sedentary control participants: a pQCT study. Bone. 2009 Jul 1;45(1):91-7.
  2. ↑ Hreljac AL, Marshall RN, Hume PA. Evaluation of lower extremity overuse injury potential in runners. Medicine & Science in Sports & Exercise. 2000 Sep 1;32(9):1635-41.
  3. ↑ Hanson NJ, Berg K, Deka P, Meendering JR, Ryan C. Oxygen cost of running barefoot vs. running shod. International journal of sports medicine. 2011 Jun 1;32(6):401.
  4. ↑ Giuliani J, Masini B, Alitz C, Owens LB. Barefoot-simulating footwear associated with metatarsal stress injury in 2 runners. Orthopedics. 2011 Jul 1;34(7):e320-3.
  5. ↑ 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.
  6. ↑ 6.0 6.1 6.2 Altman AR, Davis IS. Barefoot running: biomechanics and implications for running injuries. Current sports medicine reports. 2012 Sep 1;11(5):244-50.
  7. ↑ 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.
  8. ↑ 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.
  9. ↑ 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.
  10. ↑ Lieberman DE, Venkadesan M, Werbel WA, Daoud AI, D’andrea S, Davis IS, Mang’Eni RO, Pitsiladis Y. Foot strike patterns and collision forces in habitually barefoot versus shod runners. Nature. 2010 Jan;463(7280):531.
  11. ↑ Squadrone R, Gallozzi C. Biomechanical and physiological comparison of barefoot and two shod conditions in experienced barefoot runners. J Sports Med Phys Fitness. 2009 Mar 1;49(1):6-13.
  12. ↑ Bishop M, Fiolkowski P, Conrad B, Brunt D, Horodyski M. Athletic footwear, leg stiffness, and running kinematics. Journal of athletic training. 2006 Oct;41(4):387.
  13. ↑ Hatala KG, Dingwall HL, Wunderlich RE, Richmond BG. Variation in foot strike patterns during running among habitually barefoot populations. PloS one. 2013 Jan 9;8(1):e52548.
  14. ↑ 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.
  15. ↑ 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.
  16. ↑ 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.
  17. ↑ 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.
  18. ↑ 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.
  19. ↑ 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.
  20. ↑ Connors G, Mathew J, Freeland E. Biomechanics and Injury Prevention for Barefoot/Minimalist Running. JBJS Rev. 2023 Nov 7;11(11).
  21. ↑ 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.
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