Minimalist Footwear

By Christopher F. Geiser, M.S., P.T., L.A.T., A.T.C., Program Director of Athletic Training, Exercise Science Degree Program Everyone has different views on running; some may enjoy it as a way to stay physically fit, others may utilize it as a means of transportation, while some only run when being chased!  Fortunately, running can be done as an individual activity without a workout facility, treadmill, or equipment like many other sports.   All you need is some clean air and free time, unless you want to talk about proper footwear…

The minimalist footwear trend has hit full stride in recent years, challenging what has been accepted as truth throughout the industry.  Since the mid to late 1970’s, running footwear became increasingly restrictive, confining, and isolationist in its design.  Studies at that time reported that the majority of reported injuries were related to impact, such as stress fractures, or from Achilles stresses, such as Achilles tendonitis.  Shoe designers responded by placing large amounts of cushioning under the heel to help absorb impact forces upon heel strike.  The heel was also lifted higher than the forefoot to take tension off of the Achilles tendon.  With the foot now in a downwardly tilted position, it then became easier for the foot to roll inward (excessively pronating), so stiffer materials were added to the inside of the midsole to prevent the foot from deviating that direction.  Forty years later, a generation of us have adapted to running in this type of footwear environment.

Meanwhile, runners often ditched these heavily cushioned training shoes for slim, light racing flats, and as they acclimated to them, did not suffer ill-effects in any great numbers.  This, coupled with the success of East African runners who train largely sans-footwear in their youth, forced us to reconsider the role of footwear in performance and injury prevention.

Boiled down to its essence, proponents of minimalist footwear hypothesize that running in traditional training shoes forces us to heel strike, causing greater stresses transmitted up the leg in the very first part of the landing phase, as well as an altered body position and gait pattern.  Some also feel that the heel strike creates a braking effect on the lower extremity, decreasing running efficiency.  They state that running with minimal footwear brings a runner forward onto the mid-foot and allows the Achilles / calf muscles and intrinsic foot muscles to be active and control our motion while on the ground.  While much of this is still theoretical and anecdotal, supporting evidence is starting to appear, and the topic is increasingly prominent in conference presentations.  Daniel Lieberman, Professor of Human Evolutionary Biology at Harvard University published an article in the magazine Nature (2010) which identifies the differences between barefoot and shod runners, with the major difference being the intensity of the impact experience by the runners body initially.  Barefoot runners landed on the mid-foot, with the Achilles tendon / calf controlling most of the impact.  This decreased the rate of loading up the leg and through the body.

So what should you make of all this?  Should you ditch the shoes and never look back?  To answer, let’s first make the distinction between running for performance and running for health.  For those who run competitively and attempt to maximize their performance, there are still considerable amounts of doubt as to the effects of minimalist footwear.  Opinion articles have expressed thoughts that minimalist running is more efficient, but currently there is very little evidence to support or refute this.  There is evidence that lighter footwear is more efficient, and minimalist footwear tends to be lighter in weight, however, it is unclear if it is more efficient because of weight, or because of the mechanical differences in running patterns noted with minimalist footwear.

So let’s turn to running for fitness and general health effects.  Although early, it appears that the gait patterns associated with minimalist footwear result in less impact forces through the knee, hip, back, and upper body.  However, these come at the cost of much greater stress on the Achilles tendon, small foot muscles, and forefoot/toes.  The one factor that without a doubt contributes to increased risk for running injury is a change or alteration in training.  If we change from running 10 miles a week to 50 miles a week, we are at great risk for some type of overuse injury.  The same can be said if we change the running surface – go from grass to roads or roads to grass, and your risk of injury increases because muscles, tendons, and bones are being used in a different way than they are acclimated to.  The changes in our running pattern with mid-foot striking in a minimalist shoe put enormous amounts of  stress on the Achilles tendon, the joints of the mid-foot, and on the small muscles of the foot that control those joints.  Run a short distance in drastically different footwear and these will result in Achilles, calf muscle, and foot soreness for sure.  Run a long distance, and you become the poster child for overuse running injuries.

So if you are interested in trying minimalist footwear, start very slowly.  Of course it is best to consult with someone knowledgeable about running and its injuries first.  Check with your physician or talk to a sports medicine clinic to ask if they provide advice on running technique or training.  When starting, try an easy jog in the new shoes across a football field.  Try to land more in the middle of your foot versus on the heel.  Shortening your stride for a bit may help you acclimate a bit easier.   See how your feet and calves feel the next two days before you try it again.  Repeat the every other day jog for 3-5 sessions, then add another minute or two.  Listen to your body, your feet, and your Achilles.  Allow recovery time sufficient for tissue regeneration – a day’s rest between attempts and take every third or fourth week off of your new activity.  If you have soreness in the Achilles or feet, wait until the soreness is gone before trying again.  If you are doing this for your health, allow your body the recovery time to repair and regenerate, and don’t be in a hurry to increase the level and amount of activity.  While running, if you feel your calves fatigue and you start to heel strike, end the run for that day, or switch to more protective shoes before continuing.  Anecdotally, the rest of you will probably feel pretty good – less jarring impact on the body will allow you to recover quicker from your training.  You may feel your hips or your core muscles working differently than they are used to.  However, remember where the stress is being transmitted and allow sufficient recovery for your feet and calves.  If you’re someone with an injury history, or you’ve relied heavily on orthotics up to this point, you’ll need to take things even easier and transition even more slowly.

Remember, when changing stresses on your body that have been in place for many years, patience, persistence, and intelligence are the most important concepts!

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