Guide to Barefoot Running

The barefoot running and minimalist shoewear has become a hot topic over the past 15 years as runners have searched for answers to their ongoing foot and shoe issues. Ever since Born To Run by Christopher McDougal was published in 2009, podiatrists have been asked for their opinion on the barefoot movement.

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Performance Footcare of New York has always been careful to research and understand the risks and benefits of any new sport medicine idea before giving our opinion. The issue here is that there is a lack of research properly run prospective, double blind studies. Most of the research has come out of shoe company sponsored studies and physiology research labs. Even the subject of the benefits of forefoot/midfoot strike versus heel strike during running has not been adequately answered.

There is no simple answer to whether or not we recommend barefoot running or minimalist shoes. The variables involved for each particular patient’s situation makes it difficult to give any blanket statement on the matter. We like to ask our patients very specific questions if they are interested in trying barefoot or minimalist running:

  • Why do you want to make the switch to barefoot or minimalist running?
  • What types of foot and ankle problems have you had in the past? Have you had any orthopedic surgery in any part of your body?
  • What is your current foot and ankle problem you are trying to address?
  • What shoes do you run in right now, and what is their condition?
  • What type of surface do you run on?
  • What is your weekly mileage?
  • What is your running pace?
  • How long have you been running?
  • Are you currently training for an upcoming race?

After understanding a patient’s motivation and running history, we assess some critical physical exam factors:

  • Body type and weight
  • Foot and ankle biomechanics (are they an overpronator or supinator?)

We also inform out patients that there are some very real risks involved in barefoot and minimalist shoe running:

  • Stress fractures: due to the markedly increased pressure on the foot in comparison to regular running shoe gear, the repetitive stress from running can results in a small crack in the foot, usually in the metatarsals or the heel bone.
  • Skin puncture or laceration: minimal protection of the foot exposes the runner to sharp objects
  • Achilles tendonitis and strains: lack of the nature heel lift found in most shoes increases the pressure on the Achilles.

With this in mind, we do not recommend barefoot or minimalist running to runners suffering with:

  • Achilles Tendonitis
  • Plantar Fasciitis
  • Tibialis Posterior Tendinopathy
  • Calf Strains
  • Overpronation or oversupination

While Performance Footcare of New York does not advocate completely abandoning your tried-and-true running shoes for barefoot or minimalist shoes, we do recognize that minimalist shoe running can have the benefit of strengthening the intrinsic muscles of the feet and decreasing pressure on the knees while running. Performance Footcare of New York believes that it can be used as an additional training tool for very fit athletes who are experienced runners. We do not recommend barefoot running or minimalist shoes for the novice runner looking to lose weight with a new running and/or exercise program.

We have a protocol for starting minimalist shoe running:

  1. Make sure that you are evaluated and fit for them at a specialty running shoe store.
  2. Walk barefoot or in minimalist shoes during the day and for warm up drills until it feels normal. You should have no discomfort during the day.
  3. Make sure to stretch the plantar fascia, Achilles, and calf muscles daily.
  4. Eccentric training should be added to the stretching exercises after the first week of stretching.

Calf raises: With your heels hanging over the edge of a step, quickly raise up onto the ball of your foot. Then come down slowly with a single leg (eccentric exercise). You should perform the movement with the knees both slightly bent and then straight.

Backward walking: Walking backward on a treadmill can stretch the calf muscles. Perform this pain free and fatigue free while barefoot for 10 to 20 percent of your regular running distance.

Performance Footcare of New York recommends a 8 to 10 week transition while slowly increasing your distance. DO NOT EXCEED 1 MILE for any barefoot run during your first week. We recommend starting by performing 10% of your typical run barefoot. You can increase the distance by another 10% every week thereafter. If you start to feel pain then reduce the percentage of increase.

Post Injury Return to Running

Many of you are looking forward to returning to running after a break for injury. You have to be sure to slowly build back up to your pre-injury level. There are a couple of rules while returning:

  • Running should not hurt after your recovery. While some soreness is to be expected, true pain indicates that your body is not yet ready to return to exercise.
  • Concentrate on those exercises that you can perform without pain. Exercises that can keep your aerobic fitness without pain are ideal.

I recommend the following exercises for patients not quite ready to return to running:

  • Swimming. Being a former All-American swimmer, I can tell you first hand that swimming is a great way to stay in shape and to rebuild your aerobic capacity. This is of course practical only if you know how to swim. I would recommend 1500-3000 depending on your level of swimming expertise.
  • Elliptical: Concentrate on your cadence to get your legs used to your running pace. 90 strides per minute are ideal.
  • Water Running: Running in deep water with a floatation belt is another method of getting your arms and legs back into running motion. Your feet must not be able to hit the bottom of the pool. Make sure to hold your head high, and pump your arms. There are various techniques that you can study and try.
  • Power walk: Use the treadmill at 10-15 percent grade while walking at you maximum walking speed. Achilles tendon patients: Be aware that this exercise is not ideal for your injury.
  • Run-Walk: Alternative between running and walking allows your body time to get re-acclimated to running loads without stressing the foot and ankle too much.

When you are ready to return to running, you must stick to an organized plan. One thing to consider is environment. Treadmills, synthetic and cinder tracks, and trail running can be more forgiving on your feet. Depending on the injury, I usually recommend returning to about 50% of the typical load for the first week. If your foot/ankle responds with minimal to no pain, then you can add 10 percent distance to your runs per week. If your pain returns, then you should rest a couple of days and return to the previous week’s running load.