I had to roll my eyes at this in my alerts this morning. This was nothing startling, just a case report on 3 runners who got an injury in minimalist running shoes:
Minimalist shoe injuries: Three case reports.
Cauthon DJ, Langer P, Coniglione TC.
Foot (Edinb). 2013 May 10.
Running in minimalist shoes continues to increase in popularity and multiple mainstream shoe companies now offer minimalist shoes. While there is no evidence that traditional running shoes prevent injuries, there are concerns that the designs of minimalist shoes may increase injury risk. However, reports of injuries in runners wearing minimalist shoes are rare. We present three injuries occurring in runners that were wearing minimalist shoes at the time of injury. All three of the runners switched immediately to the minimalist shoes with no transition period. We recommend that any transition to minimalist shoe gear be performed gradually. It is our contention that these injuries are quite common and will continue to become more prevalent as more runners change to these shoes.
Even though this was only 3 published cases, we keep seeing a lot more of these injuries in runners, but what about this comment: “All three of the runners switched immediately to the minimalist shoes with no transition period“. How can any runner be so stupid as to do that? I just do not get it. The manufacturers of the shoes recommend an appropriate tranistion; all the blogs and magazine articles and books recommend it; everywhere you go you see the advice on how to transition and the importance of doing it properly; I assume most retailers give advice. How can so many be so ‘dumb’ as to not do it? Why is the advice not getting through to so many?
POSTSCRIPT: I just remembered a tweet from James Dunne (@KineticRev) on this issue from earlier this year. Found it:
To the man on my train bragging about his new barefoot running shoes: Your planned 10miler to “test them out” will be a disaster! #FACT
— James Dunne (@KineticRev) January 13, 2013
Unfortunately this is all too common. In the last 3 years I have seen more calf injury, achilles tendinosis and metatarsal stress reactions in my clinics than in the 10 years prior to that. On discussion most of these runners, if not all, did not allow sufficient time for tissue adaptation.
I’m often asked if “barefoot” running is bad or if it causes injury. My answer is generally no. However, what will significantly increase risk of injury is an inappropriate transistion.
I’m not sure if these runners are ‘dumb’ but almost all are definitely impatient! However what could be classed as dumb is thinking a particular type of shoe is the answer to all injury woes – people who think this clearly don’t understand the mechanisms of tissue damage and the multifactorial nature of injury.
Ian wrote: “However, what will significantly increase risk of injury is an inappropriate transition.” Is there any evidence which suggests that a longer, more graded transition period to wearing minimalist footwear results in fewer injuries?
“Is there any evidence which suggests that a longer, more graded transition period to wearing minimalist footwear results in fewer injuries?”
Simon – no there is not (but you knew that already!)
Just to clarify my point: In my opinion an inappropriate transition will significantly increase risk of injury when compared to not trying to transition at all.
Its a good point; we don’t know if the 3 people in that case report above (and the numerous ones we see clinically) that do this would not have still got the injury if they followed appropriate transition guidelines – I still do see injuries in those who have taken a long time to adapt.
Absolutey spot on!
…which begs the question that as we now know that there are no evidence of any benefits for barefoot running in terms of injury risk reduction, why bother transitioning to it if the chance of an injury is so high?
?
Because then you don’t need to re–transition every time you get a new kind of shoe, or try a new kind of orthotic, or talk to a new “expert,” or replace an aging shoe with a new one with stiffer padding where the last pair was broken in.
Instead you “transition” one time, to barefoot running or minimalist shoes. You learn your particular weaknesses and how you might need a conscious effort to run a bit differently because of them, you do your foot or calf exercises, you learn where you are particularly vulnerable to injury and how to watch for early signs of that, you learn whick kind of pain will get worse as you train vs which kind is just soreness you can run through, then you’re done. No more unexpected changes related to getting new shoes.
Perhaps the motivation is to have different injuries. That way the old ones can recover.
I am an on-and-off runner with a dozen different kinds of injuries I tend to get, and a dozen different “main problems” based on who I am talking to … and every time I got a new shoe or new arch support or took “expert” advice and began a new technique, that problem would be solved but a seemingly-unrelated new problem would appear in a different spot, from foot problems to toe problems to ankle problems to knee problems and back to foot problems. I do not have the money or time to go back to the doctors and back through that whole process of hunting down the cause and finding a new treatment every time something different starts to hurt.
If I was wealthy or a full-time athlete I’d spend the time and money to discover that one, “proper,” customized running shoe, and replace the shoe every six weeks like I’m supposed to … but I’m not, and the universal availability of running (and the fact that it’s free) was why it was my drug of choice in the first place.
When I switched to barefoot/minimalist running the many leg and knee problems I was having switched to one thing: pain in one spot under the edge of my left foot. It was definitely “caused by” barefoot running and was not immediately cured. So, no, it’s not a cure-all.
But as I’ve worked with the issue (initially cut back on exertion and gradually eased back into longer distances) strenghened my calves, found that sweet spot between a forefoot-strike a heel strike which I can maintain without thinking now, no new problems have shown up. Thats a huge change from anything I’ve experienced before. I now know how to run barefoot and no matter what kind of materials are available, I’ll always have the option of taking the shoes off.
That’s very subjective and hardly scientific, but conceptually, it is true for everyone: if everyone responds differently to different changing variables, you make a huge leap when you pick one set of variables, starting from scratch, and learn how you are with those.