Comparison of running injuries between shod and barefoot runners

I have previously reported that so far all the systematic reviews and meta-analyses on barefoot running vs shod running were all concluding the same thing: that there are no systematic differences between the two. Now we have the first published prospective study on injury rates between shod and barefoot running:

Prospective comparison of running injuries between shod and barefoot runners
Alison R Altman and Irene S Davis
Br J Sports Med doi:10.1136/bjsports-2014-094482

Background Advocates of barefoot running suggest that it is more natural and may be a way to minimise injury risk. In contrast, opponents believe shoes are needed to adequately cushion and support the foot. However, to date, there have been no prospective studies of injury patterns in barefoot and shod runners. The purpose of this study was to compare the incidence and rate of injuries between shod and barefoot runners.
Methods A prospective survey was conducted over the course of a year among 201 (107 barefoot and 94 shod) adult runners. Information regarding injuries and mileage was logged monthly using a custom, web-based database program. The number of injured runners, number of injuries per runner and injury rates were compared between habitual barefoot and habitual shod runners. Both musculoskeletal and plantar surface injuries were assessed.
Results Statistically fewer overall, diagnosed, musculoskeletal injuries/runner were noted in the barefoot group. However, injury rates were not statistically different between groups due to significantly less mileage run in the barefoot group. As expected, barefoot runners sustained a statistically greater number of injuries to the plantar surface of the foot. The descriptive analysis suggests a greater number of calf injuries, but lower number of knee and hip injuries in the barefoot group. Additionally barefoot runners reported less plantar fasciitis than the shod group.
Conclusions Barefoot running is associated with fewer overall musculoskeletal injuries/runner, but similar injury rates. A larger scale cohort is needed to more accurately assess differences in individual injuries between these two groups.

The strength of this study is that is was prospective, but a weakness inherent in the methodology used is that it was a cohort study. It was not a randomized controlled study that is better to ensure baseline characteristics are similar. In the above study the barefoot group was different from the shod group on all characteristics except one. The barefoot group were older; had more males in it; were taller and heavier; ran almost half the weekly mileage of the shod group; and ran slower. Both groups had been running a similar number of years. Regardless of the conclusions drawn from a study with such differences in the baseline characteristics, the results need to be interpreted in that context.

They found less injuries in the barefoot group but after controlling for the big differences in the distances run, there was no difference in the injury rates between the two groups. This study confirms the conclusions of all the systematic reviews on this topic, that there are no systematic benefits to barefoot running over shod running (or vice versa).

There were some differences noted in the prevalence of injuries in different locations which are consistent with what would be predicted theoretically and has been anecdotally noted by many. Given the such big differences in the weekly mileage run between the two groups, it is probably not a good idea to give too much weight to this as “evidence”, even if it is theoretically coherent and biologically plausible.

As always, I go where the evidence takes me until convinced otherwise… and there are still no systematic benefits of barefoot running over shod running or for shod running over barefoot running.

Altman, A., & Davis, I. (2015). Prospective comparison of running injuries between shod and barefoot runners British Journal of Sports Medicine DOI: 10.1136/bjsports-2014-094482

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