All the rhetoric and propaganda over recent years is that minimalist or running barefoot running will reduce the risk of injury. The preponderance of the recent research on injury rates has not supported that. Now we have this new study to add to the mix:
Examining injury risk and pain perception in runners using minimalist footwear
Michael Ryan, Maha Elashi, Richard Newsham-West, Jack Taunton
Br J Sports Med; Published Online First 19 December 2013
Background: This study examines the effect of progressive increases in footwear minimalism on injury incidence and pain perception in recreational runners.
Methods: One hundred and three runners with neutral or mild pronation were randomly assigned a neutral (Nike Pegasus 28), partial minimalist (Nike Free 3.0 V2) or full minimalist shoe (Vibram 5-Finger Bikila). Runners underwent baseline testing to record training and injury history, as well as selected anthropometric measurements, before starting a 12-week training programme in preparation for a 10 km event. Outcome measures included number of injury events, Foot and Ankle Disability (FADI) scores and visual analogue scale pain rating scales for regional and overall pain with running.
Results: 99 runners were included in final analysis with 23 injuries reported; the neutral shoe reporting the fewest injuries (4) and the partial minimalist shoe (12) the most. The partial minimalist shoe reported a significantly higher rate of injury incidence throughout the 12-week period. Runners in the full minimalist group reported greater shin and calf pain.
Conclusions: Running in minimalist footwear appears to increase the likelihood of experiencing an injury, with full minimalist designs specifically increasing pain at the shin and calf. Clinicians should exercise caution when recommending minimalist footwear to runners otherwise new to this footwear category who are preparing for a 10 km event.
The conclusions made by the authors were pretty clear:
Injury event analysis showed there was a higher likelihood of experiencing an injury with minimalist footwear compared with a conventional neutral shoe model, with the partial minimalist condition having a particularly higher risk.
Where the study may fall down (or at least where the fan boys are going to call the study fatally flawed and unethical) is on the adequacy of the transition to the minimalist shoe groups. The participants were given a “1-week break in period to their assigned footwear“, then began the 12 week training program. The program did follow a gradual increase in distances that were run, so should have facilitated the transition in the two minimalist groups. Is the 12 weeks adequate? This issue was discussed at depth in the discourse that surrounded the bone stress injury and Vibram running shoes study. That study did follow the advice of 12 weeks advised on the Vibram website, but the fan boys in their social media comments considered that unethical and woefully inadequate.
I guess it all comes down to which end of the spectrum that you sit, your world view and what color blinkers you use to interpret this study. At one end, this study shows that if you wear minimalist shoes you are more likely to get an injury. At the other end of the spectrum this just confirms what we know about the increased risk for injury in the transition to minimalist shoes and the need to do it cautiously. This study did not investigate what happened to injury rates following the 12 week training program.
As always, I go where the evidence takes me until convinced otherwise, and this study confirms the injury risks associated with minimalist footwear.