“Running barefoot may increase injury risk in older, more experienced athletes”

This press release is starting to the rounds:
Running barefoot may increase injury risk in older, more experienced athletes

Older athletes less likely to adapt running style to “minimalist” shoes
LAS VEGAS – In recent years there has been an explosion in barefoot running, as well as the purchase and use of “minimalist” running shoes that more closely resemble barefoot running by encouraging the balls of the feet, between the arch and toes, to hit the pavement first. A new study presented today at the 2015 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS), found that a significant number of experienced runners, age 30 and older (40 percent of men and 20 percent of women), maintained a heel-first running pattern—which naturally occurs when wearing a shoe with an elevated heel—when running without shoes. Maintaining a heel-toe pattern while running barefoot or in a minimalist shoe may lead to more frequent injuries.

“Previous studies have demonstrated that an adolescent runner’s foot strike is heavily influenced by their running shoe,” said orthopaedic surgeon Scott Mullen, MD, the lead author of the study. “Young runners quickly adapt to a forefoot strike pattern when running barefoot, whereas a heel strike is normally associated with wearing large-heeled training shoes.”

In this study, a team of researchers from the University of Kansas Department of Orthopedics and Sports Medicine measured the heel-to-toe drop of 26 runners, all age 30 or older with at least 10 years of running experience, when each ran in a traditional running shoe, and again when barefoot. The heel and forefoot thickness was measured at running speeds of 6, 7 and 8 miles per hour (mph) for women, and 7, 8 and 9 mph for men. A motion capture system was utilized to analyze foot strikes by a single blinded examiner skilled in the use of the camera system and running mechanics.

Heel-to-toe thickness of the running shoe did not significantly correlate with a change in heel strike, nor did alterations in speed. Running barefoot resulted in a significant drop in percent heel strike at all speeds; however, 40 percent of the men and 20 percent of the women persisted with consistent strike patterns across all speeds with and without shoes.

“Our study indicates that older runners (age 30 and older) are not able to adapt as quickly to running barefoot,” said Dr. Mullen. “The inability to adapt the foot strike to the change in shoe type may put these runners at increased risk of injury. Older runners should be cautious when transitioning to a more minimalist type of shoe.”

That kinda makes sense as older runners have tissues that are going to need more time to adapt to different loads that are applied to them and the injury risk during the transition to any change in the running technique is higher. This probably does make older athlete more vulnerable to injury.

But, like any press release on any health related topic we have to put the critical thinking lens on and dig deeper as we know from the published evidence that more often than not the headlines in press releases are not supported by the actual research that they are reporting on. I already followed the debacle over the running shoes causing osteoarthritis saga (and no one has still offered an explanation as to why those two barefoot running websites made stuff up about the research). So what is the above really about? The press release was put out by the American Academy of Orthopedic Surgeons from a presentation at their annual meeting. Here is the abstract from that presentation:

The Effect of Training Shoes on Running Kinematics in Older Runners
Scott M. Mulen, E B. Toby, Damon Mar, Megan Bechtold, Heath Melugin, Terence McIff
AAOS Annual Meeting; Las Vegas 2015
INTRODUCTION: Recently there has been enthusiasm for minimalist shoes or barefoot running to create a more natural running style featuring forefoot strike as opposed to heel strike typically seen in the large heeled training shoes. A previous study looking at elite competitive adolescent runners showed that these athletes changed from a heel strike pattern to a forefoot strike immediately upon transitioning from the large heel trainer to either a track flat or barefoot running condition.1 It is unknown whether more experienced runners would exhibit this same quick change in running pattern with change in shoe condition.
METHODS: Twenty-six runners of greater than 10 years running experience and all over the age of 30, were tested upon a treadmill with various speeds. Shoe heel-to-toe drop was measured using a digital caliper. They ran in both their normal running shoe and in the barefoot condition. Additionally, their running shoe was measured with respect to the height of the heel versus forefoot thickness. Running speeds of 6, 7 and 8 mph were used for the women and 7, 8 and 9 mph were used for the men. A motion capture system was utilized to analyze foot strikes by a single blinded examiner skilled in the use of the camera system and running mechanics. Statistical analysis was performed.
RESULTS: Heel-to-toe thickness of the running shoe did not significantly correlate with percent heel strike either in the shoe or barefoot conditions. Alterations in speed also did not change foot strike pattern. Running barefoot resulted in a significant drop in percent heel strike at all shared speeds (p-values < 0.001 ). However, 40% of the men and 20% of the women persisted with consistent strike patterns across all speeds with and without shoes.
DISCUSSION AND CONCLUSION: A forefoot strike has potential advantages, but recent reports indicate a high injury rate as athletes adopt a barefoot or minimalist running shoe condition.2. Alteration in foot strike pattern does not always occur immediately when older experienced athletes go from a training shoe to the barefoot running condition, in contrast to adolescent runners. Some of these runners persist with a heel strike even when barefoot and at high speeds. These more mature runners may have a much more established gait and a longer period of time may be needed to accustom to a forefoot strike with a barefoot running condition or minimalist shoe. This may lead to frequent injuries in individuals who attempt to either run barefoot or with minimalist shoes, but persist with the heel strike pattern. Older runners should be cautious when beginning a barefoot or minimalist shoe running regimen and might consider an assessment of their foot strike pattern.
References:1. Mullen S, Toby EB. Adolescent runners: The effect of training shoes on running kimenatics. J Pediatr Orthop 2013; 33(4):453-457. 2. Ridge ST, Johnson AW, Mitchell UH, Hunter I, Robinson E, Rich BSE, Brown, SD. Foot bone marrow edema after a 10-wk transition to minimalist running shoes. Med & Sci in Sports & Exercise 2013; 45(7):1363-1368

I have no more information on this study than what is in the press release and in the abstract.

Can you notice any similarities between the press release and the actual research?

The research was not even about injuries, but the press release headline and content is about injuries. They were just speculating from the research that this might be the case with no data or evidence to back it up.

There are no younger runners included in the study, so how do they know that the injury risk is greater in the older runners?

I certainly do not see how the authors can make this conclusion reported in the press release: “Our study indicates that older runners (age 30 and older) are not able to adapt as quickly to running barefoot”. Previous research shows that many runners continue to heel strike after transitioning to minimalist shoes or barefoot running. In this study the majority continued to heel strike after transitioning to minimalist shoes. What the authors found is what has already reported – ie most runners continue to heel strike. Why make the conclusion that older runners are less likely to change their foot strike pattern when other studies are showing all runners do not adapt their foot strike pattern? (which is, of course, assuming that adapting the foot strike pattern is actually a good thing). One can only conclude that the actual research does not support the statements made in the press release.

Having said that, there are some interesting findings in the actual study that are consistent with what we do know and I look forward to more detail of it being published in full.

As always, I go where the evidence takes me until convinced otherwiseand thou shalt continue to not trust press releases.

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