The Risks and Benefits of Running Barefoot or in Minimalist Shoes

Nine formal systematic reviews of the evidence have so far been published looking at the evidence on barefoot or minimalist running having systematic benefits or not. Every single one of them concluded the same thing (reviewed here and here and here). Despite those conclusions, all by people from different backgrounds and published in a variety of different journals, you still see claims that the evidence is that there are systematic benefits. I can’t figure that out. Now we have yet another systematic review of the evidence:

The Risks and Benefits of Running Barefoot or in Minimalist Shoes; A Systematic Review
Kyle P. Perkins, William J. Hanney, PhD, PT, DPT, ATC and Carey E. Rothschild, PT, DPT, OCS, SCS, CSCS
Sports Health: A Multidisciplinary Approach November/December 2014 vol. 6 no. 6 475-480
Context: The popularity of running barefoot or in minimalist shoes has recently increased because of claims of injury prevention, enhanced running efficiency, and improved performance compared with running in shoes. Potential risks and benefits of running barefoot or in minimalist shoes have yet to be clearly defined.
Objective: To determine the methodological quality and level of evidence pertaining to the risks and benefits of running barefoot or in minimalist shoes.
Data Sources: In September 2013, a comprehensive search of the Ovid MEDLINE, SPORTDiscus, and CINAHL databases was performed by 2 independent reviewers.
Study Selection: Included articles were obtained from peer-reviewed journals in the English language with no limit for year of publication. Final inclusion criteria required at least 1 of the following outcome variables: pain, injury rate, running economy, joint forces, running velocity, electromyography, muscle performance, or edema.
Study Design: Systematic review.
Level of Evidence: Level 3.
Data Extraction: Two reviewers appraised each article using the Downs and Black checklist and appraised each for level of evidence.
Results: Twenty-three articles met the criteria for this review. Of 27 possible points on the Downs and Black checklist, articles scored between 13 and 19 points, indicating a range of evidence from very limited to moderate. Moderate evidence supports the following biomechanical differences when running barefoot versus in shoes: overall less maximum vertical ground reaction forces, less extension moment and power absorption at the knee, less foot and ankle dorsiflexion at ground contact, less ground contact time, shorter stride length, increased stride frequency, and increased knee flexion at ground contact.
Conclusion: Because of lack of high-quality evidence, no definitive conclusions can be drawn regarding specific risks or benefits to running barefoot, shod, or in minimalist shoes.

Like all the other reviews, they concluded the same thing: there is no evidence for the claimed benefits!

They did find some strength of evidence that for this

overall less maximum vertical ground reaction forces, less extension moment and power absorption at the knee, less foot and ankle dorsiflexion at ground contact, less ground contact time, shorter stride length, increased stride frequency, and increased knee flexion at ground contact

Which is evidence that barefoot/minimalism is different to shod. None of that says its better, it just says its different. For some runners that may help and for other runners that may hurt – ie its subject specific.

As always, I go where the evidence takes me until convinced otherwise….and this is what ALL the evidence is saying … nuff said.

Perkins, K., Hanney, W., & Rothschild, C. (2014). The Risks and Benefits of Running Barefoot or in Minimalist Shoes: A Systematic Review Sports Health: A Multidisciplinary Approach DOI: 10.1177/1941738114546846

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26 Responses to The Risks and Benefits of Running Barefoot or in Minimalist Shoes

  1. blaise Dubois October 28, 2014 at 5:03 am #

    Why there is not a single systematic review looking the interest of the traditional / maximalist shoe??? … means asking the question to the opposite way … because the conclusion will be exactly the same … EXACTLY !

    The Risks and Benefits of Running in traditional / maximalist Shoes; A Systematic Review

    Context: The popularity of running in traditional / maximalist / technologic shoes has grow-up since 30y because of claims of injury prevention, enhanced running efficiency, and improved performance compared with running in more simple shoes. Potential risks and benefits of running in traditional / maximalist shoes have yet to be clearly defined.
    Results: Moderate evidence supports the following biomechanical differences when running in shoe versus barefoot: overall more maximum vertical ground reaction forces, more extension moment and power absorption at the knee, more foot and ankle dorsiflexion at ground contact, more ground contact time, longer stride length, decrease stride frequency, and decrease knee flexion at ground contact.
    Conclusion: Because of lack of high-quality evidence, no definitive conclusions can be drawn regarding specific risks or benefits to running barefoot, shod, or in minimalist shoes.

    Now, Is there ANY advantage for a beginner (no habit) to start with a traditional / maximalist shoe?
    (… again, I can be agree to not change an habit if there is no injury and no desire to increase performance.)

    • Craig Payne October 28, 2014 at 5:14 am #

      “Why there is not a single systematic review looking the interest of the traditional / maximalist shoe???

      …maybe because no one is making any claims that there is evidence to support it? (certainly not by me). The only claims about running economy and injury reduction are being made by those who tout barefoot/minimalism. I see no such claims being made for maximalism.

      • Daniel Riou October 28, 2014 at 11:38 am #

        Hi there,

        A quick research on a shoe website have allowed me to find evidence that companies might make some claims about ”enhanced gait”, ”increased comfort”, and ”contribute to reduce the risk of injury”. I believe Blaise is right that these statement should be science based.
        Here are a few screenshots : http://screencast.com/t/tAKe1o2yAb
        http://screencast.com/t/xU0axKpIp1
        http://screencast.com/t/4x7o1xfJFT

        • Craig Payne October 28, 2014 at 5:31 pm #

          Yes; of course the claims should be evidence based. The difference is that they are not claiming there is evidence for the claims and most of the claims are just irrelevant marketing hyperbole. Remember Vibram used to claim there was “ample scientific evidence”.

      • Alex Alvarez October 28, 2014 at 12:41 pm #

        Great discussion…
        In spain, and I think lots of places around the world, lot of shoes retailers claims that prevention and injury reduction is made by maximalist shoes, and they say what they hear from companies… and they see lots of runner every day…and the population is convinced that!

        anyway good observation: “overall less maximum vertical ground reaction forces, less extension moment and power absorption at the knee, less foot and ankle dorsiflexion at ground contact, less ground contact time, shorter stride length, increased stride frequency, and increased knee flexion at ground contact” and good reply from Blaise.

        at least this things from observation is a more natural run? more similar to the run from and athlete? 🙂

    • Ellen October 30, 2014 at 1:47 pm #

      ( I had an elaborate reply, but lost it, so this is only short an to the point.)
      I would be interested in seeing research on if there are benefits (or drawbacks) to beginning in a certain type of shoe (minimalist/maximalist).

  2. dingle October 28, 2014 at 7:01 am #

    Hoka claim their shoes alleviate fatigue. Any evidence for this does anyone know?

    • Craig Payne October 28, 2014 at 7:14 am #

      I don’t see them claiming that they have any evidence for that.

      • blaise Dubois October 29, 2014 at 7:23 am #

        Last week in Ile de la Réunion, in a shoe shop, I see a nice poster made by Hoka citing a study (that I never see… certainly not per review) that show MANY benefit (with a lot of numbers 🙂 like : reduce shock, reduce stress, increase economy, … … the only one not cited : decrease injuries. But I’m sure that the consumer that read this will be convince that he will run faster and injury free with that type of shoes… Power of marketing/conviction is sometime subtle 🙂

  3. Andy Houghton October 28, 2014 at 10:26 am #

    I think your use of the word ‘natural’ needs expanding a little. Yes if you eat too much herbal extract that is good for you in small quantities – you could die. However evolution works by letting the creature who has it ‘right’ survive and multiply. i.e therefore maybe we could say that evolution has given us the optimum foot design so why muck about with it.
    I am a UK edurance coach who happens to live where I can run off road for as far as I like straight out of my front door. I do race but I just love going for an off-froad run and minimal shoes have added greatly to my enjoyment. Much more ground feel.
    Heal striking on a tarmac surface with minimal shoes is pretty painful so I don’t think that is an option. The evolution argument is pretty strong for off road running but can’t really be used for road running.
    I don’t agree that your clip from the Berlin Marathon shows a heel striker. I think he is mainly forefoot – I am aware myself that people watching me run think I am a mid foot striker but actually I can feel where the principe landing force comes and it is definitely on my forefoot. Heel stiking means placing the foot landing in front of your vertical posture – very hard to see how this can be beneficial. Most people improve when they stop doing this – Everyone I have coached.
    When running off road in minimal shoes – actually I also use the NB minimus it feels as if the heel is there to give directional stbility – Therefore it needs to be quite narrow to actually penetrate the surface a bit. I wide heel landing area is therefore not ideal. I have run two marathons in zero drop foot shoes but I used a bit more padding teh second time – just for comfort – time not as good though!

  4. Albert Carrère October 29, 2014 at 12:38 am #

    My clinical practice, the discussions with my colleagues and scientific reasoning lead me to think like Blaise, Alex and Daniel.
    All runners have passed through my clinic and have an appropriate transition to minimalism, have improved their performance and are not at all unhappy with their new shoes. All have taken more aware of how they are running, increasing the feelings and releasing their foot. And they all say, “How could I run before these bricks?” 😉
    And as a trail runner experience leads me to the same conclusion, but I know what you’ll say:”its subject specific”…curious coincidence.

    • Craig Payne October 29, 2014 at 12:51 am #

      Albert – no one is denying that. Its just that every day we see claims about the evidence that supports doing that systematically that are simply not true. This is the 10th systematic review that says otherwise.

  5. Kevin A. Kirby, DPM October 29, 2014 at 1:18 am #

    The main differences that I see in my sports podiatry practice between the barefoot/minimalist running shoe fad and the current interest/fad in maximalist running shoes is that maximalist shoe wearers don’t seem to have fanatical and unrealistic beliefs about what their thick-soled shoes will do for them. The people wearing maximalist shoes who come into my practice nearly always had tried them on the recommendation of a friend or running shoe store and bought them because not because they were told all sorts of fantastic things about the shoes and their health benefits, but, rather, they bought them because they felt good to run in them.

    However, the people I saw wearing minimalist shoes or getting injured running barefoot over the past 4-5 years had, in their own words, “drank the kool-aid” by reading “Born to Run”, listening to all the hype from the media and the barefoot/minimalist shoe zealots, and, as a result, became brain-washed by all the made-up things that these people said about running, running form and running injury rates, about how cushioned soled running shoes were somehow bad, and that in order to run “correctly” and “naturally” you needed to be either barefoot or in thin-soled, low heel drop running shoes.

    However, with all this in consideration, we must not assume that maximalist shoes, like the Hoka One One, are not without problems since I am just now starting to see more and more of my runner patients wearing them to run in and don’t think, at this time, we can make any judgments about whether they tend to cause certain types on injuries or problems or not.

    One thing that I have noticed about the Hoka One One shoe is that very few smaller women runners (under 125 pounds) like the shoe. probably because it is just “too much shoe” for them. My guess is that the heavier runners, older runners and runners doing marathon and ultra-marathon distances will tend to do better and like this shoe more and that the lighter, younger runners doing shorter distances will not like this shoe as much. Time will tell. However, so far, the very impressive growth of sales numbers and popularity of the Hoka One One shoes probably has Asics, Nike, New Balance, Saucony and Brooks all worried about their market share.

    • blaise Dubois October 29, 2014 at 7:40 am #

      Hoka is very popular in Ile de la Réunion. I just come back from ‘La diagonal des fous’, an Ultra-trail (one of the toughest and oldest in the world)… I run a part of the trail with my minimalist inov8 and I can tel you that there is absolutely no advantage to run with super sized shoes in those trails (big rocks very instable, slippery surface, …).

      But many are following the trend… and I’m not surprise to see many runners wearing Hoka, having low back pain and knee pain… (even some high level athletes of the Hoka team have new low back problems since they used it)…

      Exactly the same that the trend to the Five Fingers but with injury to a different place! Now is a good thing in a long term? …after the adaptation process? I don’t think so!!!

    • blaise Dubois October 29, 2014 at 7:46 am #

      ” heavier runners, older runners and runners doing marathon and ultra-marathon distances will tend to do better and like this shoe more and that the lighter, younger runners doing shorter distances will not like this shoe as much.” : WHAT???

      Nothing justify more shoe than 70% of TRC rating… except some specific pathologies!

      NB : The 2 best ultra-trailers in the word actually Kilian and Francois… run in minimalist shoe (70%TRC rating) – Sense Salomon

    • Kevin A. Kirby, DPM October 30, 2014 at 3:05 pm #

      Again on the subject of Hoka One One shoes, I just saw a 115 pound female 2:55 marathoner as a patient a few days ago who is wearing the Hoka and seems to prefer it for a running shoe. This is the first smaller female runner who I have seen who prefers the Hoka shoe for running so maybe my previous analysis will change with time once I see more runners try the Hoka to see how they respond to it. So far, haven’t seen anyone who thinks that the Hoka shoe injured them as I saw in the Vibram FiveFingers shoes. Maybe more cushioning is best?

      • Céline May 6, 2015 at 2:11 pm #

        I’m a 107 pounds female, and despite the fact that I’m still far from being a marathonian (started running last year, and I run 10K for the moment), I saw a big difference with the Hoka Clifton so far. I’m faster, and less tired when I finish my run. I definitely like these shoes at this point. We’ll see in a couple of months…

  6. Albert Carrère October 29, 2014 at 10:30 pm #

    Ok Craig, we can not say 100% that run “overall less maximum vertical ground reaction forces, less extension moment and power absorption at the knee, less foot and ankle dorsiflexion at ground contact, less ground contact time, shorter stride length, increased stride frequency, and increased knee flexion at ground contact” is beneficial or is related to a lower incidence of injuries and better performance…
    Otherwise, if I prescribe shod shoes to my patients (either scientifically supported ), I doubt that I have those good results like I have now. Except for some specific diseases (and often temporarily), what benefits do I get with a drop of 6,8,16 ..? And a stack of 40mm ?, and … (endless modern technological elements)?

    Again I’m agree with Blaise.

  7. Rodger Kram October 30, 2014 at 10:45 pm #

    Imagine if the people who spent time conducting 9 systematic reviews had spent time actually conducting original research!

    As always, the sorts of arguments in this comment section make me think about eyeglasses, skis and bicycles. My glasses allow me to see optimally, but they would be horrible for my friend. Some of my very nearsighted friends use “maximalist” glasses when they drive a car and some of my younger friends can even read and drive “bare-eyed”!
    My minimalist skis are great for cross-country skiing but are horrible for moguls at Vail.
    My telemark skis are terrible for skate-skiing.
    My Fatbike is great in snow and sucks on the velodrome.
    My track bike is great on the velodrome but sucks on mountain trails.
    Why is it that when it comes to running shoes, people think that one type of equipment is best for everyone and everywhere? I can run faster and be less beaten up when I run with cushioned shoes on rocky trails but I enjoy doing a few strides barefoot on the grassy infield after track intervals.

    • Kevin A. Kirby, DPM October 31, 2014 at 3:00 am #

      Rodger:

      I agree 100%.

      Back in the 1970s, we trained in thicker-soled running shoes with more cushioning and raced and did intervals in thinner-soled “racing flats” that had minimal cushioning but were very lightweight. Now these thinner-soled shoes that have been around for at least four decades are called “minimalist shoes” by those who feel that shoe cushioning is something evil. Go figure.

      I believe it is the people who are either ignorant of the variability of the human foot and lower extremity or the people with a preset agenda who are promoting one running shoe over another as being the “best type of running shoe”. I have yet to meet an experienced competitive runner who has knowledge of the history of running shoes and the variability of running shoe design ever say that one type of running shoe is better than another for all purposes for all people.

      Personally, I’ll be very glad when all the barefoot/minimalist running shoe hype dies away so that runners can be exposed to more objective information when trying to learn about the biomechanics of running shoes.

      • Joe October 31, 2014 at 6:24 am #

        The only voices I can hear are the negative ones Kevin! 🙂

    • blaise Dubois November 1, 2014 at 6:06 am #

      I agree. Personally, I prefer my inov8 roclite for the trail in the Reunion Island and my inov8 flite for the Mont Blanc Marathon trail or road race… but who cares? … that’s me, only me.

      Now, as health professional I answer everyday to runners about choice of running shoe.

      What interest me is the science in back of possible recommandations… based on: currently available scientific evidence; theoretical coherence relative to the kinetic and kinematic effects of shoes, biological plausibility (tissue adaptation), and indirect evidence (such as publications on the therapeutic effects of plantar orthoses); and for sure commercially unbiased information.

      I try to find again and again why average running shoes have a drop of 10 (16mm some years ago), a stack of 25-30 and a maximum of rigidity. Please lighten me.
      Are runners really make a choice?
      Are runners really prefer that type of shoe?

  8. Droichead November 4, 2014 at 9:27 pm #

    Kevin,

    While I agree that false claims and unrealistic expectations in minimalist runners exists in many cases, in my opinion this is minuscule compared to similar “fads” on maximalist runners, there are hundreds of threads in amateur running forums claiming the “benefits” of pronation control and how X, Y and Z pronation level requires X, Y and Z shoe in a proportion that obliterates the posts by minimalists on the same forums about the supposed scientific benefits of their own “fad”. I agree with Blaise in that we should treat both under the same criteria (which I don’t think it is the case).

    I would disagree with your perception in terms of maximalist runners not having expectations, at least this is not my experience. I know a significant amount of them that are firmly convinced that cushioning and pronation control technologies are scientifically related to lower injury rates and buy their shoes accordingly (which exactly the same weak evidence than your behatred minimalist zealots).

    Every shoe maker these days has statements like this on their web pages, just as an example, ASCICS says on their Gel Foundation 11 things like: “The new Guidance Line along the sole guides your foot as it takes off to help improve your running efficiency.” “Dual density midsole material positioned sport specifically which enhances support and stability by helping to correct the degree and velocity of pronation”, you could get similar statements from any other maker and as already pointed out there is a firm belief by many maximalist runners that there is a strong correlation between their pronation degree and the type of shoe that protects them from injuries (probably as strong as the minimalist zealots, but by far much more numerous).

    And I don’t see that both groups are treated the same.

  9. Francis February 28, 2015 at 2:16 am #

    (Sorry if my english sound weird)
    Are humans biomechanicaly adapted to move with a running pattern? Are we just meant to walk?
    If we are meant to run is there a need for big tools on our feet outside minimum protection?

    If we need big shoes, we’re not meant to run.

    Are shoes a tool like a bicycle, trampoline, skateboard… Just a tool to move in a way we can’t do on our own? Running is a sport invented with the creation of big shoes?

    Without them, most of us will break our body with running?

    Damn! Humans are not running animals…Thanks Hoka now we can run 🙂

  10. Francis April 7, 2015 at 12:43 am #

    Anyone as the answer at “is the human body’s designed to run?”.

    And i’m not in the natural fallacy here.

    Just a “if we look at this machine from toe to head, called the human body, can we assume it is designed as an efficient running machine?”… Designed to walk for sure but run?

    Yes, no… Part yes and no… ???

    Craig, from your research what do you think?

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