I have two options for writing this article:
1) I could just leave it blank as there is no evidence.
2) I could explain why there is no evidence.
As I have commented in a number of other articles (eg the Vibram class action one) that there is no evidence that ‘barefoot’ running is any better than traditionally shod running to reduce injury risk and the reaction to those comments in some social media circles have varied from surprise to me being accused of being wrong, its probably better that I do (2) and explain it. I put the ‘barefoot’ in inverted comma’s so that it also includes the ‘almost there’ footwear that could be considered ‘barefoot’ footwear, and, yes, I do realize that there are differences between them, but lets leave that to one side for now.
There simply is no evidence that ‘barefoot’ running is any better than the traditionally shod running when it comes to reducing injury rates, yet everywhere you go in the crankosphere blogosphere you see the claims about all the extraordinary evidence that supports barefoot running. I can’t find any! I see long lists of references that some use to say that ‘barefoot’ is better, yet when I go through them, none of them actually showed that. I get emails telling me I need to read Chris McDougals book, Born to Run, with all the evidence in there that shows barefoot is better. I actually own two copies and I see no evidence in it that shows that and all I see is a serious case of misuse, misunderstanding, misquoting and misinterpretation of the evidence. Others keep mentioning the Lieberman et al paper in Nature as proof that barefoot is better. All that study showed was that traditional running shoe wearers heel strike and barefoot runners don’t. It did not show that one was better than the other. Even Lieberman himself published a disclaimer on his website over the way that this study was being interpreted! … it goes on and on and on!
Even so many of the fan boys commenting on the class action against Vibrams were confident that the case would be dismissed as there was all this evidence supporting ‘barefoot’ running. Well, the judge did not see it that way when the defendants and plaintiffs put the evidence before him in dismissing Vibram’s motion to get the case tossed out.
If you do not believe me, what have other reviews of the scientific literature found:
A 2011 review in the Journal of the American Podiatric Medical Association, Barefoot Running Claims and Controversies: A Review of the Literature concluded that
“…there is no evidence that either confirms or refutes improved performance and reduced injuries in barefoot runners…”
The ad hominem criticism of that article is that the authors were biased. Those making that criticism never actually point out where they were biased or what research actually supports it, so I do not quite get this criticism. The same criticism could not get directed against Guy Leahy, an exercise physiologist who in his review of the evidence in Tactical Strength and Conditioning Report in 2012 concluded that:
Regarding the RRI risk, the evidence is contradictory. Barefoot running may reduce the risk of certain RRIs, but may increase the risk of others. No published study has documented a direct relationship between barefoot running and running RRI risk. To date, there is insufficient evidence to recommend barefoot running as a broad intervention for RRI reduction.
In this 2012 review in the Journal of Strength & Conditioning called Running Barefoot or in Minimalist Shoes: Evidence or Conjecture?, the biomechanical differences between barefoot and shod running were reviewed, with this comment in the abstract:
Running barefoot or in minimalist footwear has become a popular trend. Whether this trend is supported by the evidence or conjecture has yet to be determined.
Physiotherapists Paul Remy Jones, Christian Barton and Dylan Morrissey writing in SportEX in 2012 on The (Re-)evolution of Barefoot Running: Does it Reduce Injury? commented that:
Currently, there is only anecdotal evidence linking a barefoot style with reduced risk of injury
and concluded that:
Studies of barefoot style running and the potential for reduced incidence of overuse injury are suggestive, but have a long way to go before becoming conclusive concluded that there is no evidence that it does…more robust evidence is required before recommendations for clinical practice can be made.
Scott Douglas, in his book, The Runners World Complete Guide to Minimalism and Barefoot Running, that I reviewed here looked at the all research and talked to experts and concluded:
Any honest assessment of the research done to date has to include these three statements:
- Nobody has proven running shoes causes or prevent injuries
- Nobody has proven running barefoot causes or prevents injuries.
- Nobody has proven that runners who wear conventional running shoes get injured more than barefoot runners or that barefoot runners get injured more than conventionally shod runners.
I have no doubt that ‘barefoot’ running will be useful to some runners and will be detrimental to others (…and don’t forget I do some of my running in minimalist shoes; I also advise transition to minimalism running for some patients; and treat a lot of injuries in others that have done it). Many runners with a history of running injury have successfully transitioned to ‘barefoot’ and no longer get the injuries they got previously (and they commonly comment on this in forums and on blog comments). But, that is just anecdotes and anecdotes are not data or evidence. For every positive anecdote about it, there is probably a negative one. As I speculated here, some injuries would probably benefit from the forefoot striking that is associated with ‘barefoot’ and others would probably benefit from the heel striking associated with traditional running shoe use.
At this point in time the evidence is clear that to recommend it as a panacea or ‘one size fits all‘ because of all the evidence that you see mentioned so often in the crankosphere blogosphere, in articles, in books, in social media and elsewhere is just simply not supported by the actual evidence. For example, see what this loon thought of the evidence. How do so many get this so wrong?
Hopefully I am not guilty of cherry picking here and only selected articles to confirm the point that I am making (ie I not falling for a confirmation bias). I am not aware of any other review articles in the literature that have analyzed the scientific literature. If there are any I missed, please point them out. There are commentaries that have cherry picked to make the argument that it is better, but that cherry picking discounts them as they are not reviews of the whole body of available literature. As always, I go where the evidence takes me until convinced otherwise and I will be the first to change my mind when the evidence tells me ‘barefoot’ running is better to reduce the running injury risk. However, what I think that the evidence might show is that the risk for some injuries will be decreased (eg anterior compartment syndrome) and the risk for other injuries will be increased (eg ‘top of foot pain‘), so it still will not be a panacea or ‘once size fits all‘.
POSTSCRIPT 1: I just posted this: Foot Strike Pattern and Injury Rates
POSTSCRIPT 2 (1 Sept): Yet another review of the science has been published, concluding:
barefoot running is not a substantiated preventative running measure to reduce injury rates in runners
POSTSCRIPT 3 (3 Oct): I missed this review from Nov 2012:
Whether there is a positive or negative effect on injury has yet to be determined
POSTSCRIPT 4 (3 Nov): Just posted this review: Barefoot Running: Current state of the play. It found the same as ALL of the above reviews!
POSTSCRIPT 5 (7 March 2014): Just posted about yet aother review: Evidence that barefoot running is better? …. part deux
As always, I go where the evidence takes me until convinced otherwise.