What evidence is there that ‘barefoot’ running is better to reduce injury risk?

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.

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47 Responses to What evidence is there that ‘barefoot’ running is better to reduce injury risk?

  1. tom jennings April 26, 2013 at 10:22 am #

    Great article. I agree, that it may work for some and not others, there is no one-size-fits-all approach. I did have an interesting conversation the other night with someone who transitioned to barefoot running. They followed the appropriate slow transition. I explained it could be the approach of less intensity and duration in a slow progressive, appropriate process that is reducing injuries; not the barefoot style. I think if every runner monitored their intensity and duration then you would see a reduction in injuries.

    • Hans April 28, 2013 at 1:26 pm #

      Why do it have to be an either/or? My experience in learning to run in gradually less shoe all the way to vff’s and now running comfortably at regular speed barefoot for 3-5k (and back to pre injury distances when running in minimal shoes) and getting rid of very longstanding hip injury, a knee problem, as well as the often experienced calf problems following in the transition to a mid/forefoot stride, tells me that it is more complex than just one or the other.

      My personal experience has been than that I have achieved far better results by looking at several factors, and not just one. I have both reduced the amount and type of shoe (but now also can run better in even heavy boots), made a gradual transition, as well as made big changes to my technique, that seem to benefit me in all conditions, even though the type of shoe, or no shoe, noticeably influences my gait. If I would have to single out one of these elements as the most important, I would point to changes in my technique. Previous to these changes, no amount of reduced running, length or intensity, helped with the injuries, and I would not have been able to run barefoot or with minimal shoes with my pre relearning technique.

      And yes, I know that this is only one personal experience.

  2. Craig April 26, 2013 at 12:50 pm #

    Exactly. I keep hammering into people that an overuse injury is due to the cumulative load in the tissues beyond what the tissue can take. There are many components to that equation – ie the slow progressive adaptation to the load, the intensity, the duration, etc etc

  3. Dan April 26, 2013 at 6:39 pm #

    An interesting article, an as far as I know largely correct but it doesn’t address one thing that I consider an important part of the debat. Why is shod considered the default and barefoot the one that must prove its befits. Surely barefoot is almost by definition the default? As far as I know there’s no evidence that shod reduces injuries vs barefoot?

    • Kevin A. Kirby, DPM April 26, 2013 at 9:31 pm #

      Dan:

      If barefoot is the default condition for the individuals of today’s society, then why isn’t the default condition (i.e. barefoot) being allowed in many restaurants and nearly all workplaces? Could it be that individuals are worried about injuring their feet and employers and business owners are worried about their employees and customers injuring their feet in your “default” condition?

      Also should public nudity be the default condition for our society?

      • Dan April 27, 2013 at 9:08 am #

        Comparing barefoot to clothes is comparing aesthetics to functionality. Wearing clothes doesn’t effect the natural biomechanics of your body. Wearing shoes in daily life for so you don’t step on something is again a completely different argument.

        When it comes to what’s the best way to run it just always strikes me as odd that the relatively new ‘running shoe’ is considered the default and it’s barefoot that must prove itself to have advantages rather than vice versa.

        Evidence that running shoes are better would, by definition, be evidence that barefoot is worse. Since there’s currently no evidence to that effect both methods are surely currently on a level pegging?

        The running shoe is a body augmentation that has no proven benefits.

        • Kevin A. Kirby, DPM April 27, 2013 at 12:58 pm #

          As soon as you said “natural biomechanics”, Dan, I knew you were one of Chris McDougall’s disciples. Is natural always better? I think the barefoot fanatics like to use that argument, that being “natural” is always better, as did Chris McDougall in his semi-fiction novel, Born to Run.

          Do you use a cell phone, automobile, or fly in planes, Dan? Do you drive to the grocery store to buy food? Do you take antibiotics when an infection arises? Are these natural for humans to use?

          When do you like to point out that natural is better, Dan? Only when it suits your purpose of defending barefoot running as being the “default” condition, being better for all people since running in shoes is “unnatural”.

          Sorry, Dan, the “natural is better” argument line has been tried before, doesn’t work, is getting old, and, I believe, is a very weak way to try to win an argument that barefoot running is better than running in shoes.

          Please, Dan, let’s keep the discussion more scientific. Just give us some scientific research evidence that barefoot running is better, and I’ll quit wearing my thick soled running shoes. I won’t hold my breath. Natural is not always better.

          Sincerely,

          Kevin

          ***************************************************
          Kevin A. Kirby, DPM
          Adjunct Associate Professor
          Department of Applied Biomechanics
          California School of Podiatric Medicine

          Private Practice:
          107 Scripps Drive, Suite 200
          Sacramento, CA 95825 USA
          ************************************************

          • Dan April 29, 2013 at 9:07 am #

            Pretty sure I didn’t state natural is better. But if you’re going to change something from the ‘natural’ way, surely it makes sense to have evidence that the thing you’ve changed to is better? All of the examples you gave are demonstrably better than their alternatives, not so with running shoes.

            Better analogies would be flippers. They provably make it possible to swim faster. Or climbing shoes (something I cram my feet into on a regular basis – much to the detriment of the health of my feet!) which are definitely not natural but do definitely improve performance.

            I’m not arguing that barefoot is better. I just don’t like the argument that it should have to prove it’s better since running shoes are considered the baseline – with no scientific basis.

            Until either minimalist or “traditional” running trainers are proven to be superior surely both should be considered to be equally valid?

          • Mark Richard July 5, 2013 at 11:44 pm #

            Mind your blood pressure!

  4. Craig April 26, 2013 at 8:08 pm #

    Why is shod considered the default and barefoot the one that must prove its befits

    I see that used a lot in the barefoot community and I have no idea why. The onus is on anyone who makes claims to support them. If you want to claim barefoot is better, then the onus is on those making that claim to come up with the evidence. To resort to the “default” argument is just another one of the many argumentative fallacies that get tossed around and don’t work. Its just an excuse used as there is no evidence!

    The onus is also on those who claim that running shoes are better to come up with the evidence also.
    As I wrote elsewhere, no injury risk reduction claims are being made by the traditional running shoe companies for their shoes. The only running shoe manufacturers that are making injury reduction claims for their running shoes are the minimalist manufacturers. By using the ‘default’ argument are you suggesting they should be exempt from providing evidence? Try telling that to a judge. This is why Vibram are in hot water legally. If the Federal Trade Commission decide to get involved this would end up being very serious for the minimalist shoe manufacturers like it was for Reebok and Skechers with their multimillion $ settlements due to the lack of evidence to support their claims for the toning shoes. The manufacturers of the so called ‘big bulky shoes’ are not making any injury reduction risk claims, and neither should they due to there being no evidence of injury risk reduction.

    I do find it paradoxical that those who promote minimalism shoes claims that there is no evidence for the bulky running shoes (and there isn’t) and demand the manufacturers produce it, yet happily promote their minimalism shoes with no evidence and do not demand that the minimalism shoe manufacturers produce some evidence. Why do they do that?

    As far as I know there’s no evidence that shod reduces injuries vs barefoot?

    You are right there is not.

    Perhaps you could explain why so many of those who promote barefoot/minimalism claim there is plenty of evidence that shows you get less injuries with barefoot when there is none. Why do they do that?

    • Dan April 27, 2013 at 9:20 am #

      I’m not defending Vibrams “reduces injury” advertising. As you said there’s not a lot of evidence either way at the moment.

      Why is the latest running shoe with motion controlled, anti pronation, etc… not also held up and told “prove to me why I need this features”? The reduces injury part is implicit. Why do they have these features if not to reduce injury?

      “Perhaps you could explain why so many of those who promote barefoot/minimalism claim there is plenty of evidence that shows you get less injuries with barefoot when there is none. Why do they do that?”

      I’m not really qualified to speak for all these people. You’ll have to ask them :).

      • Craig April 27, 2013 at 10:02 am #

        Dan

        I not sure the latest shoes are claiming to be “anti-pronation” – its not a word I recall seeing recently in adverts (I do not have mags handy to check) – most of what I recall recently are pretty ‘wishy-washy’ claims, like ‘enhance motion’; however, if they claim a feature in a shoe is ‘anti-pronation’, they probably can demonstrate that the feature does exactly what they claim it does. The aim of these features is to alter biomechanics. They are not claiming that the feature reduces injury which they can’t support. It maybe implicit that this is an injury risk reducing factor (its not), but they are not making the injury claim explicitly – there are a few adverts I recall that came very close. That is why Vibram are in hot water (and all the other minimalistic running shoe manufacturers are at risk for the same type of class action and/or FTC investigations) – they all made very explicit claims, paraphrased as “if you run in these shoes you will get less injuries”.

        Anyone is welcome to test this and start a class action against one of the more traditional running shoe companies and we can see how far it gets. Plenty of the Vibram fan boys were calling for just that to happen. I just can’t see it getting up as they were not promising a health benefit that did not eventuate to the user.

        That is why Reebok and Skechers had to settle with the FTC for >$40 million due to the evidence that did not support the health claims they made for their toning shoes. Skechers, in addition, last week tried to settle a class action against them for $40 million!!! The claims being made by the minimalist running shoe companies are no different to the claims that were made by Reebok and Skechers and if the FTC decide to investigate, they will be in hot water.

        I discussed these issues on the update on the Vibram class action post.

        CP

        • Dan April 29, 2013 at 9:13 am #

          Think we’re arguing cross purpose a bit Craig :). I’ll confess I first commented on your post after skim reading it in the pub, mostly on the basis of the title.

          I’m not sure that Vibram’s claims are much better / worse than those made by regular shoe companies – but either way I’m not defending them.

          My argument was on the basis that barefoot is often considered a second class running citizen. Something that has to prove it’s better before it’s considered equal; which to me is back to front.

          After reading your post in a bit more detail I agree with most of what you said.

  5. Mark Richard May 10, 2013 at 10:34 pm #

    Evidence for cushioned shoes? Could you post a link?

  6. Craig May 10, 2013 at 11:06 pm #

    I never claimed there was any evidence (in fact those who heard me lecture over 20+ yrs ago know that I was raising alarm bells back then).

    Who is actually claiming that modern cushioned running shoes reduce actually injuries? Perhaps you could provide a link to where people are claiming that? If there are any, perhaps you should be asking them for the evidence.

    Perhaps you could explain to me why do so many make the claims about the evidence for barefoot when there is no evidence? What are they seeing that all the experts who review the scientific literature are not seeing? I really do genuinely want to know why so many make the claims of there being all this evidence.

    I am making no claims and have never made any claims for shoes that are not backed by evidence.

  7. Mark Richard May 11, 2013 at 8:53 am #

    Do you wear Cushioned shoes for running?

  8. Craig May 11, 2013 at 9:42 pm #

    As I have said several times, I mostly run in NB Minimus shoes; sometimes in Hoka One One’s; occasionally in Nike Triax; and just did a few in the new Saucony Kinvara.

    What is your point? What has what I run in got to do with the evidence and the claims being made?

    Can you please:
    Who is actually claiming that modern cushioned running shoes reduce actually injuries? Perhaps you could provide a link to where people are claiming that? If there are any, perhaps you should be asking them for the evidence.”

    and:

    Perhaps you could explain to me why do so many make the claims about the evidence for barefoot when there is no evidence? What are they seeing that all the experts who review the scientific literature are not seeing

    • Mark Richard May 12, 2013 at 9:28 pm #

      Thanks for the answer.
      Explains your injuries.

    • Mark Richard May 12, 2013 at 9:36 pm #

      For the record I don’t barefoot run.

  9. Alison May 12, 2013 at 4:59 am #

    “Do you wear Cushioned shoes for running?”

    What a really dumb question that is. Are you expecting the scientific evidence to change or be different if he does or does not wear cushioned shoes?

    • Mark Richard May 12, 2013 at 9:26 pm #

      Scientific evidence for cushioned shoes?
      Could you post a link for that evidence?

      Thanks

  10. Hans May 12, 2013 at 9:25 pm #

    Craig, I find your approach very clarifying in terms of exposing the lack of any clear research based answers to the question of choice of shoes as well as technique.

    It still seems like you are making choices about advice to clients, and also personal choices, in regard to both shoes and technique. Could you say something about what kind of advice you are giving, and also on what you base the advice, as there is very little research support for most of this.

  11. Craig May 12, 2013 at 9:36 pm #

    Mark:
    “Scientific evidence for cushioned shoes?
    Could you post a link for that evidence?

    I have repeatedly asked you where anyone is actually claiming that there is evidence for cushioned running shoes. Where is anyone claiming that cushioned running shoes have evidence? Where is anyone claiming they prevent injury? I certainly have not been making those claims. Can you please show us where people, especially the running shoes companies actually claims that?

    The only place I see claims being made for shoes and injury is from the minimalist manufacturers. As there is no evidence for that, Vibram is facing a class action. Care to explain why none of the ‘cushioned’ running shoes manufacturers are facing class actions?

    “Thanks for the answer.
    Explains your injuries.”

    I have no injuries! Where did you get the impression from that I have one or are you just telling a lie?

  12. Craig May 12, 2013 at 9:49 pm #

    Hans

    Could you say something about what kind of advice you are giving, and also on what you base the advice, as there is very little research support for most of this.

    Its a difficult one and I will write a blog post about it one day soon.

    Yes there is a lack of evidence, but there is also the nonsensical propaganda and rhetoric with so many claims being made that are effectively lies (they are clearly the opposite of the scientific evidence).

    In the absence of evidence, I go for the criteria of consistency with the available evidence, biological plausibility and theoretical coherence (I discussed those principles here: http://www.runresearchjunkie.com/should-we-transition-all-anterior-compartment-syndromes-to-forefoot-striking/ ); so I working on an algorithm (just in my head at the moment) trying to apply that to a decision making process.

    So far the algorithm starts of with a decisions on what ‘feel’ the runner personally prefers under the foot – do they want to feel the ground more (ie minimalism) or less (maximalist) – there is no evidence that there is anything wrong with either, just rhetoric and propaganda – so its about taking the nonsense out of the decision making process and moving forward from there.

    Other steps in the algorithm will look at which tissues they have a history of problems with, and then moving towards the shoe that facilitates the technique that loads the problematic tissues the less (see this: http://www.runresearchjunkie.com/which-injuries-are-probably-more-common-in-which-foot-strike-pattern/ ) – this is applying the principles of theoretical coherency and biological plausibility.

    Given the exponential increase in interest recently on the Hoka One One’s and all the testimonials abut how many are getting less injuries wearing them (just like the testimonials from all the Vibram wearers that they get less injuries!) … we have a long way to go.

    On the whole misunderstood issue of overpronation, I think we have now learnt more that its the magnitude of forces associated with foot motion that are more likely to be problematic, so its the design features that are needed in shoes to counter that magnitude vs amount … we just need to learn more.

    Hopefully you get the picture of the approach that I think is needs…..its complicated and I have no clear answer…..yet. … at the moment it largely comes down to personal preferences … personally, I mix it up.

    • Mark Richard May 13, 2013 at 11:20 am #

      Excellent!

  13. Hans May 13, 2013 at 9:58 am #

    Thank you for the reply.

  14. Mark Richard May 13, 2013 at 4:40 pm #

    “As always, I go where the evidence takes me”
    Africa? Well some of it!

  15. Mark Richard May 13, 2013 at 4:51 pm #

    “Men occasionally stumble over the truth, but most of them pick themselves up and hurry off as if nothing ever happened.”
    ― Winston Churchill
    Probably stumbled cos of their big clumpy shoes!
    Just a little joke!

  16. Craig May 13, 2013 at 9:19 pm #

    “As always, I go where the evidence takes me”
    Africa? Well some of it!

    You mean these runners:
    http://simonfreeman.co.uk/wp-content/uploads/2011/10/group-of-runners-in-kenya.jpg

      • Craig Payne June 18, 2013 at 7:20 pm #

        I don’t see any evidence there; just a newspaper story about kids in Kenya

        • Mark Richard June 18, 2013 at 10:16 pm #

          Cherry picker

          • Craig Payne June 18, 2013 at 10:37 pm #

            Please show me ONE example where I have cherry picked? Please show me ONE study that I have left out that is relevant since this blog started (I have asked you for this before and you have failed to reply. you have also failed to reply to a number of other questions I have asked you as well). Do you even know what cherry picking is?

            If you are going to accuse me of cherry picking, you are going to have to come up with some evidence that I have left out.

            Can you please show us ONE study that shows that barefoot running is actually better?

  17. Droichead June 18, 2013 at 5:29 pm #

    Craig,

    While is true that cushioned running shoe makers do not make bold statements such as reducing injury rates, their shoe marketing is full of misleading information all over the place.

    Just from Nike webpage
    http://store.nike.com/us/en_us/pw/running-shoes/brkZ8yz#/us/en_us/pw/mens-running-
    shoes/7puZbrkZ8yz

    “Stability features for pronation control and excellent cushioning for impact protection.”

    Really? Does cushining reduce impact forces? Is it possible that cushioning modifies your runnig mechanichs and the impact forces do not change and might even increase?

    Now clicking on the lunarglide shoe:
    “Dynamic Support in the midsole provides just the stability you need without the added weight or stiffness of a traditional medial post. The floating heel-support clip moves with you and helps keep the back of the foot from rolling inward or outward upon landing to moderate excessive pronation. It wraps underfoot and tenses up as weight is applied to lock down the heel.”

    Do I really need the stability? What for?

    Does it really reduces pronation? I am not so sure that this is the case (Bennon Nigg. etc) sure it tries to do it whether it is sucessful or not is another thing.

    I could go on and on and on, with any other maker and get the same type of unproven statements, sure not as bold as VFF, which as you correctly say are in hot water for good reasons. But it the point is to go where the evidence brings you, there are a hundred of misleading statements out there from every single maker to sell their last running technology add on to the new iteration of their shoe which is unproven and misleading.

    • Craig Payne June 18, 2013 at 7:17 pm #

      You right about the support for claims being tenuous. But the important difference is that they are not linking those claims of what the shoe may or may not be doing to injury prevention or health gains. That is the difference and that is why Vibram are being sued – they made health gains or claims for a product that was not supported by the evidence.

      If you look closely at what happened with the Skechers, Target & Reebok cases and settlements with the Federal trade Commission, then all the manufacturers of minimalist running shoes are are shaky ground if the FTC decide to pursue them (they shouldn’t as they do have bigger fish that they should be frying). This is purely due to the explicit nature of the health gains that they claimed. That is something the traditional running shoes manufacturers did not do.

      • Droichead June 18, 2013 at 9:18 pm #

        Craig,

        Agreed, the most stupid thing VFF could ever do is to claim that they reduce injury risk. They could claim that is closer to barefoot running, that stimulates your feet internal muscles and tendons etc), even that they are closer to “natural running” even if anyone can clearly define this, but they went way too far in joining too many dots without any supporting evidence.

        Even stronger feet muscles as they could claim does not directly implies a healthier feet as such, and in my opinion, even if at any point in the future they are able to demonstrate that they reduce a particular injury rate, I personally think that the risk of injury in the transition period is considerably higher, particularly in runners used to a reasonably weekly mileage (say over 20-30 miles week) if the rush the transition.

        Having said all of that I find the shod industry full of unproven claims of many technologies they are supposed to implement in each iteration of their shoes that apparently help you in x/y/z areas, sure they are far more careful in their statements but they are definitely misleading.

        This is my particular opinion, that despite I am a minimalist runner for two years now, me, like you, only go where the evidence brings me and unproven claims annoy me regardless who is behind them. As an example, although I am pretty happy with the change to fairly minimal runners I have not recommended it nor advocated barefoot/minimal runners to no one of my friend runners as this is far more complicated than barefoot running=good shod running=bad (nor the other way around).

        BTW great blog, along few others out there one of the most informative in running biomechanics and the running shoe industry.

  18. Mark Richard July 12, 2013 at 9:41 pm #

    paradigm shift anyone?

  19. angie July 22, 2013 at 10:37 pm #

    Is not the study that you just wrote about for barefoot running for knee pain evidence?

    • Craig Payne July 22, 2013 at 11:24 pm #

      Angie; thanks. This is the study you referring to.

      It is NOT evidence that barefoot is better. Yes, I have seen all the claims in the crankosphere blogosphere that it is, but I pretty sure almost all of those are from people who have not even read the full study, yet assume they can comment on it with some sort of ‘authority’.

      The authors in the paper (and in subsequent comments on Twitter) were very cautious to not make that conclusion.

      All the study showed was that in healthy runners without an injury, that the ‘stress’ in the patellofemoral joint in an in vitro study was 15% lower in an acute intervention when running without running shoes. It was NOT a clinical trial of barefoot vs shod running in those with patellofemoral pain syndrome which is what some in the crankosphere blogosphere are pretending it was in their comments on it!

      If you look at some of the comments on my review of the study a number of issues came up. With barefoot, the cadence is assumed to be greater, so there might be a 15% reduction in their model, but if you are taking more steps per minute barefoot compared to shoes, then you may not be getting a decrease in load at all as you are taking more steps!

      The authors showed that the reduction was due to angles of pull of tendons from less knee flexion in the barefoot condition, yet in the crankosphere blogosphere the comments being made by those who have not read the study were all about impact reduction when barefoot (duh?).

      Why did they get the decreased knee flexion? – it could be due to the barefoot; it could be due to the increased cadence when barefoot (and not actually due to the barefoot, as you can increase the cadence while wearing traditional shoes); it could also have been due to the forefoot striking (and not actually due to the barefoot, as you can forefoot or midfoot strike while wearing traditional shoes).

      Also keep in mind the comments that I keep making: you can’t decrease the load in one tissue without increasing it in another. The authors did not report on where the load/stress went. Kulmala et al showed that if you decrease the knee loads, you increase the ankle loads. To forefoot strike (ie barefoot run) you increase the forefoot and foot dorsiflexion moments and that exposes the muscles and tendons that cross behind the ankle joint axis and under the midfoot joints to increased stress and injury risk — ie six of one half a dozen of the other!

      This was actually a good study. More and more clinicians are looking at the cadence issues in patellofemoral pain syndrome. Barefoot drills may help facilitate that, but you can certainly do it without barefoot …. so no the study is NOT evidence that barefoot running is better.

      • angie July 23, 2013 at 1:46 am #

        That makes a lot more sense than what I have been reading about this study.

  20. Asle August 2, 2013 at 12:02 am #

    Thanks Craig. I think I am getting (a better) “shod vs. unshod” overview now. It is easier to relate to what at the moment is true, that the total ground forces and load do not change when you run one mile. The difference is where the strain and load is on your legs, knees, heels, back etc. So this is more about what keeps you injury free and less about economical running. But I guess the economy is different from person to person. If you have like me backpain and knee problems you would benefit from a forefoot stride and higher cadence. That is what I myself experienced. But then I got som achilles and metatarsal problems. For me what has become clear is how strength training is more and more vital the older you get and that has helped me run with less injuries. And since shod-unshod does different things to your tendons, muscles and bones I think variations in these (together with strength training) are a good way to keep injuries away. Your articles make sense.

    • Craig Payne August 2, 2013 at 12:12 am #

      Thanks Asle. That has been my point all along: its six of one, half dozen of the other. Different running forms load different tissues differently – the total ‘load’ or ‘force’ in the system is always the same (unless you loose weight) – its just applied to different tissues.

      Since I wrote the above post; there are now 3 studies presented at conferences this year (and not in full yet):
      – one showed that the injury rate between minimalist runners and traditionally shod runners were the same
      – one showed that the injury rate between forefoot v heel strikers were the same
      – one showed injury rate in those that transitioned to minimalist running was the same as those that didn’t.

      ie six of one; half a dozen of the other!

  21. Chris January 3, 2014 at 7:00 pm #

    This guy works for the shoe industry.

    • Craig Payne January 3, 2014 at 8:30 pm #

      Actually I don’t. Care to explain why you just lied? What is your motivation in spreading bullshit? What do you hope to achieve by making stuff up for?

      And even if I did work for a running shoe company, WTF has that got to do with there being no scientific evidence supporting barefoot running?

  22. Diego December 6, 2016 at 9:57 pm #

    Dear Craig,
    I am two/three years late (as we often are in EU), yet.. interesting article! Has anything changed in the meanwhile? Minimalist/barefoot hype vanished also here in Italy, but left a mark, generally lowering heel-to-toe drop of many running shoes; many, not all models actually.
    As many, I approached the “Born to run” religion a few years ago, got enthusiastic, got inflammation in the heel tendons and in the feet, got back to using more cusioned shoes and I am now very satisfied in running mostly with 8mm drop, practicing 1 or 2 km barefoot on the track (or sometimes on the road around my block, where I live) maybe twice a month.
    This approach, I believe, helps me keeping a decent running form (barefoot really works for this), and prevents me from getting injuries at feet/tendons/calves due to overload.
    My impression is that the “barefoot” thing has a strong basis, yet we have to cope with individuals that start running when thay are in their 40 (sometimes 30) and are not prepared to run barefoot for more than a few meters; and even track and field runners have to be careful, since years of overuse may lead to constant pain/troubles in feet/tendons, so driving the runner to cushioned shoes.
    Just wanted to share a few thoughts. Thanks,
    Diego

  23. romain ensminger December 19, 2016 at 5:57 am #

    Hello there,

    Do you really think the foot stops at the anckle? That what happens above doesn’t matter? 99% of the people get low to very low nutrition.

    Shoes seem to be one side of the debate. Sure your body get’s injuries and inflammation arises from tensions and shocks. But why is it that many people get these problems nowadays? Sure shoes changed for the worse, but so did food.

    Let me clarify myself through different points :

    – Lack of proper building materials : there are thousands of nutrients (the cereal box’s list lied to you) in fresh, unprocessed whole plant foods. Which of these are nourishing the tissues, calming inflammation? Hard to say, but some might.

    – Lack of proper anti-inflammatory synthesis : The omega 3 of leafy greens are used by our body to synthesize natural anti-inflammatory molecules. But today we eat well too many oils that mess-up the optimal omega 3 to omega 6 ratio (1:1) towards over 30:1 for most junk eaters.

    – Overdamage : most of people today have fat that they carry all day, adding strain on your feet. (If you cannot see your abs you carry at least 7kg for nothing) Stick to more veggies to help with that and other points.

    – High sugar : with the high fat diet that everyone eats (meat, oils, fructose) the insulin resistance and constant high blood sugar will create uric acid crystals in tissues and might be helping to damage the underfoot. Sugar from starches is glucose and perfectly fine (fuels your glycogen stores and all cells) fructose and alcohol are the bad guys, they lurk in the sweetest fruits, sodas, fruit juices, beer, vine, most of processed foods, sauces etc… and they are mainly turned by the liver into fat or uric acid which respectively contribute to insulin resistance and global inflammation.

    So do shoes help cause the disease maybe, but there are other factors. Sorry for inaccuracy and lack of scientific terms.

    • Craig Payne December 19, 2016 at 6:07 am #

      1. Where have I ever said or implied the “foot stops at the ankle”? … actually it does.

      2. This blog is about evidence and science. Can you back up any of what you are saying with actual citations? Evidence? Science?

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