Barefoot
Running Michael Warburton Gateway
Physiotherapy, Capalaba, Queensland, Australia 4157. Email Sportscience
5(3), sportsci.org/jour/0103/mw.htm, 2001 (2564 words) Reviewers:
Caroline Burge,
School of Medicine, University of Queensland, Brisbane 4006, Australia; Larry M Feinman, Mountain
Chiropractic, Lafayette, Colorado 80026, USA; Ian Shrier, Center for Clinical Epidemiology and Community Studies,
SMBD-Jewish General Hospital, Montreal, Quebec H3T 1E2, Canada Running
barefoot is associated with a substantially lower prevalence of acute
injuries of the ankle and chronic injuries of the lower leg in developing
countries, but well-designed studies of the effects of barefoot and shod
running on injury are lacking. Laboratory studies show that the energy cost
of running is reduced by about 4% when the feet are not shod. In spite of
these apparent benefits, barefoot running is rare in competition, and there
are no published controlled trials of the effects of running barefoot on
simulated or real competitive performance.
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Well-known
international athletes have successfully competed barefoot, most notably Zola
Budd-Pieterse from South Africa and the late Abebe Bikila from Ethiopia.
Running in bare feet in long distance events is evidently not a barrier to
performance at the highest levels. Indeed, in this review I will show that
wearing running shoes probably reduces performance and increases the risk of
injury. I became
interested in research on barefoot running when I noticed that a reasonably
high proportion of runners compete in bare feet during cross-country races in
Queensland, Australia. I have based the review on articles I found containing
the words barefoot and running in Medline, SportDiscus, and
in Web publications. I found
several original research reports on the occurrence and mechanisms of acute
and chronic injuries in unshod and shod populations, and a few reports on the
energy cost of running with and without shoes (including an unpublished
thesis). Two authors provided recommendations for adapting to barefoot
running. I also found informal websites devoted to barefoot running and
barefoot living.
There are apparently no published controlled trials of the effects of running
in bare feet on simulated or real competitive performance, nor any surveys on
the reasons why people do not compete barefoot. Where
barefoot and shod populations co-exist, as in Haiti, injury rates of the lower
extremity are substantially higher in the shod population (Robbins and Hanna,
1987). Furthermore, running-related
chronic injuries to bone and connective tissue in the legs are rare in
developing countries, where most people are habitually barefooted (Robbins
and Hanna, 1987). This association between injury and wearing shoes is
consistent with the possibility that wearing shoes increases the risk of
injury, but other explanations for the association are possible; for example,
in developing countries barefoot runners may be too poor to seek medical
attention, shod runners may wear shoes because they have problems running
barefoot, and shod runners may wear bad shoes, wear shoes incorrectly, and
cover more miles. Prospective studies
and randomized controlled trials of barefoot and shod running would resolve
this uncertainty. Studies of rates of injury in barefoot and
shod runners in developed countries are non-existent, presumably because
barefoot runners are a rarity. However, there have been several studies
implicating footwear in the etiology of injuries in runners. I have grouped these as studies of acute
injuries (resulting from an accident during running) and chronic injuries
(resulting from continual exposure to running). Ankle sprains
are the most frequently reported acute sports injury, and 90-95% of these are
inversion injuries causing partial or complete rupture of the anterior
talofibular ligament and occasionally of the calcaneofibular ligament
(Robbins et al., 1995; Stacoff et al., 1996). It is claimed that footwear
increases the risk of such sprains, either by decreasing awareness of foot
position provided by feedback from plantar cutaneous mechanoreceptors in
direct contact with the ground (Robbins et al., 1995), or by increasing the
leverage arm and consequently the twisting torque around the sub-talar joint
during a stumble (Stacoff et al., 1996).
Siff and Verkhoshansky (1999, p.452) reported that running shoes
always reduce proprioceptive and tactile sensitivity, and that using bare
feet on the high-density chip-foam mats in gyms preserves proprioceptive
sensitivity. Robbins et al. (1989) considered that behaviors induced by
plantar tactile sensations offer improved balance during movement, which may
explain the preference of many gymnasts and dancers for performing barefoot. The skin
on the plantar surface (sole) of the foot is more resistant to the
inflammatory effects of abrasion than skin on other parts of the body
(Robbins et al., 1993), but stones, glass, nails or needles can still cause
bruising or puncture wounds even when the plantar skin is thickened by
adaptation to barefoot running. Extremes in temperature can also cause
discomfort, blistering or chill blains. Running shoes therefore will play an
important role in protection on some courses and in some weather conditions. One of
the most common chronic injuries in runners is planter fasciitis, or an
inflammation of the ligament running along the sole of the foot. There is
some evidence that the normally unyielding plantar fascia acts as the support
for the medial longitudinal arch, and that strain on the proximal fascial
attachment during foot strike leads to plantar fasciitis (Robbins and Hanna,
1987). Barefoot running may induce an adaptation that transfers the impact to
the yielding musculature, thus sparing the fascia and accounting for the low
incidence of plantar fasciitis in barefoot populations (Robbins and Hanna,
1987). Chronic
ailments such as shin splints, ilio-tibial band syndrome and peri-patellar
pain are attributed variously to excessive pronation, supination, and shock
loading of the limbs (Siff and Verkhoshansky, 1999, p.451). When running
barefoot on hard surfaces, the runner compensates for the lack of cushioning
underfoot by plantar-flexing the foot at contact, thus giving a softer
landing (Frederick, 1986). Barefoot runners also land mid-foot, increasing
the work of the foot's soft tissue support structures, thereby increasing
their strength and possibly reducing the risk of injury (Yessis 2000, p.124). Wearers
of expensive running shoes that were promoted as correcting pronation or
providing more cushioning experienced a greater prevalence of these
running-related injuries than wearers of less expensive shoes (Robbins and
Gouw, 1991). In another study, expensive athletic shoes accounted for more
than twice as many injuries as cheaper shoes, a fact that prompted Robbins
and Waked (1997) to suggest that deceptive advertising of athletic footwear
(e.g., "cushioning impact") may represent a public health hazard.
Anthony (1987) reported that running shoes should be considered protective
devices (from dangerous or painful objects) rather than corrective devices,
as their capacity for shock absorption and control of over-pronation is
limited. The modern running shoe and footwear generally reduce sensory
feedback, apparently without diminishing injury-inducing impact–a process
Robbins and Gouw (1991) Measurements
of the vertical component of ground-reaction force during running provide no
support for the notion that running shoes reduce shock. Robbins and Gouw (1990) reported that
running shoes did not reduce shock during running at 14 km/h on a treadmill.
Bergmann et al. (1995) found that the forces acting on the hip joint were
lower for barefoot jogging than for jogging in various kinds of shoe. Clarke
et al. (1983) observed no substantial change in impact force when they
increased the amount of heel cushioning by 50% in the shoes of well-trained
runners. Robbins and Gouw (1990) argued that plantar sensation induces a
plantar surface protective response whereby runners alter their behavior to
reduce shock. The less-cushioned shoe permitted increases in plantar
discomfort to be sensed and moderated, a phenomenon that they termed
"shock setting". Footwear with greater cushioning apparently
provokes a sharp reduction in shock-moderating behaviour, thus increasing
impact force (Robbins and
Hanna, 1987; Robbins et al., 1989; Robbins and Gouw, 1990). However, in these
studies the subjects ran on treadmills or force platforms. Further studies are needed to establish how
shoes affect impact force and shock-moderating behavior on natural surfaces
such as road or grass. Other
features of footwear, such as arch supports and orthotics, may interfere with
shock-moderating behavior and probably hinder the shock-absorbing downward
deflection of the medial arch on landing (Robbins and Hanna, 1987). These
features reportedly reduce pronation and supination or offer the wearer
lateral and arch support. They may help some people with foot pathologies,
but their benefit is uncertain for runners with healthy feet (Yessis, 2000,
p.121). Runners
with diminished or absent sensation in the soles of the feet are particularly
vulnerable to damage or infection when barefoot. Peripheral neuropathy is a
common complication of diabetes mellitus and may result in the loss of
protective sensations in the feet. Barefoot locomotion is therefore not
recommended in this population (Hafner and Burg, 1999). Indeed, proper footwear is essential and
should be emphasized for individuals with peripheral neuropathy (ACSM/ADA,
1999; ACSM, 2000). Wearing
shoes increases the energy cost of running. Burkett et al. (1985) found that
oxygen consumption during running increased as the amount of mass they added
to the foot increased; shoes and orthotics representing 1% of body mass
increased oxygen consumption by 3.1%. Flaherty (1994) found that oxygen
consumption during running at 12 km/h was 4.7% higher in shoes of mass ~700 g
per pair than in bare feet. An increase in oxygen consumption of ~4% is of little
importance to the recreational runner, but the competitive athlete would
notice a major effect on running speed. The
increase in oxygen consumption with running shoes could have several
causes. An obvious possibility is the
energy cost of continually accelerating and decelerating the mass of the shoe
with each stride. Another possibility is the external work done in
compressing and flexing the sole and in rotating the sole against the
ground--up to 13% of the work done in walking, according to Webb et al.
(1988). Frederick (1986) reported that oxygen consumption increased
substantially with thicker shoe inserts during treadmill running. Not
surprisingly, materials used for cushioning in shoes absorb energy, and stiff
midsoles should produce a 2% saving of energy compared with standard midsoles
(Stefanyshyn and Nigg, 2000). Finally,
shoes probably compromise the ability of the lower limb to act like a spring.
With bare feet, the limb returns ~70% of the energy stored in it, but with
running shoes the return is considerably less (Yessis, 2000, p.123). Thirty
minutes of daily barefoot locomotion is a recommended starting point to allow
thickening of the sole of the foot and adaptation of muscles and ligaments
(Robbins et al., 1993). Begin by walking barefoot at every reasonable
opportunity then progress to jogging, gradually increasing the intensity and
duration (Yessis 2000, p.124). After 3-4 weeks, the plantar skin eventually
becomes robust and allows longer periods of barefoot running at higher
average velocities (Robbins et al., 1993). To facilitate adaptation, perform
progressive strengthening exercises for the foot and ankle, including foot
inversion, toe flexion, and walking on the balls of the feet. Barefoot
locomotion on uneven surfaces will also help stimulate the plantar surface
and provide increased sensory feedback (Yessis 2000, p.125). • Running in shoes appears to
increase the risk of ankle sprains, either by decreasing awareness of foot
position or by increasing the twisting torque on the ankle during a stumble. • Running in shoes appears to
increase the risk of plantar fasciitis and other chronic injuries of the
lower limb by modifying the transfer of shock to muscles and supporting
structures. • Running in bare feet reduces
oxygen consumption by a few percent.
Competitive running performance should therefore improve by a similar
amount, but there has been no published research comparing the effect of
barefoot and shod running on simulated or real competitive running
performance. • Research is needed to establish
why runners choose not to run barefoot. Concern about puncture wounds,
bruising, thermal injury, and overuse injury during the adaptation period are
possibilities. • Running shoes play an important
protective role on some courses, in extreme weather conditions, and with
certain pathologies of the lower limb. Acknowledgements I would
like to thank Christian Finn and Will Hopkins for their kind assistance in
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