Barefoot Running

A group of men on barefoot running stride on the beach
We can help runners analyze both walking and running gait patterns by focusing on the proper footwear, orthotics and the various types of running shoes available. Supportive footwear, can cause weakness and fragile feet and ankles. This is why the transition to barefoot running has to be slow, deliberate and planned. We can help you when transitioning to barefoot running and we can address the muscles that may have become weak over the years, and help you strengthen these problem areas to decrease the risk of injury when transitioning to a new chosen style of running. To prevent injury, it is important to change your running technique first before attempting to change your footwear.

The number of elite long-distance runners who have originated in Kenya is disproportionate when considering their population. Interestingly, many of these elite runners shun footwear, which has caused a lot of speculation about the impact of shoes on running form. Modern athletic footwear is of quite recent origin. The sneaker, with its padding and elevated heel has really only been around since the 1970s. The sneaker was designed in hopes of reducing running injuries. Unfortunately, the hoped-for reduction in running injuries has not materialized. In fact, running injuries are possibly even more common today with more than half of competitive runners being sidelined each year due to injury. Meanwhile, some studies demonstrate that barefoot/minimalistically shod runners have a lower rate of injury than those choosing the fancy padded shoes.

Researchers and athletes speculate about why. Is it the design of the shoes, is it the fact that the shoes strongly encourage the use of heel-striking, is it the lack of proprioception caused by the shoes? Perhaps it is just faulty running technique causing the injuries. Barefoot runners and shod runners seem to use very different running techniques.

Most studies of barefoot running find that barefoot runners tend to strike with the middle or ball of the foot versus shod runners who tend to heel-strike. The stride of the barefoot runner tends to be shorter than the stride of the shod runner. The barefoot runner tends to lightly impact the ground relative to the hard impact of the shod runner.

It is clear that just ripping off the shoes and going out for the usual run isn’t a good idea. People who are used to running in padded shoes have to learn running barefoot technique or they are likely to suffer discomfort and injury. Patterns of motion need to be re-learned and different muscles and tendons need to be strengthened. Working with experienced barefoot running trainers during the transition can only help. Gait analysis on a treadmill at a running clinic is probably the most efficient way to re-train the body to run differently. The runner is given instant feedback about efforts to change habitual ways of moving.

One of the more recent studies by Dr. Dan Liberman from Harvard University concluded that barefoot running may reduce the chance of injury. Barefoot running allows for more proprioception, in other words allows the foot to feel more than when running with modern running shoes. When the runner has more proprioception they can feel the impact better and adjust their running style (body position) to reduce this impact. The thick soles of modern running shoes don’t allow us to feel the impact and the damage being done to our joints and bones. It does not allow ideal mechanics and timely muscle activation so that the body uses most optimal strategy for shock absorption). The study also found that heel striking produces a significantly higher impact than forefoot running and since modern running shoes promote heel striking they can actually cause injury. This is why many runners have chosen to try minimalist or bare foot running.

There maybe other benefits to barefoot running besides less impact on joints. One study by Hanson and Berg concluded that barefoot running requires less oxygen consumption than shod running. But out of the seven studies conducted testing this theory only two produced significant results showing barefoot running required a lower rate of oxygen consumption. Although the studies show that barefoot running has a lot of positive results in reducing injury, many more studies need to be done to discover the true impact of barefoot running. Therefore if the barefoot running transition is not done properly than it can end up causing more harm than good. There are several essential steps you should take in order avoid the common mistakes made by runners transitioning to barefoot running.

  1. Make sure your foot and body can handle barefoot running by seeing a running or sports medicine specialist. Although studies and history show that barefoot running is natural for our bodies it may not be natural for some. Due to our lifestyle of sitting for 8 or more hours a day and reduced activity some feet and bodies are not biomechanically built for barefoot or minimalist running. James Christina, DPM, says “Some people are going to be very well-adapted to barefoot running,” but others “may do horribly.” Not all human feet come in the same package. There is significant variability in human feet structure, some of which make barefoot running impossible.
  2. Transition to barefoot running slowly. You will not be able to run the current mileage you do now. Some experts suggest to switch to a minimalist shoe first then to barefoot. Other experts such as Christopher McDougall, author of Born to Run, suggest running barefoot first to work on technique then adding a minimalist shoe is desired. Again just remember with both barefoot running and minimalist you will not be logging your current miles.
  3. It is recommended to start with running on a hard surface such as a track or asphalt. This is to allow for better proprioception. When running on a soft surfaces it’s hard to feel if you are heel striking. If you are heel striking on a hard surface your body immediately gets feed back and is forced to adjust.
  4. Start with short distances such as 200m or less then walk for the same amount. This will help you build up the proper muscles in order to prevent injury. Do not increase mileage by more than 10% per week.
  5. Of course with barefoot running comes blisters. Be sure to let these drain on their own and to keep them clean. Also clean and bandage any cuts in order to avoid infections.
  6. Last but not least always check with a doctor or physical therapist before starting any new exercise routine.

Some of the possible benefits of running barefoot are that it could allow for the development of a more natural gait and strengthen muscles, tendons, and ligaments associated with a natural gait. Without the thick soles from a sneaker it may help stretch and strengthen the calf and achillies tendon.

Barefoot runners typically run forefoot or mid foot landing which is shown to put less stress on the joints. Because your foot can feel more it may improve proprioception and balance by activating smaller muscles in the feet, ankles, legs, and hips. If you have no pain or health issues there is no reason to switch running styles. It may end up causing more injury. Shoes help protect the feet from debri, sharp objects, and the cold. Since the body is not use to running barefoot if it is overdone it could lead to Achilles tendonitis or calf strain. Switching to barefoot running is not the only way to improve performance, in fact experienced sports medicine physicians recommend to improve the rest of biomechanics and only then start strengthening intrinsic foot musculature in order to change to a minimalist running style.

Barefoot running seems to have a lot of positive benefits but a lot more studies need to be done before it is decided whether running with or without shoes is best for over all health.

Should You Invest In A Gait Analysis?

In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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