Running barefoot? Don’t run into trouble

By Erika Lewis, P.T., physical therapist, Providence Sports Care Center

In the last couple of years, barefoot running has really taken off. More and more people are tossing their shoes and hitting the trail in minimal to no footwear – and often, with minimal preparation. Unfortunately, jumping in too quickly can lead to injuries. If you've been thinking about giving barefoot or minimal-shoe running a try, take time to prepare.

First, understand that running barefoot – or with a barefoot-style shoe – has a very different impact on the body than running in traditional shoes. For most people, running barefoot tends to cause a forefoot-strike pattern – that is, a pattern of landing on the forefoot or ball of the foot, rather than on the heel. Studies show that this style of running:

  • Increases the workload on the forefoot and the ankle
  • Reduces the workload on the hip, low back and knee
  • Shortens stride length by about 10 percent
  • Increases leg stiffness
  • Reduces vertical displacement (up-and-down movement, as opposed to forward/horizontal movement) by 45 percent
  • Reduces impact force by 35 percent

Based on some of these findings, you might conclude that barefoot or forefoot running reduces injuries, but none of the studies found any correlation with injury rates. For running in general, research has consistently shown that the four major risk factors for injuries are prior injury, lack of experience, running competitively and running more than 40 miles per week. These risk factors most likely apply to barefoot and minimal-shoe running, as well. In future studies, we may learn that the only difference between running with and without shoes is the location of the injuries.

For now, we just don't know whether barefoot running makes a difference in injury rates – but we do know that it works the body differently, and that's important to keep in mind if you are thinking about making a switch.

What to consider before you go barefoot

Take your time. If you've decided to make the switch to running barefoot or with a minimal-heel shoe, go into it knowing that your body will need time to adjust to the transition. We spend most of the day walking around in shoes with some type of heel, and our bodies get used to that. To make a safe transition from traditional running shoes, which typically have a 10- to 12-millimeter heel, to minimal or barefoot shoes with a 0- to 4-millimeter heel, you should allow a minimum of five or six months. Begin with just a mile or two at a time in the new running style and shoe, and gradually add mileage as your body adjusts and feels ready. It should be a very slow progression. If you pay close attention to your hip, knee and ankle mobility and stability deficits, it may take as much as a full year before you are completely comfortable doing all of your running in the barefoot style.

Consider your distance. Runners should carefully consider their mileage, as well as their current footwear and orthotics, before making major changes in shoes or strike patterns. If you run upwards of 40 miles per week, it may take several intermediate shoes to get you through the transition. You might want to spend a day in a minimal shoe without running, first, just to see how you feel. If that feels OK, then start with no more than one to two miles, just walking, before starting to run in a minimal shoe. It will take several months of dividing your mileage between shoe styles to safely make the change.

Consider your age. Beginning around the age of 30 to 40, our soft tissues start to get stiffer due to decreased tissue hydration and increased tissue fibrosis, and our hips and core muscles get quite a bit weaker. For older runners who have been wearing stabilizing or motion-control shoes, it will take a lot of time, patience and work to transition safely to barefoot running.

Consider your experience. If you're not a runner, you'll need to allow extra time to get your body in shape for running in general. Start with walking first. Mix a little bit of jogging into your walk very gradually, listening to your body, and don't add a lot of mileage to begin with. There are many websites, smart phone applications and books available to help you safely build up your baseline mileage to a 5-kilometer (3.1-mile) run.

Consider your weight. An above-average body mass index, or BMI, mean extra load on the joints. People who are carrying extra weight potentially have a higher risk of injury with barefoot running. It may be safer to start with a more traditional shoe, walking first, and then mixing in jogging, until you've taken off the extra weight.

Consider a happy medium. In our clinical setting I encourage my patients to work on more of a mid-foot strike, which is a happy medium between the heel strike and the forefoot strike. With a mid-foot strike, you tend to spend less time in pronation – that is, prolonged or excessive rolling inward at the mid-foot. My patients who run with a mid-foot strike tend to have less lower-leg strains and fewer Achilles problems.

Get some guidance. There is no one-size-fits-all strategy for going from running in shoes to running barefoot. Ideally, you should work with a knowledgeable footwear specialist and a physical therapist to build a program that addresses your specific needs.

The physical therapists at Providence Sports Care Center, and throughout the Providence Sports Rehabilitation offices regionally, offer videotaped gait analysis and functional movement screenings to assess your running mechanics, movement pattern dysfunctions, muscle imbalances, flexibility and strength. Based on this information, we can give you expert, individualized guidance to help you work safely toward your running goals. Our staff also can refer you to the right people to fit you into the most appropriate minimal or supportive shoe for your feet and running style.

Listen to your body. As in any new sport, if what you're doing is causing pain, back off – don't push through it. Persistent pain may be a sign of an overuse injury and should be assessed by a physician. In addition to listening to your soles, listen to your soul. If you try barefoot running – or any style of running – and it's just not enjoyable, don't beat yourself up about it. Running isn't for everybody. There are plenty of other great ways to stay active – keep exploring until you find something you enjoy.

About the author

Erika Lewis, P.T. provides physical therapy at Providence Sports Care Center. For athletes in any sport and people of all ages, Providence Sports Care Center provides orthopedic, rehabilitation and cardiology care in downtown Portland. Their phone number is 503-962-1900.