For thousands of years people walked and even ran with either minimal protection on their feet or if you go back far enough in time, with no protective foot wear at all. So what is all the fuss in the medical community about the new wave of minimalist running foot wear that is now available, both for every day walking and for running?
I have some thoughts on the subject both from a perspective of having treated thousands of patients over a thirty year career and from recent research regarding the concept of wearing minimalist running foot wear. From a practical stand point, when our ancestors, the cave man, went to hunt and gather, he was not concerned about walking on concrete or asphalt surfaces, nor was he concerned about the possibility of stepping on broken glass and unless he was being chased by the prehistoric equivalent of a tiger or bear, he was not forced to run long distances.
From that perspective alone the notion of running barefoot or even walking around barefoot makes no sense to me. My clinical experience backs that up as you cannot imagine the things that happen to people's feet from not using just a little common sense by wearing protective covering on their feet when they are out and about.
So, most of us can agree that we need some kind of foot protection; that is where the minimalist shoe comes in. At the very least, the purpose of the modern minimalist shoe and minimalist running shoe is to protect the foot, but still allow the foot to function in its normal gait cycle. One might describe it as a glove for the feet. If you go into various forums discussing running and walking you will see arguments for and against the use of the minimalist running shoe.
Lets just say this: those that can walk and even run either with a minimalist shoe or even barefoot are just plain lucky (if you consider this trait as luck). It comes down to more than just making a blanket statement that "minimalist running shoe is better than wearing conventional running shoes". The reason some people can run barefoot or even with the minimalist shoe comes down to genes. They just happen to have a foot structure, gait cycle that is conducive to this type of running. Said in reverse, not all people can do this because of their foot structure, type of gait and even perhaps their size.
When running, most runners, sprinters excluded, come down first on their heels. In a normal gait, the bottom, middle to outside of the heel has to absorb all the shock that is created by the event known as "heel strike". Look at any good running shoe, even some not so good running shoes and what you will notice is that they all have in common at least one component, and that is heel cushioning. This absorbs some of the shock, so that the shock of the heel hitting the ground in not sent up through the foot to the leg.
As a side note a study was performed on the running patterns of runners in a marathon. Although the majority of runners were what is known as heel strikers, meaning they came down heel first, it was observed that most of the elite runners, those who actually run a marathon to win it, were either midfoot runners or forefoot runners landing on the ball of their feet. Among the non-heelstrike runners 21.43% were found to be wearing minimalist shoes, but no significant difference between shoe type and rank was found.
A minimalist running shoe has no heel shock absorbing capability but instead attempts to create what is known as forefoot strike (FFS) pattern. This will occur in two types of runners. Certainly a sprinter will exhibit this pattern and if you have looked at sprinters racing shoes, for years, they have leaned more towards a minimalist running shoe rather than a typical running shoe. More conventional runners who typically exhibited (RFS) rear foot strike would have to change their gait pattern to one where they come down on the middle portion of the bottom of the foot. For most of us, this is abnormal.
Therein lies the problem. For someone who has been a "traditional" runner and has decided that they want to run in minimalist running shoes, they will need to change their gait in order to do so. Have you ever tried to change your gait? There is a saying in medicine, "structure follows function" meaning that the musculo-skeletal system adapts to the way it functions. If you have walked or even ran in a certain pattern for many years, your skeletal system has adapted to that pattern and your bones, muscles, joints all line up in a manner to allow you to "walk that way". So it is virtually impossible to change your gait.
Don't believe me? Try walking or even jogging in a way that is not normal to you. Maybe putting more weight on the outside of your foot, or eliminate heel strike. See how long it lasts. I will tell you how long it will last. As long as you are consciously thinking about it, you should be able to walk or run in your "new" gait pattern. Once you stop actively thinking about it, you will automatically go back to your "old" way of ambulating.
Lets take this further. You are an active runner and you are buying into all this hype about minimalist running. You go out and purchase the latest and greatest minimalist running shoe out there. In order for you to run in the shoe, you are going to have to change your gait, because this new shoe does not allow you to run in the more traditional way (RFS). Not only will you have trouble remembering this new gait while you are running, but because you have changed your gait to one that is not normal for you, you open yourself up to a multitude of injuries, including soft tissue injuries all the way up to stress fractures. (there is a reason the major shoe companies have spent a gazillion dollars over the years in research trying to come up with the perfect running shoe and maybe more importantly, different shoes for different foot structures.)
One of the most common conditions we as foot specialist see is plantar fasciitis. To the casual observer who knows anything about the condition most would argue it occurs from overuse of the foot which then over stretches the plantar fascial ligament and causes irritation. Aside from the weekend warrior who played too much tennis and injured his ligament, it has been my observation that plantar fasciitis seems to be seen more as a result of people who wear flimsy (minimalist) shoes like ballerina shoes, sandals,flip flops and other non-supportive shoes. I cannot make a blanket statement and say this will happen in everyone, but certain foot types are more prone to this condition as a result of a shoe that does not adequately support the foot.
Alright, you now know my position on minimalist running shoes but you are still inclined to try them, so let me give you some guidance.
I would recommend before switching directly from a conventional running shoe to a minimalist running shoe you should try what is referred to as a transitional minimalist shoe. What is the difference?
When we look at a traditional running shoe we refer to the "heel drop" which is the difference in the lift of the heel from the ground versus the lift of the forefoot from the ground that the running shoe provides. This means the heel is higher off the ground than the forefoot. The point of this is to take stress off the achilles tendon. To switch directly to a pure minimalist shoe will put a lot of strain on the achilles tendon which could open you up for injury. Those runners who exhibit an equinus foot structure (tight heel cord) may be more open to injury from the shoe transformation.
Using a transitional minimalist running shoe will give you a compromise between a traditional running shoe and a minimalist running shoe and allow you to start to adapt to the changes that will occur in your gait pattern. If you find you have no problems with the transitional minimalist running shoe over the next few months then at that point you might consider the "barefoot style" minimalist shoe, keeping in mind that you have further reduced the "heel drop" effect and the shock absorbing capabilities of your shoe.
Ok, so I just get done explaining all the reasons why you should not go barefoot. Well this next section is going to give an argument for walking barefoot, particularly, outside. I want to start by making it clear that I am acting as a reporter here. I am just relaying this information and although I find it somewhat intriguing, I am not sure if I actually recommend the concept of earthing to you.
What exactly is earthing? Also known as grounding it is the concept of grounding your body to the earth by walking barefoot (outdoors). The first point to make is that skin is a good conductor. It has been noted by those that practice acupuncture that the ball of the foot is an especially good conductor. What you are actually conducting is the transfer of electrons from the earth to your body. The significance of this according to "earthers" is that this flow of free electrons might be the best source of antioxidants available to man. These electrons negate free radicals which are circulating through your body. Free radicals are the end result of inflammation. Chronic inflammation in most medical circles is considered a contributor to many disease states.
Yes, we need inflammation when we sustain an injury. Inflammation is due to the increased blood flow to the injured area. The increased flow of blood brings nutrients to the area and that is how the body heals itself. One of the things that blood brings to the injured area is a burst of oxygen. The breakdown of oxygen produces free radicals which help repair the injured tissue. The problem is that over production of free radicals gets into healthy tissue and does damage to that tissue. Quite a paradox. Free radicals repair damaged tissue but injure healthy tissue.
The free radical theory is that the body ages more rapidly because of excessive damage to the tissues when there are too many free radicals floating around the body. Free radicals are produced by injury to tissue, but are also caused by environmental factors such as polluted air and from a lot of the foods we eat.
In addition to the antioxidant properties of grounding, it is also postulated that earthing may thin your blood making it less thick thus improving blood flow throughout your body. If this is true than earthing could potentially reduce your chances of blood clot thus reduce your chance of a heart attack or embolism. It might also reduce your risk of dementia that is caused by micro clotting in the brain.
The concept of earthing is in its early stages and I do view this with a degree of skepticism, but I would encourage those who see the beneficial possibilities in this simple concept to explore it further. A good place to start would be this article on earthing.
Foot-Strike Pattern and Performance in a Marathon
Kasmer ME, Liu XC, Roberts KG, Valadao JM (Medical College of Wisconsin, Milwaukee, WI; Footworks Orthotics Inc., Milwaukee, WI)
Int J Sports Physiol Perform. 2013 May;8(3):286-292
Int J Sports Physiol Perform. 2013 May;8(3):286-292
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