In June 2011, I attended the ACSM (American College of Sports Medicine) National Conference and was fortunate enough to hear two experts discuss their work and research involving running injuries, specifically to the heel. Dr. Daniel E. Lieberman, Harvard University, and Dr. Irene Davis PhD., P.T, University of Delaware each offered valuable information for runners whether they run barefoot or choose to wear shoes.
I attended the session “Barefoot Running: So Easy a Caveman Did It!” presented by Dr. Daniel E. Lieberman who told his audience that shoes were created to soften the impact from heel striking to our bodies. The cushioning in shoes puts less strain on our calf muscles and blunts the impact of landing on our heel, but in doing so it prevents the muscles in our lower leg from engaging in or being utilized to the extent for which they were created.
Evolution Principles discussed by Daniel E. Lieberman :
- We have evolved differently than our ancestors due to our environment. We are mismatched; when we should be walking barefoot we have had to wear shoes for protection. Having arch support and cushion in shoes is abnormal; we should have strong, flexible feet.
- Symptoms (pain, injuries) are the actual adaptations to the environment we are experiencing (as a result of wearing shoes).
- Natural selection is the best engineer. Our feet were designed to evolve and adapt to the environment, but wearing shoes has prohibited this evolution.
- We are all abnormal. We used to be hunters & gatherers and walked 9 – 15km to find food. The arches in our feet adapted by becoming strong and flexible. Now we wear shoes with counter-balances which prevent our feet from getting stronger and more flexible, and instead of hunting for food, we eat processed and packaged food.
Dr. Irene Davis PhD., P.T., is not only a Professor in the Program of Physical Therapy at the University of Delaware, she also conducts research in the Motion Analysis Laboratory and is the Director of the University of Delaware Running Injury Clinic. She believes that landing on the mid-to-fore foot, not on the heel, is essential for injury-free running. Her presentation at the conference focused on collision impact: the amount of force the body is exposed to when a person lands heel-first while running. Dr. Davis pointed out that running shoes with a lot of cushioning in the heel theoretically create a more stable surface due to the wider shoe base (width of shoe at the heel), however, the wider heel is actually more unstable in the sense that it gets in the way of proper foot strike.
For those of us who heel-strike while running, our heel is the first part of our body that makes contact with the ground, and the angle at which we make contact with the ground halts the momentum of our stride and causes our foot to rotate (pronate) inward. Pronation is a normal function of the foot, meant to absorb the shock of impact (thus preventing injury); it’s over-pronation that can cause problems.
What is wrong with landing heel-first? The collision impact causes injury. Collision force between the body and the ground is 6-7% landing heel-first (takes impact of entire body); 1.4% landing mid-fore foot (takes impact of foot only). In order to alleviate chances of injury, avoid over-striding, focus on a high stride frequency, and do not lean forward from the hips.
Learn more about collision impact and foot strike from Dr. Lieberman’s website.
Do you run with a barefoot style? Lieberman analyzed runners from the Western Rift Province in Africa and noticed they naturally landed on their fore-foot. However, once they put on shoes, their form changed in response to the shoe, and they began to land heel-first. Landing heel first for a runner who has not been doing so can be a source of discomfort and possibly injury until the feet, ankles, and legs become accustomed to it. Likewise, the shod runner who takes off his/her shoes to run will find that the change in how the foot lands will result in foot, ankle, or leg discomfort or injury.
Another reason why cushioned shoes work against our natural response to impact and foot strike is because the body adapts how it lands on the ground according to the surface it lands on. For example, if you were to jump off a trampoline onto cement, your body would naturally land softer on the cement absorbing the shock of the landing throughout the body. However, if you jumped off a trampoline onto thick, soft mat, you would land louder and heavier, because you know that the mat is soft and it will absorb the impact of your landing.
Dr. Davis presented a case study that made barefoot running seem to be a magic bullet in solving one specific athlete’s injuries. The high school athlete in the study was a heel-striker who suffered from plantar fascists and elevated pressure in all four compartments in his foot. The pressure was so severe that it had to be relieved through four EPF (endoscopic plantar fasciotomy) surgeries. He had some success with these surgeries, but the pain and symptoms always came back. During this time he also went through three different pairs of custom orthotics with no relief. Visually, you could tell there was an imbalance in his gait because his anterior tibias were hypertrophied due to the muscular imbalance between his shins and calves. He eventually threw away his orthotics and sneakers and began to run in Vibram FiveFingers®. The Vibram shoes allowed a natural foot-strike pattern (mid/fore-foot) and could possibly be the reason he stopped landing on his heel. His injuries healed and have not returned. However, it is important to remember that one case study does not fit all runners.
To summarize, barefoot running may be best for you or it may not. Running in today’s running shoes or running barefoot can each result in injury. Lieberman and Davis agree that running form is more important than running shod or barefoot. The modern running shoe does alleviate some injury with its padding, and if you are not experiencing injuries and feel good about your running, barefoot running may not be for you.
Transitioning to Barefoot Running
- If you are curious about barefoot running and decide to give it a try, do so with caution. Here are some tips to follow in making the transition.
- Start slowly: Try walking for 8 minutes and jogging for 2-> then walking for 7 minutes and jogging for 3 etc. building to 10 minutes.
- You can transition from shod running to neutral shoes with less cushion;
- look for shoes that have a consistent amount of cushioning from toes to heel. For example, most shoes have more cushion in the heel than in the toes, making the heel higher than the toes, as if a wedge was placed under the shoe. You want to avoid this.
- If trying to run completely barefoot, start on clean pavement that is neither too hot (to prevent blisters) or too cold (icy).
- Keep feet relaxed and be careful not to point your toes.
- Decrease stride length while increasing stride frequency.
- Don’t ignore pain.
Should I wear shoes that place me on my mid-foot?
Trismarter clients often ask us about shoes that ‘teach’ your foot to land on the mid-fore foot, and for most, we do not recommend them. This is because an athlete should learn how his or her body mechanics change for your entire body (from ankles, knees, hips to shoulders) as a result of landing on the mid-foot and with a full body lean. Ideally, you should feel this kinesthetically so you know how to adjust your landing and body position depending upon terrain. It really is a mind-body connection. Just wearing a shoe that is built to propel you off of your forefoot isn’t going to teach your body the mechanics it needs to enjoy a lifetime of injury free running.
Another reason we do not recommend athletes wear shoes that place your foot in a specific position rather than the athlete doing it his/herself, is that an athlete needs to take advantage of the spring-like loading and re-loading that happens between the muscles in the foot, ankle, and lower leg. Even though we refer to the foot landing as mid or fore-foot, there is a moment in time when the heel does touch the ground. This is necessary for the absorption of collision impact and the resulting propulsion of the body forward. The foot lands on the outside edge of the mid-foot (area between top of arch and base of toes), below the knee (not in front of it) with the shin 90 degrees from the ground, and rolls inward while the heel drops to the ground, muscles recoil, ankles flex and extend, and the athlete moves forward. If he or she lands and propels from the toes only (as some shoes promote), development calf and shin injuries can occur. We see this often when athletes try the Chi running technique or do a lot of uphill running without allowing their heel or Achilles tendon to drop to the ground during flexion and extension.
Some shoes that maintain a level sole from heel to toe are: New Balance MT101, New Balance Nimbus, Merrell Collection, Nike Free Family, Vibram FiveFingers®, Vivobarefoot, RunAmoc Lite, Teva Nilch, Asics Piranha SP® 3, and Inov8 Bare-X Lite 150. This list mixes trail and running shoes and is by no means complete.