Barefoot running: What's the latest? Can it reduce injury?

The argument between whether barefoot running is better for you over wearing footwear (shod) has been debated for years. The theory is that barefoot runners are less susceptible to injuries to their shod counterparts purely based on how the foot strikes the ground. The postulation is that barefoot runners land either in the middle of the foot (mid foot running) or on their toes (forefoot running) whereas shod runners with shoes are said to have a tendency to strike the ground with their heel first (rear foot running). The theories suggest barefoot runners suffer less injuries because of the way the foot strikes the ground, creating less forces through the ankle and the knee, causing less injury.

Depending on where you gather your statistics, approximately 90% of novice runners rear foot strike and at least 75% of those are said to sustain some form of injury. A recent study by Hashish et al (2018) have investigated into this further. They compared in a group of existing barefoot runners and a group of shod runners. All of the shod runners habitually were rear foot runners. The shod runners were gradually phased onto barefoot running over an 8-10 week period.

After the 10 week study, none of the runners sustained an injury. 1/2 of the runners changed how they struck the ground through the study. Yet they found that none of the runners had adopted a forefoot running style, without explicit instruction. Which therefore signifies if you're looking to reduce your risk of injury from rear foot running, then perhaps barefoot running may not be answer due to the reluctance of those making the transition to run on the forefoot. The researchers also highlighted the potential for harm to be caused if barefoot runners do not adopt a fore foot running style. However, the risk for tightening and shortening of calf muscles from performing this is increased and the tibialis anterior to be put on undue strain and shin pain can be a common theme.

From a biomechanical and transferable to normal daily life, we as physiotherapists encourage rear foot strike as this activates our gluteals and prevents overuse of our calves and hamstrings. Furthermore, this is an accentuation of a normal walking gait.

However, an additional study by Ling et al (2018) found that barefoot running techniques had a positive change on people who suffer with low back pain! They found that the postural changes required to adopt to barefoot running meant that the natural arch of the low back lessened and the back muscles were allowed to relax and not over-work (the main reason for many with low back pain). Yet, the study was conducted on only a handful of people (17 people) and over a very short period of time (4 weeks), but the findings are promising for the management for low back pain.

And there you have it. Whilst barefoot running may not be a new thing. Some will love it, some will hate it. It is a subject that the physiotherapy world feels it needs to perform research in, and whilst there appear to be benefits, like anything there are limitations.