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Barefoot running is gaining in popularity. Recently, Dr. Oz promoted barefoot running on his new TV show. He went as far as demonstrating the proper technique for barefoot running. Watch the video HERE. I am thrilled to see one of the most trusted and respected physicians of our time promote barefoot running. However, not everyone is happy about all this interest in barefoot running.

Late last month the American Podiatric Medical Association (APMA) released a position paper on the barefoot running:

APMA Position Statement on Barefoot Running:

“Barefoot running has become an increasing trend, and a possible alternative or training adjunct to running with shoes. While anecdotal evidence and testimonials proliferate on the Internet and in the media about the possible health benefits of barefoot running, research has not yet adequately shed light on the immediate and long term effects of this practice.

Barefoot running has been touted as improving strength and balance, while promoting a more natural running style. However, risks of barefoot running include a lack of protection–which may lead to injuries such as puncture wounds–and increased stress on the lower extremities. Currently, inconclusive scientific research has been conducted regarding the benefits and/or risks of barefoot running.”

I would love to hear your thoughts on the APMA’s position statement and/or Dr. Oz’s comments.

Image CreditHealthy female feet Photos by Pond5

  • Bob Neinast

    Well, the first thing I’d say is that Dr. Oz didn’t really promote barefoot running. Running in Vibram’s is not “barefoot”. As Ken Bob Saxton of RunningBarefoot says, minimal shoes are not “barefoot.” You just don’t get the same sensory feedback that you get when barefoot, and that full sensory feedback is vital for running barefoot properly. If you are wearing a knight’s full-body armor with metal gloves and trying to thread a needle, and you manage to switch to a pair of thin leather gloves, sure, it’ll be a big improvement. But it still doesn’t have the benefits of going bare-handed. Similarly, it is that very same feedback that counters the APMA’s statement about stress on the lower extremities.

    Regarding the APMA’s statement, why is the shod state the default? While they stress that there is not adequate research on barefoot running, the truth is that there don’t seem to be any studies on the benefits of shod running. In fact, one can find all sorts of studies of the damages that shoes do to feet, from arch problems to bunions to corns. When studies are done, they almost always seem to compare one sort of shoe to another sort of shoe, or one sort of orthotic to another sort of orthotic, but the comparison is never to long-term barefooting.

    Footwear research seems to be at the stage of recognizing that corsets aren’t very good, but they seem to keep trying to come up with better back braces that don’t do the damage that corsets do. Yet, the (real!) research on back braces shows that it weakens the back muscles and that backs heal better and stronger without them.

    Regarding punctures, the APMA really doesn’t have much real world experience. In 12 years, I have punctured my soles occasionally. However, that has been while hiking with a 30-pound backpack and bushwacking through heavy brush. In that same bushwack I’ve also punctured (or scratched) my legs, but there is no dermatologist organization claiming I should quit wearing shorts. Also, of course, if you step on a nail, the rubber soles of running shoes won’t stop the nail, and by the time you feel it, the nail will already have a lot of force driving it into your sole. If you are barefoot you can feel that nail immediately and react immediately. And with the shoe on, there is a good chance of driving the Pseudomonas aeruginosa that thrives inside the shoe into the wound, giving a rather nasty bone infection. See, e.g., Soft tissue and bone infections from puncture wounds in children.

  • Dr. Nirenberg

    Bob – You are absolutely right! Regarding puncture wounds – sometimes in shoes they can be worse because a piece of the running shoe can be “pushed” into the foot!

  • http://Runningshoesarenotevidencebased. Dr I Thomas

    The widespread promoting of running shoes is not evidence based.

    I am a medical doctor and have been running barefoot (no, I do not use the wimpy Vibram Five Fingers and other pathetic imitations of barefeet ) for a year. I have run over gravel, grass, concrete, aspphalt and over trails. My longerst barefoot runs have been 24 km with the average run being between 7 to 10 km. I have had fewer injuries ( more on that below ) while running barefoot than when I ran with expensive ASICS running shoes.

    My injuries while running with shoes:
    1. Calf muscle fibre tears
    2. Ligamentous injuries of the ankles
    3. knee pain
    4. Iliotibial band syndrome
    5. Soft tissue strains of the lumbar spine.
    Each of these required me to stop running for weeks.

    My injuries while running bare foot:
    1. Two minor puncture wounds from thorns ( one removed on the spot ) another removed at home with scissors and forceps.
    2. Two stubbed toes
    None of these required me to stop running for even a day.

    In summary, over a year of running barefoot, I have had far fewer injuries than when I ran with expensive, widely acclaimed running shoes. The few minor injuries I have had while running barefoot have not caused me to have any time off running.

  • Dr. Nirenberg

    Hi Dr. Thomas —

    It is great to hear about your success with barefoot activity, and it is nice to have another doctor open to the potential benefits of barefoot running!

    Can you tell us a little bit about how your routine? Do you do any particular stretching? Did you try VFFs? How did you build up to 24km?

    Do you advise your patients to BF run?


  • “Barefoot” Sal Rodriguez

    I’m am a 36 year old male. In my mid-to-late 20s I ran numerous races from 5Ks to Marathons, all shod. Toward the end of that streak I experienced what I can only describe as a cross between Achilles Tendonitis and Plantar Fasciitis. I took a long break from running and trained and focused on getting fat and depressed. A couple of years ago I made a slow and painful comeback to running; did a few 10Ks and half-Marathons here and there. About seven months ago, realizing that I required motivation and inspiration, I stumbled across the book “Born to Run” by Christopher McDougal. The book changed my life. Since then, I have experimented with shoes, VFF, and real Barefooting. After several sessions of 1 mile in shoes, 1 mile in VFF, 1 mile Barefoot, I began to hate running in shoes. My feet felt like blocks. I chucked the shoes. I then continued. After a few weeks I began to hate running in VFF. My feet felt smothered. I chucked the VFF and went completely barefoot. (I save the VFF for weight training in the gym and casual use).
    I have now completed two official 5Ks completely Barefoot, yes with a capital B. My AT and/or PF has not returned. My calves and feet feel stronger than ever. My landing in softer, even now at a much heavier weight than my 20s. Barefooting requires a greater alertness and mind-body integration. I’m more aware of everything, from posture, to cadence, to every minute detail of the terrain. And no, I have no calluses, blisters, or scrapes on my feet. My constantly evolving and improving form has left those things behind. Although I run on all surfaces, including city streets, I have not cut my feet.
    Running is fun again. Seven months – I’m never going back. I’ve already cleaned out my closet.

  • Dr. Nirenberg

    Thanks for the reply. How long did it take you to get use to running BF? AND – What kind of stretching and/or muscle strengthening do you do, if any?

  • Sean Gavor

    Where is the evidence that wearing running shoes does anything but weaken your feet? Our current evidence for barefooting might be anecdotal but how many unpaid spokespeople are going to bat for the benefits of shoes?

    All paradigm shifts in Scientific orthodoxy come as the results of “crazy people bucking the trend.”

    Examples such as peptic ulcers and bacterial origin of mitochondria should remind us that orthodixies come and go. We’ll look back on the 2nd half of the 20th century as an era of profound ignorance regarding the barefoot running phenomenon.

    Then, some sociologist will link it to the greed and excess of the era and here we go….but by then, we’ll be cranking out 100 milers barefoot with no clothes on 😉

  • Dr. Nirenberg

    Thanks, Sean! There is evidence against shoes, and some preliminary evidence in support of barefoot activity. However, I cannot – yet – find one research study or peer-reviewed published paper that shows barefoot activity is detrimental.

    Further, the scientific community is, in general, slow to embrace new concepts. The brain was considered rigid and unchangeable until very recently when it was discovered to have plasticity. The examples are endless. Perhaps, BF activity will one day be added to that list. What was the moment when you realized barefoot might be better than shod?

  • Sean Gavor

    Thanks for the reply, Doc. I accepted the advantages of BF vs shod about a year ago but was too afraid to try it because of all the broken glass everywhere (I live in urban NJ). I ran a few ultras last year and there was this huge buzz about a new book coming out called Born to Run. I knew about the Tarahumara and was familiar with some of the characters (pun intended) in the book so I was really excited when it came out. I found the Minimalist running Google group after doing a search for Barefoot Ted and read his review on the Feelmax shoes. I’d been wearing Nike Free since the Spring and I thought they were a lot better than any other shoes I’d tried. That is, until I started wearing the Niesas a few weeks ago. I wear them everywhere as my regular ‘shoe’ now and I’ve been running in them exclusively for about two weeks.

    All of my concerns about the glass are gone because I’m very comfortable with the puncture resistance of the sole. Wearing these is about as close to barefoot as anything I’ve tried (including Vibram). The initial runs in the shoes were about 1/2 on pavement and 1/2 on grass and about 6-8 miles in length. These runs were much more impactful on the leg structures than even the 20 mile runs I was doing in shoes. However, once I recovered I noticed that everything was becoming stronger. I realize that its still really early in my transition but yesterday, I did a 1/2 marathon with ~11 miles on paved surface and I’m only a *little* sore today.

    If I stay on this trajectory, I should be able to complete marathons and short ultra distances by next summer wearing the Niesas. Its going to take a lot more time to toughen up the skin on the soles of my feet before I can go totally BF but so far, the transition has been amazing. I have to say, the best part about it is as my feet get stronger, it takes less effort to run at any given speed. That’s a nice bonus for a “back of the packer” like me.

  • Dr. Nirenberg

    Thanks for the reply. I have not tried Feelmax, but I now I will! In terms of your feet becoming stronger, do you also notice any other changes that can be attributed to BF running? Improved posture, stronger gluts, hamstrings? I would love to report on you running a marathon! Keep me posted!

  • Sean

    I’m noticing that I’m more sore after the barefoot/niesa runs but that its a different type of soreness than I’ve experienced in the past. Injuries of old (mainly achilles tendonitis) would keep me from running for a few days until the swelling/pain went down. With the BF style, I’m noticing that the feet start to get sore around the 10 mile mark. With shoes on, this sensation would usually show up at around 25-30 miles. With BF, I’m able to run faster (all of my BF runs are faster than usual) but not as long. I suspect that my feet will require an adaptation period of at least a few months since I’ve only been at it for three weeks now and my longest run is ~13 mile. The frozen ground and the fact that I run almost exclusively on asphalt may also be factors. I managed a totally BF mile last night but it was too cold (25, windchill 15) so I had to put the niesas back on.

    One of the main things I’m noticing early on is that I’m running more confidently. Its hard to explain and I’m sure its a psychological phenomenon but since I’m feeling the ground like never before, I’m more cognizant of my surface and my focus is concentrated. I used to just run and ‘zone out’ after a while but when I’m BF I have to pay attention to everything. Its also a lot more like trail running since every step is ‘different’ focusing on different strings and structures in the legs. The feet take more of a pounding but the soreness in the legs is non-existent. I think my posture is much better BF. I notice that my back is straight and my chest is out more often.

    Its hard to tell right now if the quads, glutes, hammies or calves are getting stronger per se but I think that if they are, I’ll be posting good times next year. I’m looking toward Mar 6 for my first attemp at a barefoot marathon. Its possible that I’ll be up to that level before that but I want to be conservative since this whole thing is so new (to us 20th centurians) and radical (for my previously coffined feet).

    I’ll keep you posted. Thanks so much for your interest. Its good to know that there are good doctors out there who listen to their patients more than their ingrained orthodoxies.

  • Jules

    I am very interested in this topic. I’m in late 40s and after 10+ years of semi-sedentary lifestyle started triathlons and running about 3 years ago. Latest event was a 100 miler over pretty rough terrain… that was October and I still have sore ankles from the twisting and strain.

    I can buy the logic and feel energised by the various debates. I am not worried about toughening up or puncture wounds or dog dirt, but I am concerned about the weather. I have a pretty enthusiastic nature, so half-way and using VFFs is not really on my agenda.

    I have (I think) poor circulation in my hands and feet. I get painfully cold. I live in UK and for 2-3 months it’s pretty cold! What is the advice for protection from icy weather? I ask here rather than the places like BF Ken as I suspect you might give a more informed response.

    Hope you can advise

  • Dr. Nirenberg

    Jules – Feet need protection from the cold to prevent numerous problems, including frostbite. You can try finding somewhere to run indoors, a track or treadmill perhaps. These options are not ideal. The other option is to find a minimalist type shoe that will still let your foot sense or “feel” the ground and provide warmth. I do not know of a good minimal shoe for cold weather running, but I would consider wearing socks with Feelmax Kuusa perhaps.

    If you find a good minimalist shoe for the cold weather, please let me know!!

  • Jules

    Thanks Doc, appreciate the advice and I will let you know how I get on.

  • Barefoot Sal

    Sorry for the delay. Only 10 months late! I posted a youtube video recently:

    It took me about 6 months to get used to BF. For warm-up I walk around the block twice (normal suburban block) then go for it, going slow in the beginning until I feel quite loose and warm.

    I don't do any particular type of stretching or muscle work directly related to BF. I do bicycle often (22 miles today) and weight train at least once per week – basic weight lifting, with some kettlebell swinging. Comparing BF to shod, after all my running experience, I believe my body requires LESS running-related stretching due to the natural gait and form that I now have. My entire body feels better running BF, for 1 hour, at 215lbs, than it did running shod, for a half-hour, at 180lbs!

    Again, please excuse my delayed response. The good news is, I have more experience to share!

  • Dr. Nirenberg

    Thanks for the reply! It is great to receive feedback about the benefits of barefoot activity!