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Barefoot Running
Onwaree Ingkatecha
Faculty of Sport Science, Burapha University, Chonburi, 20131, Thailand
Email: onwaree@buu.ac.th
Abstract
Running is one of the most popular sport activities which millions of people have
engaged in. It is convenient, inexpensive and offers numerous health benefits. With a pair of
shoes, people can start running. The modern running shoes have been thought of a protective
device from different surfaces and environment. Shock attenuation has been one of the
primary roles for running shoes to provide shock absorption. The various materials have
been added to improve the wearer’s performance and impact force reduction but some
researchers concluded that expensive running shoes were no better at reducing impact forces
than were low-cost shoes as well as other studies which postulated that barefoot running
could reduce impact force. In addition, the incidences of running and overload injuries which
occur as a result of repetitive microtrauma from chronic loading of skeleton, especially lower
extremities, had risen as well. With the release of the book about Tamahumara Indians in
Mexico, Born to Run, barefoot running has seen a rise in popularity over the last half a
decade. There still are the controversial issues if barefoot running is helpful or harmful.
Some studies showed the impact reduction which leads to injury prevention while some
studies argued that it could stimulate more injuries and long-term effects on feet. There are
still a lot of debates over barefoot running about benefits and safety. However, this trend has
spread to the footwear manufacturers. The minimalist shoes which offer little protection on
the heel have been launched to the market.
Keywords: barefoot, minimalist, running injuries, footwear, biomechanics of running
Onwaree Ingkatecha
Introduction
Millions of people are involved in recreational running all over the world. Running is
one of the most popular forms of aerobic exercises which requires no membership,
inexpensive and offers numerous health benefits. The health benefits of running are similar
to the benefits achieved by all forms of moderate intensity cardiorespiratory exercise. It helps
improve the efficiency of cardiorespiratory system, decrease cholesterol, prevent heart
diseases and hypertension, improve immune system, control body weight. Aside from health
benefits, there are several psychological benefits such as stress reduction, confidence and
attitude improvement. Running can be performed anywhere with a pair of shoes and
comfortable clothes.
Biomechanics of Running
Running is a complex task involving the coordination of all the body’s segments. It is
a modification of walking but different in significant aspects. The running cycle consists of a
stance phase, where one foot is in contact with the ground while the other leg is swinging,
followed by a float phase where both legs are off the ground or no double support. The
stance phase is divided into two sub-phases: early stance and late stance, and the swing phase
is divided into three sub-phases: early swing, mid-swing and late swing (Fig. 1) (Hunter et
al., 2008).
Fig. 1. Phases of running cycles, based on event of a single lower-limb (Hunter et al.,
2008).
Barefoot Running
The stance phase serves to absorb impact forces and maintain forward momentum
and to support the body’s weight. The late stance functions to accelerate the body forward
and upward by an increase in the limb length. The swing is the enhancement of the forward
and upward ground reaction thrust. This phase begins as the foot moves forwards.
Kinematics of Running
Kinematics is the study of the motion of object. The variables describes as a function
of the percentage of the total running cycle. The trunk and pelvis are tilted forward in order
to keep the forward acceleration. The hip is flexed between 25° and 30° at foot strike. The
hip extends maximally just before toe-off. During the early stance, the knee and ankle joints
flex. A further 20–30° of knee flexion occurs early in the stance period which is a natural
mechanism that cushions some of the impact force. Most runners initially contact the running
surface with their rearfoot. In the late stance, the knee extension and ankle plantarflxion are
followed. The ankle plantarflexes up to 30° before toe off (Novacheck, 1998; Lafortune et al,
2000). The heel contacts the ground with the foot in a slightly supinated position (Mann et
al., 1981). After that, the foot progresses into pronation accompanied by hindfoot eversion
and tibial internal roation which increases mobility of subtalar joint and forefoot. After
maximal foot pronation, the subtalar supination begins at heel-off and remainder of the
stance phase for propulsion (Dugan & Bhat, 2005). After take-off, the hip starts to flex and
continue through the midswing. The knee and ankle undergo flexion for toe clearance. The
hip and knee joint start to extend in preparation for touchdown at late swing phase (Hunter et
al., 2008).
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Fig. 2. Knee flexion angle as a function of (a) the thigh angle and (b) the ankle angle
(Lafortune et al., 2000)
Kinetics of Running
According to the 3rd law of Newton, Foot contact generates a reaction force from the
ground which is divided into three components; vertical ground reaction force,
anteroposterior ground reaction force, and mediolateral ground reaction force. The vertical
component is the largest component which effects the human skeleton. The previous studies
provided the information concerning the magnitude, direction and point of application. Its
magnitude is 1.3 to 1.5 times body weight during walking while the magnitude of vertical
ground reaction force in running is able to approach 3 to 4 times body weight. In addition,
the peak impact force relates to running speed. As the running velocity increases, the
amplitude of ground reaction forces increases (Cavanagh & Lafortune, 1980).
Fig. 3. Vertical ground reaction forces compare between rearfoot striker and
ab
Barefoot Running
midfoot striker (Blazevich, 2007)
The vertical impact force presented in Fig. 3 showed the characteristics of a rearfoot
runner and midfoot runner. Running style is classified according to which part of the foot
makes first contact with the ground. Runners with a mid- or forefoot impact will tend to
experience a lower impact force as the loading is cushioned by the active contraction of the
calf muscles (Grimshaw et al., 2006)
Human Foot and Functions
In order to provide support for standing and a lever for propulsion, the stability of
foot during weight bearing derives from articulations and ligaments from the heel to the
central metatarsal heads. As well as being the firm supporting base, it needs to be flexible for
propulsion and moving on the irregular surfaces. The human foot is a complex structure with
26 bones, several joints, ligaments and soft tissues. It is divided into 3 parts; forefoot,
midfoot and rearfoot. The forefoot, the most flexible part, includes five metatarsal bones and
fourteen phalanges. The midfoot includes five tarsal bones arranged in two rows. The
rearfoot includes talus, which forms the pivot of ankle joint, and calcaneus which forms the
heel (Fig. 4a).
There are three arches from the structural formation (Fig. 4b); the medial and lateral
longitudinal arches, and transverse arch. The medial longitudinal arch is the highest and most
important, is composed of the calcaneum, talus, navicular, cuneiforms and the first three
metatarsals. The lateral longitudinal arch is lower and flatter than the medial arch. It is
composed of the calcaneus, cuboid, and the fourth and fifth metatarsals. The transverse arch
is composed of the cuneiforms, the cuboid, and the
five metatarsal bases. These arches are strengthened by
ligaments and tendons (McKinley & O’Loughlin, 2008).
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Fig. 4 a) Anatomical structure of right foot (superior view) b) Longitudinal arches of
foot (McKinley & O’Loughlin, 2008)
The arch of the foot is an important design feature for the stability and function of the
foot. It is capable of supporting itself by the foot natural arch support mechanism known as
the windlass mechanism (Hicks, 1954), that the medial longitudinal arch is raised on
dorsiflexing the first metatarsophalangeal joint.
Running Injuries
Many injuries are related to running because of the high impact forces. Since
recreational running becomes dramatically popular among people, the incidence of running
injuries has risen. Several literatures indicated that the etiology of running-related injuries
was multifactorial characteristics (Keller et al., 1996; Satterthwaite et al., 1999; Taunton et
al., 2002; van Middelkoop et al., 2008; Buist, et al, 2010; Buist, et al, 2010; Harrast &
(a)
(b)
Barefoot Running
Colonno, 2010; Lynch & Hoch, 2010; Chang et al., 2011). The factors that causing running
injuries could be categorized into three factors: training, anatomical, and biomechanical
factors. The training factors have been routine excessive mileage, increased intensity,
duration and frequency of running, irregular surface running, running experiences, orthotic
use, the type of shoe insoles, the racing group, training duration and terrain, incorrect
footwear, training errors. The anatomical factors have been identified as the abnormalities or
malalignment of the body, especially lower extremities such as tibia varum, rearfoot varus,
and leg length discrepancies. The biomechanical factors have been the magnitude of impact
forces (Cavanagh & Lafortune, 1980), the rate of impact loading (Nigg, 1986), and the
magnitude of push off forces (Winter, 1983).
Most of the running injuries are overuse injuries which occur as a result of repetitive
microtrauma from chronic loading of tendons, muscles, or bones. Lun et al. (2004) studied
musculoskeletal injuries of 87 recreational runners who had no history of injury at the start of
the study and found the incidence was 79%, which was the same for both sexes. van Gent, et
al (2007) summarized that running injuries occurred 7%-50% at knee, followed by the lower
leg (9%-32.2%), the foot (5.7%-39.3%) and upper leg (3.4%-38.1%). van Mechelen (1992)
stated that 50-75% of injuries are due to overuse from running.
Table 1 study characteristics (van Gent et al., 2007)
Author, year
of publication
Study design Running type No. included/analyzed
(%)
Taunton et al.,
2003
Prospective
cohort
Recreational runners, registered
in training clinics, interested in
either completing a 10 km race
or improving their existing race time.
1020/844 (82.7%)
Lune et al.,
2004
Prospective
cohort
Recreational runners, running more
than 20 km/week.
153/87 (56.8%)
Steinacker et
al., 2001
Prospective
cohort
58 runners in training for a marathon, of
whom 42 did participate in a marathon.
58/58 (100%) of whom
42 ran a marathon.
Satterthwaite et
al., 2009
Prospective
cohort
Runners participating in a marathon. 1054/875 (83.0%)
Satterthwaite et Prospective 1054/916 (86.9%)
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al., 2006 cohort
Wen et al.,
1998
Prospective
cohort
Runners participating in a training
program for a marathon.
355/255 (71.8%)
Bennell et al.,
1996
Prospective
cohort
Track and field athletes during one
season.
111/95 (85.6%) of whom
21 were long distance
runners.
Macera et al.,
1989
Prospective
cohort
Runners wishing to be notified of road
races.
966/583 (60.4%)
Walter et al.,
1989
Prospective
cohort
Runners participating in a 4,
5.6, 16, or 22.4 km race and all adult
members of the organizing clubs.
1680/1288 (76.6%)
Bovens et al.,
1989
Prospective
cohort
Runners participating in a
training program for a marathon with
three phases (finished with a 15, 25,
and 42 km race, respectively).
115/73 (63.5%)
Lysholm &
Wiklander,
1987
Prospective
cohort
Competitive athletes of two track and
field athletes during one season.
60/60 (100%) of whom
28 were long distance
runners.
Kretsch et al.,
1984
Prospective
cohort
Runners participating in a marathon. 1098/459 (41.8%)
Author, year
of publication
Study design Running type No. included/analyzed
(%)
Nicholl &
Williams, 1982
Prospective
cohort
Runners participating in a marathon. 3462/3429 (99.0%) of
whom 1140 ran a half
marathon and 2289 ran a
full marathon.
Macera et al.,
1991
Retrospective
cohort
Runners participating in a 5 or
10 km race, or in a marathon.
534/509 (95.3%) of
whom 347 ran a 5 or 10
km race and 162 ran a
marathon.
Jakobsen et al.,
1989
Retrospective
cohort
Runners participating in a half or a full
marathon.
831/831 (100%)
Maughan &
Miller, 1983
Retrospective
cohort
Runners participating in a marathon. 497/449 (90.3%)
Nicholl &
Williams, 1982
Retrospective
cohort
Runners participating in a half or a full
marathon.
614/557 (90.7%) of
whom 242 ran a half
marathon
and 312 ran a full
marathon
Barefoot Running
The modern running shoes have been thought of a protective device from rough and
uneven surfaces, excessive ground impact forces, and cold - wet environments. Running
shoes were first designed in the 1970s. Footwear characteristics found to influence injury
rates include shock absorbing properties (Finestone et al., 1992; Milgrom et al., 1992;
McKay, Goldie & Oakes, 2001; Torkki et al., 2002), arch support system, outsole and
midsole materials (Chiu & Wang, 2007), shoe flexibility, toe box room (Miller, 2000),
pressure over the plantar surface area (Jordan, Payton & Bartlett, 1997). Shock attenuation
has been a major concern for footwear designers and manufacturers, as one of the primary
roles for running injuries reduction by providing shock absorption (Cavanagh, 1980; Nigg,
1986). In addition, the deformity of the foot such as overpronation has also been identified as
a key factor related to running injuries (Hart and Smith, 2009).
The three primary categories of running footwear in the market are motion control,
cushion trainers, and stability shoes. Motion control shoes are developed to control excessive
rearfoot motion (Williams et al., 2001). Motion control running shoes are rigid, durable,
stable control-oriented running shoes that limit pronation. These shoes are designed to
provide significant support for flat-footed or severe overpronators. Cushion trainer shoes are
developed to attenuate lower extremity loading (Williams et al., 2001). The investigations
have been focused on midsole cushioning in order to reduce the impact force and running
injuries (Andreasson & Peterson, 1986). The midsole will provide the extra shock absorption
and is best for runners with a high arch. Stability shoes are designed for the runners with a
normal arch. It is believed that assigning running shoes matched to arch type, injury risk
could be reduced (Knapik et al., 2010). Footwear manufacturers have tended to pay more
attention to shock absorption and cushioning than to motion control in designing running
shoes with much attention to midsole hardness.
Barefoot Running
Basically a minimalist lifestyle is a lifestyle that is free of complications, clutter,
confusion and distraction to change their lives from turmoil, materialism, and a poor work
life balance, to something more holistic. People still believes that if something is more
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complex and complicated then it must be better, but the minimalists prefer to look for elegant
simplicity as the deciding factor of quality.
The human foot is designed that the toes are spread and extended. In well-developed
societies, the foot’s natural shape has been changed by long wearing footwear which the heel
is elevated above the forefoot, the toes become elevated and pinched together over time. This
deforms the foot, and leads to the foot problems, gait abnormalities, musculoskeletal
pathologies. Several researches supported the claims that going barefoot was healthy and
natural (Robbins & Hanna, 1987; Cook, et al, 1990; van Mechelen, 1992). Barefoot running,
minimalist running and natural running are all terms that describe running in a manner that
allows the foot to function the way it is designed. With the release of the book about
Tamahumara Indians in Mexico, Born to Run: A Hidden Tribe, Super Athletes, and the
Greatest Race the World Has Never Seen, the interest of barefoot running has popularly
risen.
In order for effectiveness and safe, persons need to organize physiologic and
neuromuscular responses to the environment. There are significant alterations to running
pattern. Several studies have found consistent changes in barefoot running, for example,
decreased stride length, increased stride rate, decreased range of motion at the ankle, knee,
and hip, and more ankle plantarflexion at foot strike which allowed weight bearing at the
metatarsal heads instead of the heel (Lieberman, 2010). Divert et al. (2005) concluded that
these changes in foot strike pattern were largely designed to reduce the impact forces.
The potential benefits of barefoot running
1. Reduction of ground reaction forces; Barefoot running reduced impact force when
performed on a sufficient number of steps (Divert, et al., 2005, 2008; Squadrone & Gallozzi,
2009; Leiberman, et al., 2010). In addition, there is adaptation of the intrinsic musculature
with resulting increased strength and, therefore, a medial longitudinal arch that is higher and
better able to deform with impact and provide improved shock attenuation (Robbins &
Hanna, 1987). De Wit et al (2000) found that runners adopted a flatter foot placement to
attempt to limit local impact on the heel when running barefoot, whereas there was a
tendency to land heavily on the heel due to the extra cushioning in running footwear.
2. Increased running economy; Burkett et al. (1985) found that oxygen consumption
during running increased as the amount of mass they added to the foot increased; shoes and
Barefoot Running
orthotics representing 1% of body mass increased oxygen consumption by 3.1%. Flaherty
(1994) found that oxygen consumption during running at 12 km/h was 4.7% higher in shoes
of mass weighing 700 g than in barefoot but there were some research stated that the
difference in running economy between shod and barefoot is not significantly different
(Squadrone & Gallozzi, 2009; Franz, Wierzbinski & Kram, 2012)
3. Increased proprioceptive input; It has been suggested that footwear material
densities affected periphearal sensory information (Ganevia & Gurke, 1992; Kurz &
Stergiou, 2003). The barrier between the plantar and supporting surfaces would hinder foot
position awareness provided by feedback from plantar cutaneous mechanoreceptors in direct
contact with the ground (Robbins, et al, 1995). The continuous use of modern footwear
limited sensory feedback to the brain, which reduced the brain’s ability to process sensations
and adapt to the motor responses appropriately (Shakoor & Block, 2006; Doidge, 2007). The
improved proprioceptive ability led to a reduction in foot position errors and fewer lateral
ankle sprains which caused by impaired proprioception (Robbins, et al, 1995).
4. Increased muscle strength; Rao and Joseph (1992) evaluated 2,300 Indian children
between the ages of 4 and 13 and found that the incidence of flat feet was more than three
times greater in shod than in unshod leading them to conclude that shoe-wearing in early
childhood was detrimental to the development of a normal arch. Robbins and Hanna (1987)
stated that barefoot training increased adaptation of the intrinsic muscles of the foot. A recent
study suggests that minimally supported shoes might actually improve rehabilitation
outcomes as compared to conventional running shoes (Ryan, Fraser, McDonald, & Taunton,
2009).
5. Decreased risk of foot deformities; There were several studies concerned with the
increasing of hallux valgus and flatfoot in modern societies based on the assumption of
inadequate footwear’s consequences. Sachithanandamm & Joseph (1995) surveyed 1,846
adolescents and found that the prevalence of flat feet had increased in those who wore shoes
before the first 6 years of age which supported by the study of Staheli (1991). The stiff and
tight footwear might lead to deformities of foot structures during growing up, Wolf et al.
(2008) concluded that optimum foot development could only occur in barefoot conditions.
The potential harms of barefoot running
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1. Injuries from running surfaces; The skin of the foot is exposed to debris such as
glass, nails, rocks and thorns and have a chance to injure. (Squadrone & Gallozzi, 2009).
2. Exposure to microorganisms/infectious agents; Cracks, blisters, or scrapes on the
feet will have a higher risk of infection.
3. Lack of support; Less cushioning and a thinner heel shoes should be used with
caution and awareness of the possible increased injury risks (Denton, 2005).
4. Poor running pattern; causes muscle strains.
Minimalist running shoes
The evolution of running footwear has been changed. Minimalist running shoes have
been believed that it does not only improve the efficiency of a runner’s stride, but also
dramatically reduce running-related injuries. By forcing a runner to land on midfoot or
forefoot instead of heel, minimalist footwear reduces the amount of impact absorbed by the
ankles, hips and knees while still protecting the feet with shoes.
The characteristics of minimalist running shoes (Richards & Hollowell, 2011; Kaselj,
2012);
1. Anatomical correctness: Minimalist shoes have little padding or arch support. It
requires a runner to rely more on their own feet and legs to take care cushioning and
stability.
2. Close to the ground: The sole is made of a material is to allow proper
communication between the sensory organs of the foot and the ground. The thinner and
firmer the shoe, the more ground feel (proprioception). The increased ground feel allows the
body to adjust to the forces of running in a more efficient way and is optimal for learning
natural running pattern and technique. Without a firm message to the nervous system, the
body does not know which muscles to use, how hard to turn them on, and how long to keep
them on for. To get a clear message in thick/soft shoes, people are forced to strike the ground
harder and drive the foot onto a firm surface to give the feedback that requires.
3. Neutral/lack of drop: This means the difference in height, as measured from the
heel to the ground, and the forefoot to the ground. Regular running shoes have a 12 mm to 24
mm heel-to-toe drop, while more minimalist shoes have at least less than 9mm. It was
postulated that wearing a greater heel height provided less stability in the elderly population
Barefoot Running
(Robbins et al, 1997; Tencer et al, 2004). The arches of foot are designed to be supported at
the ends, and that means heel, ball, and toes in level and balanced contact. This facilitates
stability and balance in mid–stance. While it will protect the foot from hazards on the
ground, it will also prevent the natural inclination of the arch to flatten over time. This will
prevent the ligaments and muscles in the foot from developing and functioning for optimum
strength and health.
4. Light weight: The shoe doesn’t add much to the weight of the lower leg, and
allows the foot to swing back to the ground with a natural motion.
5. Wide toe box: The toes are spread and extended. This allows for optimal balance
and stride. When the big toe is compressed to be out of alignment, the front end of the arch
does not work. The big toe is not allowed to aid in balance, stability, and propulsion.
6. Rotational and Longitudinal flexibility: Rotational flexibility is the ability to roll
the shoe up from toe to heel and the longitudinal flexibility is the ability to roll the toe box in
one direction and the heel in the other and. The foot naturally bends in all directions. Most
shoes are stiff in the middle and stiff where the toes bend at the ball of the foot or MTP joint.
7. Slipper-like: Shoes should fit well enough that they can be tied loosely enough to
take off without untying, but not come off mid-run. Minimalist shoes have little structure for
the top of the foot.
Fig. 4. The comparison between modern running shoes and minimalist
running shoes
New Direction in Running Footwear
From the 1960’s to present, the running footwears have been developed from brown
rubber to the super cushioning heel by many research which conducted to develop for
functions and styles. The several features; raised heel and arch support, are believed that
these parts of the shoe will help prevent common running injuries. Why are the super
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cushioning footwear not able to reduce the incidences of injuries? This big question is
discussed among investigators, doctors, runners and footwear manufacturers. Consumers are
looking for more comfortable, safe and satisfied. Therefore, the studies are directly geared to
the “back to basics” or minimalist lifestyle to improve the functioning of footwear and let the
feet move in their natural way, hold the feet in the right places and support the body weight
at the right locations.
Since the human lower extremity is not a delicate, rigid, passive structure but is a
flexible, active, well designed structure which is capable of handling the impacts during
running. Dr. Froncioni (2006), the orthopaedic doctor, predicted from the medical
establishment’s point of view that the changes would come about in footwear design.
However, this trend has spread to the footwear manufacturers. The minimalist shoes, the
better shoes with thinner heel and less midsole which offer little protection on the heel have
been launched into the market.
Conclusion
The blogosphere and popular magazines are full of debate about barefoot running,
with testimonials to it as a more 'natural' and less injury. It seems that footwear design
returns back to a minimalistic state as the natural design of the feet and how the feet function
when running. As running shoe trends change towards “minimalist” shoes and shoe
manufactures scramble to bring their new products to the market. Currently there is only
evidence that forefoot or midfoot striking patterns may help prevent repetitive stress injuries.
To date, there is no scientific evidence directly examining the efficiency of minimally
supported or barefoot on running injuries.
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