Hit the ground running barefoot
by Thea O'Connor
WHEN physiotherapist Michael Warburton recommends barefoot running or walking to runners suffering recurring ankle problems, the typical response is surprise. "Most people expect the opposite: more tape, more strapping and more expensive shoes," says Warburton, who has used barefoot locomotion to strengthen feet for 10 years in his Capalaba, Queensland, practice. "I get good feedback from clients who report less injuries as a result."
From a third to more than half of recreational runners get injured at least once a year, resulting in painful stress fractures, shin splints and achilles tendinitis. This injury rate may suggest humans aren't made for distance running. But perhaps it's the modern running shoe that's not up to the task.
Sharene Hurnen, 43, of Canberra, is one of many distance runners who discovered that kicking off her running shoes allowed her to kick-start her running habit again and remain injury free.
She now loves to run long distances, up to 100km at a time. Four years ago this would have been impossible as Hurnen was plagued by injuries including tendinitis; that, despite following professional advice to try orthotics and wear the heaviest motion control shoe on the market to stop her flat feet over-pronating, or rolling in too far.
Hurnen was advised to give up running, not something she wanted to hear. "When I came across barefoot running on the internet I thought nothing else is working so I'll give it a go," she recalls. "It took me six weeks to toughen up the soles of my feet and retrain myself from striking the ground with my heel, which I used to do when wearing shoes, to striking the ground with the ball or middle of my foot, which is a more comfortable way to run without shoes."
She walked barefoot everywhere and started running a kilometre a day, eventually working up to a 2007 half marathon in which she ran barefoot, experiencing no pain at all.
Three years later Hurnen is still injury free and still running barefoot, except for rocky off-road events when she slips on a thin pair of glove-like shoes, to protect the soles of her feet. "Running barefoot strengthened my feet so they can do what they were designed to do in the first place. It's been a massive revelation to me."
Evolution may explain Hurnen's striking recovery. Humans have been endurance running for millions of years according to evolutionary biologist Dan Lieberman of Harvard University. And they didn't need a pair of Nikes to do so. Until the mid-1970s all humans ran shoeless or in minimal footwear such as sandals, moccasins or thin running flats.
Lieberman's latest research, published in Nature in January, indicates humans are able to do so comfortably and safely by landing with a flat foot, a midfoot strike, or by landing on the ball of the foot before bringing down the heel, a forefoot strike. In contrast, those who wear modern running shoes mainly land on their heels first.
This seemingly small difference in gait, which Lieberman measured in shod and unshod runners from Kenya and the US, makes running much less jarring.
Heel striking generates a rapid high-impact force -- about 1 1/2 to as much as three times the body weight -- the moment the foot collides with the ground. That's equivalent to someone hitting your heel with a hammer using 1 1/2 to three times your body weight. Scientists suspect this spike in force, or impact transient, causes repetitive stress injuries.
Conversely, with a forefoot strike, impact forces increase smoothly throughout the stride with no impact transient. Still, this doesn't prove the running style is less injurious, and flies in the face of popular belief.
Running shoes with pronation-control features and elevated, cushioned heels (PCECH) have been the gold standard for the past 30 years, with many sports medicine professionals prescribing them to help prevent injury.
So Craig Richards, of the University of Newcastle in NSW, rocked the status quo in March last year when he reported in the British Journal of Sports Medicine that there were no studies that found PCECH running shoes reduced injury rates.
Podiatry New Zealand responded by stating consumers would be foolish to believe the study. The release was withdrawn but is indicative of the, well, foothold PCECH running shoes have among health professionals. And it only touches on the ferocity of a debate that has been simmering for decades.
"The sports medicine sector has been prescribing a treatment without proven benefit for close to 30 years," says Richards, who's critical of the integrity of the sports science literature, noting the influence of running shoe companies on sports medicine.
In his paper Richards reveals that a shoe company sponsors the International Federation of Sports Medicine, Podiatry New Zealand and Sports Medicine Australia, and that these organisations recommend the firm's footwear. "In the light of my finding, such recommendations cannot credibly be made."
Sports Medicine Australia president Tim Pain defends the practice. "You have to use the best evidence that's available. There's enough evidence that PCECH shoes reduce the impact forces the foot is under to be able make these recommendations."
Pain acknowledges a lack of research proving that reducing impact forces reduces injury rates. "Barefoot running raises some good questions," Pain says. "It's controversial so [it] makes you question what you are doing, which is good. There's probably a middle ground to the issue."
Warburton doesn't recommend barefoot running to shod runners who aren't having problems. "However, if you've experienced repeated running injuries despite using orthotics and trading up to the best shoe available, going barefoot or running in shoes that make it easier to use a fore-foot or mid-foot strike is definitely worth trying."
Marathon runner Bethany McCarthy, 32, claims she cured shin splints, stress fractures and compartment syndrome -- where muscles bound by connective tissue swell, resulting in a painful increase in pressure -- by using barefoot running to learn how to run with a forefoot strike. "My feet have become stronger and I don't have any problems with over-pronating any more."
She has put shoes back on, this time a shoe without pronation-control features, and has clocked up 13 marathons and four ultra-marathons of 100km each without any foot or calf injuries. She says: "Of all the professional advice I received, no one ever . . . suggested avoiding a heel strike".
Minimal running shoes such as the Vibram FiveFingers shoe and the Dunlop Volley are becoming more popular as a fore or mid-foot strike is much easier without a cushioned, elevated heel. Vibram partly funded Lieberman's study.
Richards is so convinced minimal shoes are the way of the future that he has patented a barefoot running shoe.
He acknowledges that putting anything on the sole of the foot interferes with the sensory feedback loops that help the foot to know where it is in space, which is important for stability and adjusting foot and leg movement to provide natural cushioning. "We're trying to get the right balance between minimising such interference while offering some protection," Richards says.
For those keen to try barefoot running, "go slow" is the message. Just as old bad habits can cause problems, so can new ones that reawaken muscles unused to putting one unshod foot in front of the other.
For more information,visit www.barefootrunning.fas.harvard.edu
