Does Barefoot Running Lower The Incidence Of Musculoskeletal Injuries?
Lower extremity injuries are extremely common among runners. Approximately, 79 percent of runners sustain at least one lower extremity injury per year.1 Due to reductions in impact loading as well as increased strength in the foot and lower leg musculature, some have suggested that barefoot running may reduce injury rates in comparison to shod running. Advocates of barefoot running have promoted it as a means to reduce injury risk while opponents argue that barefoot running can increase injury risk due to the lack of cushioning and support afforded by modern running shoes.
Researchers have found that shoe gear can affect gait patterns during running. Up to 89 percent of runners wearing traditional shoe gear land with a rearfoot strike while the majority of barefoot runners land with a forefoot strike.2-5 Higher rates of loading occur with rearfoot strike in comparison to forefoot strike. Several studies have found increased loading to be associated with common running injuries.6-8 Similarly, previous studies have found increased injury rates in runners with a rearfoot strike gait pattern. For example, Daoud and colleagues found double the injury rate in runners with rearfoot strike gait on the Harvard cross-country team.9
Opponents to barefoot running cite risks including increased stress to the Achilles tendon, increased stress to the plantar fascia and higher loads to the metatarsals from a forefoot strike pattern. True barefoot running also places the plantar skin at risk of abrasions, lacerations and foreign bodies.
A recent study by Warr and colleagues examined foot strike pattern and injury incidence in 1,027 military recruits.10 Contrary to Daoud’s findings, this larger group of more recreational runners showed no difference in injury rate between rearfoot strike and forefoot strike runners.9,10
Another recent study by Altman and Davis examined injury rates in barefoot and shod runners.11 The researchers of this prospective study examined injury rates among 201 adult runners (107 barefoot and 94 shod) over the course of one year. To be included in the study, runners had to have been running for six months prior to the study and running more than 10 miles per week. The barefoot runners were required to run 50 percent of their yearly mileage truly barefoot and the remainder in a minimalist running shoe.
The study found no significant difference in injury rates between the barefoot and shod runners.11 The study did find a lower rate of musculoskeletal injuries per runner in the barefoot group, which may be attributed to the lower number of miles in the barefoot group. Barefoot runners in the study ran significantly fewer miles than the shod runners, possibly due to lower tolerance by the plantar surface of the foot. When normalized for mileage, there was no difference in injury rates between the barefoot and shod runners. Barefoot runners did sustain a significantly higher number of injuries to the plantar foot.
The results of this study do not show a decrease in risk of musculoskeletal injuries in barefoot runners. Injury rates were similar between the barefoot and shod running groups. When researchers adjusted the injury rates for mileage, the injury rates did not differ significantly. Further studies are needed to examine the effect of barefoot and shod running on the development of specific injuries.
References
1. Van Gent RN, Siem D, van Middelkoop M, van Os AG, Bierma-Zeinstra SM, Koes BW. Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review. Br J Sports Med. 2007;41(8):469-480; discussion 480.
2. Squadrone R, Gallozzi C. Biomechanical and physiological comparison of barefoot and two shod conditions in experienced barefoot runners. J Sports Med Phys Fitness. 2009;49(1):6-13.
3. Lieberman DE, Venkadesan M, Werbel WA, et al. Foot strike patterns and collision forces in habitually barefoot versus shod runners. Nature. 2010;463(7280):531-535.
4. Hasegawa H, Yamauchi T, Kraemer WJ. Foot strike patterns of runners at the 15-km point during an elite-level half marathon. J Strength Cond Res. 2007;21(3):888-893.
5. Larson P, Higgins E, Kaminski J, et al. Foot strike patterns of recreational and sub-elite runners in a long-distance road race. J Sports Sci. 2011;29(15):1665-1673.
6. Milner CE, Ferber R, Pollard CD, Hamill J, Davis IS. Biomechanical factors associated with tibial stress fracture in female runners. Med Sci Sports Exerc. 2006;38(2):323-328.
7. Pohl MB, Mullineaux DR, Milner CE, Hamill J, Davis IS. Biomechanical predictors of retrospective tibial stress fractures in runners. J Biomech. 2008;41(6):1160-1165.
8. Pohl MB, Hamill J, Davis IS. Biomechanical and anatomic factors associated with a history of plantar fasciitis in female runners. Clin J Sports Med. 2009;19(5):372-376.
9. Daoud AI, Geissler GJ, Wang F, Saretsky J, Daoud YA, Lieberman DE. Foot strike and injury rates in endurance runners: a retrospective study. Med Sci Sports Exerc. 2012;44(7):1325-1334.
10. Warr BF, Frykman P, Sauer S, Goss D, Seay J. Army running injuries don't correlate to heel-striking. Paper presented at: American College of Sports Medicine (ACSM) 61st Annual Meeting, presented May 30, 2014, 2014, Orlando, Florida.
11. Altman AR, Davis IS. Prospective comparison of running injuries between shod and barefoot runners. Br J Sports Med. 2016;50(8):476-480.
