To Bare or Not To Bare

To Bare or Not To Bare

Original publication of article: Asia Trail Magazine

By Doug Tahirali

Five years ago, when someone said ‘barefoot running’ it evoked images of rail thin East Africans, South African runner Zola Budd or if you are old enough, British Bruce Tulloh!  Today barefoot running (BFR) makes people think of those ‘funny toe shoes,’  effectively combining true barefoot running with the newer minimalist running shoe craze.  BFR is also now closely linked to forefoot strike in runners versus heel striking.   Recently Vibram, the maker of those infamous FiveFingers  shoes became famous for a $3.75 million class action law suit for deceptive marketing.   How did we get to this point so quickly?

Early History – Once hominids became upright, running could not have been far behind.  Shoeless.1860s – Track spikes become popular in England. These shoes have minimal heel cushioning.

1950s – 1960s – British Bruce Tulloh broke many European records running barefoot. Later he runs across the USA in shoes.

1960 Rome – Ethiopian Abebe Bikila won Olympic marathon gold running barefoot by accident as meet sponsor Adidas ran out of his size.  He had trained both with and without shoes but thought no shoes was better than too tight.

1962 – Bill Bowerman, University of Oregon track coach and Nike co-founder releases a small leaflet “A Jogger’s Manual.”

1964 Tokyo – Bikila breaks world marathon record wearing shoes.

1966 – Bowerman publishes a book called “Jogging.”

1968 – Original Nike Cortez comes out.

1974 – Nike Waffle trainer and explosion of Nike

1977 – Jim Fixx becomes releases “the Complete Book of Running”  fully popularising running for fitness and weight loss.  Millions are running in cushioned,  high heel Nike shoes.

1984 – Jim Fixx dies while jogging beginning controversy whether jogging is good for you at all!

1999 – Designer Robert Fliri proposes a minimalist shoe to Vibram USA CEO Tony Post.  FiveFingers is conceived!

2004 – Harvard’s Daniel Lieberman becomes the father of the current interest in barefoot running when his group publishes
a paper in the journal Nature that concluded “The fossil evidence of these features suggests that endurance running is a derived capability of the genus Homo, originating about 2 million years ago, and may have been instrumental in the evolution of the human body form.

2005 – release of Vibram FiveFingers.  BFR now changes to include minimal footwear.

2007 – Lieberman et al. release a follow up paper suggesting humans have evolved to be particularly adept endurance runners to “help meat-eating hominids compete with other carnivores.

2009 – “Born To Run” book published by Christopher McDougall.  It takes a lot from the work of Lieberman and re-visits the Tarahumara tribe seen in 1981 in Peter Nabokov’s book “Indian Running.”

2009 to Now – More studies comparing barefoot runners (and minimalist) to shod runners in efforts to see if there is any difference in running economy and any difference in injury rates between the two.

2012 – Lawsuit brought against Adidas and their health claims for their glove-like Adipure trainer.

2013 – Several lawsuits against health claims by toning shoes:  $40 million from Sketchers, $5.3 million from FitFlop and $2.3 million from New Balance.

2014 – Vibram settles a $3.75 million class action law suit for deceptive marketing that seemed unsubstantiated.  Vibram claimed the FiveFingers would:

  • strengthen muscles in the foot and lower leg
  • improve the range of motion in the ankle, foot and toes
  • stimulate neural function important to balance and agility
  • eliminate heel lift to align the spine and improve posture
  • allow the foot and body to move naturally.
Vibram must pay each customer a partial refund and can no longer make these claims.  They must promote the settlement extensively which is why we have heard of this one more than the other law suits!
Clearly the history of jogging has only been for the last 50 years and BFR gaining popularity in the last 10 years.  As a result any studies are very short in duration and  any trends impossible to note.  To make any health claims on so short an history is crazy!  As seen in previous Asia Trail issues, current research on all running injuries seems quite inconclusive and similarly the jury is still out on the pros and cons of BFR.  It would also be very interesting to see who was paying for these studies and their vested interest in the outcomes of the research.  I do feel however that in time the research will support some of the claims that Vibram had made, perhaps a little too hastily.

What Does The Science Say?

  1. Broad support of the concept of BFR would be Michael Warburton’s retrospective review of past research in which he found:
    • running related injuries to bone and connective tissue in the legs are rare in developing countries where most are unshod.
    • where both barefoot and shod populations exist (Haiti), injury rates of lower extremity are substantially higher in shod population
    • footwear can increase the risk of ankle sprains
    • plantar fasciitis is rare in barefoot populations
    • running barefoot reduces oxygen consumption by a few percent.

    Actual bare foot running may allow for ‘grounding’ – an exchange of electrons between your foot and the ground supposedly a potent anti-oxidant and anti-inflammatory!

    In 2010, Daniel Lieberman pointed out that barefoot runners with a mid-foot to forefoot strike generate smaller collision forces, markedly less than heel striking, shod or unshod!  This was attributed to a more plantar-flexed position and more shock absorption through the ankle and foot.  However in the spring of 2012, Lieberman published a summary of BFR type research so far and concluded that “we simply do not know yet” the influence of BFR on injury risk.  Yet a few weeks later Lieberman published what appears to be the first evidence that natural, forefoot running (a byproduct of BFR) causes significantly less risk of repetitive stress injury than those who heel strike.  Rear foot strike showed 2.6 times more chance of injury and 3-4% less efficient than forefoot strikers.  The interesting Hansen et al. study (2012) showed that when tested on a treadmill, BFR is 2% more economical but 5.7% more economical when tested outdoors on ground!  Since many studies are done on treadmill this research seems to show that differences may not be as obvious when drawn from treadmill results!  Perl et al. (2012) found even more amazing results – minimally shod runners are significantly more economical that regularly shod runners REGARDLESS of type of foot strike!  The results are almost too good to be true!

    At the 2012 meeting of the American College of Sports Medicine 3 studies were presented by DePaoli et al., by Michigan’s Adrian College and by Altman et al.  THey showed that runners on a treadmill (see what i mean?)  are faster and more economical but also have high rates of injury during the transition phase.  Altman’s internet survey of 109 runners making the transition to BFR showed 18 runners reporting a muscle or bone injury plus 16 had injury to the bottom of the foot.

    On the other side of the argument, evidence also builds up contrary to what we have already seen about BFR!  A late 2000s University of Newcastle review effectively damned sport shoes in general when it comes to injury prevention.  They found NO PUBLISHED RESEARCH showing a relationship between injury prevention and using motion control shoes or shoes with large high cushioned heels.   Many extend this to the minimalist shoes unable to live up to their grandiose claims of injury prevention.   A 2013 study in the Journal of Applied Physiology showed 19 heel strikers to be more economical by a considerable margin measured on a treadmill over 18 forefoot strikers!  Even more amazing, when the forefoot strikers then tried to heel strike, even they tested as more economical than their habitual forefoot style!!  They felt heel strikers burned less carbs and used more from fat and other sources thus postponing the ‘hitting of the wall’ which is due to carb depletion.  A 2013 Brigham Young University study thought to test if BFR strengthened the foot.  They believed if the foot muscles did indeed get stronger then the arch would rise and could be measured.  They put their runners through a 10 week minimalist shoe trial and found no significant gains in arch height.  Another survey of 566 runners asked if they had tried to transition to BFR.  Of the one third that had tried, 32% had injuries and switched back to old form.   So by he 2014 meeting of the American College of Sports Medicine there were 5 research presentations showing NO significant benefits in terms of running economy for BFR over conventional shoes.
    An interesting set of pictures sums up the whole debate.  One researcher took photos of the moment of foot strike for 50 distance runners at the US Olympic trials.  The photos captured every possible strike position from solid heel strikes to mere baby toe strikes!

    When patients ask me if they should try barefoot running my first question is why?  As the saying goes…if it ain’t broke, don’t fix it!  Barefoot running is not for everyone and most people should question why they are making the change.  I will often say that 2 things will help your barefoot success – you were born in the Rift Valley and/or you spent a good portion of your life running barefoot.   Next issue will continue nicely from here when the discussion will focus on footwear.

    What I see with BFR is the increased injuries when the transition is done too fast. This is due to too many different elements in your run style that have to change for successful transition. BFR is one extreme end of the current shoe spectrum so you must move to zero rise (flat from toe to heel) and zero cushioning! One must change foot strike pattern, stride length, stride frequency, body position and also change demands on your musculature. This is a bit of a Goldilocks dilemna because you must get everything ‘just right’ for this to work for you!

    The research is mixed and inconclusive so again, why make the switch?  As well evidence is hard to compare in areas of injury prevention, running efficiency, body posture etc.  Simply put, things are not as simple as X causes Y, and yet these studies put all the focus of injury on shoe or foot strike when a myriad of other things also come into play!  In time we may yet see that barefoot running has advantages over other styles. Right now it is just too new to make any sweeping statements, but I feel some of Vibram’s claims will prove correct, given time.