The Barefoot Running Injury Epidemic

The Thing To Do

The developing barefoot running injury epidemic is plainly a secondary effect of the rise in popularity of barefoot running. “Everyone is reading Born to Run and wanting to run barefoot,” says Pribut, referring to the bestselling book by Christopher McDougall that is widely credited with starting the barefoot running trend.

What is not known is whether barefoot runners are now disproportionately represented in physical therapy and sports medicine facilities—in other words, whether barefoot runners are more likely to develop overuse injuries than shod runners. Koch and Pribut are not ready to say that this is the case. “The more barefoot runners there are, the more injured barefoot runners there will be,” says Pribut, who attributes the spike primarily to the burgeoning number of barefoot runners.

But Maharam and Fogt see evidence that switching to barefoot running is causing injuries that would not otherwise happen. “I see one injury over and over in the barefoot runners who come to me,” says Fogt: “plantar fasciitis.” A painful and difficult-to-overcome heel injury, plantar fasciitis accounts for less than 15 percent of all running injuries. The fact that it accounts for more than 90 percent of injuries in the barefoot runners Fogt sees suggests that it is barefoot running specifically, not overuse generally, that is causing these injuries. Thus, unless barefoot running is concurrently drastically reducing the likelihood of knee pain and other common running overuse injuries, then its overall impact on running injury risk is probably an increasing effect. If this is indeed the case, then the barefoot running injury epidemic is an ironic reality, as barefoot running is overtly promoted as a way to reduce injury risk.

Koch points out that the apparent injury risk associated with barefoot running may actually be artificially low. “There are a fair amount of people who have tried it but have stopped pretty quick, just because they realized that it was not going to work for them,” he says.

I am one such case. I began running in Vibrams in 2006. Despite easing into virtual barefoot running very slowly, I developed calf, ankle extensor and achilles strains immediately and could not quickly overcome them, so I went back to running full-time in running shoes.

Defenders of barefoot running contend that such injuries are easily avoided by a gradual adoption of the practice, but that wasn’t my experience (my first “barefoot” run was one minute). Moreover, I think that this contention that every barefoot running injury is an exception to the rule is a classic fallacy of faith-based versus evidence-based belief. As Koch puts it, “It’s totally misleading to tell people that when they get injured running in shoes, it’s the shoe’s fault, and when they get injured running barefoot, it’s the athlete’s fault. It makes no sense. You’re going to have injuries either way. It’s running.”

One thing all of the medical professionals I interviewed for this article agree on is that many runners have no business even trying to run barefoot. “Runners who have what I call biomechanically disadvantaged feet need shoes, and often orthotics too,” says Maharam.

What’s a biomechanically disadvantaged foot? “People with poor forefoot stability, overpronators, and even supinators are asking for trouble if they ditch their shoes, or even wear the wrong shoes,” says Fogt.

It doesn’t stop at the feet, though. According to the experts, other biostructural factors predispose runners to injury, and going barefoot could exacerbate some of these structurally based predispositions to injury. “When we look at a runner and consider whether running is even appropriate for a person, we’re looking from the spine all the way down to the foot,” says Koch.

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