Posted by Steve Middleton, MS, ATC, CSCS, CES, CKTP
“Barefoot” or “minimalist running” is the current lingo in the fitness world. It is designed to encourage “natural running motion”. Yet, not many people understand what this actually means.
“Traditional” running shoes have a heel that is higher than the toes. This encourages a heel strike which, for years, experts have agreed was the ideal walking pattern. Gait evaluation in athletic training and physical therapy curricula describe the heel-to-toe gait approach as part of their lower extremity assessment courses. To provide cushioning, shoe manufactures have continued to add padding and height to the heel region of the shoe which now mimic women’s wedge heels.
Most runners develop knee, hip and low back pain at some point. This is not because running is bad, as many physicians and other experts have said in the past; it is because traditional running shoes encourage heel striking which is bad. Furthermore, many shoes have added medial arch supports to prevent the arch from flattening during ambulation.
When the heel is the first part of the foot to contact the ground, the body must dissipate the forces in some way. The next shock-absorber in the body is the medial and lateral meniscii of the knee which, with wear and tear of overuse, can lead to osteoarthritis. Farther up, the sacroiliac joints can act as a shock absorber by moving superiorly. However, this is not ideal because it can lead to sacroiliac joint dysfunction with subsequent low back pain and/or “sciatica”.
Barefoot running uses the body’s natural shock absorption system: the medial longitudinal, lateral longitudinal and transverse arches of the foot. With midfoot striking, the arch of the foot should go through a controlled flattening (mitigated by eccentric contractions of the anterior and posterior tibialis as well as the plantar fascia) to absorb the impact. This greatly reduces the stress on the rest of the lower extremity.
Yet, many people that try the barefoot approach run into injuries. It isn’t because barefoot running is inherently bad but because it is a major transition to go from normal running shoes to minimalist shoes. A gradual transition is best recommended starting with a shoe like the Nike Free or Saucony Kinvara with a gradual transition to a Merrell Glove or Vibram Five Finger.
Also, many people have arches that are hypomobile (pes cavus) due to traditional shoes. The high arch supports have lead to shortening of the tibialis muscles and, possibly, the plantar fascia. The elevated heels have lead to shortening of the calcaneal tendon which limits dorsiflexion and leads to hyperflexion of the tarsals.
As clinicians, we can encourage this transition through a variety of techniques. Instrument assisted soft tissue mobilization can quickly lengthen the calcaneal tendon to restore normal dorsiflexion while relieving pain. IASTM or myofascial release can be used to ensure adequate length to the tibialis muscles. If the midfoot is rigid, joint mobilizations/manipulations of the navicular inferiorly can encourage proper pronation.
To facilitate correction and maintain longer results from the treatment, RockTape can also be used as an effective adjunct. By running a continuous 2 inch strip from the superior portion of the lateral malleolus under the foot where it then attaches onto the skin above the navicular. As the tape contracts back to its origin, it facilitates the inferior translation of the navicular which encourages pronation.
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