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By GRETCHEN REYNOLDS
Columnist.
When Dr. Douglas Brown,
a radiologist in Provo, Utah,
noticed an uptick recently
in the number of barefoot
runners he was seeing with
heel and foot problems, he
wondered if there might be
a connection between their
unshod training and their
sore feet. But he couldn’t find
any scientific studies that had
examined the issue.
So he approached Sarah
Ridge, a professor of exercise
science at Brigham Young
University in Provo who studies
impact injuries in sports, and
suggested she undertake one.
The resulting study,
published last month in
Medicine & Science in Sports
& Exercise, will probably add
fuel to the continuing debate
about the benefits of running
barefoot or wearing minimalist
“barefoot” shoes. Does the
barefoot style reduce a
runner’s risk of pain and injury
(as enthusiasts believe)? Or
does barefoot running simply
contribute to the development
of a different set of injuries in
some runners?
To find out, Dr. Ridge began
by recruiting 36 experienced
runners, men and women,
who, until then, had run
between 15 and 30 miles a
week while wearing normal
running shoes. She sent them
to Dr. Brown for baseline M.R.I.
scans of their feet and lower
legs to check for any injuries or
problems.
Those who believe in
barefoot running often point
out that humans ran and
walked without shoes for
millenniums before footwear
was invented. They argue that
being unshod is normal for
humans and should reverse
past injuries related to modern
running shoes and prevent
future ones.
But anecdotal evidence,
including from physicians
who treat runners, indicates
that some people who take
up barefoot running develop
entirely new aches and
injuries.
Dr. Ridge’s volunteers
all started the study with
normal feet and lower legs,
according to their M.R.I. scans,
which were read by multiple
radiologists.
Half of the group members
were randomly assigned to
continue running as they had:
same mileage, same shoes.
The other runners were given
a pair of Vibram Five Fingers
barefoot-style shoes and
asked to begin incorporating
some barefoot-like mileage
into their runs, but gradually.
They were told to wear the
minimalist shoes for one mile
during the first week of the
study, two miles the second,
three the third, and then as
much as they liked, which is
what the Vibram Web site
recommended at the time of
the 2011 study.
After 10 weeks, both groups
of runners received a follow-up
M.R.I. There was no evidence
of injuries to or changes in the
tissues of the lower leg, like the
Achilles’ tendon, in any of the
runners. But more than half
of the runners wearing the
minimalist shoes now showed
early signs of bone injuries in
their feet.
Specifically, most had
developed bone marrow
edema, an accumulation of
fluid, similar to what happens
during bruising, in their foot
bones. The radiologists graded
the edema on a scale of 0 to 4,
with 0 representing no edema
and 1 the slight bone damage
caused by simply moving
around on and loading the
foot. This amount of edema
is considered healthy, a sign
that the bone is responding to
training and growing stronger.
Most of the runners in
HEALTHY HABITS…
Barefoot Running Can Cause Injuries, Too
the control group, who
were wearing their normal
shoes, had edema levels of 1
throughout their feet.
But a majority of the runners
in the minimalist-shoe group
had developed at least a level
2 edema, “which indicates
early bone injury,” Dr. Ridge
said, and three had signs of
more-extensive level 3 bone
edema, “which constitutes an
actual injury.”
Two even had full stress
fractures or level 4 edema, one
in her heel bone and one in
his metatarsal, one of the long
foot bones.
Almost all of the runners
in the minimalist shoe group
were spontaneously running
fewer miles at the end of the
10 weeks than they had been
at the start, “probably,” Dr.
Ridge said, “because their feet
hurt.”
Why some of the barefootstyle
runners developed
serious foot problems and
others did not is not yet clear,
but Dr. Ridge is now analyzing
additional data about the
volunteers, which includes
information about each
runner’s mileage, running
form, body weight and other
variables.
“What we hope to see is
whether there are some
runners who, because of their
biomechanics or other factors”
seem to be particularly
predisposed to foot injuries
during the transition to
barefoot-style running and
“perhaps shouldn’t” make
the switch at all from normal
running shoes, she said.
She hopes to have findings
ready to publish by this
summer.
The results don’t mean
that everyone who chooses
to switch to minimal or no
footwear will court foot injury,
Dr. Ridge said. “But I would
tell anyone who wants to try”
kicking off their normal shoes,
“to be extremely cautious
during the transition period.”
In her study, substituting a
mere mile per week of normal
running at the start with one in
minimal shoes “was probably
too much,” she says. So go
slow.
Barefoot-style running may
have been natural for our
ancestors, Dr. Ridge points
out, but it’s a new experience
for most of our feet.
www.nytimes.com
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