Note: This is part 2 of a series covering the topic of minimalist footwear & running form/style to prevent injuries and promoting life-long healthy living habits. (Find Part 1 here) We’ve also created an 8-week training program and book on the subject that you can find here or on amazon. You should always consult your doctor or another licensed healthcare professional, like a physical therapist, before making any drastic changes to your footwear or running style as it may lead to an injury. 

Running as a sport boasts nearly the highest injury rate, in some cases up to nearly 85% in novice or amateur runners [11]. That’s a crazy high number of injuries. Basically, 8 out of every 10 runners experience some kind of running-related injury each year.

I became one of those people at the beginning of 2019. I had been a regular runner (which I consider running 3x/week for at least 3 miles per run) since 2015. In 2019, my new year’s resolution was to run a half marathon before my 30th birthday. I ended up achieving that goal, finishing my race in 1:58:22, not bad for a first run at it. However, walking back to my car, I felt a sharp pain in my right foot. Soon, I couldn’t put any weight on it. A few weeks in, and it looked like I had a stress fracture in my right foot. It took me off the road and using a stationary bike for 6-8 weeks. And then, when I started running again, I developed plantar fasciitis, which limited my mileage and running until 2022, when I began focusing on foot strength and changing the way I run (more on that later).

Now, because of that high injury rate, everyone from coaches, athletes, and amateur runners look for ways to decrease the impact running places on our joints, specifically knees, hips, ankles, and backs.

Minimalist Footwear & Injuries

This drive to decrease running impact leads many to focus on either footwear or addressing running form and foot strike. Some runners end up focusing a little bit on both. And, in reality, focusing on both is likely going to be the most effective, since most problems likely do not stem from one single factor.

Now, that being said, this search for injury-reduction in running leads some people to opt for “barefoot” or “minimalist” footwear. The thinking here is that, since shoes are a relatively new invention, from an evolutionary standpoint, our bodies naturally know how to run injury free without cushions or pronation control or other fancy bells and whistles we normally find in today’s running shoes.

In fact, this idea was popularized when the book Born to Run hit the shelves in 2011. That’s about the time you began to see people running barefoot all over the place. It was also about the time where Vibram came out with their five finger shoes.

With the increased popularity of minimalist footwear, it wasn’t long until researchers began exploring whether it actually made a difference in injury rates of runners. Some runners, plagued by chronic conditions like tendinitis or plantar fasciitis turned to these minimalist options as a way to continue running and prevent injuries.

Minimalist Footwear?

As we mentioned in the last article, the topic of barefoot running either meets harsh criticism or great praise depending on which professional (or runner) you talk with. And there’s good reason for it. Many people that just took off their running shoes and tried to crush a 5K ended up injuring themselves. Podiatrists, orthopedic doctors, and physical therapists felt that this strategy of “just going barefoot” would lead to higher injury rates.

On top of that, many companies, like Nike, had invested millions of dollars to develop more effective cushioning in shoes, pronation controls, and other features aimed at reducing impact and decreasing running injuries. The problem was that, according to one study, “In short, it is possible that the role of running shoe technology in injury prevention has been largely overrated.”[7]. It seems that, simply adding more cushion to our running shoes hasn’t prevented injuries the way we thought it would.

Some researchers have gone so far to say, “we propose that in general clinicians should recommend footwear that is lightweight, comfortable, and has minimal pronation control technology.” [1]. So, research recommendations like that leads some to explore the option of removing cushion and support from their running shoes and moving more towards minimalist footwear.

Proposed Benefits of Minimalist Footwear

Now, I’ve already mentioned a few of the proposed benefits of minimalist footwear:

• A more natural foot strike and running form
• Allows the feet and ankle to work and function the way they were designed
• Lighter on your legs & low back
• Less restricting and allows for more “ground-feel” or proprioception (nerdy term)
• Potentially last longer since you don’t have to worry about foam in the cushion breaking down over time

But, what does the research say about the possible benefits of minimalist footwear?

With all of the information floating out there about barefoot or minimalist shoes, it helps to take some time to sift through actual clinical research. I could tell you how I switched from traditional, cushioned running shoes to minimalist footwear and noticed a great improvement in my running tolerance (which is true), but that’s just one person telling you their experience. You don’t want to simply rely on some YouTube videos or running blogs to base decisions about your running technique or footwear. There’s actually a lot of research out there, though you may never have seen it.

So, let’s a take a look about what clinical researchers have discovered about minimalist footwear.

Research About Minimalist Footwear

Let’s start with the quote from above: running shoe technology may not actually prevent running injuries the way we think it would [7]. In fact, one study puts it this way: “Footwear is frequently perceived as a risk factor for running-related injuries, but empirical evidence fails to support such beliefs.” [9]. So, it seems that runners, coaches, and even clinical professionals place too much weight on footwear.

There have been studies showing that there is a lower number of injuries per runner when comparing barefoot and what they call “shod” (traditional, cushioned running shoes) runners. However, the average mileage for barefoot runners in these studies was lower than shod runners, so it makes it difficult to know whether the lower injury rate is due to the shoes or less running [2][7]. But, it does look promising that barefoot or minimalist running is associated with fewer overall injuries.

However, there are studies showing that running in minimalist footwear can lead to greater plantar support, decreased force transmission to the knees and hips, and decrease collision forces when compared to shod running [4][6][10]. Now, one study suggested that the reason for these changes wasn’t so much a factor of the shoes themselves, but how those shoes changed the way the subject of the study began to run [7]. It might not have been the shoes, so much as how the shoes change the running technique.

Shoes Change the Way We Run

By removing the cushion from the shoes, runners naturally begin shifting away from a “heel strike” and begin moving more towards a “forefoot” or “mid foot” strike. And that may actually be the greatest proposed benefit of minimalist shoes: they may change the way we run so that we experience less impact forces in our feet, legs and back. For that reason, many runners decide that they’ll try this whole “minimalist” footwear running and see if it helps decrease their pain and injury rate while running.

In fact, some researchers suggest that clinicians, trainers and professionals should recommend footwear that is lightweight, comfortable, and has minimal support or pronation control features [1]. Again, that’s not because less cushion is inherently better than more cushion in shoes. It’s because, by removing cushion, our feet are then able to better correct any running technique issues because they’re better able to get feedback from the ground we’re running on.

But, is it really as simple as “going barefoot” or buying some minimalist footwear and going for a run? Unfortunately, the answer to that question is a clear, “no”. To successfully transition from shod or “regular” shoes to minimalist footwear, runners need to plan on a “transition timeframe” or transition program.

Transitioning to Minimalist Footwear & Forefoot Running

As mentioned above, transitioning to barefoot or minimalist footwear involves more than just throwing off the shoes and starting to run barefoot, or with minimal support. Even in the “traditional” running circles, exercises and preparation play a vital role in successful running. The same holds true, and perhaps is even more important, when you’re considering drastically changing your running form. Because, whether you think so or no, going from traditional footwear to minimalist footwear is going to cause some real changes in the way you run.

In fact, some research suggests that, if you’re used to wearing traditional cushioned and supportive shoes, switching to barefoot or minimalist running can cause decreased running stability at the beginning. And that makes sense. Your feet have been supported by cushions and pronation control for a long time. If you take all of that support away, it takes time for your feet to build up strength and the ability to run and walk with stability.

As we’ll discuss below, the transition to minimalist footwear almost always accompanies a transition to what’s commonly called “forefoot running”. (Check out our book on the subject here) This type of running, the type of running that kids start off with, uses our legs in a different way than the traditional “heel strike” running patter encouraged by todays cushioned shoes.

That being said, transitioning out of traditional, cushioned shoes requires focusing on a few areas:

• Wear schedule & building up tolerance
• Foot and Ankle strengthening
• Running form and forefoot running

In the following sections, we break down each area and how it relates to successful transition to minimalist footwear.

Wear Schedule

Again, transitioning to minimalist footwear requires more than just simply buying minimalist shoes and wearing those exclusively for all activities. You have to think of it like this: if you wear  traditional cushioned shoes now, your feet live in a world were they’re always supported. Just like we talk about in our exercise course, if we don’t use muscles, they get weak, atrophy, and lose function. The same is true of your feet. So, to transition to minimalist footwear, you need to slowly build back the strength in your intrinsic foot muscles.

This can be done with a combination of exercises and “easing in” to wearing minimalist shoes. In fact, one study suggests that starting with 2 hours a day in barefoot or minimalist shoes  for 5 days a week for 8 weeks is enough to help increase intrinsic foot strength [5]. The point is to ease into it. Another study suggests that runners begin training in minimalist footwear for up to 25% of regular training and increase gradually up to 100% at the end of the transition schedule [11].

Now, when I first began transitioning into minimalist footwear, I began by simply wearing my barefoot/minimalist shoes during the day, but I didn’t begin running right away. In fact, I swapped regular morning runs for regular body-weight exercises. I did these exercises while barefoot, which helped increase and improve the strength in my intrinsic foot muscles. I wore the minimalist shoes at work for about 2 weeks before I began running in them. You might find another system that works for you, but the research does recommend building up a tolerance for your new footwear and beginning to intentionally strengthening the intrinsic muscles of your foot.

Exercise & Preparation

In addition to building up tolerance for wearing your new minimalist footwear, research shows that certain foot exercises help increase your tolerance for barefoot walking and running. For example, one study showed that only 4 simple foot exercises improved calf strength and stability during walking [5]. That’s important, because transitioning to forefoot running requires a lot more calf strength.

These four exercises included:

• Foot Doming while Seated
• Foot Doming while Standing
• Plantar Flexion & Inversion
• Toe Spreading

Now, why would exercises be so important? Well, if you’ve been wearing traditional, supportive & cushioned shoes for years, odds are that your feet have grow weak. We have a lot of little muscles in our foot that are designed to build up our foot arch and support our weight as we walk. However, if those muscles get supported and never have to work, they grow weak and atrophy. In fact, many people who experience pain or an injury when transitioning to barefoot or minimalist footwear do so as a result of having feet that are simply too weak to handle the activity. That’s why building up tolerance is important. Foot exercises can help as well.

Beyond basic foot exercises, we also recommend doing regular exercises aimed at improving mobility, motion and strength to improve all body parts related to running. One great book that contains an exercise program for becoming a lifelong runner is Train Smart Run Forever. For example, if you sit at a desk all day, you likely have tight hip flexor muscles, which need to be stretched to allow for an effective forefoot running style. We’ve adapted the 7-day training program in that book for use in transitioning to barefoot running in our book The Natural Runner, available on Amazon or our Website.

Forefoot Running

Now, all of this talk about minimalist footwear leads us to running technique, specifically forefoot running. As mentioned above, the big benefit to transitioning to minimalist footwear may not be so much about the shoes themselves as much as what those shoes do to our running form. By removing the cushion and support a couple things happen: 1) we no longer want to run by stretching out our leg and landing on our heel, since the lack of cushion would cause pain and 2) the decreased support allows for the natural pronation (rotation) of the foot during running. This results in what’s referred to as a forefoot strike, instead of the traditional heel strike.

In heel striking, you land on your head and your foot and body-weight shift from your heel to your goals. In forefoot striking, you land on your forefoot (the ball of your foot) and your foot and body weight shift back towards your heel at the end of a step. This means that, instead of stretching out your leg in front of yourself when running, your foot tends to land directly under your body and center of gravity.

How does this change in foot strike affect impact forces, and potentially, injury risks? Well, one study suggested that —even on harder surfaces— “barefoot runners who forefoot strike generate smaller collision forces that shot rear foot strikers.” [6]. By allowing the foot to do what it was designed to —absorb force by landing on the ball of the foot and  cushioning the landing onto the heel— runners who forefoot strike experience less impact force, which can prevent injuries. The key is to make sure that shift shift to minimalist footwear also leads to a change in running form that decreased impact.

Forefoot Strike Technique

So, how do you exactly start running with a forefoot strike? Well, one thing is pretty clear from the research: it doesn’t happen overnight. In fact, one study showed that even after an 8-week period, runners who were new to minimalist or barefoot running still demonstrated lower running stability than when they were wearing shoes [3]. This seems to show that, it takes a bit longer than 8 weeks. And in reality, most researchers, coaches, and healthcare professionals tell runners that it is closer to 6-12 months to “fully transition”.

This may mean that runners transitioning to forefoot striking may need to temporarily decrease mileage to prevent injuries, complete exercises to build up strength in certain muscles, and go on what’s commonly referred to as “training runs” to really focus on form and technique.

On these training runs, you’ll want to focus on 1) not over-striding (which can lead to heel-striking) 2) having your feet land with your ankle beneath a flexed knee, 3) keeping your core and body upright 4) pulling your leg and heel up towards your rear end and 5) increasing your cadence instead of stride length.

Running form for Forefoot (or Mid-foot) Striking

So what does “good” running form look like? Well, I described it a bit in the section above, but it involves avoiding over-striding. This is was most runners do. To run faster, they stretch their leg out in front of their body, landing on their heel. This results in longer, slower strides, which makes you less efficient as a runner, but can also increase the impact through the knees, hips, and back.

Simply changing stride-length can have a great impact on your running form. It helps increase your cadence (the number of steps your take in a minute), and improves your form by encouraging you to stay in an upright posture, using your elbows to drive back behind your body to propel you forward.

This picture shows the difference between heel striking and forefoot strike:

You can see in the picture on the left, the runner stretches forward and lands on their heel with their knee extended. They then end up “pushing” off with that foot and stretching forward with the other leg, to land on that heel. In the picture on the right, you can see that the length of the steps is shorter. Also, the heel is getting pulled up towards the read, instead of stretched out in front of the body.

Summary

There’s obviously a lot of information out there when it comes to running technique and footwear options. And there’s much more to be said about the topics we’ve covered in these articles. Hopefully, they’ve provided enough information and evidence to give you a good 30,000ft view of this topic and a good starting point to go forward.

The main takeaways, as I see them are that changing the type of shoes by itself doesn’t do much for you. Yes, minimalist footwear does provide zero toe drop, which can help with tightness in the calf and achilles tendons. But, if you put on minimalist shoes and then go out and try to run 5 miles without changing your running form, you’ll likely end up with an injury. Changing your shoes means you’ll likely have to change your running form from a heel strike to more of a mid-foot or forefoot strike. And that transition takes at least 3-6 months.

Remember, your feet are used to being supported and stabilized by the cushions in your shoes. If you take all of that cushion and support away, you’ll need to intentionally work on strengthening the intrinsic muscles of your foot and your calf muscle as well. You’ll also need to change the way you run to decrease the impact force to your foot as you run.

As always, if you’re thinking about making a drastic change to your footwear or running form, it’s always a good idea to get the advice or guidance from a qualified professional; whether that be a running coach or physical therapist.

References:

[1] Agresta C, Giacomazzi C, Harrast M, Zendler J. Running Injury Paradigms and Their Influence on Footwear Design Features and Runner Assessment Methods: A Focused Review to Advance Evidence-Based Practice for Running Medicine Clinicians. Front Sports Act Living. 2022 Mar 9;4:815675. doi: 10.3389/fspor.2022.815675. PMID: 35356094; PMCID: PMC8959543.

[2] Altman AR, Davis IS. Prospective comparison of running injuries between shod and barefoot runners. Br J Sports Med. 2016 Apr;50(8):476-80. doi: 10.1136/bjsports-2014-094482. Epub 2015 Jun 30. PMID: 26130697.

[3] Hollander, K., Hamacher, D. & Zech, A. Running barefoot leads to lower running stability compared to shod running – results from a randomized controlled study. Sci Rep 11, 4376 (2021). https://doi.org/10.1038/s41598-021-83056-9

[4] Hollander K, Liebl D, Meining S, Mattes K, Willwacher S, Zech A. Adaptation of Running Biomechanics to Repeated Barefoot Running: A Randomized Controlled Study. The American Journal of Sports Medicine. 2019;47(8):1975-1983. doi:10.1177/0363546519849920

[5] Hutchison MK, Dorociak R, Modafferi A, et al. Can Foot Exercises and Going Barefoot Improve Function, Muscle Size, Foot Pressure During Walking and Qualitative Reports of Function in People with Flat Foot? Foot & Ankle Orthopaedics. July 2018. doi:10.1177/2473011418S00257

[6] Lieberman, D., Venkadesan, M., Werbel, W. et al. Foot strike patterns and collision forces in habitually barefoot versus shod runners. Nature 463, 531–535 (2010). https://doi.org/10.1038/nature08723

[7] Malisoux, L., & Theisen, D. (2020). Can the “Appropriate” Footwear Prevent Injury in Leisure-Time Running? Evidence Versus Beliefs. Journal of athletic training, 55(12), 1215–1223. https://doi.org/10.4085/1062-6050-523-19

[8] Pedro A. Latorre-Román, Felipe García-Pinillos, Víctor M. Soto-Hermoso, Marcos Muñoz-Jiménez,
Effects of 12 weeks of barefoot running on foot strike patterns, inversion–eversion and foot rotation in long-distance runners. Journal of Sport and Health Science. Volume 8, Issue 6, 2019. https://doi.org/10.1016/j.jshs.2016.01.004.

[9] Ramsey CA, Lamb P, Ribeiro DC. Factors Influencing Runner’s Choices of Footwear. Front Sports Act Living. 2022 Mar 31;4:829514. doi: 10.3389/fspor.2022.829514. PMID: 35434615; PMCID: PMC9008269.

[10] Sánchez-Ramírez C, Alegre LM. 2020. Plantar support adaptations in healthy subjects after eight weeks of barefoot running training. PeerJ 8:e8862 https://doi.org/10.7717/peerj.8862

[11] Warne, J.P., Gruber, A.H. Transitioning to Minimal Footwear: a Systematic Review of Methods and Future Clinical Recommendations. Sports Med – Open 3, 33 (2017). https://doi.org/10.1186/s40798-017-0096-x