What is Minimalist footwear?

Firstly, the world of sports medicine and science, and indeed just about every field of human endeavour, likes to work within frameworks and definitions. Frameworks and definitions offer us systems of checks and balances against which we can measure outcomes. Without these we are merely speculating, or worse, guessing.
So what is the definition of “minimalist” or “minimalism”? Well, herein lays one of the biggest challenges of this discussion, because, to put it bluntly, there is no definition, no description, no framework, and so, no understanding of what this oft used term actually means.
Unfortunately, the term minimalism has somehow been endowed with magical powers that promise an athlete injury free running, a back-to-prehistoric-man experience, better connection with Mother Earth, and, best of all, an instant transformation to “perfect running form”... whatever the heck that is!

So letʼs get our facts straight here:
1. Every single athlete is an experiment with a sample number of 1. In other words, every athlete is different and will have different requirements in running shoes along the continuum of stability to maximum support, minimalist to barefoot. There is NO one size fits all and there is no magic bullet with any category of running shoe or barefoot running
2. Experimentation is good, and mixing the signals from foot to brain with less structured footwear, worn judicially along with ones usual training shoes, or, even introducing careful running barefoot on grass, is an excellent idea and may be important in injury prevention.
3. The notion that todayʼs “minimalist footwear” ( i.e. that marketed, and marketing is the key word here, as greatly reduced midsole height or even “zero drop” shoes) are somehow substantially different or better than racing flats that have been on the market for many years, is false and misleading. ASICS has always had outstanding racing flats in its range, and today offers shoes like the Piranha® and Hyperspeed®, which are extremely lightweight, low to the ground and flexible, and by any sensible description would be considered excellent “minimalist” shoes.
4. It is critical to understand that these shoes, just like every so-called minimalist shoe on the market, are NOT designed for everyday training. The risk of injury wearing this type of footwear full time is just too great. Minimalist shoes are for minimal training, and a tool to mix up the training session, or, strictly for race day. Simple as that!
If you would like a more in-depth examination of our current understanding of minimalist and barefoot, the claims being made, and what the science offers us please read on.

Letʼs examine some of the often made claims, and see what the science tells us.
WHAT IS MINIMALISM?
The biggest problem with this whole discussion is that there is a lot of “cherry picking” going on. In other words,proponents from both sides of the argument are selectively using small pieces of the published scientific literature to support their own theory or belief, and thus taking the conclusion of the entire scientific paper out of context.This practice is well known and is called confirmation bias and it is a tendency for people to favour information that confirms their beliefs or hypotheses. People display this bias when they gather or remember information selectively, or when they interpret it in a biased way. For more information on this, check out http://en.wikipedia.org/wiki/Confirmation_bias

Likewise, cherry picking, suppressing evidence, or the fallacy of incomplete evidence is the act of pointing to individual cases or data that seem to confirm a particular position, while ignoring a significant portion of related cases or data that may contradict that position. For more information, take a look at http://en.wikipedia.org/wiki/Cherry_picking_%28fallacy%29

A great example of both confirmation bias and cherry picking comes from a Canadian physiotherapist Blaise DuBois, who is a vocal supporter of the minimalist movement, and travels the world charging delegates large sums of money to attend his workshops on the topic. Let me give you more detail:
On the 10th November 2011, DuBois posted on the international podiatry education forum Podiatry Arena, that wearing shoes causes weakness, one of many topics I debated him on in a Running Event forum in Austin December 2011. In fact, DuBois has made many statements in public forums and on his website that have been taken as gospel, but which in fact do not hold up to scientific scrutiny. These statements are a good starting point for critical examination since they
represent mainstream thinking of the “minimalist” movement (whatever that is!)

So let us now examine these one by one and see what the science tells us:
1. That wearing shoes causes muscle weakness. The exact quote from his website is “we also know that big shoes weaken foot tissues”. DuBois then draws the long bow that weak muscles lead to flat feet (a patently ridiculous notion that logically therefore assumes anyone wearing shoes must be flat footed). He is basing his comments on some studies that have shown a high correlation between flat feet and shoes when you compare shoe wearing to non-shoe wearing populations. So how does one interpret that?

In fact, there are many ways in which the results and conclusions of these papers may be interpreted, including:
1) The shoes caused the flat foot
2) Those with flat foot choose to wear shoes more often because itʼs more comfortable and the shoes did not cause the flat foot
3) Itʼs nothing to do with the shoes and those who wear shoes more often ambulate on harder surfaces and the flat foot was due to the hard surface
4) etc.
Anyone who accepts any one of those possible conclusions above another is guilty of confirmation bias, and confirmation bias is the antithesis of science. Those with an agenda to promote will believe that correlation is causation and interpretthat research as "1. The shoes caused the flat feet". However, conclusions 2 And 3 are just as valid... along with probably
many others! This is the classic misuse, misrepresentation, misquoting and misinterpretation of the science.
WHAT IS MINIMALISM?
In fact, there is an abundance of literature, and practical clinical evidence that clearly demonstrates having weak foot muscles results in the exact opposite of a flat foot, namely a very highly arched or ʻcavusʼ foot type. This is commonly seen in advanced diabetic disease, Charcot-Marie-tooth Disease and Gillain-Barre Syndrome!
Once this was pointed out to Du Bois (and he was told by a senior Podiatry Arena Veteran that he was not a real scientist and that he should refrain from plucking made up facts from the air. The full debate is available at http://www.podiatryarena.com/podiatryforum/showthread.php?t=73232&page=2)
He disappeared from the Arena never to be heard of again!
Apart from the above, the concept that wearing traditional athletic footwear “weakens foot tissue” is an obvious nonsense for the following reasons:

• There is not even close to being any evidence for this notion (given the strength of the claims being made you would kinda think that there would be)
• If running shoes were to weaken muscles, then you would assume that they do it by restricting motion. The evidence is that running shoes do not do that.
• If it were true, then you would expect to see more pronated/flat feet in runners compared to the general population. There is absolutely no evidence that is the case.
• If someone is a non-runner and then takes up running (letʼs say in the most motion controlling running shoe), then surely they are going to be using muscles more and the muscles will actually get stronger (I would love the barefoot running community to explain away this point!)
• I have no doubt that barefoot running can make muscles stronger, but that does not mean that they were weak to start with.
• Weakness of intrinsic foot muscles actually leads to a higher arch foot, not a flat pronated foot! And we know from the evidence of Lizis et al (2010) that muscle strength is not even related to arch height.
• If this was the cause of flat/pronated feet, then how do you explain a flat/pronated foot in those who do not wear running shoes or even any shoes at all?
• There are no studies that show shoes cause flat feet

Finally, I would consider that if big shoes weaken foot tissues, then every elite snow skier (maybe the ultimate example of a stiff, heavy, bulky shoe), and every cyclist who wears a very stiff carbon fibre cycling shoe will have weak foot tissues and the consequences of that, presumably flat feet. In a word... they donʼt!
2. Our next quote states, “Many studies on the subject prove that athletic shoes cause deformities like hallux valgus (bunions)”.
Hmmmm... well sorry, but this is simply not the case. There is not one single study anywhere in the scientific literature implicating athletic footwear in the generation of hallux valgus. Perera et al, J Bone Joint Surg, 2011; 93, found that “footwear is probably more important in progression than causation”, and at no point in time mentions athletic footwear. The two extrinsic factors the authors specifically call out are high-heeled narrow shoes and excessive weightbearing.
WHAT IS MINIMALISM?
3. Next was, “I recommend minimalist to the beginner, to the overweight”.

OK, I canʼt even begin to tell you all how much this statement concerns me. This is the classic example of applying one rule to all, and I really hope with all my heart no-one truly believes this.
I think everyone with an interest in and love of, running would have read the words of one of the true pioneers of the world of sports medicine, Dr. George Sheehan. George invented one of the truly great quotes related to the study of humans in motion... “every athlete is an experiment with a sample number of 1”.

Put simply, every single athlete, every runner, is different at every level. Think:

• Gender
• Age
• Weight
• Biomechanics
• Height
• Injury history
• Medical history
• Footwear
• Lack of footwear
• Lower limb stiffness (which automatically modulates impact history independent of footwear
or surface)
• Strength
• Flexibility

Need I go on? To promote the application of the same rules to every athlete, from child to overweight to elite runner is wrong, dangerous and absolutely unable to be supported by the scientific literature. Everyone is different, everyone has different requirements. I particularly like the following recent quote from Dr. Daryl Phillips, a hugely respected podiatrist and biomechanics researcher “For any of us to say that there is one normal would be absolutely insane.” Enough said.
Children especially have immature skeletons that require protection and cushioning. This is the reason Sports Medicine Australia (SMA); the key body for sports medicine in Australia has developed guidelines for the safe participation of children in sport. This handbook may be found at http://sma.org.au/wp-content/uploads/2009/05/childrensafetyguidelinesfulldoc.
pdf
This guideline has been written by a panel of established medical experts, and similar guidelines are published by the American College of Sports Medicine.
WHAT IS MINIMALISM?
The SMA guidelines specifically state “Footwear: Correct and well fitting footwear is essential to reduce injuries in sport.
Important features of correct footwear include:
• fit
• cushioning
• stability
• an absence of shoe-related pain or discomfort in the foot or lower limb.

4. Next on the agenda is the statement “Are you a heel striker? The cause is the shoe.”
I have several problems with this statement, not the least of which is that this comment somehow assumes there is some issue with heel striking. There is not. In fact, two recent studies have looked at this exact issue.
The first, Foot strike patterns of runners at the 15-km point during an elite-level half marathon. Hiroshi Hasegawa; Takeshi Yamauchi; William J Kraemer Journal of Strength and Conditioning Research; Aug 2007; 21, 3, found that 74.9% of all runners in the cohort (283 runners), were heel strikers.
The second study, by Pete Larson and co-workers, whom many of you will know as the administrator of Runblogger, found even more support for heel striking amongst marathon runners. Larson, P, et al, (2011): Foot strike patterns of recreational and sub-elite runners in a long-distance road race, Journal of Sports Sciences, 29:15, 1665-1673 found that of 936 distance runners studied, 88.9% of runners at the 10km mark were classified as rear foot strikers, 3.4% as midfoot strikers, and only 1.8% were forefoot strikers!
This study also found that “A large percentage of runners switched from midfoot and forefoot footstrikes at 10 km to rearfoot strikes at 32 km”, and the authors surmised that this was “presumably due to fatigue”.
So this begs the question, if midfoot or forefoot striking increases fatigue, why would we consider it superior to heel striking, the ambulatory style overwhelmingly favoured by most runners, including many elites?
Further analysis of the assertion that footwear is responsible for heel striking exposes major flaws, especially when assessing the study of Mc Carthy and co workers (Like Barefoot? Only Better? Mc Carthy et al, 2011, American Council on Exercise Certified News September 2011).
In this study, the researchers recruited 16 healthy, injury-free female subjects, ages 19 to 25, all of whom were considered recreational joggers. Two weeks prior to testing, each of the subjects was fitted with a pair of Vibram FiveFingers Bikila ($90). To get accustomed to running in the Bikilas, the subjects were then asked to wear the shoes while running for up to 20 minutes per day (or until discomfort), three times a week for two weeks. Once acclimated to running in the Vibrams,
subjects returned to the lab for 3-D motion analysis and measurement of ground-reaction forces as they ran under three separate conditions: (1) while wearing the Vibrams; (2) while wearing a pair of neutral running shoes (New Balance 625); and (3) while barefoot. The order was randomized between Vibrams and the running shoes, but the barefoot condition was always measured last.
The results? Mc Carthy and her team reported that all of the subjects were rear-foot strikers while wearing typical running shoes, landing predominantly on the heel. However, while running barefoot and in Vibrams, approximately one-half of the subjects switched to a forefoot strike pattern while the other half continued to impact the ground with their heels. Most of the barefoot/ minimalist/ Born to Run crowd tell us this is impossible and that it would hurt too much, but in this controlled experiment, this is exactly what happened. So, only 1 in 2 of the runners in this study, after training three times a week for two weeks in the Vibram shoe, were able to achieve a forefoot strike pattern. This flies in the face of Blaise Du Boiseʼs insistence that shoes cause rearfoot striking. They do not.
WHAT IS MINIMALISM?
“Itʼs tough to re-learn to run,” says Dr. John Porcari, one of the principle researchers. “When you look at the data, even though we encouraged them to run with a more forefoot strike while wearing the Vibrams, half of the subjects still continued to land on their heels. Even with two weeks to practice and instruction in how to use the barefoot shoes, [the subjectsʼ] bodies still tended to run the way theyʼve always run.”
This makes complete sense, since that is the way the vast majority of us run, and, according to Larson, heel strikingprobably allows us to conserve energy.

5. Our next gem is, “The absorption and antipronation systems in shoes do not lower injury and do not improve comfort.”

Well, two very recent studies, one of which has bizarrely been used to support the above comment, comprehensively disagree with this dodgy assertion. In his late 2011 study, Michael Kinchington and co-workers (Kinchington, M. 2011: Effects of footwear on comfort and injury in professional rugby league, Journal of Sports Sciences, 29:13, 1407-1415) concluded that “a footwear program consisting of athlete education, prescription of footwear, and frequent rotation of footwear resulted in a lower incidence of injury (p<0.005) and higher comfort ratings (p<0.001). Fairly comprehensive I would have thought. Now I know this study is about rugby, but it specifically looks at the road running that occurs as a part of rugby training. I actually spoke with Michael Kinchington and he assures me the conclusions he draws from this study, in his opinion, can be equally applied to road running.
The second study is the one bizarrely used to support statement #5 during our debate in Austin, and it relates to research by Cheung and co workers (Cheung, R., et al (2011): Effects of motion control footwear on running: A systematic review, Journal of Sports Sciences, 29:12, 1311-1319). The conclusions to this study are actually the exact opposite to what DuBois would have you believe! He either does not understand the research or has manipulated the conclusions to suit
his own end.
Now this was a very interesting study, because it was a systematic review, one of the most stringent scientific processes possible. And what Roy and his colleagues did was take 14 different “relatively better quality studies” from seven electronic databases and had them analysed by two independent investigators. They concluded “that motion control footwear is effective in reducing the amount of foot pronation and the vertical impact peak during running”. They were not however able to show an effect proximally, i.e. that such footwear effected tibial or femoral rotation. This notwithstanding, it is pretty damning of Du Boisʼs assertion that “absorption and antipronation systems do not lower injury and do not improve comfort”. According to the latest research, they do!

6. On more than one occasion, Blaise has publically stated “the promotion and prescription of technology shoes is currently done by ignorance by health professionals”.

Oh dear! I wonder what my health professional colleagues would be making of that. That they are all ignorant?
He goes on to also say “it is also done by shoe retailers by biased information, obtained most of the time from big shoe companies.” I think this is pretty condescending toward most of the retailers I know who are exceptionally well informed and take nothing they are told as gospel. He is also ignoring the fact that a company like ASICS (or
Nike, or Brooks, or adidas) just cannot afford to say things that cannot back up with research. There are controls in place that do not allow companies to say things that cannot be substantiated. This is the reason Reebok is currently embroiled in a lawsuit in the USA over its toning shoe product. Reebok made claims the consumer watchdog ruled could not be supported by the research. It has to date cost them almost USD30 million. Ouch!
He further comments “it is done by shoe companies by financial interests”.
Well... yes, it is. Every company has a range of products we hope to sell to the consumer at a profit so the company may remain a viable commercial entity. Blaise runs workshops all over the world and charges up to $650 per person for the privilege. And good on him, I have no problem with that as long as he realises and acknowledges that he, like the shoe companies has a product to sell for his own “financial interests”.
WHAT IS MINIMALISM?
What I do wonder is how much of his own cash is ploughed back in to research to make his product safer for athletes. I strongly suspect the answer is “none”.
Athletic footwear companies have to sell the odd pair of shoes from time to time. It makes me wonder how much any of the “footwear company bashers” really understand about the whole process that takes a shoe from an idea to production. The answer of
course is “absolutely nothing”, so let me clarify the process right now.
This is the process ASICS follows, and I imagine it is similar for the other major footwear brands.
First, we need a concept. This is where I come in, because in my role as the ASICS International Research Consultant, it is my job to travel the world, attending high end scientific meetings in the fields of sports medicine and biomechanics, to identify major trends in terms of injury or footwear function. For example, some 5 years ago I attended the International Society of Biomechanics meeting in New Zealand, where much of the independent research was focused on female
athletes. As a result of what I learned at this meeting, ASICS commenced a 4 year study, at a cost of nearly 1 million dollars, investigating the specific issues of the female athlete in relation to tendon, ligament and soft tissue behaviour.
Nothing at all to do with footwear, but maybe, just maybe the research would allow us to learn something that might make sport safer for female athletes.
The upshot of this research was a concept that female runners might need a slightly higher platform to run on, because the research showed us soft tissue stretched more in woman athletes, especially around the Achilles tendon.

So the concept was born. Now it is over to the designers to give input in relation to execution. Typically there will be 10 or more designs, (all created using sophisticated CAD technology which allows substantial testing in the computer before the product even exists), which are submitted to an international development team for consideration. This team consists of experts from different backgrounds: engineers, toolmakers, biomechanists, sports medicine experts, marketers and
retailers. Together, the International Design Team will select several of the submitted designs for initial mock up. Usually this first stage involves the creation of a plaster CAM model which represents the first real assessable product.
Once the team have agreed that the concept is viable, prototypes are manufactured, and these are then submitted for testing. Typically this testing is carried out completely independently at 2 institutions separated by a big stretch of water.
One is in Japan, and at the University of Melbourne in Australia. It is important to note that the testing done at these two sites is completely independent of the other and looks at completely different parameters, often with the institutions being “blinded” to what the other is testing.
At this first prototype stage, we already introduce the shoe to the wear testers, who are distributed across 3 continents to make sure there is no ethnocentric bias.
The results are then collated, and what is called the “1st sample” is manufactured, all with new tooling, based on the feedback from the prototype. The process is then repeated in relation to research and wear testing, as it is with the “2nd sampleʼ.
If all has gone according to plan with these 3 prototypes (and about a year has passed), the product will proceed to “photo sample” stage, which is the precursor to the real thing. Research and wear testing continue until finally we are satisfied the concept has become the reality and it fulfils its original promise. The last prototype is then made, called the “salesmanʼs sample” which is used to showcase the upcoming new product.
WHAT IS MINIMALISM?
In all, between 5 and 6 prototypes, hundreds of hours of laboratory testing, hundreds of wear testers putting thousands of miles on the prototypes, in a relentless process of test and re-test.
So when I read a recent comment like, “the technologies presented annually by running shoe companies have no solid scientific evidence”, I invite him to read the above, and to peruse:

Estrogen-induced effects on the neuro-mechanics of hopping in humans Adam L. Bryant, Simon Bartold, Ross A. Clark, et al Eur J Appl Physiol (2011) 111:245–252

Effects of estrogen on the mechanical behaviour of the human Achilles tendon in vivo Adam L. Bryant, Ross A. Clark, Simon J. Bartold, et al J Appl Physiol (June 19, 2008)

Tibial acceleration variability during consecutive gait cycles is influenced by the menstrual cycle, Clark, R.A., Bartold, S.B., Bryant, A, L, Clinical Biomechanics (2010)

All these papers were published in high impact peer-reviewed scientific journals, and all led directly to the introduction of new technology in womenʼs running shoes.

7. “Shock absorbing shoes do not lower the stress put on the skeleton, I talk here about knees, hip and back.”

Well, he can talk about whatever he wants, but only if he understands the biomechanics, which clearly he does not.
Firstly, in the world of biomechanics, we do not talk about “shock absorption” because it erroneously gives the impression that shock can somehow be created or destroyed, which of course it canʼt. Real scientists therefore only ever talk about“shock attenuation”, indicating that energy can be stored and returned or shifted somewhere else.
In any case, this comment is another nonsense, because there are a myriad of studies showing that athletic footwear
• Alters accelerations
• Reduces pressures
• Attenuates dangerous frequencies
• Protects from the environment
• Reduces torques and moments
• Influences injury patterns

Letʼs take a look at what the literature tells us.
• Cushioning in athletic shoes has been shown to attenuate skeletal shock transients and to reduce peak plantar
• pressures
• Cushioning systems greatly increased comfort, reduced the occurrence of painful feet and allowed many people
• who would not otherwise have participated to enjoy the “jogging boom”.
• Cushioning in athletic shoes has been shown to attenuate skeletal shock transients and to reduce peak plantar
• pressures (all from Shorten M, Running shoe design: protection and performance 2005, included in references)
• Barefoot running is characterized by a significantly larger loading rate than in shod running and, in general, more than one impact peak was found for the barefoot condition. Yes, that is correct... barefoot running increases the impact load (of course), and according to DuBois and others this is what causes injury! So how can barefoot running be “the gold standard”? (Biomechanical analysis of the stance phase during barefoot and shod running. De Wit ,B., De Clercq, D, Aerts, P. Journal of Biomechanics 33 (2000) 269}278 )

I could go on quoting references like this all day, but the take home message is that the literature overwhelmingly supports the notion that athletic footwear substantially reduces the stress put on the skeleton
WHAT IS MINIMALISM?
8. “80% will change their biomechanics and run this way after only a few steps.”

This statement assumes that if you take your shoes off or run in minimalist footwear you will miraculously change your running style for the better and achieve “perfect form”.
Well, we have already exploded this myth by citing the Mc Carthy study in point number 4 above (Like Barefoot? Only Better? Mc Carthy et al, 2011, American Council on Exercise Certified News September 2011).
The relevant quote directly from this study is, “When you look at the data even though we encouraged them to run with a more forefoot strike while wearing the Vibrams, half of the subjects still continued to land on their heels. Even with two weeks to practice and instruction in how to use the barefoot shoes, [the subjectsʼ] bodies still tended to run the way theyʼve always run.”
Once again numbers are being plucked from thin air to cherry pick confirmation of theories. Terrible science!

9. “Barefoot technique is the gold standard.”
10. Is it really? Well letʼs scratch the surface of this statement and see what we find!
Perhaps the biggest discussion point currently is on the vexatious issue of “drop”. This very recent addition to athletic footwear vernacular has been introduced to replace the term raise gradient, which describes the distance, in millimetres, of the midsole height, from under the ball of the foot to under the heel. In other words, it is a representation in millimetres of the height of the midsole from heel to toe.
For many years, most manufacturers have used a standard gradient of between 10-12mm, and I will be first to acknowledge there is little or no science to this, aside from the assumption that an angle of roughly 10 degrees is an optimal position for the foot to be positioned at foot flat. There are problems with this assumption, as there are with nearly every variation of gradient from 10mm down to 0 drop. Not the least of these is that midsoles “scale”, in other words, a 10mm platform in a size 7 shoe does not produce the same “ramp angle” as a 10mm gradient in a size 13 shoe.
Letʼs put these issues to one side for the moment, and examine the hype currently engulfing us in relation to the perception from some quarters that less drop is more, and that in fact zero drop is the best, and barefoot technique is the gold Standard (Quote podcast www.therunningclinic.com).
What is the science behind these assumptions? Well, there really is none. There are many theories, but, as with so much of the barefoot and minimalist discussion, very little hard science.
The theories go something along the following lines...:
• Barefoot or zero drop running forces the athlete to assume a midfoot or forefoot strike pattern. OK, well, assuming this is true, which the McCarthy study (Like Barefoot? Only Better? Mc Carthy et al, 2011, American
Council on Exercise Certified News September 2011), comprehensively established was NOT the case, who says that mid foot and forefoot striking is best?
Now I will be the first to agree that if a runner wants to go faster, he or she must get their centre of mass closer to their contact point, and ONE (of the many) ways this can be achieved, is by shifting from a rear foot strike to a mid foot or forefoot strike pattern. I accept this is a valid training protocol for sub elite and elite athletes (which currently represent less than 1% of the total running population), or an accomplished runner who is interested in going faster.
However, please let us not lose sight of the fact that the vast majority of runners have no interest in racing, no interest in getting faster, and really just enjoy running for its social and health benefits.
WHAT IS MINIMALISM?
I also acknowledge that for a runner with persistent or recurring overuse injury, changing the way one runs (the ubiquitous “form”,) may indeed be very beneficial. However, the claims made that barefoot or minimalist running is the answer to, or cure for, all overuse injuries associated with running, has as much scientific support as the notion that “traditional” shoes serve a similar purpose. The scientific evidence is absent that barefoot or minimalist running prevents injuries. The scientific evidence is absent that traditional running shoes prevent injuries. There is NO evidence, either way.
Let us be clear, and let me once more reiterate. It is a case by case assessment. Some runners get injured wearing a traditional running shoe. That is not at all necessarily (although it could be), the fault of the shoe. Some runners get injured whilst running barefoot. That is not at all necessarily (although it could be), the fault of the going barefoot.
I think this whole thing is best summed up by Nathan Koch, a PT and Director of Rehabilitation at Endurance Rehab in Phoenix, Arizona, U.S.A.:
“Itʼs totally misleading to tell people that when they get injured running in shoes, itʼs the shoeʼs fault, and when they get injured running barefoot, itʼs the athleteʼs fault. It makes no sense. Youʼre going to have injuries either way. Itʼs running.” In fact, about 60% of all runners get injured, but to put this into perspective, 80% of all badminton players get injured, and simply drawing breath, sitting on a couch, eating a donut, carries with it a 30% risk of sustaining an injury!
The other things that we need to know about midfoot and forefoot striking, is that while I agree these strike patterns reduce the loading at the knee (external knee joint moments), they increase the external ankle joint moments and load the Achilles tendon and calf muscle complex. So many times I read the comment that forefoot running reduces knee load, as if this is a magical panacea to injury, without the major “BUT”... it increases loading on the ankle, Achilles tendon and calf.
Finally, there is chatter that if one wears a heeled shoe, it is impossible to midfoot or forefoot strike. I am sure anyone reading this document would be able to see that comment for the nonsense it is.
The next assumption is likely to be along the lines of:
• Because barefoot or minimalist running reduces the weight over traditional footwear, there is a clear benefit in terms of energy expenditure.

Hmmmm... well, energy expenditure is commonly measured by monitoring oxygen uptake during running, and the above statement assumes that footwear will incur a greater oxygen uptake than barefoot running. This makes complete sense given the foot is at the end of the leg and acting somewhat like a pendulum. Increased weight of, or on, the foot increases energy expenditure right?
Well... maybe not. A very recent study (Metabolic Cost of Running Barefoot versus Shod: Is Lighter Better? Jason R. Franz, Corbyn M. Wierzbinski, and Rodger Kram, Medicine & Science in Sports & Exercise, Publish Ahead of Print, February 12th 2012 ) brings this into focus. The key findings were as follows:
1. For every 100g (3.5oz) (the average weight of a deck of playing cards) added per foot, energy cost increases by approximately 1% whether running barefoot or shod.
2. Running barefoot and in lightweight shoes does not significantly differ in energy cost.
3. When controlling for shoe/foot mass, running in lightweight shoes requires ~3-4% less energy than running barefoot. So, according to Alex Hutchinson, a scientist now writing for Runnerʼs World, there are 3 possible ways
these results can be interpreted:

1. Running in shoes takes less energy than running barefoot.
2. The heavier your shoes are, the less efficiently you run.WHAT IS MINIMALISM?
3. Running barefoot "offers no metabolic advantage over running in lightweight, cushioned shoes."

For the record, the official conclusion of the study was option 3.

Perhaps my all-time favourite argument of the barefoot and minimalist movement is:
• We should all run barefoot, or as close to it as possible, because that is the way our ancestors ran 10,000 years ago.

This type of statement is much beloved of the likes of Daniel Lieberman, author of the famous Nature article looking at shod vs. unshod runners. Dr. Lieberman is an evolutionary biologist and is very keen on the concept that we ran that way back then, and we should be doing it right now too!
Well, I donʼt know if it is just me, but I have a few thoughts. I am not sure if Dr Lieberman has considered this, but I am confidant Neanderthal man did not run a lot like modern man. I am pretty sure Og was not focussing on his running form whilst trying to snag a Woolly Mammoth. In addition, cavemen and cavewomen all died before they were 40 (Caspari &
Lee, PNAS 2004), so there is no good evidence that barefoot running made their feet healthier. Maybe it destroyed their feet, and this is why they were killed in battle, or selected by a big predator for culling from the herd. I can just hear the discussion between two sabre toothed tigers, “Hey Floyd… look at that one, heʼs been barefoot running and now heʼs limpin” “Yeah I notice that Petey… letʼs cut him outta the tribe... he looks like goooood eatin!”
So it is time to close off this diatribe, and as a final word, I would like to offer the following:
I explain to my patients that they will naturally run and walk in the manner which is most metabolically efficient and causes the least amount of discomfort for the given conditions. Anything they consciously do to alter their gait will increase the metabolic cost which will then lead to an earlier onset of fatigue. Our movement patterns are as unique as our fingerprint so why in the world should we be expected to all run the same?
Likewise, I believe in the benefits of judicious barefoot running on grass, mixing terrain and surface and adding less structure footwear to accompany mainstream running product.
Most of all I believe running should be fun and sociable and that over-analysis of anything is likely to dilute oneʼs enjoyment of life.
Happy running!
WHAT IS MINIMALISM?
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