ABC’s of Minimalism: Dr. Mark’s Reply to Jeff Galloway’s Views on Running and Injury

Posted on 23 July 2011

Here I am at the JFK 50 ultra...running in Newtons.

With all his books, coaching experience, training methods, racing achievements, and Ironman-like durability with just over a half-century of miles on his legs, Jeff Galloway is a respected fixture in the running community. And along with many other runners, I’m a subscriber to his email newsletter .But his take on minimalist running shoes in his most recent newsletter is not one that I share.

Here’s what he wrote:

Many runners who own one of the minimal and exotic shoes that have popped up on today’s market will tell you that these shoes have solved their running problems. I hear the other side of this issue, about every day, from those who have been injured (often severely) by using these products or by running barefooted. Many have to stop running for 4 to 6 months. Thousands have reported significant problems.

I’ve seen this fad come and go 5 times during my 52 years of running. Something will come out in the media about minimal support/barefooted running, and thousands will try it. About a third of those who try it run for short distances and like the tingle of the feet so they run more. Without support, the distance or the surface of the run will often cause an injury–including a number of serious ones such as stress fractures. Each fad cycle ends when those injured tell other runners about their experience–so that very few want to put themselves at risk.

Minimal shoe/barefooted running has its place if the foot can handle it: Short runs when running on a safe surface can give the foot a bit more strength and develop a lighter touch. Unfortunately, there are lots of risks on most running surfaces: pieces of glass, medal or rock–hidden below even the most groomed grass surfaces. There are also lots of surface irregularities that can produce serious trauma injuries in one step.

Today’s shoes have decades of orthopedic research behind them and can protect the foot from most of the problems due to running surface. Go to a store with trained and experienced staff members, like my Phidippides stores in Atlanta, and get the best advice.

Here’s my reply to Jeff:

I am curious about the runners who are showing up everyday claiming to have been injured as a result of minimalist shoes. Over a year ago in Shepherdstown, West Virginia, I opened the first footwear store in the nation purely devoted to minimalism and sold no shoes with traditional elevated heels. Two Rivers Treads was only the first store of its kind. There are now six new stores in the country who have embraced minimalism – and all are partners with the Natural Running Center, where I am also its executive director. All of these stores are completely aligned with the education message of teaching good form, prescribing more functional footwear, and the progressive adaptation to more natural running.

At Two Rivers Treads, we just don’t sell shoes; we have a discussion with each and every customer regarding their running, injuries, goals, and some simple and clear instruction on how to reduce impact loads on their joints. We have sold over 3,000 pairs of shoes in a year and only five customers at most have returned with an injury and blamed the shoe. This is far less than Galloway’s daily experience. Are the injured runners just going to the doctor instead of back to us? I doubt it as we would be the first place they would return to if they felt it were the shoes. Do I have scientific data for all this….no, we are a small business.

Maybe we are doing something different when we sell minimal shoes. So just what are we doing? The following educational information is included on our store walls and handouts.

Let’s first define how we interpret minimalism, a minimalist shoe, the risks, and the gradual progress.

What is Minimalism?
— Free the foot to develop naturally
— Look for the least amount of shoe you can safely wear now
— Work toward reducing the amount of shoe necessary through strengthening the foot and improving your stride
— Running is a natural movement of the body, rather than an unnatural act that requires artificial support to perform safely
— Embraces the notion that the beefier the shoe, the more a runner’s natural stride is inhibited

What is a Minimalist Shoe?
— Complements natural foot function
— Heel to toe drop is very low
— Material under the foot is thin….allowing maximum ground feel
— Upper is Soft and Flexible
— Light Weight and Flexible

Effects of a Modern Running Shoe?
— Impairs your natural bounce
— Promotes heel striking
— Alters your natural lever (heel lift)
— Creates unstable base
— Causes loss of sensory input
— Causes skin atrophy
— Creates unhelpful movement memory

What are the Risks of Minimalism?
— Foot is NOT guided into running stride
— Feet need to do some of the work and need to get strong
— If form is incorrect and you are not strong in the right places you may develop soreness….so listen to your body and progress gradually

How to go Minimal?
— Take it slow at first
— Add distance gradually
— The more minimal the shoe the more adaptation it will take
— Progress through the stages of Shoes from Neutral/Transition to Minimalist to Barefoot Style
— Do some barefoot running and walking

For early adapters who are weak in their foot and hip stabilizers a minimal shoe may be what we call a “neutral –transition shoe”, such as a Newton Isaac or Altra Intuition.

Now how do we define shoes? This too is on our store walls, and the shoes are displayed this way in the Natural Running Center Shoe review section:

Barefoot-Style Shoe
— Your feet “feel” the ground
— Thinnest layer of protection between foot and ground
— Heel and toes are level
— Land on the midfoot/forefoot
— Lightweight

Minimalist Running
— Some cushiony comfort
— Little to no heel-to-toe drop
— Enhanced ground feel
— Soft, flexible shoe moves with feet
— Ideal for all surfaces– road, trail, track

Neutral/Transition
— Similar protection to most running shoes but without elevated heel
— Little to no heel-to-toe area drop
— Foot is in natural position
— Encourages midfoot/forefoot landing
— Ideal “starter” shoe for transitioning runners to minimalist/barefoot-style

The real folks making this happen in a small community such as Shepherdstown are my lead employees, aka the Shoe Guys, Tom Shantz and James Munnis. Tom and James lend some practical and philosophical advice on the topic.

Here’s Tom: “We give verbal warnings to all minimalist shoe buyers. I have been adapting for a little over a year now. It’s a slow process. What I have found that works best is to have two pair of shoes. One that is ‘flat’, zero drop, and one that has a drop of 5mm. One should transition into the 5mm shoe first. It should take approximately 2 weeks. The zero-drop shoe should take you approximately three months to transition into. Once you have transitioned into both shoes you should continue to slowly increase your distance in the zero-drop shoe. The 10% week rule is out the window. Try 1% increase in the zero-drop shoe. For a younger runner who has been in racing flats the transition is much shorter.”

Now here’s James: “It’s still funny to me how three million years of evolution is still considered a fad by some folks. Nobody who has ever followed our advice on gradual transition has ever been injured from the act of running completely barefoot, or in minimalist shoes. Many do have the usual fatigue and discomfort over a period of up to a year or so trying to undo the weakness and atrophy of the most excellent foot that has been caused by horrible traditional footwear for everyday wear and for running. Mother Nature has given us a foot that is very endurable and survivable, despite our very recent efforts to screw it up with the many ridiculous features of a traditional running shoe. Would anyone please tell me one single reason to elevate a human heel above the forefoot for anything, or to interfere with our natural suspension system with arch support, and especially for running?”

So there you have it: Two Rivers Treads’ Shoe Guys have spoken. And as their informal comments reflect, it is not about the shoe, but the education. An example of one of the fun educational sessions hosted by our store is the recent Natural Running Roundup with Chris McDougall

Here’s to healthier running.

P.S. This essay originally appeared on Pete Larson’s RunbloggerPete is also an advisory board member of the Natural Running Center.  My essay also generated a number of comments on Runblogger, including one by Rick Meyers, whose running store is also partnered with the Natural Running Center. Here’s Rick’s comment:

Hello All: Rick Meyers here. I own The Runner’s Sole located in Chambersburg, PA. I started this store nearly 3 years ago and had all of the traditional shoes with the bulky heels. I didn’t take the minimalist approach upon opening only because I wanted my store to succeed. However, with time and the minimalist movement well under way, I have reduced the amount of shoes in the traditional sense and put more minimalist shoes on my wall. I am a 100 mile guy and I wear Newtons for most of my races including Old Dominion 100 last month.

I spend nearly 20 minutes per customer educating them in the minimalist movement and how things will differ from the traditional shoe to the minimalist shoe. I explain to them the need for patience and gradual progression of going minimal but the advantages of doing so. I allow them to try on traditional shoes and run on my in-store treadmill as well as the minimalist shoe for the same length of time and at the same speed. Finally, I encourage them to run on the treadmill completely barefoot for the same time/pace. Then I allow them to make the decision of what is best for THEM. Most of those who come into a running specialty store are educated people who knows their bodies/feet better than anyone else does. More often than not, the traditional shoes are left behind and the minimalist shoe finds a new home.

I encourage them to read and continue to educate themselves on this movement with regards to running biomechanics. I also tell them to be very patient and allow their feet to strengthen to withstand the less supportive shoe. For each person this is obviously going to be at different time frames for adaptation. I also educate them to take careful stock of their bodies/feet and to back off if they are experiencing unexplainable injury or soreness.

We are a nation of “everything now” and I have found that this approach to the minimalist movement is cause of injury that Galloway cited. Since I have taken this approach to educating customers, I haven’t received any returns in shoes or customers who have experienced injury. I can’t seem to recall anyone who has purchased traditional shoes blame the shoes for injury, but as my customer data base shows, those customers who purchased traditional shoes are either moving to a less bulky shoe with each new shoe purchase, or have gone minimalist completely. I appreciate Galloway’s attempts of getting people moving during this time of the obesity epidemic and I also understand the approach of the shoe manufacturers building oversized shoes, because let’s face it, we are an overbuilt nation. The shoe that most are running in isn’t as important as getting people up as Mark has said.  I would rather see someone running in their old KISS 8″ platform boots than developing the medical complications of obesity. But the minimalist movement has reduced traditional injury and I feel that overtime, there will be more people running, injury free, more often, and turning the obesity epidemic around. Run on!!!

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18 Responses to “ABC’s of Minimalism: Dr. Mark’s Reply to Jeff Galloway’s Views on Running and Injury”

  1. Dominic says:

    Just looking for more info on injuries from running with minimalist footwear.
    I run once or twice a week and about two months ago moved from Nike Frees to VFFs. Having overcome the pain in my calves I now get a dull pain in the tops of my feet. It feels like I’ve sat on them and the bones are out of line.

    Any suggestions?

    Thanks,
    Dominic

    • I’d suggest getting your extremities adjusted by a chiropractor who has done some of Dr Marc Charette’s extremity adjusting work. It sounds to me that you just need a pretty basic talo-navicular ‘pull’ move that is even taught at undergraduate level these days. Joints are supposed to move from A to B and back again. If they don’t, they just fire up irritation of the nervous system. The joint biophysics is much the same as when washing up, and two saucers adhere to each other. Smooth porcelain surfaces with a tiny film of liquid between them can be surprisingly ‘hard’ to prise apart. This represents the sort of ‘joint jamming’ that is possible, and when a good talo-navicular and talo-calcaneal separation is achieved (often heard and felt as a little ‘pop’), the whole area feels better very quickly. This is because the hyper-excitable state created by the stiff joint has had its dynamics changed with rapid restoration of normal motion from A to B instead of being jammed into ‘A’.
      Cheers, Keith Livingstone (chiropractor).

  2. How can Galloway say that he’s seen a minimalist/barefoot fad come and go for 52 years. We haven’t even had these built up shoes for that long. When he started running, all he HAD were minimalist shoes! I didn’t get my first pair of Nike waffle trainers until 1978 or so. That’s only 33 years ago. Before that, I had a pair of what? I think they were Onitsuka’s (bought at the YMCA) that were more minimal than most racing flats today.

    Gotta say, he’s lost a ton of credibility.

  3. Jeff says:

    @Dominic

    That dull pain on the tops of your feet, are those tiny muscles between your metatarsals screaming for rest. This is an early sign of what could be a long road to recovery. If you’ve ever had shin splints, you’re aware of the aching pain due to the muscles in your lower leg essentially being pulled or torn away from the tibia (shin bone). Likewise, these tiny muscles in your feet are being overstressed and as a result are causing major trauma to the small bones (metatarsals) in your feet. This is usually due to inadequate strengthening of the feet (arches) and calf muscles and/or improper running form/technique.

    To me it seems like you have not spent enough quality time in your Nike Frees. If I were you I would stop using your VFFs immediately and focus on bringing down the inflammation using a combination of RICE (rest, ice, compression, elevation) and strengthening exercises for the arches and calf muscles.

    Furthermore, you could very well be on track to developing a metatarsal stress fracture so continue running with caution. I fully endorse VFF and minimalist shoes, but the transition from a traditional foam-cushioned outsole to a shoe with a 0-5mm heel drop should take a full 12-months to ensure proper strength and running form has been achieved.

    Hope this helps.

    Jeffery Zahavich, MSc Kinesiology, CSEP-Certified Exercise Physiologist

  4. Steve says:

    Hi

    I’m comming at this from a totally different perspective. In March this year I got pretty badly injured whilst training for Comrades Ultra Marathon. I was diagnosed with severe plantar faciitis in both feet.

    It has been a long lay off and I now just started running again. All I’m doing is very short distances – about 2km a few times a week. This is completely barefoot on a mixture of soft trail and grass.

    My question is can this slow build up to full fitness be done safely whilst barefoot?

  5. Francois L'Abbe says:

    Hi,

    I am now at 33 minutes, two times a week with my Lunas and about the half of that time is barefoot, progressing at about 1 or 2 min/week. I also do the achilles strenghtening exercises from Blaise Dubois website “La Clinique du Coureur” and I think it really helps.

    I’ve found a cheap solution for my transitional shoes in cutting 10 mm off the heels of my olds Brooks Defyance and have now a 20-18 heel-to-toe profile and a not-too-bad transitional shoe.

    An enthousiast reader of the Natural Running Center

    Francois L’Abbe
    Quebec city, Canada

    • MarkC says:

      Francois,

      I cut my Brooks Burn and T5 racers to be level in 2007-2008 before true zero drop shoes were produced.

      you can cobble many shoes. many are still too soft though.

      Mark

  6. Getting back to Dominic’e dilemma about aching calves and metatarsals: From those symptoms, it sounds like you may be running up on your forefoot without letting your heel touch. Doing this would put lots of undue pressure on the muscles of your lower legs and your feet as he describes. The midfoot strike recommended for naturalistic running involves allowing the heel to touch lightly behind the forefoot so the body weight isn’t being totally supported by the foot and calf muscles with each landing. I’ve met a couple of people now that have gotten stress fractures in their feet moving to minimalist shoes. When I asked them if they were running on their toes (which I suspected), they said they thought that’s what they were supposed to do. The problem is that people can buy their shoes from places that provide no guidance or education on how to use them (certainly not a condition unique to the shoe business). I obviously haven’t seen Dominic run, but his symptoms sound consistent with that problem.

    • MarkC says:

      Well put Mark…running on the ball of foot is “sprinting”. full foot settles down to load the springs for recoil. a relaxed passive motion.

      Dr. Mark

  7. SF Jackson says:

    The reply to J. Galloway’s opinion of barefoot trends addressed one category of Galloway’s criticism — injuries due to inadequate transition time, lack of technique, etc — but doesn’t say much on the subject of catastrophic trauma due to stepping on something large and sharp.

    These are two very different classes of injury: training/technique-related injury is probably close to 100% preventable IF people exercise the necessary patience, self-concern, etc.

    But catastrophic injury due to stepping on something like a large piece of glass, a nail pointing upward from some firm surface, etc., is something else again. Certainly that risk can be greatly *reduced* by the techniques of running cautiously and using eyes to scan every the landing point of every single footfall — but it seems to me there’s a point of attention-fatigue in that scanning activity, especially in the latter half of long runs, that renders it perhaps just a matter of time before someone doesn’t see a serious hazard, and lands full force right on it.

    What are others’ experiences with this, either personal, or in a professional capacity (such as doctors, rehabilitative therapists, etc?) How many experienced, attentive barefoot runners suffer deep puncture wounds or catastrophic cuts to the muscles or tendons of the foot, from running onto something heinous?

    I am as cautious as can be in my barefooting but this risk does remain in the back of my mind, and though it is fairly low, the consequences of it happening could be high. I think this is what does tend to nudge barefoot running slightly into the “extreme sport” category. (Like skydiving, say — totally fine for hundreds or thousands of jumps — until that one time, darn it, when neither parachute works as designed. Ouch!)

    Background on my commentary: I’m a barefoot runner myself, started in March 2011 and am still in the transition phase. I can comfortably run (now) about 8 miles at an 8 or 9 minute pace on asphalt, concrete, or dirt path.

    4 or 5 years ago I used to run in New Balance running shoes and had typical knee issues and excessive tiredness from bad running form. Since converting to barefoot I’ve comfortably doubled my distance endurance while having essentially none of the joint pain I had formerly. I am a 100% convert myself; the only thing that stops me from joining the barefoot-evangelism movement is that small risk of a very serious trauma from a piece of glass, nail, etc. I’d not want to be responsible for someone elses’ suffering an injury like that, even if it was due to their own lack of attention, excessive enthusiasm, etc.

    • MarkC says:

      SF,

      thanks for thoughtful post. the puncture injuries are highly overblown. i’ve not seen them or had one myself in well over 1000 barefoot road miles. think of kids playing all summer barefoot..how many of them suffer these feared injuries? more get carpal tunnel from video games these days. keep up the barefootin’ and keep up to date on your tetanus shot too :)

      Dr. Mark

    • Patrick says:

      About the nail issue; i’ve gotten a nail through my asic running shoes before that pierced by foot. Luckily it was a roof tack, so it only went into my foot a few milimeters. It bled but wasn’t as bad as it could be. So traditional running shoes don’t offer as much protection as you think.

  8. Kurousagi says:

    I have been a VFF convert as soon as I saw my brother wear a pair. I had been wearing Vans skate shoes prior, for everything, with an almost no heel drop already, very short transitional time for me. As for OP I have some tenderness in my feet some mornings after being hard on my feet, walking flat on my heels when tired, or just plain putting too much stress on them when carrying things, but that usually is resolved after 5 minutes or so.
    I just stretch and flex my feet daily and it seems to be a non issue. I am not a runner by any standard. I used to run long distance when I was younger in traditional shoes, but I hated them. My parents took me to a podiatrist and they put me in insoles, talk about feet pain, weak arches, and feet. I used to get cramps in my feet from curling my toes. I made the decision to stop wearing the insoles when I felt they were causing me more pain then walking barefoot. It took some time but my feet adjusted, and I am all the happier for it.
    I wear my VFFs practically 24/7, much to the chagrin of my ex-wife. She hates the look and says so every time she sees them, twice as much if someone compliments me on them or positively inquires. I have stepped on a few things, a small nail, a thorn or two, and a staple, yes I have my tetanus shot. I find that other than the nail, I step light enough to avoid any real damage past a first layer break. The nail was a blind step through some precarious stuff to begin with and it was only about a 1/4 of an inch puncture, again because of how aware I am of my feet I felt it almost instantaneously.
    Is it impossible to hurt your feet? No, but I find that as opposed to most people running in more traditional shoes, running blind of their feet, any danger is going to be minimal at best.
    P.S. If you want to learn how to be a light foot, walk/run on gravel like I did when I was a kid/still do today.

  9. Rick says:

    My original goal was simply to rid myself of the orthotics I wore for over 30 years. That accomplished, my next goal is to build up to running a marathon in minimalist transition shoes, eg Nike Frees or Saucony Kinvaras. Meanwhile, I have started changing my everyday walking shoes to more minimalist versions; flatter, more flexible, and lighter. I’ll be happy if I can occasionally run a few barefoot miles too, but at this point, I don’t feel the need to go any further in the minimalist direction, though I love the whole idea.

    • MarkC says:

      Rick,

      you got it! walk all day in the skinny shoes and you’ll get strong and move with elasticilty. the shift to a minimal marathon is months and maybe year plus.

      think of Milo the Wrestler who owned a calf at birth. he picked it up every day….so guess what, in a year he picked up a cow.

      Dr. Mark

  10. Mike S. says:

    I wonder how many of the people presenting with foot injuries from barefoot running are new to running, tried to do too much with a too short transition, and would have had similar or worse problems with mainstream running shoes.

    The last few times I tried to start a running exercise program I stopped due to foot, ankle, and knee pain. I was using regular running shoes each time. I gave up on the idea entirely ten years ago, and only renewed my interest when I encountered minimalist running.

    I don’t have any statistics. But my suspicion is that some significant portion of the patients going to podiatrists due to minimalist running would have gotten injured on any running program. They became enthusiastic because of the concepts here and in Born to Run and the hope (maybe renewed hope) that this attempt to make running a routine would be successful. Then they pushed too hard too fast.

    Now I need to figure out how to convince my Dad to try this. He loves running and used to cover more than 30 miles per week, but had to stop because of joint injuries. Maybe this is his way back in.


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