Categorized | Injury

You Can Run a Marathon with Flat Feet, No Orthotics, and Minimalist Shoes — and without Injury

Posted on 27 May 2012

by Dr. Nick Campitelli.

Julie is all smiles, and rightly so. She just finished her first marathon --and pain-free.

The debate continues amongst medical professionals, podiatrists, runners, and the media as to “Should we be running with supportive shoes with motion control?” For years the norm has been to support the arch with a custom or rigid orthotic to prevent overuse injury. This device was added to a cushioned running shoe that was designed to control or stop motion to joints of the foot.

The question has arisen lately, “Does the foot really need all this support?”
The short answer is no.

Meet Julie — a 35-year old runner with flat feet and valgus knees that was being treated with custom orthotics and ASICS motion-control shoes. She has been running this way for over 10 years and had chronic low back pain and occasionally knee pain. The symptoms were attributed to running with her biomechanical deformity which she was told she will eventually lead to more severe problems to her knees.

Julie came to my office, looking for help. I am pleased to report that Julie became yet another of the many patients, or rather “success story,” whom I have transitioned into minimalist running shoes while abandoning their motion-control shoes and custom orthotics.

Six months ago, Julie ditched the orthotics and gradually transitioned out of her motion-control shoes into a minimalist shoe. Our game plan was to gradually reduce the time in her orthotics with each run until she was running all her runs without them. She began following my protocol of starting her runs in  minimalist shoes and then switching back to her traditional running shoes for the remaining run. This was done incrementally using a 10% increase in duration in the minimalist shoes. At the same time, she began a 14-week Hal Higdon beginner marathon training program.

Julie's feet.

The results?

Initially, there was the typical transitioning soreness to her calf muscles and feet which eventually went away, She began running in the New Balance Minimus trail shoe with a 4mm drop and eventually switched to the new Minimus Zero, and then select runs in Vibram FiveFingers, the Bikila model. After three months of running, her knee pain resolved. She no longer had low back pain and even stopped stretching her hamstrings daily as it was no longer necessary because her back pain was gone.

Julie's shoes.

And her first marathon? She completed the 26.2- mile race in 4:17:18 — and in 83-degree weather!. No foot pain, no shin pain, no knee pain, no back pain. Most importantly, with no artificial support. How great is that?

Dr. Nick Campitelli is a board-certified podiatrist, specializing in foot and ankle surgery. He is also on the NRC Advisory Board. This essay originally appeared here.

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31 Responses to “You Can Run a Marathon with Flat Feet, No Orthotics, and Minimalist Shoes — and without Injury”

  1. David Goulette says:

    Well done Julie! And good work Dr. Campitelli. We need more stories like this.

  2. Alex says:

    I love stories like this, for obvious reasons, and this one especially, for somewhat selfish reasons. That picture of Julie’s feet may as well be mine, and similarly, minimalist running has been nearly miraculous. I’ve also done a marathon, and two trail ultras as well, in zero drop shoes, and can happily say I’ve not suffered any injuries. But of course, this isn’t about me as much as it is Julie, and it isn’t wholly about her either. This is about what’s possible, embracing that while rejecting the limits others ascribe to you.

  3. MarkC says:

    Nick,

    thank you for helping Julie and for describing how she learned.

    this story is perfect example of smart retraining of the human spring…this is what it is all about. you cannot force or hurry this. for many the progression of weakening spring has been years.

    Dr. James Stoxen has shared a lot on this. The paradigm below is adapted from his thoughts.

    You Can Reverse the Trend By Gradually Reducing Your Shoes and Re-Training the Spring

    • I am Born Barefoot
    • I run fast barefoot- i am a child
    • I jump and bound high and far
    • I run in thin and flexible shoes
    • I run in supportive shoes
    • I run with orthotics and supportive shoes
    • I can’t run so I walk with orthotics and supportive shoes
    • I walk with orthotics and supportive shoes and a cane
    • I walk with orthotics and supportive shoes and a walker
    We know where it goes from here

    Mark

  4. Rima says:

    This is remarkable…and very encouraging!!

  5. James says:

    Thanks Dr. Campitelli, it’s nice to see a podiatrist who supports the move away from highly engineered shoes. I overpronate like Julie and I’m almost certain the foot and knee pain I’ve had running in the past was caused by wearing stability shoes and orthotics. This is very inspiring.

  6. Lisa says:

    I also transitioned from orthotics and cushioned running shoes to NB road minimus over a 3 month period starting in December. I did a lot of feet strengthening exercises and a gradual entry into the minimus shoes with a focus on increasing my cadence and midfoot striking. After suffering from years of off and on shin pain, knee pain from previous menisectomies, I have to say I feel great! No shin pain, my muscles don’t even feel like I need to stretch after a 15 km or more run. I did get a bit of an Achilles tendon problem when I trained and ran a 1/2 marathon, but it is not bothering me on shorter runs. If you are patient enough to transition gradually, you’ll be converted! I switched my kids (age 11 and 7) to minimalist Merrell shoes too and they both love them! Seeing as my son is extremely flat footed (much like the photo), I am glad to report he is NOT complaining of foot pain like he used to and feels his feet are stronger. Glad to see that flat feet don’t have to limit you!

  7. Paul says:

    Hi Dr Campitelli,

    I was wondering if you had any advice on a rather unusual situation? My girlfriend was an accomplished club runner for many years and then unfortunately was diagnosed with Rheumatoid arthritis. Quickly this stopped her in her tracks and she could barely walk for many months. However, due to the miracle of modern science (a combination of old and new drugs) she has almost complete remission, suffering only from fatigue. This has meant that she now can run again (crazy I know!), but because her immune system appears to have ceased to attack the joints the disease is held in stasis. She recently completed a trail 10k in under 48 mins, astonishing when I think about the situation she found her self in 2 years ago.
    My question is this, she ran for many years without a single injury and she naturally has very good form. I recently recommended she bought a pair of minimalist shoes which she has and she runs in them with no problem.
    We recently spoke to a very medically informed running coach about this, re whether she should look to be coached to maintain perfect form. He suggested there is no harm. However, he mentioned that ‘hard’ running suppresses the immune system and recommended a middle ground area of exercise so the immune system is not supressed.
    Now these are not questions you can ask your doctor when you have RA, they tell you ‘DO NOT RUN!!!’ but you guys may have a different perspective. When you are in remission essentially the drugs are designed to suppress your immune system and RA is marked by an OVER-ACTIVE immune system, so suppression may not be a bad thing.
    As she now has normal reading for all the blood results and no wear and tear on her joints so far, how should assess this based on the medical facts?
    Complex question I know!

    • MarkC says:

      Paul,
      a great question in which there are no clinical trials so all we can do is go to basic science. healthy aerobic activity helps patients with any medical condition. the 2008 Guidelines of Exercise make this clear. there is a 600 page report you can download from here http://www.health.gov/paguidelines/

      My recomendation for all runners, whether they have a medical condtion or not, is “Train Don’t Strain”. Arthur Lydiard used this approach when training cardiac patients bask to health in the 60′s when the US doctors advised “rest”. Rest helps nothing and the longer you rest the quicker you deteriorate. Too much stress does the opposite too.

      So become a body whisperer. She will race better too with this approach. my mantra is that every run i finish should feel as if i could do it again.

      congrats to her on the active approach to restoring health.

      Mark

  8. Paul says:

    Thanks for the kind words Dr,

    I think that is a sound approach and listening to your body appears to be one of the sacred tenants to longevity in sport which is often overlooked and certainly undervalued.

    best,

  9. katie says:

    I suffer with planter fascia for over two years now, went thru it all physical therapy, shots, orthodics, surgery on both feet. The surgery failed. I have been putting up with it since then. they are really starting to be very very painful. I also wear a heavy motion control and stability shoe. Went to a new shoe place that gave me this website to try and help me strengthen my feet. He put me in an neutral running shoe and put orthodics in those and said maybe i can work torward the new balance minamalist shoe. I need some advice on what i should be doing and if thats right. another shoe store put me in a stabil shoe one month ago that wasnt as strigent as my older pair but those did nothing but hurt my feet more the last store I went to that put me in the nuetral shoe said he didnt feel that shoe was right for me. my physical therapt rec an orthodic plus motion control-stability shoe. so confused!!!!

    • NickB says:

      I too suffer from planter fascia and rather than going down the normal route of Ibuprofen, cortisone orthotics etc I am embarking on the barefoot principles and working on strengthening my feet and legs. My logic is that all of the other treatments are about the symptoms but back to basics and barefoot if a fundamental shift – while counter intuitive does to me feel like the “right answer”.

  10. Asle says:

    Thanks for a good story similar to mine. I transitioned to minimal shoes and now run mostly in Leming shoes. Yes, they are great for running and walking. I have probably used 2 years slowly running more in Vibrams, Merrell Trail Gloves and eventually my favorite shoe the Lemings because of the wide toe box. I use The “Correct Toes” that have done wonders to my arches. My arches are really good now. A year and a half ago I could show you a really flat foot but now it looks great and I have no problems running 15km in my Leming shoes. But I also have flat forefeet and can not run far barefoot or without metatarsal pads in my shoes. I wonder if flat forefeet can be “cured” or if it is possible to train my forefeet so I can run barefoot or just run without pain in my forefeet which I always have. I live in Norway and would be happy if I could buy an online session with Marc or Dr. Campitelli. Is this possible?

  11. HyperV says:

    This is just fantastic => “And her first marathon? She completed the 26.2- mile race in 4:17:18 — and in 83-degree weather!. No foot pain, no shin pain, no knee pain, no back pain”

    Julie’s story is such a great inspiration for us new barefoot runners.

  12. Trudy says:

    I was wearing Nike Free shoes for the past few years. I was experiencing shin pain (shoes were worn out) and pain and alignment issues in my lower back. Chiropractor suggested a podiatrist. I had an assessment done last December and was told I am flat footed and a severe overpronator. I purchased custom orthotics and neutral shoes…on my 3rd pair of shoes trying to find a way to run pain free. The podiatrist has tried many adjustments on the orthotics. My left foot hurts the most as I toe in on that foot and then roll outward putting pressure on my outer toes. I’m at a loss…I was hoping to do my first full marathon next year. I’ve always been drawn to minimalist shoes. Would they be a possibility?

  13. Andy Davies says:

    I have worn orthotics in my shoes since I was about 17. Before having them I used to walk to college (about 1.5 miles) and my legs would ache all over a really dull annoying ache.

    Since walking with the orthotics the aches vanished….

    However I gave running a shot with the orthotics and it was almost the opposite, knees ankles shins u name it were sore after running.

    I’m now 31 so do I ditch the orthotics completely, and see how I go, or try running without them and walking with them?

    Thanks,

    Andy

  14. bot says:

    hi dr. nick can i have your opinion and recommendation? way back 2-3 years i purchased a shoe which is adidas uraha 2. its a neutral type and i dont care that time if it is a neutral, stability etc. its just lately about 3months ago that i became aware of different shoe types. so i went to a store here in our country. the Philippines which offers a gait analysis service and turned out that i am from the slight stability category and look out for a guidance shoes that offer a light stability feature which is the brooks ravenna 3. now after running with it for few months iv noticed that my knee sometimes felt little knee pain as well as plantar faciitis. is this because of the shoe or whatin my adidas i’ve been runnning with it for many years ang the only injury i’ve encountered is shin splints because of over training ^^, would it be a smart move to go back again to neutral?thanks in advance.

  15. Joshua says:

    I just want to say thank you for this.

    My whole life I have been flat footed and my whole life I was told I would have problems and be forced to wear perscription shoes/and or orthotics, and I have. I am now 23 and have worked in shipping/receivig for the past 5years. This type of job requires you to stand for 8hrs a day on your feet with a 1hr lunch to rest.

    I have spent close to $1,000 in orthotics and shoes over those 5 years and I have always had back and foot pain at about the 2-3hr mark and I always pressed through it.

    After reading this I figured what is $100 more to try a pair on NB Minimus shoes, so I bought me a pair amd worked up to them slowly until I could wear them for 8hrs.

    I can thankfully praise the lord and give thanks to this doctor for the results I am having. Gone are my days of back and foot pain. I can now work an 8hr day and at the end of it just have mildly sore feet, about what any can expect from lifting 30-70lb boxes for 8hrs.

    This was a true blessing.

  16. Christian says:

    Hi Nick,

    After ready Julie’s story I felt that I could ask you a question. I am a regular gym goer and recently started on the Insanity Shaun T workout on DVD. What I have encountered is find the right trainers to work out with.

    Any advise?

  17. Joshua says:

    Wanted to let everyone know Belleville now has the first ever minimalist boot. They are in a 8″ military design, come in black, tan, and green but if you are like me and required to wear boots to work these give you that ability while still being a minimalist shoe. Best thig to ever happen to boots.

  18. Paolo says:

    Dear Nick and Julie,
    when I first read this post almost a year ago it really inspired me as I had been wearing orthotics for flat feet for most of my life. After a gradual transition that led me to rebuild my foot arches, finally last week I successfully ran my first marathon (a trail one) with my vibram fivefingers ( http://webrunus.blogspot.ch/2013/05/my-first-marathon.html)

    Everlasting gratitude to you!

  19. Tamara says:

    I just read this article and I have been wanting to make the switch. I have very flat/ wide feet/ and I have most of my problems with my ankles when I get into mileage over 12. What is a good shoe to start off transitioning. I now wear adrenaline. Thanks so much

  20. Bee says:

    Dear Dr Campitelli

    I have a 14-year-old son who is flat-footed (like Julie’s) and have problems finding appropriate shoes even for walking in. He even resorts to running bare-footed around our vicinity or in his crocs which he says feels more comfortable than shoes. Walking or standing for prolonged period will result in lower leg and calf pains.
    Bought him a pair of Vibram five fingers but that makes his toes sore.
    I am very inspired by Julie’s story and thought of getting him a pair of NB minimalist. However, the above article is about a year old and NB may now have better or improved models. Would appreciate if you could recommend a pair for him to try on – he is very slim built, shoe size is UK 7.5 to 8. He loves running and we are trying out 5km and 10km runs taking place in August and December respectively. We hope he will be able to run his full marathon next year if everything goes well.

    Looking forward to your reply!

  21. Ian says:

    i too have a very FLAT AND WIDE FOOT
    i used a regular Fila running shoes for 10months

    i weigh 253lbs before i started running
    and now after 10 months i now weigh 184lbs

    i ignored and endured so much pain running everyday thinking that the pain will go away in time
    i run 8-10k everyday and i thought that the pain was just because of the weight but when i did some research i found out that my extremely flat foot is the reason why its hurting really bad

    although the pain became lighter i still do feel some pain
    and i was thinking that i should giveup my running

    but i do enjoy running and somehow fell inlove with running

    was looking for a good shoes for my foot
    just want to ask should i go for motion control or what?

  22. Asle Benoni says:

    Hi,
    No one seems to have an answer to my question about flat forefeet. I have no problems with my plantar fascia. The problem is my forefeet. Since changing to forefoot landing I have got all sorts of problems. Sesamoditis (I did not know about it before I got it myself), inflammation behind my second metatarsals, swelling in my forefeet etc. My specialist says that it is not possible to fix flat forefeet with any kind of training. It is nature that has given me a bad and weak arch in my forefeet. I also have Mortons Toe. I can not use metatarsal pads as these hurt under even more.

    Would like to hear if Mark or anyone has any experience with this!

    • MarkC says:

      Asle,
      really tough without seeing your foot. many have toes in extension from footwear and this creates an abnormal forefoot. where do you live? need someone who really understands the foot and running to look at you.

      thanks for visiting the site
      Mark

  23. Paul says:

    Interesting read ive been suffering from Shinsplits for on and off 2 years now I have very flat feet, its refreshing that you don’t recommend orthotics im sure its just a cash earner for some. What would you recommend for a male flat footed runner ive almost given up on running.

  24. Dave says:

    Great article. However I haven’t had the best luck with the transition. I wore orthotics for about 15 years and I decided a year ago to make the transition. I’m not a runner but I was active and liked to do long walks. I dropped to a merrell mixmaster 2 and I was doing ok in them but I developed ankle issues that really have hurt everything. I can’t log mileage over a 2 mile walk without paying for it later. My foot is a flexible flat foot and displays classic mortons foot on both. Not really sure what to do now as it seems I just keep irritating the tendons on the outside of my ankle. :(

  25. Anna says:

    Does anyone have any scholarly articles on the subject?

    I have a similar story and am a huge advocate of minimals shoes and training barefoot (no shoes) with calisthenic and body weight exercises to correct problems that are related to flat feet.

    My new doctor dismisses this completely and keeps trying to shove orthotics into my shoes (i’ve tried them for years with no positive results).


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