Q: In the transition to minimalist footwear, am I going to get hurt? And how long does this transition take?
Jay Dicharry responds:
There has been a lot of interest lately in the transition to minimal footwear. Am I going to get hurt? How long does this transition take? Is this really better for me? Will my old shoes take it personally? Last year at this time, there were 6 minimalists shoes on the market. This year there are 64. It’s a hot market, and folks are taking notice. While shoes are nice to talk about, let’s not forget that it’s the runner in the shoe that plays an active role in this equation. Shoes don’t run by themselves.
The recent article by Giuliani et. al. ( Giuliani J, Masini B, Alitz C, Owens BD. “Barefoot-simulating Footwear Associated With Metatarsal Stress Injury in 2 Runners,” Orthopedics. 2011 July) has raised some concerns.They highlight two cases of stress fractures in two different runners who transition to minimal footwear. The switch to minimal footwear can be dramatic. You get more “feel” since the squishy midsole is reduced or gone. You get a lower differential from your rear foot to your forefoot. These two factors change: a) the position of the foot (heel isn’t higher than the forefoot in full contact) and; b) the demand of the runner to stabilize the foot inside the shoe. In short, with less “stuff” in between you and the ground, you need your body to do a bit more, and will be forced to accommodate to a bit more as well.
Ever hear about the experiment with pre-school kids with the marshmallow? Researchers put a kid in a room with one marshmallow on the table and tell him/her that they can eat it and they’ll get another one. But, if they don’t eat it, they’ll get two marshmallows later. The tester walks out of the room and the kids go into panic mode when sitting in front of this stellar, delicious marshmallow. Most eat the single marshmallow for instant gratification. They fail to see the merits of waiting patiently for a better result.
What in the world do toddlers and marshmallows have to do with running shoes? A lot. The switch to minimal footwear can pay off in the long run, but you need ensure you’ve got what it takes for a successful transition. Obviously any time you make a change to your body, there is an adaptation period that needs to occur. A lot of “experts” say that it will take six months to a year to fully transition to a minimal shoe. I’d like to think that this is overly cautious, and like to discuss why using the anatomy. Here at our Lab, we’ve found great success using the following three criteria for runners looking to run with “less”.
1. Mobility: Traditional running shoes have about a 10-13mm drop from the heel to the forefoot. This creates a “rocker” effect in the shoe. Take a look at a shoe from the side and you’ll see that the curve from the ball of the foot to the tip of the toe rises up. Since your foot is flat, you need to ensure that you have enough mobility (called dorsiflexion) of the big toe to allow the foot to roll over. Additionally, since the heel is higher in a traditional running shoe (think a small high heel) the heel chords are used to operating in a shortened position. You need to ensure that you’ve got the mobility needed to allow the heel chords to operate form their slightly lengthened position. So what to you test?
◦ Ankle mobility (heel chords) – you need to be able to dorsiflex (cock the foot up towards the shin) about 25 degrees. Lack of mobility here means you’ll need to stretch the calf and Achilles.
◦ Plantar facsia mobility – with the ankle in about 5 degrees of dorsiflexion, you need to have 30 degrees of dorsiflexion at the big toe. If you don’t have this, you can’t roll over the toes, and will be forced to spin off of the forefoot.
2. Single-leg Standing Balance: normal balance has been identified as standing on single leg for 30 seconds with a still upper body and full foot contact. Since the midstance phase of running is essentially a single leg squat, it is essential that the runner is able to maintain the foot in contact. A triangle between the inside ball of the foot (1st MTP), end of the big toe (distal phalanx of the 1st ray), and outside ball of the foot (5th MTP) should be seen. When in single leg stance, the muscles in the foot need to be “pro-active” not “re-active”. If you are wobbling your foot back and forth when standing on one foot, you’ve got some room to improve your “proprioception” – or sense of where and what you’re your foot is doing during contact. The most successful way to improve single leg balance is to perform it frequently (15-20 times a day) for small doses (30 seconds each).
3. Ability to Isolate the Flexor Hallucis Brevis: a key factor that distinguishes humans from primates is our medial longitudinal arch. This arch is actively stabilized by the flexor hallicus brevius (FHB). While standing, try to drive the big toe (1st MTP) into the ground (plantar flexion) while slightly elevating (dorsiflexing) the lesser toes. Make sure not to roll the ankle in or out. This test enables screening of muscles inside the foot that stabilize the arch. The FHB can be easily distinguished from the longus (FHL), as the FHL crosses another joint in your big toe (1st IP joint), resulting in your big toe curling. Spend some time getting to know your foot. Aim to drive the big toe down while lifting the little toes (without curling the big toe!), and lift the big toe up while driving the little toes down. It’s the best way to work on coordination of muscles that actively stabilize the foot in stance. It’s your foot – control it! If you can do this, it’s a sign that you can keep the rear foot stable on the forefoot when the body sees the greatest amount of pronation (which is just slightly after midstance and AFTER the heel is off of the ground by the way.)1 Midstance is when forces are highest throughout the body- about 2.5 times your body weight. You need the internal strength to be able to respond to these forces to keep things in alignment.
***
When your foot “works” it can actively stabilize the transfer of forces through the foot. If you don’t pass these three tests, no worry -simply get to work on improving your limitations. Pay a visit to your local PT if you need help with specific exercises and stretches to improve.
If you lack mobility, research shows it takes 10 to 12 weeks to gain significant improvements. So stretching for two weeks likely won’t be enough for most folks. Improving tissue length can take some time. If your limitations are in the balance aspect, you’ll be amazed how quickly this improves if you simply “practice practice practice. “Typically, about two weeks yields a significant improvement. Finally, strength gains take about 6-8 weeks to achieve. So if you really have trouble isolating your foot muscles, this could take a bit to get them stronger – but you can always improve the strength of your muscles!
Passing these three tests doesn’t mean that you should go run a marathon in your new minimal shoes on day one, but we’ve seen that folks who master these have little to no problem making the transition. I’ll note here that these tests are not new in my mind. I’d like all runners – even those who run in traditional shoes – to pass these tests. Its that when the “stuff” under your foot is less, these traits are that much more important.
So invest some time to improve your foot. Because it’s always better to be able to eat two marshmallows instead of one! Shoes make a difference, but it’s the runner in the shoe that you’ve got control over.
This essay originally appeared on Jay’s blog. Go here.
Hello,
Please , just leave me a reply.
JG
Agree, Jay, that each person is different.
In my general practice, I teach (for 90% of my patients) a transition of
* 1 month for light trainers
* 3 months for very flat racers
* 6 months for five fingers
* 12 months for barefoot
You can decrease this time if you are a forefoot striker
You need to be more gradual if you have calf/Achilles tendon/plantar fascia/metatarsal problem
You need to be less gradual if you have a knee/hip/low back problem
You need to be drastic in your transition if you have a anterior compartment syndrome
Blaise
Blaise,
I am a lifetime runner and I had surgery for chronic anterior compartment syndrome in college. I am now 39 and considering a transition to minimalist running. I am interested in more information about your comment that the transition needs to be drastic if you have anterior compartment syndrome. What do you consider drastic? Do you have any suggestions for me in making a successful transition?
Thank you,
Brian T.
Brian,
you need to immediately change your loading pattern with this injury. take off shoes, land soft and quiet, and get a metronome and set cadence to at least 170.
Mark
Hi, Is barefoot running for everyone ? I am running on Vibram KSO for about a year now but keep going with injuries. I’ve started pretty slowly 2-3 minutes with my vibrams and took about 4 months to finish a 5k. Then all my runs were on Vibrams. No more pain to my back (have 2 hernia) but since then I’m having ‘Periostitis’ and now a ‘fracture’ to my left foot. The doctor says it’s a fracture to the Metatarse, the third one I think. After my perisotitis I went back to training but very slowly … Runing 1 minute, walking one minute, then 2 minutes, then 3 minutes and so on, It’s a 12 weeks program to get back to a 20 minutes straight run.
So I am wondering if I should keep going running barefoot ?
Daniele :0)
First, get one thing straight…running in VFFs or any type of shoe or sandal is not barefoot running. Barefoot running is running barefoot (nothing between you and the ground). Whether you intend to run completely unshod or in VFFs, you must master the technique of barefoot running first and THEN transition into VFFs. If you have a metatarsal stress fracture it is because your technique is wrong and you are striking the ground too hard with your forefoot. It is really a forefoot/midfoot landing as opposed to a strike. Read “Barefoot Running Step by Step” by Ken Bob Saxton. This will clarify many things and get you off on the right foot (pun intended).
http://www.amazon.com/Barefoot-Running-Step-Shoeless-Technique/dp/1592334652/ref=sr_1_sc_1?ie=UTF8&qid=1318994764&sr=8-1-spell
Thanks Jay,
We do this at our running shoe store Two Rivers Treads and give a handout on progression. Have not had the runners coming back injured and most get it. The test i think is a nice governor to reinforce the gradual transition. For those with hallux valgus like myself a correction called Correct Toes is a miracle. I wear them running barefoot and in shoes. http://trtreads.org/Chapter_6.html
All the best to healthier running
Mark Cucuzzella MD
Thanks for the article, it is very informative, however i am trying to transition to some saucony kinvara and then at some point would like to move to my merrell trail gloves which I wear for everyday use for now. I have good flexibility in my toes and achilles and can do all these tests that are mentioned. i have been working on the transition for about 2 1/2 months now and am getting some soreness at the base of my toes on the bottom of the foot and on my big toe on my right foot. Is this something that is normal? any help would be greatly appreciated
Keith,
Thanks for the note. really tough to tell without seeing you. you may have late stage pronation which can be putting pressure on your big toe. sometimes too soft a shoe can make your toes work too. Try the Merrells and maybe do some short distances of true barefoot.
Mark
Thanks a million for this article! I’ve been transitioning to the Altra zero drop Intuitions and I really love them. But – over the past 4-6 weeks I’ve had pain in my FHL to varying degrees in both feet. Funny thing is that the pain switches between feet. I’ll have it in my right foot for a couple of weeks then my left, then back to my right. Today I started a run with soreness in my left foot and when I got home the left was “cured” and the right hurt! The article gave me great insight on this and the exercises should help a lot.
I run with a cushioned shoe and have had injuries. I also have scoliosis and have to wear a lift in my left shoe or my left hip lowers. Can i use natural running techniques with a traditional (i.e. cushioned) shoe? If not should i run w/o the lift with natural running techniques? OR should i transition to a minimalist shoe and use the lift?
Richard these are great questions and without seeing you do not want to make specific suggestions.
A few keyconcepts though. For running the leg length difference matters little to none…you land on one leg. Standing and walking it makes a difference. So you are best to run with shoes where you can feel the ground and stabilize well and equally.
You can try torun “natural” with a traditional shoe but it is difficult as the heel gets in the way and puts your ankle into plantar flexion…so i suggest if you want to run midfoot/forefoot then get a level shoe.
Find a good Athletic Trainer or PT to assess your movement patterns.
Mark
Hello,
Thanks for the article and great website. I have began running about 6 months ago and have been plagued by injuries. First was my right hip. I was training for a 5k and found that my pace was too fast and my foream was poor (overstriding and heel strikning). I took a month off from running and did some research. I read Born to Run by McDougal, then The Big Book on Endurance Racing by Maffetone and finally ChiRunning by Dreyer. I’ve tried to put their suggests to into my running.
I stopped wearing my overcushioned Ascics GT running shoes and switched to Merrel Trail gloves. I was aware of the risk of transitioning too quickly and the risk for stress fractures so I simply walked in them for 2 weeks. Then I starting running 3 miles at a very slow pace. I focussed on my form, trying to land on my forefoot, picking up my heals, leaning with my ankles. I trained for a 10K and completed it. Hip pain resolved.
However now my plantar fasciitis has returned. Arrrg. So annoying. Do you think I transitioned too quickly? Should I have gone to a neutral shoe first like Nike Frees? I’ve watched the sock docs video on plantar fasciitis and have been doing the scruntching a towel under your toes exercise every night as well as massaging my soleus. I’ve also iced my plantar fascia. I really want this problem to get better before I resume my running. Any suggestions would be much appreicated.
thanks
– Hung
Hung,
Congrats on taking up the challenge to be fully well. Yes the transition is gradual though. Think every mile is 1200 reps with 3 times your body weight. See most recent home page post.
http://naturalrunningcenter.com/2011/12/15/stabilizing-mid-stance-essential-task-healthy-running/
You are correcting a lot but there are always areas of weakness. do some more mobility work and walk in the barefoot style shoes all day…this is the strengthening. you will heal the PF forever if you recreate a natural strong foot.
Keep at it.
Mark
Hung, it might not be the shoes and since you’ve been in the Trail Gloves for some time now I’d just stay in them – UNLESS you feel better in a different minimalist type shoe. Some shoes just don’t work for certain people. But, as I write about here, http://sock-doc.com/2011/06/running-shoes-prescription/, there’s a lot more to it than the shoes when it comes to injuries, especially PF. BTW – you say you watched my video on PF but I don’t discuss massaging the soleus (but actually the tib posterior) and I don’t recommend icing it either.
Hi Dr. Mark,
We met briefly at the NY Barefoot Run and you had given me some good advice on transitioning to BF running. I have however been unable to continue running due to a nagging case of PF. When I met you at the NY BF event, I was recovering from PF in my right foot. It took a month of targeted exercises like stretching and strength training to make the right foot feel better. Thereafter, I slowly started on a transition regimen; first couple of weeks I walked BF as much as I could. Gradually I started running small distances (e.g. 0.5 miles) followed by rest. All this while I was cross training (weights, yoga, biking etc) to stay active. Things seemed to be progressing well till I started noticing a tearing sensation in the arch of my left foot especially when I lifted off. It wasn’t painful but definitely bothersome and continues to this day.
I visited an orthopedic specialist who diagnosed PF again and recommended stopping any kind of BF activity. I was also told that I am flat footed and overpronate so I would need arch support anytime I’d like to get back to running. This seems like a circular logic to me since I was running in motion control shoes with over the counter orthotics prior to coming down with PF.
I am really eager to get back to running and would greatly appreciate any help or guidance to get out of this injury cycle.
Thanks
PG
PG,
As the article states there are a lot of “chassis” issues related to a smooth transition to more natural running. You are moving and using muscles different. PF will go away and with proper rehab and if you get the foot strong and balanced like it was when you were a kid it will never come back.
Soem good deep massage in the PF while flexing and extending toes is helpful. It would be useful to see your feet as there are so many varieties of “flat feet” and most are completely normal and healthy.
Come visit us.
Mark
PG,
clipping another reply on a different thread from the Sock Doc which i agree with…this may help
I’m very anti-orthotics, as I discuss here, http://sock-doc.com/2011/09/unnecessary-orthotics/, and I don’t think you’ll ever have a normal gait if you remain in them. I also don’t think you’ll correct your injury if you stay in your orthotics. The pain in your foot may go away with them in, but the orthotics will cause enough gait dysfunction and muscle imbalances (further weakening your feet too) that you’ll eventually end up with another injury, sooner or later. Orthotics definitely don’t “maintain” an arch. They do, however, weaken your arch by trying to push up on the arch and support it. But to support any arch, especially one in your foot, you must support the both ends – your heel and your toes. Orthotics do not accomplish this.
It sounds like you have symptoms of plantar fasciitis, so my video on PF will hopefully help. Walking barefoot as much as you can now and doing the exercises and therapies I show in the video will help to strengthen the posterior tibialis muscle and support your arch, naturally. This will start to heal the foot. You should also make sure your street shoes are low-heel, not supportive, and flat too.
Can you overcome ANY tendonitis? Definitely.
Steve
ok – I admit it. I got too enthusiastic and didn’t transition gradually enough. I think I got a stress fracture on the outside of my left foot. Now what? I took a week off, then started back with 2 mile runs every other day. No pain during the run. Soreness later. Should I be mostly in my old shoes, and transition more gradually? Or should I take this low-mileage opportunity to go barefoot and only add mileage gradually?
Tomas,
yes exhuberance can set in with barefoot and minimalism. i have folks progress no more than a minute a day when returning from stress fracture. remember a mile is 1200 reps so even 2 miles is a significant stress when bone is being restressed.
foot strength and control are critical so lots of barefoot walking, single leg standing are important.
having your form assessed as well as “chassis” issues (strength/stbaility/mobility) really important to get at cause. often it is just a new stress but often there are other issues.
You will run pain free again…stay the course.
Mark
Hi Dr Mark! To get right to the point, I might have scoliosis in my spine. Would it be dangerous to my health to run, not nessessarily barefoot, but in VFF bikilas or in some sort of a minimalist shoe? I have worn my vibrams for a while now and at most my feet hurt after long distances or long periods of time on my feet never really my back, though. I’ve just recently been aware of an ache in my back and had X-rays earlier this week which provided me with the possible information of the scoliosis. I really enjoy everything about the shoes and the way they make me feel about 97% of the time- but the other 3% I feel like I’ve definitely over-exerted myself. should I stick with it and see what happens? should I go more slowly and lesser distances? Or should I stop entirely? Thank you!
Hi Dr Mark!
I’m becoming interested in barefoot/minimalistic running. As my only available shoes at the moment are my Saucony Hurricane 14 I’ve tried to run with them using the barefoot technique. Can this produce any kind of injury? The first time with this new “form” I run 6km (4’40″min/km) and felt great (faster and lighter than before), even the sore in my calfs after finishing was terrible. I’ve left one day rest and tomorrow will try again, although I’ll do less km.
Thank you!!
Vince,
go gradual and listen to any soreness. takes several months to “reset” everything again.
Mark
Thanks Dr Marck.
After a five days of calf soreness, it has completely disappeared, so now I try again to run with forefoot/middlefoot landing, but only very short distances, doing intervals. I can say thankfully that my shin splints and knee pains have gone and, even I am preparing for a fitness test, I have rediscovered de joy of run.
I know I cannot do 10K running session yet, but I feel that soon I’ll be running that distance again, but lighter, faster and enjoying it much more.
I cannot thank you enought for your divulgation task and information effort.
thanks Vince….you get it 🙂
Hello, I have neuroma in my left foot (the electric zinging that occurs in my 2nd and 3rd toes). All I’ve read is that orthotics are the only relief. I believe there must be another way and am hoping that it can be healed rather than something to live with. It seems that minimalist or barefoot running works for PF. Would it work for neuroma? Strong pressure on the ball of the foot seems to aggravate it and I’ve had to stop running because of it. Thanks in advance for your advice.
I found your video on neuroma. Thank you, it is helpful. I’ve begun barefoot running and will continue, I do feel a very slight improvement which is better than none. Thanks for a great site, so much information it takes awhile to go through it!
I use leather shoes with raised heel when at the office and I usually have them on for basically half of the day or 12 hours. Can I expect any benefit from using “barefoot” shoes which I will get to wear for much shorter period (about 8 hours a week). Won’t I end up getting more prone to injury, or would I end up having the barefoot gait even when wearing heel elevated shoes?
Thanks
Plantar fasciitis sufferer since jul-2012. I just got custom orthotics but i would love to get at the root cause of my problem. I am going to work on the tests you indicate in this article and try to maintain a log as to how i progress in each of these critical areas.
the drill to isolate the flexor hallusis brevis is a toughie as it seems that all of my toes want to come up. I know the idea is to try pushing the big toe into the ground while raising the other toes and reise the big to while forcing the others into the ground. If one were to either hold the big toe or the remaining toes down with your hand would that help one to transition to doing this exercise without the assist of a hand holding the toes down
it sems that a resistance band…the type the physical therapists use works well…just wrap it around the big toe or the remaining toes and hold the leg out straight and apply resistance against the band.