Plantar fasciitis is what I often refer to as a nuisance injury. It’s rarely painful enough to stop someone in their tracks but it can just keep hanging on and gradually worsening over time until it becomes debilitating. Plantar fasciitis (PF) is a unique injury in that it commonly affects young athletes but just as commonly affects older sedentary individuals and almost anyone in between. Studies show that 10-15% of the adult population in the U.S. will seek treatment for it at some point in their lives.

Reputable running retailers know that their customers rely on their expertise for help with foot or leg pain. While only licensed medical professionals can legally diagnose and treat medical conditions, those who work in running retail can certainly benefit from a better understanding of the anatomy, causes and treatment options of PF.

Most people take between 8,000- 10,000 steps each day just for everyday activities. Walkers take roughly 2,000 steps per mile while runners take 1,000- 1,500. For a number of reasons these steps can begin to overload the plantar fascia. Fortunately 80% of those Affected can resolve the condition once the causative factors have been identified and treatment initiated.Many times very simple treatments go a long way not only in resolving PF but also in preventing recurrence.More severe cases may require surgery but this is the exception rather than the rule.

Anatomy: The plantar fascia is a ligament that originates at the bottom of the calcaneus (heel bone) and extends to the bases of the phalangeal bones of the toes.Ligaments differ from tendons in a few important ways. Ligaments attach one bone to another and function as stabilizers. Tendons attach muscles to bone and function to provide movement. A ligament cannot be strengthened by exercising it like a muscle/tendon unit can. The plantar fascia becomes thicker and tighter as plantar fascia progresses to the point where it almost “bowstrings” out as the toes are pulled up towards the ankle.

Function: The plantar fascia is the most important non-muscular structure that supports and stabilizes the foot and arch. It does this through a process called the “windlass mechanism.” You can think of the windlass as a winch or a pulley system that helps raise The arch of the foot. This happens after initial foot strike while the heel is raising and weight is transferred to the forefoot during the propulsive phase of gait. As the heel rises and the toes bend upwards, the Plantar Fascia winds around the metatarsal heads (the bones at the ball of the foot) which act as a pulley. This tightens the fascia and assists the arch in rising. The rising arch is important because it brings pronation to an end and helps stabilize the foot for the power generating phase of the running stride. If the plantar fascia is subjected to excessive strain during this phase then it will become injured.

Symptoms: The most common complaint is heel pain especially after arising from bed or sitting. Pain usually improves gradually with walking only to return again.Runners often state that they have no pain during the workout. Variations of PF pain include pain that radiates into the arch, pain that worsens as the day progresses.PF does not cause ankle, lower leg or forefoot pain but because plantar fasciitis is so common, many individuals misdiagnose themselves with this condition. X-rays may show a bone spur but this does not often affect the prognosis or treatment.

Causative factors include: weight gain, worn or inappropriate footwear, increased activity, working on hard floors (warehouses, hospitals, schools). Those with a pronated foot type as well as high arched individuals may be more prone to PF than those with a neutral foot type. For some, there are no easily identifiable causative factors. There are a number of theories on why PF is so common. Some speculate that it is due to weaker foot muscles due to wearing shoes. Others look at the artificially hard and flat surfaces such as concrete and asphalt which are more common than ever before. Obesity is certainly a contributing factor for some.

Most people with foot pain will self-treat by purchasing either a softer shoe or a soft insole. I emphasize to my patients that the plantar fascia does not get injured when the heel hits the ground (for most people) but when the heel lifts and transfers weight to the forefoot. More cushioning in the shoes or insoles will not relieve tension on the fascia but a more supportive shoe and or insole can. Stability shoes and firm insoles can potentially relieve tension on the fascia by affecting pronation and/or supporting the arch.

Those suffering with PF often ask which shoe or insole is “best for plantar fasciitis?” Of course there is not one single magical shoe or insole that cures plantar fasciitis for all individuals but the same fitting principles that most shoe fitters follow are a good starting point. Insoles work great for those who are already in an appropriate shoe. I recommend insoles be selected based on comfort and foot type but explain that firm insoles relieve tension on the fascia better than cushioned insoles.

Stretching exercises that isolate the plantar fascia and Achilles tendon have been shown to help reduce pain of PF. I emphasize that the studies show that these need to be done 2-3 times per day until symptoms resolve. Icing and over-the-counter pain medications can help manage symptoms but rarely resolve PF by themselves.

If initial treatment does not resolve symptoms then physical therapy, night splints and cortisone injections may be warranted. Night splints are worn when sleeping and are designed to gently stretch the plantar fascia.They are not the most comfortable thing to sleep in but are effective for many people in relieving the morning pain.

It goes without saying but runners want to keep running even if they are in pain. Many physicians advise no running or activity until PF resolves. However, except in very rare instances, I allow my patients to remain active while we initiate treatment. I may advise them to decrease the intensity of running by avoiding speed or hill workouts or have them replace one or two of their weekly running workouts with biking or swimming but I rarely have them shut running down altogether. I do tell them though that if they clearly are getting worse despite treatment then they will have to stop until it improves.

Runners should not overlook the fact that they likely take 8,000-10,000 walking steps each day so they need to make sure they have protective shoes and insoles during the day too.

I explain to all my running patients that PF can recur So they need to make note of which treatments work best for them and employ them when symptoms flare. Usually recommend using insoles only as much as needed and encourage my patients to remove them once their pain resolves. Their feet will them how often they need to be worn. Some of my patients can go months or even years without their insoles others may get PF as soon as they come out of the shoe. The insoles are a tool to be used as needed.

Like most overuse injuries, the longer PF persists the more difficult it to resolve so recognizing it and treating it is best done sooner than later. In my experience those who are overweight or work in jobs where they spend long periods of time on concrete floors have the most difficult time resolving PF.

The running form debate has become almost as hot as the barefoot debate recently. On one side are those who are perfectly content and comfortable running with no thought on form and on the other are those who believe that better running form can decrease the risk of injury and improve running performance. Like most issues with two diametrically opposed viewpoints the truth might lie somewhere in the middle. Human movement patterns are highly unique. The ways we walk and run are as singular as our signature. What we all have in common though is that our bodies are programmed to move in the most efficient manner.

There are benefits to certain running form changes. For example, shortening the stride will automatically decrease impact forces and promote a mid- or forefoot landing pattern. This can be beneficial for some runners. But making wholesale changes to running form has not been proven to decrease risk of injury and can actually decrease running efficiency. There are some interesting studies on walking and running that can shed light on the topic.

Noted biologist McNeil Alexander’s research has shown that we move in the manner which uses the least amount of energy. This is a universally accepted fundamental of human gait that needs to be understood and appreciated by anyone who works with runners. Our neuromuscular system will automatically select the most efficient movement patterns for the given conditions. Gait patterns are dependent on such factors as neuromuscular coordination, joint range of motion, fitness level, and body mass index among other things. Even culture and mood are known to influence human movement patterns. Movement patterns are highly variable from person to person. What may be efficient for one may not be for another.

Biomechanist Benno Nigg proposed the “preferred movement pathway” (PMP) to build on Alexander’s work. The PMP is a theory based on the premise that each individual has a unique strategy for moving efficiently. Each of our joints has a preferred movement path and anything that causes deviations from that path such a shoe, insole or different running style may cause fatigue and/or increase the risk of injury. Our bodies are very capable of adapting to changing conditions but will always strive to keep the joints working within a narrow range within the preferred movement pathway. PMP theory helps to explain why runners do not always respond in predictable ways to shoe and insole or gait alterations. When runners are faced with a change such as a different shoe, insole or running form, they will make alterations to compensate for those changes in order to maintain their preferred movement pathway.

A pilot study done at the University of Massachusetts last year incorporates a respect for Alexander’s and Nigg’s work by instructing runners to alter their gait but allowing the runners to select their own manner for doing so. Previous studies have shown that while running form can be changed those changes tend to be lost as fatigue sets in and over time without periodic reinforcement with biofeedback.

This study looked at altering running gait for runners with a history of stress fractures. Previous research has suggested that runners who are vulnerable to tibial (the long bone between the knee and ankle) stress fractures land with higher impact forces than non-injured runners. These impact forces can be measured in the lab using accelerometers and treadmills embedded with computerized pressure sensors.

The researchers in this study made a point of not telling the runners how to reduce the impact other than instructing them to “run softer.” The runners were not given any instructions on cadence, stride length, heel/toe landing pattern, arm swing etc. While running on the treadmill the runners then watched a video monitor which gave them feedback on the impact of their footstrike. They had been instructed to try to keep the impact below a set level. It was expected that the runners would self select the movement pattern that was most efficient for them – which they did. The study showed that the runners were able to lower the impact forces of running by approximately 50% over the course of a 30 minute run. This was a small study on one specific type of running injury so large scale conclusions cannot be drawn from it but it does suggest that this form of gait alteration shows promise for those with a risk of stress fractures.

Recently some footwear manufacturers and retailers have begun offering running form instruction. Most of these running form programs proclaim decreased risks of injury and increased running efficiency. They also promote an idealized running form that we should each be expected to strive for. Because walking and running is so unique there is no clinical definition of normal or ideal gait. Despite the fact that runners come in all shapes and sizes, have varying levels of fitness an running experience, most of these programs expect that all can be taught to run in a manner that mimics some idealized running technique.

I use high speed video in my clinic as a gait assessment tool. The video can allow us to see great detail that is missed with the naked eye. When an inexperienced or an injured runner asks me if they are “running wrong” of if they should change something about their gait based on what the video shows I often give them some small things to change such as shortening their stride if they are injured. But I also cite the above studies and explain that there is no such thing as running wrong. For newer runners I emphasize that running form changes naturally as power develops, running economy improves and speed increases. If they are patient and diligent in their training their gait will naturally evolve but making changes consciously will not necessarily reduce their injury risk or improve running efficiency.

Gait analysis involves much more than simply watching someone walk or run. Forms of gait analysis include plantar pressure measurements, muscle EMG, 3-D computer aided analysis, energy cost as measured by oxygen ventilation, power output, and center of mass deviations. Each of the methods of gait analysis provides specific forms of information, but none of them can paint a complete picture of the complexities of human gait. This article will focus on 2-dimensional video gait analysis, primarily because it is relatively inexpensive and can be incorporated into a podiatric clinical setting easily.

Observational Gait Analysis
Observational gait analysis has been practiced for more than 100 years but became more of a science in the 1970’s when pressure mat technology and high-speed video became available. Mechanical analysis and mathematical modeling of gait have become increasingly sophisticated as the technology utilizing force platforms, high speed video, accelerometers, and more powerful computers continues to advance. 10,11 While video gait analysis has not caused a revolution in the clinical setting, it has provided the opportunity in research settings for a better understanding of human movement, and is becoming a more useful clinical modality for sports medicine practitioners.

Biomechanics and human performance research labs began using video gait analysis (VGA) techniques en masse in the 1970’s and 1980’s as the technology became more user-friendly and affordable. As technology improved and the body of knowledge grew, some clinical settings adapted the techniques to better evaluate movement pathologies, to provide a visual record of therapeutic progress, and to assist in surgical planning for neuromuscular disorders such as cerebral palsy. Early research often focused on attempts to understand normal gait, gait development in children, and deterioration of gait in the elderly.11

In the athletics setting, VGA has been used by coaches and trainers to evaluate and refine sport-specific skills, and thereby improve performance and/or decrease risk of injury. Recently, there has been growing acceptance of the use of VGA in the clinical sports medicine and rehabilitation setting.1,18 Physical medicine and rehabilitation practitioners have increasingly used VGA to assist in evaluation and therapy of gait pathologies related to traumatic brain injuries. Physical therapists are increasingly employing VGA into their practices as well. Many running footwear retailers, despite lacking formal biomechanics training, are now using it to sell running shoes.

Sports medicine podiatrists, while not always providing rehabilitation services in the clinic, are typically prescribing and monitoring the rehabilitation of their patients. Video gait analysis can serve as an additional clinical tool to better visualize biomechanics and movement patterns in order to monitor treatment progress. It also provides visual information to improve communication with patients. Gait analysis has been increasingly used to evaluate a subject’s movement patterns in order to assist in diagnosing pathologies, improving performance, and/or monitoring therapeutic interventions such as gait retraining or orthoses.

The primary criticism of observational gait analysis (OGA) is the limited reproducibility and usefulness of the data and/or subjective observations. Newer video analysis software has overcome some of these limitations. Much of the published research supporting use of video analysis is on pathologic gait such as in cerebral palsy or traumatic brain injury. Most research on the reliability and repeatability of OGA as well as other orthopedic measures points to low to good inter-rater reliability, and often better variability with more experienced observers.3-4,6-9,22-23 Some studies have shown good reliability in rehabilitation settings with hemiplegic patients.8 Some of the studies evaluating gait analysis reliability were done without the capability of slowing down or stopping the video for a more detailed exam, which likely contributes to less than optimal outcomes. Newer highspeed video analysis software allows observers to slow down (even frame-by-frame), magnify, and stop the video. They also include tools for calculating angles and obtaining other measurements. A recent study using software with this capability (Dartfish®) showed that inter-rater reliability was higher with the software with tools versus using standard video software that lacked these tools.25

Physician Rating Scale (PRS)
In an attempt to standardize Observational Gait Analysis (OGA), some researchers advocate using summary assessments such as the Physician Rating Scale (PRS).5 The PRS classifies six gait variables on a 2–4 point scale. When tested on the PRS, some variables, such as knee position in mid-stance, have been shown to have good to excellent reliability yet only moderate accuracy. The research does seem to suggest that the more variables that are observed, the less accurate are the observations; so, it may be likely that future studies will show better reliability and repeatability with more specific observational criteria. Formal methods of OGA such as the Rivermead Visual Gait Assessment or the Observational Gait Scale appear to improve the reliability of judgments, yet they do not necessarily affect the accuracy.7 Gait researchers seem to agree that standardized gait analysis training and methodology would likely improve outcomes.1,9-11

While the body of research on human movement has grown tremendously in the last 30 years, there is still no single universally agreed-upon model of normal human gait. Human movement patterns are highly unique and are affected by a large number of variables including age, sex, and body composition. Even mood and culture influence how humans ambulate. To complicate matters further, humans do not respond in systematic ways to orthotics, bracing, footwear, or other biomechanical interventions.15

It seems obvious, but in order to assess abnormal gait, it is imperative to understand normal gait.2 One study concluded that a key reason for low reliability was that the raters did not seem to be familiar with the normative values for the tested gait variables.9 Not only is a grasp of normal gait important but also understanding common gait compensations is essential.10 Biomechanics and gait theories arise from different corners of the research field. The disciplines of podiatry, physical therapy, orthotics/prosthetics, exercise physiology, and neuroscience, among others, have unique and oftentimes conflicting theoretical perspectives on human movement. Practitioners should make an effort to understand the different theoretical principles.10

Humans move in the manner that is most metabolically efficient and causes the least amount of discomfort.19 The metabolic energy cost of walking and running is due to the acceleration and deceleration of the body on each step. Conserving energy of ambulation is achieved by minimizing the vertical and lateral displacement of the human’s center of mass (CoM). The CoM is located just anterior to the second sacral vertabra and midway between the hip joints. It is impossible to ambulate without vertical and lateral translations of CoM.1

Saunders and colleagues in 1953 used the term “determinants of gait” to describe key gait strategies humans use in order to control the CoM and minimize the metabolic cost of gait. Other researchers have now refined Saunders’ original five determinants to six.11,16-17 While there is general agreement by researchers that these movements occur, there remains controversy on their role in energy conservation. Understanding these determinants of gait are an important part of mastering the fundamentals of gait.

1) Pelvic rotation: The pelvis rotates in the transverse plane to bring the hip joint forward during hip flexion and backwards during hip extension. The hip rises and falls vertically during this movement. Pelvic rotation allows the hip joint to move through a smaller distance than the foot for a given stride length. This conservation of hip ROM is more efficient than a hip that is fixed in the transverse plane, and results in decreased vertical movement of the hip, further conserving energy and providing a smoother movement pattern.1,11

2) Pelvic obliquity: The pelvis tilts in the frontal plane in an alternating manner with hip flexion and extension
so that when the hip of the stance leg is at its highest point, the pelvis slopes downward so that the hip of the swing phase leg is lower. This pelvic tilt conserves energy by minimizing vertical displacement of the trunk. During normal walking gait, the pelvis drops 4-5 degrees from the stance leg to the swing leg.1 This determinant presupposes that the swing leg can be shortened adequately to clear the ground through knee flexion and ankle dorsiflexion.

3) Knee flexion in stance phase: Knee flexion in mid-stance shortens the leg, which minimizes vertical displacement of the CoM. Peak knee flexion is approximately 15 degrees in normal walking.1

4) Ankle mechanism: The heel effectively lengthens the leg at initial contact because it is located posterior to the ankle joint. This minimizes vertical displacement of the CoM.

5) Foot mechanism: Just as the heel effectively lengthens the leg at initial contact, the foot lengthens the leg
at toe-off as the ankle plantarflexes—again, minimizing vertical displacement of the CoM.

6) Lateral displacement of body: A narrow base of gait requires less lateral movement in order to preserve balance. Energy is conserved by minimizing lateral movement of the CoM.

Gait abnormalities can be placed in perspective by keeping the above six concepts in mind. Deviations from the above parameters should raise questions or at least attract the observer’s attention. Because humans place such a high priority on moving efficiently, they only deviate from these patterns to avoid painful stimuli, or because they cannot move in the most efficient manner because one or more segments of the kinetic chain are dysfunctional. This dysfunction could be due to hyper- or hypo-mobility of joints, muscle imbalances, vestibulomotor problems, or sensory deficits.

Gait analysis is easily performed in the clinical setting and incorporates patient history, physical exam, and functional assessment.1 VGA can be done using a single high-speed, high-definition camera, video software, and a treadmill. A systematic approach to gait analysis is important since the gait cycle is so short and repetitious.

A typical gait analysis protocol starts with a general assessment and becomes more focused. Initial assessment looks for symmetry and smoothness of movement. Next, temporal-spacial parameters such as cadence in steps per minute, angle and base of gait, stride length, arm swing, movement of the trunk, and rise of the body are assessed and measured.1,10-11 Although measuring speed, cadence and stride length is easily done, many researchers question the value of these measurements since there is such a broad range of what is considered normal.

For example, intrinsic factors such as subject height, sex, and extrinsic factors such as length of runway, treadmill,
or even room size affect temporal gait parameters.9,13-14

Finally, kinematics are assessed by observing subjects’ gait from lateral, anterior and posterior views to assess sagittal and frontal plane movement. Some labs use ceiling-mounted cameras directly over the subject to capture transverse plane motion. Key kinematic angles and events as described by Kirtley10 are:

• Ankle dorsiflexion at contact
• Maximum rearfoot eversion
• Knee flexion at contact
• Knee adduction in late stance
• Ankle plantarflexion during push-off
• Knee flexion in swing

Visual Feedback to Patients
A significant benefit of VGA is the visual feedback it provides to patients. By being able to see their gait patterns, they are better able to understand the problem and the objective of therapeutic interventions. Patients often expect
to see dramatic kinematic differences in different shoe and/or orthotic conditions. However, kinematic alterations (such as peak rear-foot eversion) due to orthotic interventions in runners, while they can be significant, are often smaller than expected.15 Kirby and others have proposed that the positive benefits of orthoses are likely due to mechanisms other than alignment or kinematic changes.12 A significant limiting factor evident with VGA is that the motion of the foot is disguised when shod (Figures 1 & 2). Researchers have used running sandals and cut holes in heel counters to overcome this limitation, however, this is not practical in the clinical setting. Stacoff’s study showed that shoes actually exaggerate the appearance of rear-foot frontal plane motion. 20 Awareness of this limitation is important to keep in mind when evaluating kinematics of gait.

Figure 1: Runner with decreased ankle dorsiflexion and mid-foot landing pattern at initial contact as is common in barefoot running gait

Figure 2: Same runner as in figure one with increased dorsiflexion and heel strike landing pattern as is common in shod running gait.

Does the video replace or supersede a physical exam? Certainly not, but it can shed light on gait impairments that may not be revealed in a static assessment. According to noted gait researcher Casey Kerrigan M.D., “…gait analysis can be used to focus and optimize rehabilitation treatment including prescription of exercises, biofeedback… (or) orthotics…”. 1 According to author and researcher Michale Whittle, “With the improvements in measurement and analytical techniques, the major limitation now is not the ability to produce high-quality data but knowing how best to use these data for the benefits of patients.”15

Mathematical and robotic modeling of the musculoskeletal system holds promise for the future of gait analysis
and therapy. Computer programs will one day allow us to input patient data from a gait analysis, and then create models to see how that model responds to interventions.1,10-11

References
1 DeLisa, JA (ed) Gait Analysis in the Science of Rehabilitation, Department of Veterans Affairs Scientific and Technical Publications, Baltimore, MD 1998.
2 Lehmann, JF, et al., Biomechanics of Normal Gait, Phys Med Rehab Clin North Am, 3:125-38, 1992.
3 Krebs DE, Edelstein JE, Fishman S. Reliability of observational kinematic gait analysis. Phys Ther 1985;65(7):1027–33.
4 McGinley JL, Goldie PA, Greenwood KM, Olney SJ. Accuracy and reliability of observational gait analysis data: judgments of push-off in gait after stroke. Phys Ther 2003;83(2):146–60.
5 Koman LA, Mooney 3rd JF, Smith BP, Goodman A, Mulvaney T. Management of spasticity in cerebral palsy with botulinum- A toxin: report of a preliminary,randomized, double-blind trial. J Pediatr Orthop 1994;14(3):299–303.
6 Williams, G Et al., Observational gait analysis in traumatic brain injury: Accuracy of clinical judgement, Gait & Posture, 2009 (9):454-459.
7 Lord SE, Halligan PW,Wade DT. Visual gait analysis: the development of a clinical assessement and scale. Clin Rehabil 1998;12:107–119.
8 Tenore N, Fortugno F, Viola F, et al., Gait analysis as a reliable tool for rehabilitation of chronic hemiplegic patients. Clin Exp Hypertens 2006, 28:349-55.9 Eastlack, ME, Et al., Interrater reliability of videotaped observational gait analysis assessments, Phys Ther, 1991, 71(6):465-472.
10 Kirtley, C, Clinical Gait Analysis Theory & Practice, Elsevier Chruchill Livingstone, London, 2006.
11 Whittle, MW, Gait Analysis: An Introduction, 4th edition, Butterworth Heineman Elsevier,Philadelphia, 2007.
12 Huerta JP, et al., Effect of 7-degree rearfoot varus and valgus wedging on rearfoot kinematics and kinetics during the stance phase of walking, JAPMA, 2009 99(5): 415-421.
13 Oberg, T, et al., Basic gait parameters: reference data for normal subjects 10-79 years of age, J Rehab
Research & Development, 1993 (30):210-233.
14 Murry MP, et al., Comparison of free and fast walking patterns of normal men, Am J Phys Med, 1966, (45):8-24.
15 Nigg BM, Biomechanics of Sport Shoes, Calgary, 2007.
16 Saunders JB, Inman VT, Eberhart HS, The major determinants in normal and pathological gait, JBJS, 1953, (35A):543-558.
17 Inman VT, Ralston HJ, Todd F, HumanWalking,Williams & Wilkins, Baltimore, 1981.
18 Crowell HP, Milner CE, Hamill J, Davis IS, Reducing impact loading during running with the use of real-time visual feedback, J Ortho & Sports Phys Rehab, 2010 40(4):206-214.
19 Alexander R, A model of bipedal locomotion on compliant legs. Phil Trans R Soc London, 1992; 338(B): 189–98.
20 Stacoff A, et al., Tibiocalcaneal kinematics of barefoot versus shod running, J Biomech,2000 (33): 1387-1395.
21 Dierks TA, et al., Lower extremity kinematics in runners with patellofemoral pain during a prolonged run, Med & Sci in Sports& Exercise, 2011, 43(4) :693-700
22 Wrobel JA, Armstrong DG, Reliability and validity of current physical exam techniques of the foot and ankle, JAPMA, 2008;98(3):191-206.
23 KEENAN AM, BACH TM: Video assessment of rearfoot movements during walking: a reliability study. ArchPhys Med Rehabil 77: 651, 1996.
24 Mackey AH, Lobb GL,Walt SE, et al., Reliability and validity of the Observational Gait Scale in children with spastic diplegia. Dev Med Child Neurol 45: 4, 2003.
25 Borel S, et al., Video analysis software increases interrater reliability if video gait assessments in children with cerebral palsy, Gait & Posture, March 18, 2011; online abstract prior to publication

Since the publication of Christopher McDougall’s Born to Run: A Hidden Tribe, Superathletes, and the Greatest Race the World Has Never Seen, barefoot running has been gaining a dedicated following in countries around the world. Whether this trend is good, bad, or neutral has yet to be determined. “There are no large-scale, long-term studies that support claims of reduced injury rates or performance enhancement,” said Paul R. Langer, DPM, University of Minnesota Medical School, Twin Cities. Still, proponents claim many benefits, while detractors warn of risks and injuries.

According to Dr. Langer, runners move differently when barefoot—stride length is shorter; the knee is more flexed when landing; the ankle is more plantarflexed; runners land on their mid- or forefoot; and the foot lands closer to the body. Proponents of barefoot running claim these differences in form are responsible for decreased risk of injury. They also cite improved proprioception, increased arch strength, and more efficient movement. Some claim that shoes are unnecessary, and go so far as to blame them for the relatively high incidence of running injuries.

Opponents point to a lack of scientific evidence of risks or benefits. “There’s no proof either way,” said David W. Jenkins, DPM, Arizona School of Podiatric Medicine, Midwestern University, Glendale, AZ. “But generally speaking, the clinical community is skeptical, and many think that barefoot or minimalist running is downright bad.”  But not everyone agrees. Drs. Langer and Jenkins both engage in, or are transitioning to, barefoot running. “This is nothing new,” said Dr. Jenkins, pointing out that his high school football team used to train barefoot once a week. “The key is to build up very gradually and be especially careful if you wear minimalist shoes,” he said. “They can give a false sense of confidence,” he noted.

Read the full article here.

Photo courtesy of WCCO.

Photo courtesy of New York Runner.

Photo courtesy of Footwear Insight.

Photo courtesy of Runner’s World.

As a runner, podiatry student and running store employee, I became fascinated with the effects of footwear on human movement. Because of what I was learning through the gait research I began to ween myself off of the cushioned running shoes that were so popular at the time and to look to lower profile footwear understanding that my body could absorb running impact very efficiently all by itself if given the appropriate feedback. Shoes inhibit sensation to our feet just as gloves inhibit sensation to our hands. Future posts will discuss research on barefoot/minimalist running and the bionegative efects of footwear.

Don’t get me wrong, I am not a hardcore barefoot fanatic but I do see the benefits of minimalism and I treat the consequences of footwear on a daily basis in my clinic.

Photo courtesy of Running Times.