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Snyder Physical Therapy and Sports Rehabilitation

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Blog – The Great Debate: To Shoe or not to Shoe

The Great Debate: To Shoe or not to Shoe      
By Rob Kobza PT,OCS,CSCS

As a Physical Therapist that treats a large number of foot and ankle patients I am often asked “What do you think about barefoot running?”  My usual response is, I believe we should run like we are barefoot but do it while wearing shoes. This may sound a little contrary however I have my reasons for this response.  First the majority of people in this country have been wearing shoes since we could walk and even before.  Putting our feet in shoes and forgetting about them or maybe neglecting them is a better term has caused the muscles in our feet to weaken.  These muscles have forgotten how to control the various movements that our feet go through on a regular basis if we are barefoot.  These muscles have not been adequately trained to endure the rigors of barefoot running.  The majority of people will not take the time to learn how to strengthen those muscles adequately.  We are a society that is so fixed on getting from point A to point B as quickly as possible and will not routinely take a detour.  This detour is training the various muscles that control foot and ankle movement.  I see this on a regular basis with our running clients who have knee pain.  The vast majority of these runners have a significant amount of hip weakness.  It is now widely accepted that hip weakness is one of the most significant contributors to knee pain in runners.  The only reason I mention this is to illustrate that runners want to run, and strengthening takes away from their running time.  Not only are the muscles not adequately trained in our feet but the skin and soft tissue on the bottom of our feet have not been conditioned to run without some padding under our feet.

Back to the debate;  88% of shod runners(runners with shoes) strike the ground with their heel first.  This is also called rearfoot strike.  It has been shown there is significantly more vertical ground reaction force in heelstrikers as compared to landing flat or on the ball of the foot. This increased ground reaction force has been associated with tibial stress fractures and plantar fasciitis.  Two common ailments that no runner wants to hear come out of their doctors mouth.  There have been a few recent studies that have shown that switching to forefoot running has decrease pain and improved function.  Since Kenyans have been so successful in long distance running their running form has been studied and it is shown that they are in a mild forefoot striking pattern.

Rearfoot striking is really a product of our shoewear.  The simplest way to prove this is to do a little experiment.  If you take your shoes off and go outside and run on your sidewalk, I can almost guarantee that you will not heelstrike.  You won’t heel strike because it will be uncomfortable and you will automatically become a forefoot striker.  Our shoes with elevated and cushioned soles have really caused our heelstriking ways.  In the part of the country where I live there are very few dirt trails.  The vast majority of runners are running on concrete which also does not lend itself to running barefoot.  Even a hundred years ago there were far fewer paved roads and sidewalks which lends itself to barefoot running, not so today.  I also don’t think your boss would appreciate it if you came to work barefoot so again we throw our feet in a shoe and forget about them and allow our foot muscles to weaken.

In a roundabout way I am saying we were designed to run barefoot however there are too many obstacles to become avid barefoot runners.  So back to my first response to a patient:  I believe we should run like we are barefoot, but just do it while wearing shoes.

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~Fay L. 3/27/13