Survey finds 31% of runners have tried minimalist footwear

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By Chris Klingenberg

A significant percentage of avid runners have tried running in minimalist shoes, according to a recent survey-based study in which runners reported both positive and negative responses to making the switch in terms of pain and injury.

Although some users reported that switching to minimalist shoes relieved their existing running-related pain, others said they had to stop wearing the shoes due to associated pain or injury. Runners’ pain-related responses tended to be dependent on the site of pain.

Marissa Cohler, MD, a physiatrist at Schwab Rehabilitation Hospital in Chicago, and Ellen Casey, MD, an assistant professor in the Department of Family, Community & Preventive Medicine at Drexel University College of Medicine in Philadelphia, conducted a survey of runners’ attitudes toward and experiences with minimally shod running.

Of the 560 people who responded to the survey, most were female (71%) and aged between 30 and 39 years (37%). Most (80%) described themselves as competitive amateurs, while 20% reported they were recreational runners and less than 1% said they were elite runners.

Of the 175 runners (31%) who said they had tried minimally shod running, 55% were women and 41% were aged between 30 and 39 years.

“Runners who were male and younger in age were more likely to have tried minimally shod running,” Cohler said.

Nearly a third (29%) of those who had tried minimalist running shoes reported they had experienced an injury or pain while using the shoes. The most common body part involved was the foot. Most (61%) of those reports involved a new injury or pain, 22% involved recurrences of old problems, and 18% were a combination of both old and new musculoskeletal problems.

More than two thirds (69%) of those who had tried minimally shod running said they were still using minimalist running shoes at the time of the survey, but nearly half of those who had stopped said they did so because of an injury or pain. The most common sites of pain or injury that caused survey participants to discontinue minimally shod running were the foot (56%) and the leg (44%).

While some runners who tried minimalist running shoes suffered some pain and discomfort, a greater percentage (54%) said they had pain that improved after making the switch. The anatomical area most often associated with improvement was the knee. The results were published in the August issue of PM&R.

“The findings were consistent with a previous population survey as well as published case reports and kinetic studies that have demonstrated foot and ankle problems related to stress to be associated with use of minimalist footwear,” Cohler said. “The injury improvement in those with knee problems was also consistent with prior research demonstrating reduced patellofemoral kinetic parameters and reduced collision forces in forefoot strikers [which is the pattern of running that minimalist footwear encourages]. It should be emphasized that we suspect this potential benefit is not necessarily a result of the shoes themselves, but rather the impact the shoes have on a runner’s foot strike pattern.”

Reed Ferber, PhD, CAT(C), ATC, an assistant professor of kinesiology and nursing and director of the Running Injury Clinic at the University of Calgary in Canada, noted that changes in loading patterns associated with different foot strike patterns may help explain the findings.

“From a mechanical standpoint, landing with a forefoot strike decreases loading to the knee and hip joints, but the load is then shifted and results in a significant increase in strain to the Achilles tendon, plantar fascia, and foot. So you’re trading one injury for another,” Ferber said. “Minimalist shoes do not ‘cure’ running-related injuries, but rather result in different types of injuries.”

Joseph Hamill, PhD, professor of kinesiology at the University of Massachusetts Amherst, concurred.

“Running with a forefoot pattern does not decrease injury risk. The rate of injury risk is the same as running with a rearfoot pattern. What does change is the site of the injury,” Hamill said. “My advice to clinicians and thus to runners is that you should not use minimalist shoes exclusively. Use different types of shoes and cycle their use.”

Of those who had tried minimalist footwear, 35% said they had done “nothing in particular” to prepare for minimally shod running, whereas 43% said they had consciously focused on changing their running style to a midfoot or forefoot strike. Less than one third of the respondents said they had used a gradual adoption program, which Cohler said is what she would recommend.

“Runners should start with a strengthening program for the foot intrinsic and calf muscles,” Cohler said. “They then should very slowly and gradually build up their mileage.”

Chris Klingenberg is a freelance writer based in Massachusetts.