Running Confusion - Shoes vs Orthotics vs Barefoot Movement
Do you think our early ancestors wore half-length or full-length orthotic shoe inserts? Would their video-recorded gait assessments have revealed more under or over-pronators in the general population?
If we try to imagine how life was back in the day of the caveman we could safely assume that his ability to run both short sprints and long distances was necessary for surviving in a wild environment. Without the ability to track food or flee from dangerous predators the human evolution may not have been possible. What we can also be sure of is the caveman did not run in a pair of Asics trainers with rear-foot gel-cushioning outer soles structured for either a neutral or over-pronating gait. Nope, our early ancestors would have been running barefoot.
Many thousands of years later and despite our advances in footwear design and technology there is a ‘barefoot running’ revolution gaining traction in some circles. The idea is that we as a species have spent more time running barefoot than we have in our fancy high-tech shoes and therefore we are more physiologically suited to running barefoot.
The modern running shoe
It wasn’t until as recent as the previous 30-40 years that running became a popular activity for the prevention and management of chronic disease and to improve health and lifestyle. In response to this growing popularity so followed the development of the modern running shoe.
In an oversimplified view the idea of a cushioned shoe is to reduce impact forces exerted on the foot, forces which can contribute to joint and tissue damage as well as bone stress-fractures. Similarly, a misalignment such as an overpronation or ‘rolling in’ excessively is correctable by inserting a device called an orthotic, which compensates and partially corrects the misalignment, into one’s shoe.
The increasing number of people running resulted in a relative increase in the number of injuries seen throughout the population. The simplified yet very plausible idea of ground impact forces being a primary cause of running injury led to the mass adoption of the running shoe as an essential piece of clothing/equipment. The design and technical features of the shoe orthotic also evolved and became more widely used.
However, less simplified arguments suggest the ‘hardness’ of the impact force itself is not the direct cause and may have only part or possibly even zero influence on injuries sustained. This opposing idea suggests that our brains regulate how our muscles react to impact forces, controlling soft tissue vibration and stress, with results seemingly unaffected by how soft or cushioned our shoes are. In other words it would seem to be the speed at which these impact forces are applied rather than the intensity of the forces themselves which may be more important in injury prevention.
Running injury rate not impacted by good shoes?
To support this theory some reports state that the number of running-related injuries has not changed despite the use of the constantly ‘improving’ modern running shoe which seeks to reduce and control the intensity of impact forces but has little effect on influencing the speed at which they are applied across the joints.
A lack of evidence in the effectiveness of shoe and or orthotic prescription for preventing injury may suggest our modern shoe technology is largely ineffective? But remember these are trends, looking at large numbers of people in the various studies - they do not account for ‘outliers’ who do in fact pick up injuries by running in less structured or supportive footwear. However for some people these trends provide enough motivation to support not using the running shoe making claims of the obvious merits for barefoot running.
I see numerous problems with this scenario.
Firstly, we cannot ignore the tendency in modern times for people to so easily adopt extreme views. It doesn’t take much now via the hyper-interconnectedness of the internet to spread a new idea and for it to gain significant traction. Many people seem to love a controversial and wildly opposing theory to support their dissatisfaction for the other, easily convinced by the attention and ‘support’ for an idea by a large enough audience.
Secondly, the occurrence of running injuries can be related to a great many different factors such as intensity, frequency and amount of training done by the participant. Their personal injury history could also play a significant role in their risk to injury. Each injury has its own unique biomechanical characteristics and while a barefoot running approach may be suitable for some it certainly would not be suitable for all.
To my knowledge we do not have a single known common physiological risk factor that accurately predicts any running injury. It could be the intensity of impact forces for some, more the speed for others, strength, balance and coordination could also be a factor, as could muscle endurance. A full assessment by an experienced Chartered Physiotherapist would be able to determine the main contributing factors to the injury.
So, should you run with shoes, with or without an orthotic or simply run barefoot?
The most appropriate answer to provide here is that there is ‘no one size fits all’ approach.
Consider the following quote:
“how one runs probably is more important than what is on one's feet, but what is on one's feet may affect how one runs”
Though a little cryptic this quote sums it up quite nicely. Your individually unique biomechanical profile, any existing muscle imbalances and your learned walk and running gait will largely determine your risk of injury and potential need for a particular shoe or orthotic device. In some cases you may even be suitable for barefoot running with the appropriate transition preparations.
Often a shoe or orthotic is needed as a temporary measure to correct a learned imbalance and reduce impact forces if needed and in other cases is a more permanent requirement, such as with a leg length discrepancy.
If your running causes you pain or repeated injury then I can only recommend that you seek a professional gait and lower limb assessment sooner rather than later.