COMMENTARY

How Do I Run Barefoot With Shoes on?

Andrew J. Vickers, PhD, DPhil

Disclosures

October 19, 2011

There is a plausible theory that mankind came down from the trees to run across the African savannah in pursuit of prey. Running is not much in demand as a survival skill anymore, but it is by far and away the most popular participation sport in industrialized nations. This may be great for cardiovascular health, but it is apparently a disaster orthopedically; a typical estimate is that 60% of runners suffer injuries a year. Such high injury rates seem somewhat of an anomaly if we were indeed "born to run." I doubt that, for example, 2 out of every 3 eagles suffer wing injuries each year.

Some runners have used the evolutionary origins of running as a premise to argue that we should run barefoot (those proto-humans in Africa many millions of years ago were certainly not wearing Nike Lunarglides). Recent years have seen some runners abandon high-tech running shoes in favor of bare feet or "minimalist" shoes that mimic a barefoot running style. This has led to debates about whether the best way to avoid injury is to run with or without shoes.

Certain aspects of this debate are fairly settled. Few dispute that barefoot running is a very recent phenomenon in the United States or that, whatever the relative overall rates of injury, barefoot runners are more likely to experience ankle and foot injuries whereas those in running shoes suffer injuries of the knee, thigh, and hip. This makes the barefoot running debate pretty much guaranteed to generate more rhetorical light than scientific heat:

1. Large numbers of runners will cure their injuries by switching to barefoot running. Given that most runners currently wear shoes, there is a large population with upper leg injuries that will improve once they go barefoot.[1] This may be little more than a surfer reducing his risk for drowning by switching to skydiving.

2. There will be an "epidemic" of injuries from barefoot running. Barefoot is recent, so podiatrists and orthopedists will start to see runners presenting with injuries attributed to barefoot running.[2] This "epidemic" gives no information whatsoever about risk because there is no denominator.

3. There will be little evidence. Carefully planned, long-term studies cannot be conducted on a recent trend.

Of greatest interest from a statistical point of view, lack of evidence can be used rhetorically by both sides. An advocate of barefoot running, Dr Craig Richards, a researcher at the University of Newcastle in Australia, puts the burden of proof on shoe manufacturers: "there's no evidence that [modern] running shoes prevent running injuries."[3] On the other hand, Dr. Bennon Nigg, Professor of Biomechanics at the University of Calgary, takes the status quo position to argue, "There is no direct evidence ... that barefoot running reduces injury."[4]

"No evidence" sounds like an important claim. If an industry spokesman claims that there is "no evidence" that a pollutant is harmful, that appears to mean that it is safe. But it probably means that it might be safe or it might be toxic. We just don't know because the studies haven't been done. Absence of evidence is not evidence of absence.

As the barefoot running debate illustrates, when there is no evidence, we tend merely to reassert our prior beliefs. Which is fine, I guess, as long as we don't misleadingly use the term "no evidence" to suggest that we are right. We don't want to end up recommending that athletes run barefoot with shoes on.

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