Barefoot Running Stumbles

The irresistible promise: Ditch your padded sneakers and run faster with fewer injuries. So why is the minimalist running craze causing maximum pain

The 2011 L.A. Marathon was going well for Joseph Gabriel. After 26 miles enduring a cold rain and gusty winds, he was still on pace to break four hours—his goal after four months of training. But as he turned onto Ocean Avenue in Santa Monica, with the finish line in sight 300 yards away, he felt a sudden tug above his left ankle.

"It wasn't painful; it was more like a pulling sensation. I thought it was a muscle," Gabriel recalls". I had no idea what had happened and didn't want to make it worse." So he stopped—and the crowd went nuts. "Everyone was yelling my name—it was printed on my race bib. They shouted, 'It's right there, keep going!' And I'm like, But I can't walk!" So Gabriel hopped the final stretch on his good leg. Time: 4:02:44.

Gabriel had ruptured his Achilles tendon. It took three months of rest and rehab before he could run again, gingerly. His physical therapist, Darwin Fogt, M.P.T., wasn't surprised by the injury—and not because his patient was 50 years old. To Fogt, Joseph Gabriel was yet another victim of the so-called barefoot running craze.

Gabriel didn't run (and finally hop) the L.A. Marathon barefoot; he trained and raced in a pair of minimalist running shoes—the kind with a nearly level heel, or "lower drop" in athletic-shoe parlance. He was one of legions of runners who'd read the bestselling book Born to Run, about Mexico's Tarahumara, an indigenous tribe whose members compete in races of 100 miles or more in flat sandals—and almost never get hurt.

In the book, author Christopher McDougall blames spongy shock-absorbing shoes for breeding runners with poor form and weak feet. McDougall, who also wrote about the Tarahumara for Men's Health in 2006, visited Harvard University, where he met Daniel Lieberman, Ph.D., an evolutionary biologist who studied gait mechanics. Lieberman showed that when barefoot runners land forefoot first—in front of the arch—their gait is measurably less jarring than shod runners who hit the ground with their heels. In January 2010, with the popularity of Born to Run soaring, the journal Natureput Lieberman's research on its cover.

"Lieberman's publication, McDougall's book—it was a perfect combination of events," says Matthew Silvis, M.D., a sports medicine physician at Penn State who teaches barefoot technique. Shoemakers rushed to meet the new demand, introducing lighter, flatter shoes with names like Bare Access and Minimus. Glovelike footwear called FiveFingers or Skeletoes became popular. "Barefoot running" became shorthand for the minimalist movement.

But now Dr. Silvis, who is studying injury rates among barefooters, says he is seeing an alarming number of foot stress fractures, calf tears, and Achilles strains in runners transitioning to barefoot or minimalist running. Fogt, president of Evolution Physical Therapy in Culver City, California, concurs. He says he finds plantar fasciitis in the majority of his barefoot runners, compared with perhaps 15 percent of traditional runners.

Fogt's client, Gabriel, admits that he bought into the craze. "I drank the Kool-Aid," he says. "I just thought I should do it because of what I had heard, even though I was having no problems with what I was using at the time." The promise of a more efficient stride was irresistible: "I got the new minimalist shoes, threw out my old ones, and out the door I went."

LIGHTWEIGHT SHOES CAN MAKE A RUNNER feel faster; and with no initial pain, a new convert to minimalist running is tempted to log miles as he always has. For Gabriel, months of high-mileage training without proper conditioning added strain to his hamstrings, calves. . .and Achilles tendons. It's not just older guys who are at risk; Fogt sees people of all ages with injuries related to barefoot-style running. Dr. Silvis is currently treating a 20-year-old elite distance runner with a history of stress fractures who tried a barefoot approach in an attempt to ease the shock to his tibia bones. But, says Dr. Silvis, he "straightaway ran at his normal distance and intensity, and subsequently fought Achilles difficulties for weeks."

That's typical, says Nathan Koch, P.T., a physical therapist based in Scottsdale, Arizona. "Runners are always trying to get faster, looking for an edge," he says. "They're also always hurt. And when they're hurt, they want answers. So people made assumptions that if you could run barefoot, your injuries would go away."

In May, researchers at the University of Wisconsin at La Crosse published a study demonstrating that a forefoot or midfoot landing—the usual technique in lighter shoes with a less cushioned heel—increases the load per step on the Achilles tendon by 11 percent compared with a heel landing. That's about 7,000 extra pounds of force over a mile for a 150-pound runner, says study author John Willson, Ph.D., now an associate professor of physical therapy at East Carolina University. That kind of force, says Fogt, is the reason anyone who's making the switch from conventional shoes to minimalist footwear needs an extensive training period to ready the foot for barefoot style. "And not everyone's foot is able to tolerate barefoot running, even with the training period," he says.

Neither McDougall nor Lieberman asserted that barefoot running had any proven benefit over shod running. Lieberman merely demonstrated that forefoot strikers are, quite literally, lighter on their feet. He also observed from habitually barefoot cultures—he visited the Kalenjin tribe in Kenya—that human anatomy is innately suited for running.

The problem? "People took our paper, which was about a very small, limited topic, as telling them how to run," Lieberman says. "Running is a complex skill that you can't learn how to do just by taking off your shoes."