PT perspective on “barefoot” running

Running barefoot requires very good foot stability and strength, and an already strong background in running or sports that involve running.  The foot needs to be adequately prepared for the loading forces(easily 3x body weight) with a foot now unsupported by a shoe.  Most patients of mine have not spent adequate time walking and doing activities barefoot, so this is a big change. Bodies need time to adapt. Those that grew up running around with bare feet, and live most of their days for work or life without shoes have undoubtedly developed a different arch and foot strength than most of us here in the US. Most of us here have developed different ankle and foot patterns and adaptations based upon our years of modern life in shoes. That isn’t necessarily bad, but it cannot be ignored. That can’t be magically undone by one day just throwing away your shoes. Most of us have likely not developed the ankle and intrinsic foot muscles to be able to properly support our bodies without outside shoe support for activities such as jumping and running or any high impact loading.
 The foot, made up of tendons, ligaments, plantar fascia, intrinsic tensile structures, needs time to adapt to those loading forces. Running as a sport on its own, even with a normal supported shoe with minimal arch support is STILL an enormous change and stress on tendons and ligaments for people who are new to running.
 I have no issues with people wearing Vibram type toe shoes during their everyday activities.  This is assuming they have a relatively stable arch, and gradually wean them into their daily routine. If someone already has a major foot dysfunction such as excessively collapsed arches, bunions, foot deformity, they may not be an ideal candidate. Even then, I would say this is a definite change in support from normal athletic shoes, so gradually weaning them in for a few hours a day is suggested.
The inherent problems with running barefoot is that poor foot support for collapsed arches, excessively rigid arches, global ankle weakness from deconditioning or prior ankle sprains can potentially lead to more ankle sprains, foot sprains, toe injuries. Poor foundation and lack of foot support can cause issues up the chain as well including knee issues and pain, ligaments sprains, ACL injury etc.
My main suggestion for barefoot running is to start with short amounts of duration on a compliant surface. Similar to normal running progression with someone new to running, I would suggest the compliant surfaces such as treadmill or track. Less favorable choices would be hard packed dirt(assuming it is very well packed), blacktop pavement, and last choice would be cement.
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