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This is a letter in the current NZ Medical Journal: Barefoot running and walking: the pros and cons based on
In response to the recent debate on barefoot running and walking of children
published in the New Zealand Herald1 we have put together an argument relating to
the pros and cons based on current evidence.
There is very limited evidence specifically relating to barefoot running and walking in
children. One study from Germany reported that the increased prevalence of flatfoot
and hallux valgus (bunions) in modern societies may be the consequence of
inadequate footwear in childhood.2 The German study postulated that barefoot
walking represents the best condition for the development of a healthy foot.
Walking and running on different types of surfaces such as grass, sand, and artificial
running tracks may indeed enhance healthy foot development. However, the problem
of barefoot walking on hard surfaces such as pavements may alter the biomechanics
of walking and running. This may lead to potential arthritic changes and consequently
a reduction in foot function.
A more worrying concern is the impact of obesity and overweight on children’s feet.
A recent study from New Zealand suggested that three lifestyle risk factors related to
obesity: low physical activity, skipping breakfast, and insufficient sleep on
To prevent children undertaking physical activity may exacerbate a major issue
already within New Zealand. A recent study from Australia suggests that the function
of the arches of the feet in overweight and obese children may change and this might
worsen if excess weight impacts on the foot throughout childhood and into
Another problem to address relating to barefoot walking is the issue of children with
diabetes. The long-term complication of diabetes on the foot includes infection,
ulceration, and a loss of peripheral sensation. A UK study by Karabouta5 found over
50% of adolescents with Type 2 diabetes had peripheral neuropathy and weak
posterior tibial pulses. The authors recommend that all children with Type 2 diabetes
need podiatric surveillance for complications from the time of diagnosis. A study
from rural Australia suggested that walking barefoot is a risk factor for diabetic foot
It is interesting to note that certain types of footwear may cause injuries in children. A
study from Ireland showed that there was an increasing trend in orthopaedic injuries
using Heelys and Street Gliders.7. Another study using a cloth sport shoe showed
inferior cushioning capability but the same lateral stability as the other sports shoes
for children.8 However, a study from Germany reports shows that slimmer and more
flexible children's shoes do not change foot motion as much as conventional shoes
and therefore should be recommended for children of all ages.1
Painful feet in children are often caused by flatfeet or mechanical instability of the
arches of the foot. A recently conducted New Zealand review on children’s shoes
found no evidence to support the suggestion that different types of footwear reduced
pain in children’s flatfeet.9
Finally, a study from Australia found significant structural differences between the
feet of European and Australian children.9 The German children displayed
significantly longer and flatter feet relative to their Australian counterparts, whereas
the Australian children reveal a significantly smaller ball angle, implying that the
forefoot of the Australian children is squarer in shape.
These findings imply that footwear must be designed to cater to the unique foot
dimensions of children in different continents to ensure that shoe shape matches foot
shape. Most footwear companies do not vary the dimensions of their shoe lasts to
accommodate intercontinental differences in foot morphology based on racial and/or
environmental factors. The results of this study will have immediate implications for
the design of comfortable footwear suitable for the developing feet of children.10
In summary, further research is required in this area.
AIM: The first aim of this study was to assess how changes in the mechanical characteristics of the foot/shoe-ground interface affect spatio-temporal variables, ground pressure distribution, sagittal plane kinematics, and running economy in 8 experienced barefoot runners. The second aim was to assess if a special lightweight shoe (Vibram Fivefingers) was effective in mimic the experience of barefoot running.
METHODS: By using an instrumented treadmill, barefoot running, running with the Fivefingers, and running with standard running shoe were compared, analyzing a large numbers of consecutive steps. Foot/shoe-ground interface pressure distribution, lower limb kinematics, V.O(2) and heart rate data were simultaneously collected.
RESULTS: Compared to the standard shod condition when running barefoot the athletes landed in more plantarflexion at the ankle. This caused reduced impact forces and changes in stride kinematics. In particular, significantly shorter stride length and contact times and higher stride frequency were observed (P<0.05). Compared to standard shod condition, V.O(2) and peak impact forces were significantly lower with Fivefingers (P<0.05) and much closer to barefoot running. Lower limb kinematics with Fivefingers was similar to barefoot running with a foot position which was significantly more plantarflexed than in control shoe (P<0.05).
CONCLUSIONS: The data of this study support the assumption that changes in the foot-ground interface led to changes in running pattern in a group of experienced barefoot runners. The Fivefingers model seems to be effective in imitating the barefoot conditions while providing a small amount of protection.
Popular Mechanics has this storÿ: The Running Shoe Debate: How Barefoot Runners are Shaping the Shoe Industry
A group of running rebels are shedding their shoes and reporting years of injury-free miles. Some ultramarathoners, biomechanics experts and doctors think that's probably a good thing. Others go so far as to say running shoes are in fact causing injuries. Meanwhile, running shoe companies continue to precisely measure runners, and pound and flex shoes in their high-tech labs. Could shoes—and shoe companies—be covering hundreds of thousands of perfectly able bare feet? If shoes are doing damage, just what are the companies measuring?
I have to say thanks to Podiatry Arena for this resource. This is an issue that comes up in my clinic from time to time; here at Podiatry Aena you get exposed to all the pros and cons and at a minimum develop a well informed view (as opposed to a fanatical view) on the topic. Thanks guys!