The Center for Podiatric Care and Sports Medicine

Barefoot Running May Be More Dangerous Than We Thought

Posted by on Tuesday, March 19th, 2013


I think at this point we can all agree that barefoot running has taken the running world by storm. It’s everywhere you look: on the streets, on commercials, and on marathon runners (complementing their snazzy custom outfits). But until recently, there hasn’t been good evidence about barefoot running’s safety. Many athletes, podiatrists, trainers, and talking heads have touted its benefits, often citing very official-sounding biomechanical data. They argue that the foot and leg respond to the rigors of pad-less running by cushioning steps the way they were meant to be cushioned: with ankles, knees, and hips. After all, back in the caveman years we weren’t wearing padded sneakers. We were built for barefoot running!

Of course, as is frustratingly often the case in science, the anecdotal, “common sense” argument just doesn’t stand up to careful testing. We aren’t the same people we were back in the caveman years. We are brought up wearing padded shoes. We wear them all throughout childhood when our feet, ankles, leg bones, and hips are maturing. And cavemen weren’t running on pavement.

As podiatrists have become increasingly aware of barefoot runners with foot problems, they’ve become increasingly interested in studying the issue formally. Dr. Douglas Brown, a radiologist in Utah, decided it was time. He worked with Sarah Ridge, professor of exercise science at Brigham Young University, to examine the foot condition of 36 experienced, healthy, male and female runners before and after stints with Vibram’s Five Finger “barefoot” running shoes. Their control group continued a 15-30 mile/week schedule in traditional padded running shoes. The barefoot runners were instructed to start with just a mile/week in the Vibram shoes, as is suggested on the Vibram website.

Before the study and again after 10 weeks, Dr. Brown gave each runner an MRI to evaluate their condition. The control group scored a 1 on the bone marrow edema scale. Bone marrow edema is an accumulation of fluid in bone. A score of 1 is healthy. It reflects bone that is responding to training by getting stronger. However, most of the experimental group had developed a level 2 or above, signifying early bone injury. Two of the runners in this group had full-on stress fractures (edema level 4). So, clearly, barefoot running may present real risk, especially for runners who are just starting to adopt it. (And clearly this view is catching on, as evidenced by a recent lawsuit).


The caveman argument reminds me of the classic pregnancy argument against hospitals: “Women have been having babies forever, so why bother with all these fancy medical interventions?” Just because something is possible without modern technology, doesn’t make it better. Millions of women died in childbirth back in the “good old days.” Similarly, if we were to examine the foot bones of cavemen we might find evidence of a lifetime of stress fractures. And remember this: most died before they reached 30. Young bones can handle a lot of trauma. Baby boomers beware.


If you have any foot problems or pain, contact The Center for Podiatric Care and Sports MedicineDr. Josef J. GeldwertDr. Katherine Lai, Dr. Ryan Minara and Dr. Mariola Rivera have helped thousands of people get back on their feet. Unfortunately, we cannot give diagnoses or treatment advice online. Please make an appointment to see us if you live in the NY metropolitan area or seek out a podiatrist in your area.