05/20/2013    Brad Makimaa, DPM

Biomechanics of Barefoot Running (Jefferson J. Mennuti, DPM)

I would like to clarify some of the ideas of this
principle. I would also like to call for someone
in one of our "Podiatric educational
institutions" to create a revolutionary road map
for the prescription of the proper shoes based on
speed and patient makeup. We are the shoe gurus
and there should be no second place on this
issue. If you want to run in any style, you must
see a podiatrist first. Just like a school
physical for sports is mandatory.

This is not a black and white issue. Everyone
will or can run on the forefoot. Just speed up.
Therefore simply asking the patient how fast they
run will set apart the majority of the shoe
categories. Think of track spikes. There is
literally nothing proximal to the rearfoot. Not
needed because you are sprinting on the forefoot
only. If your patient wants to run in that
fashion and is at approx 8 min/ mile pace or
lower then forefoot running is a viable option.
At 10 min/ mile you will work much harder trying
to forefoot run than a heel toe style. More
effort goes into deceleration.

I have experimented with this many times and
would love to see research done further. When
running on a treadmill and same for the road, I
alternate speed between intervals of 10,9,8,7,6,
and 5 min/ mile pace (5 is a little tough). Then
attempt forefoot for each speed and heel toe for
each speed. A very clear delineation of effort is
present. Very obvious at the extremes, i.e., 10
min/ mi on the toes and 5 min/ mi on the heel
seems absurd and very difficult.

As you increase speed and transition closer to
forefoot, then stability needs change as well.
This reduces the importance of orthotics and
stability shoes (not eliminate). As you decrease
and have a heel toe gait then this support is
critical for injury prevention (providing
overpronation is present).

This is just a basis for what category of shoe
works. Obviously, pronation, equinus, weight, all
biomechanical principles all come into play and
variables change but this speed evaluation gets
you started.

If someone is a slower runner and wants to run
barefoot. This is not ruled out, but they must
understand that this is not just wearing or not
wearing a different shoe. It is literally a new
sport. It is not just new shoes. Every day, I see
injuries from attempted barefoot or natural
running shoes because the patient continued a
heel toe gait with the new shoes. They were not
fast enough and had no idea how to change their
gait. Instead of buying new shoes, the concept
is really buying a new running style.

Bottom line- Research showing what shoes work at
what speed and what running style will create a
road map of where runners need to look. Or, more
importantly not look. i.e., What is ruled out for
them. Then we, the shoe gurus, can tweak the
suggestion based on our biomechanical exam.

Note- I overpronate (mod). I run/ train in rigid
orthotics and Asics Kayano (stability shoe). 8-9
min/mi mid to FF gait. I race in orthotics and
Asiscs Tri Noosa (a racing triathlon shoe with
stability) 6-7 min mile 5k all FF and 8 min/ mi
for half marathon, mostly FF gait. (Yes, I am
afraid to give up orthotics for the 5k) mentally)

Brad Makimaa, DPM, Key West, FL,
drmak3@comcast.net

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