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Barefoot Running Injuries: Common Injuries and How to Prevent Them

Posted by on Nov 6, 2010 | 5 Comments

There’s no doubt barefoot running has become more popular.  As more people ditch their shoes (or move to a true minimalist shoe), we’re seeing a positive correlation in barefoot running-related injuries.  New barefoot/minimalist shoe runners (BFR/MRs) generally fall into two camps:

1. Early adopters- this group does a lot of research prior to beginning.  This group is the most likely to be reading this right now.  This group educates themselves of the potential dangers of barefoot running.  Generally, this group does not experience significant problems becasue they do their homework and prepare accordingly.

2. Trend followers- This group is likely to try barefoot running after hearing a story on the news, reading an article online, reading Born to Run, or purchasing a pair of minimalists shoes like Vibrams.  This group generally will not do prior research.  This group will typically try BFR/MR first, experience problems, then seek advice.

Hopefully this information will help both groups.

One of the dangers of beginning BFR/MR is doing too much too soon.  Your feet have likely spent most of their active life confined in shoes. Shoes weaken the bones, muscles, ligaments, and tendons of your feet. The skin on the soles of your feet will not be used to the sensory input of the ground.  In order to prevent injuries, it is important to begin barefoot running cautiously.   Barefoot running feels wonderful!  The urge to do too much before your feet are ready is very powerful.  As such, it is important to follow a conservative plan even if you feel great in the beginning.

Going too fast or running too far may result in a myriad of injuries, including tendon and ligament damage, excessive blisters, stress fractures, and other over-use type injuries.   If at any time you experience pain, STOP! Add a second day of rest, and then try again. Continue until you are pain-free.  Do not give in to the temptation to “run through the pain.” The soft-tissue injuries that can occur during the foot-strengthening process can set your progress back by weeks or even months. TOO MUCH TOO SOON (TMTS) injuries are the greatest obstacle to successfully transitioning to barefoot running.

A fairly universal complaint is often referred to as the “top of the foot pain” (TOFP); it feels like a dull ache on the top side of your foot.  This seems to be a function of your foot anatomy adapting to the different stresses of using new muscles, tendons, and ligaments. It could also be caused by the stress placed on the metatarsal bones (metatarsalgia).

Regardless of the cause, the solution is RICE (rest, ice, compress, and elevation).  Minor TOFP should not inhibit running.  If the pain reaches a moderate level or you experience sharp, shooting pains, stop running until the pain subsides.  If you continue to press through the pain, you run the risk of developing a stress fracture of the metatarsal bones.  This injury could sideline you for months, so exercise caution.

Achilles tendon and calf muscle soreness and tightness is a common issue.  This develops from the lengthening of the calf and Achilles when going from a raised heel shoe to a zero drop (heel and forefoot are the same height) shoe.  Also, the natural running form BFR/MR use requires the calf muscles to actually work.  It is important to let your heel touch the ground with each stride as it unloads some of the energy from the calf and Achilles.  “Running on your toes” and preventing your heels from touching the ground is a very common mistake many new barefoot and minimalist shoe runners make.

To prevent injury to the Achilles/ calf muscles, it is a good idea to stop running if pain develops.  I use the weightlifting analogy.  If you experience soreness similar to the feeling you get a day or two after weightlifting for the first time, it is okay to continue running.  If you experience sharp, shooting pains, stop and do not run again until the pain subsides.

Blisters are a fairly common issue for the new BFRs. Generally, blisters result from some combination of heat, friction, and moisture. If all three are present, blisters tend to form quickly.  In the absence of one variable, blisters may still form if the other two conditions are fairly extreme. For the new barefoot runner, friction is usually the main culprit.  Moisture is a non-issue unless you are running in mud or rain. Heat can be an issue if running on a hot surface such as asphalt on a sunny day or some treadmills. If blisters do develop, they can be an indicator that your form is not quite as good as it could be. Where blisters develop can be very informative. If blisters develop on the heel, that is usually an indicator that you are heel striking or over-striding.  If they develop on your toes or the ball of your foot at the base of your toes, that can be an indicator that you are “pushing off” with each stride.

If you develop blisters, you probably should take a few days off.  Personally, I take two or three days off, then tape the blister and wear minimalist shoes for a few weeks.  That protects the affected area and allows me to run in comfort.

The question of popping blisters is debatable.  Leaving it intact will help prevent infection and may speed healing.  Popping it usually makes it more comfortable to run.  I play it by ear.  If the blister is severe, I leave it.  If it does not affect my gait, I leave it.  If it does affect my gait (i.e.- lots of fluid, but not necessarily severe), I pop it.

Another potential area of concern is puncture wounds.  When running barefoot, you have little or no protection against glass, nails, thorns, or other such debris.  It is absolutely critical to develop your skill at analyzing the terrain immediately in front of you. This is necessary to avoid potential dangers.  With practice, this skill will become automatic.  However, until that occurs, ALWAYS watch your path.  If you encounter an area that contains hazards, it is best to avoid that area.

One final area of concern is tripping or stubbing your toes on objects. My only two barefoot injuries came about because of this. I tripped on a root when running a 50-mile ultramarathon barefoot, and tripped on a speed bump while on a training run.  In both cases, my falls could have been prevented had I not been distracted. Again, it is critically important to watch your path to identify potential hazards. Also, it is vitally important to pick your feet up enough to avoid tripping over hazards.

Barefoot and minimalist shoe running does not have to be dangerous.  Knowing the common injuries, what they feel like, how to prevent them, and how to treat them will result in a MUCH more enjoyable experience.  All of us can play a role in educating others to help prevent these problems.

Feel free to forward this article with anyone that may be interested in barefoot running, minimalist shoe running, experienced injuries, or may otherwise find it useful.

If you found this information useful, please consider checking out my barefoot running book. I outline a versatile plan for helping new barefoot and minimalist shoe runners transition safely.  You can read the first 52 pages for free here.

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5 Comments

  1. Jen
    November 9, 2010

    Thanks for the post. I can see how I’m doing some things backwards and hope to correct that now. I read the free part of the book and loved it. I’m going to go purchase it. Thanks for all the info!

  2. sage
    November 8, 2010

    In the “stubbing the toes” category, my injury came from just that. At mile 12 of a 25k trail race, I stubbed all four small toes on an invisible stump (hidden in tall grass at the side of the 6″ wide trail). I finished the last 5k, but I’d fractured my 4th toe at the metatarsal joint, requiring surgery and 10 weeks on crutches.

    Four months after the accident, I’m cautiously beginning to run again. I hate invisible stumps!

  3. Joe
    November 7, 2010

    Doesn’t TOFP have a lot to do with landing too much on the forefoot? The pain seems to center right at the joint between the second metatarsal meets the second and third cuneiform bones. For reformed heel-strikers (hi!), it’s easy to overdo the landing towards the toes which would seem to drive impact forces through the metatarsals and pound that particular joint.

    Personally, I really discovered that when I finally went completely barefoot and found I was not only hitting one foot harder than the other, I was also leaving that foot on the ground too long. Several other form deficiencies became apparent once it was just my skin on the ground. VFFs are wonderful, but they still mask a whole lot of feedback. Near-barefoot is not barefoot.

  4. Jason
    November 6, 2010

    Good comment, CB. I agree, sometimes BFR/MR is portrayed as a cure-all solution. It has dramatically reduced my instance of injuries, but does not eliminate them. I still get a bout of TOFP every spring when I ramp up my training mileage.

  5. C. Beth
    November 6, 2010

    What I’m finding right now is that BFR & MR don’t automatically fix all form/strength issues! I’ve had ITBS return–something I dealt with when wearing shoes too. I’m having to tweak my form (oops, guess my hips were swaying too much!), introduce specific strengthening exercises, and get professional help from someone who’s treated a ton of ITBS. I appreciate you blogging about this because sometimes the message seems to be, “Start running barefoot and you’ll be pain-free!” For those who experience that…awesome. But for the rest of us, we still gotta use those injuries that do come, to teach us to run better (with or without shoes!)