Going Barefoot: Strong ‘Foot Core’ Could Prevent Plantar Fasciitis, Shin Splints, and Other Common Injuries

Press release:

As your cold-weather footwear makes the seasonal migration from the back of your closet to replace summer’s flip flops and bare feet, don’t underestimate the benefits of padding around naked from the ankles down.

Barefoot activities can greatly improve balance and posture and prevent common injuries like shin splints, plantar fasciitis, stress fractures, bursitis, and tendonitis in the Achilles tendon, according to Patrick McKeon, a professor in Ithaca College’s School of Health Sciences and Human Performance.

The small, often overlooked muscles in the feet that play a vital but underappreciated role in movement and stability. Their role is similar to that of the core muscles in the abdomen.

“If you say ‘core stability,’ everyone sucks in their bellybutton,” he said. Part of the reason why is about appearance, but it’s also because a strong core is associated with good fitness. The comparison between feet and abs is intentional on McKeon’s part; he wants people to take the health of their “foot core” just as seriously.

The foot core feedback loop

McKeon describes a feedback cycle between the larger “extrinsic” muscles of the foot and leg, the smaller “intrinsic” muscles of the foot, and the neural connections that send information from those muscle sets to the brain.

“Those interactions become a very powerful tool for us,” he said. When that feedback loop is broken, though, it can lead to the overuse injuries that plague many an athlete and weekend warrior alike.

Shoes are the chief culprit of that breakdown, according to McKeon. “When you put a big sole underneath, you put a big dampening effect on that information. There’s a missing link that connects the body with the environment,” he said.

Muscles serve as the primary absorbers of force for the body. Without the nuanced information provided by the small muscles of the foot, the larger muscles over-compensate and over-exert past the point of exhaustion and the natural ability to repair. When the extrinsic muscles are no longer able to absorb the forces of activity, those forces are instead transferred to the bones, tendons, and ligaments, which leads to overuse injuries.

It’s not that McKeon is opposed to footwear. “Some shoes are very good, from the standpoint of providing support. But the consequence of that support, about losing information from the foot, is what we see the effects of [in overuse injuries].”

Strengthening the foot core

The simplest way to reintroduce the feedback provided by the small muscles of the foot is to shed footwear when possible. McKeon says activities like Pilates, yoga, martial arts, some types of dance, etc. are especially beneficial.

“Anything that has to deal with changing postures and using the forces that derive from the interaction with the body and the ground [is great for developing foot core strength],” he said.

McKeon also described the short-foot exercise, which targets the small muscles by squeezing the ball of the foot back toward the heel. It’s a subtle motion, and the toes shouldn’t curl when performing it. The exercise can be done anywhere while seated or standing, though he recommends first working with an athletic trainer or physical therapist to get familiar with the movement.

He notes the exercise seems to have especially positive results for patients suffering from ankle sprain, shin splints, and plantar fasciitis. It’s even been shown to improve the strain suffered by individuals with flat feet.

The payoff could be more than just physical, as there could be financial savings. With strong feet, McKeon suggests that – depending on the activity – consumers may not need to invest hundreds of dollars in slick, well-marketed athletic sneakers (though he doesn’t recommend going for the cheapest of cheap sneakers, either). People with a strong foot core can actively rely on the foot to provide proper support, rather than passively relying on the shoes alone.

“You might be able to get a $50 pair of basketball shoes that don’t have the typical support that you’d expect. Because you have strong feet, you’re just using the shoes to protect the feet and grip the ground,” he said.

The easiest way to get started on strengthening the small muscles of the foot, though, is to kick off your shoes in indoor environments.

“The more people can go barefoot, such as at home or the office, is a really good thing,” McKeon said.

Would changing gait pattern decrease your likelihood of running injuries?

ROSEMONT, Ill. (April 6, 2016)–Are runners less injury-prone trekking barefoot than in pricey running shoes? Maybe, according to a new literature review in the March issue of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS). Advances in running shoe technology in the last 40 years have not reduced injuries, but racing “barefoot” in shoes with minimal cushioning could help runners change their strides and landing patterns to prevent repetitive heel pain and stress fractures.

Three of four active runners sustain injuries, mostly in the knee and lower leg. Most distance runners who use cushioned running shoes run heel-to-toe, or in a rearfoot strike (RFS) pattern. This action is associated with longer strides and excessive load force–up three times the runner’s body weight–on the lower leg, knee, and hip. This leads to bone and soft-tissue injuries, tibial stress fractures, and severe heel pain, such as plantar fasciitis.

Minimalist, including barefoot running has become popular in recent years. Minimalist running shoes have thinner soles and less cushioning and are more flexible than conventional runners’ footwear. Advocates believe these shoe changes alter running so the front or middle of the foot strikes the ground first–a forefoot or midfoot strike (FFS and MFS)–which reduces load stress on the knee, lower leg, and heel. Flatter foot placement dissipates load impact on the heel.

“Injury patterns among long-distance runners are unacceptably high, and while some research in minimalist running seems promising regarding injury prevention, there still are a lot of unknowns, and the debate continues,” says lead author and orthopaedic surgeon Jonathan Roth, MD, with Fort Belvoir Community Hospital in Virginia. “Evidence to date shows that changing gait patterns, not shoe selection, is the best intervention to lower the injury prevalence in runners. Minimalist shoes may give better feedback to runners and allow them to focus on changing their gait, but not everyone does, and this could lead to more injury.”

Dr. Roth added that increasing acceptance of minimalist running has outpaced medical evidence of its benefits. Orthopaedic literature, however, has demonstrated that with less-cushioned footwear, runners spontaneously transition from the RFS to the FFS gait pattern. Whether FFS running truly can reduce injuries is unknown, but the most compelling data were published in a 2012 study involving a Division I collegiate cross-country team. The results showed:

  • The athletes had a 75 percent injury rate per year, categorized as either traumatic or repetitive;
  • Strike type was characterized for each athlete and showed that 31 percent ran in the FFS pattern and 69 percent demonstrated RFS; and,
  • There was no difference in the traumatic injury rate between FFS and RFS runners; and,
  • FFS runners were 1.7 times less likely to sustain repetitive injuries than RFS runners.

Other findings in the JAAOS literature review include:

  • Barefoot and minimalist running is not injury-proof and poses risk for metatarsal (toe) stress fractures, plantar fasciitis, and puncture wounds;
  • Runners can transition to the FFS pattern in any shoe with appropriate training; and,
  • Barefoot and minimalist running is an emerging phenomenon that requires further exploration of its orthopaedic implications to identify true long-term benefits and risks.

Runners interested in exploring minimalist running shoes to provide more feel and less of a heel-to-toe offset, and to allow easier landing midfoot to forefoot, “should consider themselves as non-runners and start over by walking and gradually adding running distance week to week,” advises Dr. Roth. “This will help assure proper transitioning to build strength, flexibility, stability, and endurance around the foot and ankle.” Transition from a RFS to FFS gait pattern should be a gradual process–over many months. Runners should expect to run minimal mileage when transitioning and always remember the 10 percent rule when increasing in distance. An abrupt switching of gait patterns can lead to an increase in other repetitive stress injuries if not done correctly.