It’s been a while since our last Vibram Transition post. For the time being, we’ve been focusing on testing other minimalist shoe options (lots of exciting reviews coming soon!), but I wanted to come back to this series and talk about one of the less emphasized parts of barefoot/minimalist running: injury. “Injury” often feels like a dirty word in the barefoot/minimalist community. In this post-Born to Run world, many people are touting barefoot/minimalist running as the solution to running injuries associated with heel-striking/traditional footwear, and it’s not hard to find testimonials about how switching “cured” people of their knee pain, shin splints, plantar fasciitis, etc. Of course, there are also plenty of people who would argue that so many people switching to barefoot/minimalist, and doing “too much, too soon”, is going to result in an “epidemic” of foot/ankle/leg injuries in the coming years! While there is scientific evidence indicating that runners with a midfoot/forefoot strike may be injured less often, and plenty of anecdotal evidence suggesting that switching to barefoot/minimalist might help runners overcome injuries and/or prevent new ones, it doesn’t mean that going barefoot/minimalist equals becoming injury-free.

This post feels very timely for me, because I’m nursing an injury (or at least almost-injury) of my own at the moment. For the past 2-3 weeks, my right hip has been bothering me when I run. For the most part it was just a little soreness in the joint, but not enough to make me stop running. Stretching well afterwards eliminated any soreness/stiffness by the time I woke up the next day, so I didn’t think too much of it. However, this all came to a head a few days ago when, after only running for about a mile, I was forced to turn around and limp home because my whole right hip/butt-cheek/thigh started to seize up. I’m still not sure if I pulled a muscle, hurt my hip joint, or both. Either way, ouch! Because of this, I wanted to do some research on barefoot/minimalist running injuries, as well as possible ways to deal with/prevent them, to see if I could identify what was causing my own pain and help out any readers who are experiencing the ouch.

There are several common injuries associated with barefoot running. Many of them can be attributed to doing “too much, too soon” (TMTS), but these injuries could happen at any point if you, for example, have a big jump in mileage, get sloppy with your form, or even switch to a different type of minimalist shoes. Here’s a list of a few to look out for:

1. Plantar fasciitis: This is caused by inflammation of the plantar fascia, the thick tissue on the bottom of the foot that connects the heel bone to the toes. Arch support in traditional running shoes weakens the arch, like the muscles encased in a cast beginning to atrophy. Minimalist shoes often have no arch support, and this sudden added stress on the arch can result in plantar fasciitis if a person tries to do TMTS.
2. Achilles tendonitis: The built-up heels of traditional running shoes and heel-striking compresses and weakens your achilles tendon. Your achilles tendon must stretch out to accommodate the low or nonexistent heel-toe drop of minimalist shoes (or your bare feet). Forcing this to happen too fast can result in achilles tendonitis.
3. Stress fractures in the feet. Again, this injury is related to doing TMTS. You must allow your feet to strengthen gradually to accommodate your minimalist or barefoot form or you may get stress fractures, which are small fractures or cracks in the bone.
4. Dropped metatarsal. This occurs when one of the metatarsals in the forefoot drops out of alignment with the others. The dropped metatarsal is then closer to the bottom of the foot, making it the main focus of any force applied to the bottom of the foot (like a step). Because switching to minimalist/barefoot running often means switching to a forefoot/midfoot strike instead of heel-striking, the added stress on the metatarsals can result in this type of injury.
5. Strains/soreness/pain in the calf, ankle, foot, and achilles. All of these body parts can be weakened by traditional footwear. Minimalist/barefoot running is a great way to reawaken these muscles, bones, and tendons, but poor form or doing TMTS can result in (sometimes extreme) soreness, pain, and even strains!
6. Broken toes, blisters, cuts, abrasions, bruising, etc. of the feet. This is pretty self explanatory, but many people who run barefoot sometimes sustain injuries from running on particularly rough surfaces, stepping too hard on a rock, cutting their foot on something sharp, stubbing a toe, etc. The best way to prevent these types of injuries is to be aware of your surroundings. Blisters and bruising could also happen if you are transitioning too quickly.

Luckily, there are several relatively simple ways to deal with and/or prevent injuries from occurring in the first place. The first, and many would argue most important, way to prevent injuries from barefoot/minimalist running is to pay attention to your form. Many runners will tell you that one of the best ways to evaluate your form is to go for a run completely barefoot, as minimalist shoes will sometimes allow you to get away with being a little sloppy with your form. Any pain you feel while barefoot will give your body the feedback it needs to adjust an improper form. Be sure to check out Dr. Mark Cucuzzella’s video on natural running for a great technical explanation of proper form. Also important to maintaining good form is being aware of your cadence, or the number of steps you take per minute. People often quote 180 bpm as a good target because it forces you to stay light on your feet to keep up the quick foot turnover. To help prevent soreness in your legs, butt, and hips, and to keep yourself loose, you can invest in a deep-tissue massage tool like the Stick or a foam roller. For soreness or pain in the arches of your feet, try rolling your feet over a tennis ball.

Bottom line is that barefoot/minimalist running is not equivalent with injury-free running. If you are out for a run and start to feel injured, STOP. Rest for a few days if needed. You don’t want to turn something small into a chronic injury or an injury that will keep you from running for several weeks/months instead of just a couple days. Unfortunately for me, hip injuries do not appear to be commonly associated with minimalist running, but more-so with more traditional running techniques. A couple days of rest, pain killers/muscle relaxants, and a heating pad seem to have done the trick in relieving my hip pain, so hopefully this won’t become a persistent problem. My best guess is that something is off with my form that is causing me to strike the ground harder than I should be with my right leg. On the other hand, my right hip has always been a little funny–it cracks and pops on its own (one of my many charming similarities to a 90-year-old woman)–so perhaps, minimalist or not, I was destined to have a few troubles with it. For now, I’ll keep stretching it out as best I can and continue working on my form. If anyone has any tips on hip pain or if you have any questions, let me know in the comments!

Miss a Vibram Transition post? Read them here:

Vibram Transition – Chapter 1

Vibram Transition – Chapter 2

Vibram Transition – Chapter 3

Vibram Transition – Chapter 4

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