Minimalist Shoes and the Loss of Padding

author : AMSSM
comments : 3

Member question

With the advent of barefoot running and minimalist shoes, does having the normal padded running shoes provide good shock absorbing protection for the ankles, knees and hips?  Going to minimalist shoes, is this effect lost and may have a negative affect?  Or does the fact that running in minimalist shoes 'should' correct your form thereby not needing the extra padding of normal running shoes?  For people that run 3-4x or more per week, I 'would think' that the cushioning in a regular shoe would help the long-term health of the joints?

Answer by Benjamin A. Hasan, MD
Member AMSSM

Let me start by stating that I believe in an explanation for the superior foot mechanics and resistance to injury among talented young runners from countries in Africa, such as Kenya, who grow up running on soft packed dirt paths without shoes. The schools in many of these communities are far from their homes, and running to and from school is actually practical. International marathon coaches involved with heavy recruiting from those areas have shared these ideas.

Their feet grow (develop) during years where these young boys and girls are running long distances regularly. This is my view of the developmental (growth and adaptation while running barefoot) issues regarding barefoot running. Growing up running barefoot leads to the foot growing and developing in a manner different from those of us who grew up wearing shoes to run.

Taking away padded shoes from a runner who has run for years only in shoes does not offer a chance for altering their foot development. The feet have already grown and are developed.

Now, to specifically address you questions about padding in traditional shoes:

The portions of the body above the feet depend on the stability, cushioning, and biomechanics of those structures below. This relationship is known as the "kinetic chain." Padding, shoe fit, design, materials, and weight of shoes affect the ankle, knee, hip and spine above them. Much research has been done regarding this.

By wearing less padding, less design components, and less arch support in a runner who has been used to relying on these can certainly have a negative impact on the ankles, knees, shins, IT band, quads, and hips above.

The cushioning has been shown to be helpful. Whether this is true only for those who run 3-4 times per week compared to other runners is not known.

Finally, the incidence of overuse running injuries in North America is huge. Injury is a major cause for many recreational athletes to quit their sport. This has a detrimental effect on much of the rest of their health for the rest of their lives.

Syndromes such as calcaneal fat pad contusions, shin splints (medial tibial stress syndrome, posterior tibial tendinitis, anterior tibial tendinitis), plantar fasciitis, achilles tendinitis, metatarsalgia, stress fractures, quad tendinitis, hamstring strains, patellofemoral syndrome, jumper's knee, and many other specific injuries can be addressed by various technical design components of modern running shoes. For pronators, motion control shoes commonly offer the runner a source of prevention for many potential injuries. When injured and planning their return to play, runners can benefit significantly from the padding, structural support, and the mechanical effect on their gait provided by appropriately fitting running shoes.

Despite paying fairly close attention to the popularity of this issue, and despite using these same shoes myself to run in, I do not believe that the minimalist shoes should replace traditional running shoes in most cases.

Thank you for your questions Ron.

Sincerely,

Ben Hasan

Benjamin A. Hasan, MD
Family and Sports Medicine
Northwestern Memorial Medical Group
Interim Program Director
Northwestern Lake Forest Hospital Family Medicine Residency

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date: July 23, 2012

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AMSSM

The American Medical Society for Sports Medicine (AMSSM) was formed in 1991 to fill a void that has existed in sports medicine from its earliest beginnings. The founders most recognized and expert sports medicine specialists realized that while there are several physician organizations which support sports medicine, there has not been a forum specific for primary care non-surgical sports medicine physicians.

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The American Medical Society for Sports Medicine (AMSSM) was formed in 1991 to fill a void that has existed in sports medicine from its earliest beginnings. The founders most recognized and expert sports medicine specialists realized that while there are several physician organizations which support sports medicine, there has not been a forum specific for primary care non-surgical sports medicine physicians.

FIND A SPORTS MEDICINE DOCTOR

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