Another highly emotive issue, this. There was a huge jump in popularity of barefoot running particularly after Christopher McDougall’s book, ‘Born to Run’ was released in 2009. Since then, many companies have developed barefoot shoes (an oxymoron which we live with), and many coaches have aligned themselves with these companies, which makes it a surprisingly complicated and – as mentioned – emotive (often financially driven) topic.
As with all of my blogs, I will remove the emotion, and see what the data says.
So, to start with a running shoe perspective, let’s look at what the unbiased, unemotive, non-financially-rewarding evidence says;
Pros: What Evidence Shows
- Change biomechanics & improved economy?. Research demonstrates that running in barefoot or minimalist footwear often shifts runners into a forefoot strike pattern, which reduces peak vertical ground reaction forces and redirects loading from knee to ankle—potentially easing knee strain. Some athletes even develop stronger intrinsic foot muscles and stiffer Achilles tendons after transitioning .
- Running efficiency: Studies report slight improvements in oxygen consumption (VO₂), suggesting minimalist running may be up to ~2–4 % more efficient .
Cons: Risks You Shouldn’t Ignore
- Higher stress on the ankle, Achilles & forefoot: Biomechanical research flags increased Achilles tendon loading, calf strain, metatarsal stress, and forefoot stress fractures in barefoot/minimal planting .
- Transition injuries are common: Many runners experience calf or Achilles issues, and studies report habituation injuries (particularly bone stress injuries in metatarsals) in minimalist transitions.
- Evidence on injury reduction is inconclusive: A year-long prospective study found barefoot runners had fewer diagnosed injuries per runner—but similar injury rates when accounting for lower mileage. They also had more plantar foot injuries, though fewer knee/hip problems. A broader review concluded there’s no clear evidence that barefoot running lowers injury risk.
| Injury Type | Shod Running | Barefoot/Minimalist Shoes |
|---|---|---|
| Knee/hip injuries | Higher incidence | Lower occurrence |
| Plantar/foot injuries | Lower | Higher (including blisters, cuts, metatarsal stress) |
| Calf/Achilles issues | Typical occurrence | Higher occurrence |
So injury type changes dependent on footwear, but injury prevalence is pretty much identical. (Incidence of Running-Related Injuries Per 1000 h of running in Different Types of Runners: A Systematic Review and Meta-Analysis, Videabak et al, 2015).
However the barefoot runners all had consistently lower mileage, but the same percentage of injury. The ability to build volume in barefoot shoes is incredibly hard, and not for everyone.
Natural Isn’t Always Best: The Role of Modern Innovation
One of the common sales techniques for barefoot shoes is that they are “natural” or primal.
We evolved over hundreds of thousands of years without shoes – the argument is that shoes are not “natural”.
But this is extremely reductionist, and we must remember that not all natural changes are beneficial, and most changes in quality of life and healthcare have not been natural.
Throughout history, modern innovations have extended lifespans and improved quality of life:
- Vaccinations & antibiotics – weirdly a contentious issue, I know, but undoubtedly vaccine development has prevented millions of deaths from infectious diseases over the past century.
- Modern medicine has significantly reduced mortality rates for both mothers and children.
- Dental health and hygiene – Enhanced oral health, digestion, and self-esteem.
- Prosthetics & orthotics – Allowed amputees and injured individuals to walk again.
- Supportive athletic shoes – Helped those with foot deformities like flat feet or hallux valgus maintain function and avoid pain.
The last point is a discussion in itself; some claim that modern day, narrow shoes are the primary cause of bunions (hallux valgus) or foot deformity, where as research continually shows that the key driver is actually genetics – family history (90%) (Hallux Valgus Inheritance: Pedigree Research in 350 Patients With Bunion Deformity, Pique-Vidal et al., 2007).
“Not natural” would rule out most things we take for granted in our day to day life, including whatever medium you are reading this on.
And what about exercise that isn’t running?
Away from running there is also no solid evidence that barefoot squatting reduces injury (Effect of Footwear on the Biomechanics of Loaded Back Squats to Volitional Exhaustion in Skilled Lifters, Brice et al., 2021), or that there is any performance gains to be had when deadlifting (Footwear Affects Conventional and Sumo Deadlift Performance, Valenzuela et al., 2021).
Comfort is a different thing, of course, and should never be downplayed.
In fact, I would argue that comfort is the most important thing.
I myself own a pair of vivo barefoot shoes. I find them comfortable, for short periods, and useful in some of my pulling exercises in the gym i.e deadlifting. I have no emotional or financial relationships with any particular shoe type or brand. I own weightlifting shoes, running shoes, Metcons, Vans etc etc.
I wear what I find most comfortable for the task at hand.
Practical Guide: If you are a Runner and want to try Barefoot Shoes
- Start gradually – Begin with 5–10 minutes on soft ground once or twice weekly. Progress slowly—no more than ~10 % weekly mileage increase .
- Strengthen feet and calves – Foot exercises, calf raises, and balance drills are a must
- Listen to your body – Soreness is normal—but sharp tendon or bone pain is not. Back off immediately.
- Choose quality minimalist shoes – Go for thin, flexible soles with little drop, but enough protection; avoid full barefoot on hard surfaces.
- Mix it up – Alternate barefoot sessions with regular running. Varying footwear reduces repetitive stress and improves resilience .
Final Verdict: Balanced, Evidence-Informed Approach
- Barefoot/minimalist shoes can reduce load on knees and strengthen foot musculature, but they increase load on ankles, calves, metatarsals, and plantar foot—especially during hasty transitions. Essentially, it is a case of choosing your pain-point.
- Current research is mixed; definitive injury-reduction claims are lacking.
- Natural movement is appealing—but modern aids like supportive shoes, prosthetics, and medicine have vastly boosted our collective health and quality of life.
- If trying the shift, do it slowly, build foot strength, heed pain signals, and always back up with robust evidence and professional guidance. It will take a long time (18 months would be a realistic aim), and the performance benefits may not exist.
At DC Injury Clinic, I of course advocate evidence-based injury reduction strategies tailored to each runner. Feel free to contact me to discuss further, or add to the discussion.