Yes, ladies and gentlemen, it is now official, barefoot is best. Well almost... if we do a bit of liberal interpretation . To quote Vivobarefoot's article (I've changed the link to point directly to the paper)...

Harvard Professor Daniel Lieberman has released his latest ground breaking research: "Foot Strike and Injury Rates in Endurance Runners: a retrospective study" which shows runners with a rearfoot strike have almost twice the rate of injury than those who forefoot strike, a characteristic found in skilled barefoot runners.
— IT’S OFFICIAL BAREFOOT IS BEST

Unfortunately, the paper is locked away behind a form that makes you buy it in order to read it, so I've not read the whole article yet, but the abstract gives us a good idea...

Purpose: This retrospective study tests if runners who habitually forefoot strike have different rates of injury than runners who habitually rearfoot strike.

Methods: We measured the strike characteristics of middle and long distance runners from a collegiate cross country team and quantified their history of injury, including the incidence and rate of specific injuries, the severity of each injury, and the rate of mild, moderate and severe injuries per mile run.

Results: Of the 52 runners studied, 36 (59%) primarily used a rearfoot strike and 16 (31%) primarily used a forefoot strike. Approximately 74% of runners experienced a moderate or severe injury each year, but those who habitually rearfoot strike had approximately twice the rate of repetitive stress injuries than individuals who habitually forefoot strike. Traumatic injury rates were not significantly different between the two groups. A generalized linear model showed that strike type, sex, race distance, and average miles per week each correlate significantly (p<0.01) with repetitive injury rates.

Conclusions: Competitive cross country runners on a college team incur high injury rates, but runners who habitually rearfoot strike have significantly higher rates of repetitive stress injury than those who mostly forefoot strike. This study does not test the causal bases for this general difference. One hypothesis, which requires further research, is that the absence of a marked impact peak in the ground reaction force during a forefoot strike compared to a rearfoot strike may contribute to lower rates of injuries in habitual forefoot strikers.

(C)2012The American College of Sports Medicine

— Foot Strike and Injury Rates in Endurance Runners: a retrospective study

The sample size isn't very big and it doesn't conclusively prove barefoot it better than shod running - barefoot isn't even mentioned - but if they can come to their conclusion from such a small sample, we can further extrapolate to say barefoot has got to be better as you will almost certainly land on your forefoot when running barefoot. It's hurts too much not to.

Now to see if I can get my hands on that paper.

Monday night's episode of Health Check (listen here) on the BBC World Service covers the topic of barefoot running with the reporter taking a quick spin barefoot round a track (and surprises herself) and then follows up with an interview with Daniel Lieberman in which he briefly covers what he discusses in his recent paper. What is quite impressive is just how much coverage barefoot running gets in one programme: over 11 minutes of a 28 minute programme. Impressive.

The programme also discusses the human ability to run extreme distances and includes an interview with a complete nutter Tim Davie, one of the BBC's directors, following his recent completion of the Marathon Des Sables and gets some scientific input from Daniel Lieberman.

Quite an interesting programme and it's great to hear barefoot running getting some exposure on a reputable service like the BBC World Service. Maybe we'll see a lot more barefoot or minimalist runners off the back of this, or even in this year's London Marathon on Sunday morning.

The programme is available for international listeners too.

I've finally managed to get my hands on The Lieberman "letter": Foot strike patterns and collision forces in habitually barefoot versus shod runners reported in January's edition of Nature and I've read through it, the accompanying Harvard site and a lot of the reviews other people have made, and here are my observations.

First and foremost, I believe this paper has been over-hyped and misinterpreted (possibly deliberately as it makes "good news") in a big way. I think the main reason for this is it's the first major research paper in years that actually involves comparisons between barefoot and shod runners. There have been other recent studies that have documented the merits of different foot strikes (fore/mid/heel), but none have made the comparison between barefoot and shod runners. There's also the added attention barefoot running is currently enjoying thanks to Christopher McDougall's book: Born to Run (my review).

The paper itself doesn't provide anything particularly new, at least for someone who has already made the transition from running in shoes to barefoot, or who has watched the running style and landing of runners of varying degrees of age, speed and profession. What is does do is officially put some science behind the anecdotal evidence many barefoot runners talk about with regards to impact and foot strike when running barefoot. This is the "I told you so" part I mentioned in my previous post.

I think most people and the media are reading a lot more into this paper than the authors are actually stating and not actually reading what's right in front of them. Essentially, the paper is only documenting and comparing their observations on...

• foot strike patterns in shod and barefoot Americans and Kenyans (groups 1-5)
• and collision forces in shod and barefoot Americans (groups 1 and 3)

... who have been habitually barefoot or shod. Nothing more. It's there in the title: "Foot strike patterns and collision forces in habitually barefoot versus shod runners". All corresponding hypotheses about reducing injuries are exactly that - hypotheses. There is no research (yet) indicating that running barefoot reduces impact related injuries or running in shoes causes injuries. It only suggests there could be a correlation and this is the part that I feel the media and most people have hooked onto. "May" is being treated like "Will".

The authors didn't really help prevent this by finishing off the paper with...

Evidence that barefoot and minimally shod runners avoid RFS strikes with high-impact collisions may have public health implications. The average runner strikes the ground 600 times per kilometre, making runners prone to repetitive stress injuries. The incidence of such injuries has remained considerable for 30 years despite technological advancements that provide more cushioning and motion control in shoes designed for heel–toe running. Although cushioned, high-heeled running shoes are comfortable, they limit proprioception and make it easier for runners to land on their heels. Furthermore, many running shoes have arch supports and stiffened soles that may lead to weaker foot muscles, reducing arch strength. This weakness contributes to excessive pronation and places greater demands on the plantar fascia, which may cause plantar fasciitis. Although there are anecdotal reports of reduced injuries in barefoot populations, controlled prospective studies are needed to test the hypothesis that individuals who do not predominantly RFS either barefoot or in minimal footwear, as the foot apparently evolved to do, have reduced injury rates.

Unfortunately this is a bit of a sensational closing paragraph which has just the right ring to it to catch the media's attention with the last sentence being ignored in most reports I've seen. Thankfully, the authors have acknowledged that their paper has been misinterpreted by the media on the first page of the supporting website.

The supporting website itself covers the much broader topic of barefoot running and it's merits. It draws on and references material from this and other studies to help put together a good single resource for people curious in the merits of running barefoot. It does emphasis in several places that this is really only for informational purposes and does not constitute a definitive statement on the best way to run or the effects on injury.

So whilst this paper doesn't actually document anything new, I feel it will start the ball rolling on more controversial and potentially sensational research. I think this study it just the stepping stone needed for others to actually research the effects of running in shoes vs running barefoot with respect to injuries and performance. I do have one slight reservation with stating this though: in this litigious world, would the running shoe manufacturers actually allow such research to see the light of day if it proves shoes are causing more harm than not?

Just a quick note to say, no, I've not been sleeping under a rock (sleep, what's that?). Yes, I've heard about the Lieberman Paper and seen/heard the BBC news article and all the other summaries and opinions cropping up all over the net since it was released earlier this week, I've just not had the chance to actually sit down and read it, or more specifically the Harvard site setup for it, yet.

The thing is my wife and I have just had our first baby and sadly she's got a heart condition, so I've spent most of my free time (when I'm not cramming in 6 hours of solid work in the morning) travelling to and from Oxford (I live 35 miles away in Reading) every day to see my little one.

Hopefully, I'll get a chance to read it in the next few days and post my own opinions on it. From the little bit I've read in various locations, my initial thoughts are: "It's about bloody time some one published a modern paper detailing one/some of the benefits of barefoot running" and "I told you so", but this is only based on second hand information.

Time for a beer, dinner, relaxation, and maybe some reading of this study on my iPod Touch instead of TV tonight, though I do now have a two rather interesting books to read too: Brain Training For Runners (I love subjects involving using the brain to better our lives - think Tony Buzan) and Why We Run. Naturally, both will get a review here once I'm done with them.