Minimalist Running Shoes: The Medical Evidence

Does minimalist running decrease your chance of injury?

minimal running
Running shoes can change the way your foot lands on the ground. Credit: Robin Skjoldborg / Getty Images

Barefoot running and minimalist running have become popular among long distance runners in the past few years. Since the publication of the book Born to Run in 2009, minimalist running has grown exponentially. The book followed the Tarahumara Indians of Mexico, and their ability to run barefoot for hundreds of miles without experiencing injury. Proponents of minimalist running point to differences in gait style resulting from barefoot running as one of the possible reasons why this difference occurred.

What Is It?

Generally, minimalist running includes both barefoot running, or running with minimalist shoes that provide little or no cushioning or support. Most runners prefer a minimalist shoe to actual barefoot running to protect the sole of the foot from puncture or abrasion.

While this explains what minimalist running is, the key to understanding the difference with traditional running is to understand what minimalist running does to a runner's gait. The most common gait pattern in runners is a rearfoot strike (RFS) pattern where the heel of the foot lands first. About 80% of runners have a RFS gait pattern. The alternative to RFS is either midfoot strike (MFS) or forefoot strike (FFS) gait pattern. For the sake of this discussion, both MFS and FFS will be grouped together as FFS as the MFS pattern is relatively uncommon and shares most characteristics with FFS.

The key to minimalist running is that it tends to change the gait pattern of the runner.

Runners who are RFS with traditional footwear tend to transition to a FFS pattern of gait when they run barefoot or wear minimalist running shoes. Landing with a back of the foot is painful when barefoot, or in minimalist shoes, so runners tend to naturally change their gait pattern when they switch to a minimalist approach.

Why Gait Matters

How your foot lands when you run has effects on your body, your gait, and your risk of injury. Runners with different foot strike patters are noted to have some differences; among these are some of the following differences exhibited by FFS runners compared to RFS runners:

  1. Shorter stride length
  2. Higher stride frequency
  3. Better energy transfer

In particular, FFS runners absorb more energy from their stride in their foot and ankle, and therefore decrease the amount of energy transferred up the extremity to the knee and hip joints. This is not to say that all is perfect with minimalist running, as there have been downsides noticed as well. For example, the stress of the forefoot and ankle is higher, and injuries to these ares is noted to be increased in FFS runners.

Injury Differences

Here's what we know: there are biomechanic differences in gait in runners who have RFS gait and those with FFS. Runners with a RFS pattern tend to have more injuries up higher in the extremity including the knee and hip, whereas runners with FFS have more problems with the foot and ankle.

There are many claims of superiority of one gait pattern over another (better performance, higher efficiency), however these theories have not yet been shown in real life studies on runners. 

Injury differences can be summarized as follows:

InjuryMinimalist Running Shoes (FFS)Traditional Running Shoe (RFS)
Injury Risk Based on Gait Pattern (from Murphy, et al.)
Patellofemoral PainLower riskHigher risk
Tibial Stress FracturePossible lower riskPossible higher risk
Plantar FasciitisPossible higher riskLower risk
Metatarsal Stress FractureHigher riskLower risk
Puncture WoundsHigher riskLower risk

Bottom Line: Should You Switch?

There are some compelling theories for why a switch to minimalist running may benefit many runners. A few things to note: First, there is very limited data in runners to show that a change to minimalist running will change overall injury rates, rather they may just change the types of injuries that are more likely to occur. Second, it is clearly possible to change gait patterns without changing shoe style, although this may be harder for some people. Lastly, if you are considering a change, this should be incorporated gradually, and over several months to make the transition. Abrupt changes to minimalist footwear has been strongly associated with a high chance of injuries to the foot and ankle. All that said, if you have been challenged by injuries further up the extremity, such a knee joint problems, then a switch to minimalist running may be just what the doctor ordered!


Roth J, Neumann J, Tao M. "Orthopaedic Perspective on Barefoot and Minimalist Running" J Am Acad Orthop Surg. 2016 Mar;24(3):180-7.

Murphy K, Curry EJ, Matzkin EG. "Barefoot running: does it prevent injuries?" Sports Med. 2013 Nov;43(11):1131-8.

Continue Reading