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Review
. 2020 Apr 21;6(1):e000577.
doi: 10.1136/bmjsem-2019-000577. eCollection 2020.

From Barefoot Hunter Gathering to Shod Pavement Pounding. Where to From Here? A Narrative Review

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Free PMC article
Review

From Barefoot Hunter Gathering to Shod Pavement Pounding. Where to From Here? A Narrative Review

Peter Francis et al. BMJ Open Sport Exerc Med. .
Free PMC article

Abstract

Understanding the current prevalence and incidence of running injury from an evolutionary perspective has sparked great debate. Proponents of the evolutionary approach to understanding running injury suggest that humans ran using less injurious biomechanics prior to the invention of cushioned running shoes. Those who disagree with this view, point to the many runners, wearing cushioned running shoes, who do not get injured and suggest that the evolutionary approach is indulging in a 'natural fallacy'. This polarises the scientific debate into discrete categories such as 'shod' vs 'barefoot'. This review aims, first, to describe humans' innate impact moderating mechanisms which arise from our evolutionary legacy. Second, we discuss the impact of footwear on these mechanisms and the potential link to injury in some runners. Finally, we discuss the role of barefoot training in sports medicine and attempt to make some practical suggestions as to how it might be integrated in our modern urban environments.

Keywords: injury; running; running shoes.

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Humans’ innate impact-moderating mechanisms on variable terrain. As the foot makes contact with the pebble (inset) it causes deformation of the skin and underlying tissues. This alters the position of the foot and the location and stimulation of the mechanoreceptors. Rapid and subtle adjustments are made via reflex arcs arising from stimulation of sensory nerves and modulation at the spinal cord. Based on this information (feedback) and visual input (feedforward) the brain directs motor output of the major muscles. Landing with a degree of flexion at the hip, knee and ankle provides mechanical advantage for muscles (gluteal, hamstrings, quadriceps, triceps surae) to absorb energy (eccentric control of deceleration) and generate propulsion during extension (concentric phase). Positioning the foot in the forefoot position (inset) on landing allows the Achilles tendon and the medial longitudinal arch (assisted by intrinsic foot muscles) to stretch as the heel comes towards the ground and rebound like a spring.
Figure 2
Figure 2
The proposed mechanism by which shoes may facilitate biomechanics which predispose some runners to certain types of injury. Cushioned footwear encourages a rearfoot strike which is associated with an extended lower limb and a more upright torso. This in turn encourages a longer stride length in which the base of support is located further away from the centre of mass. In this position, the limb does not have mechanical advantage during ground contact which may encourage excessive breaking forces and increased repetitive tensile loading due to prolonged eccentric muscle contraction. One of the reasons these more ‘blunt’ running mechanics may occur is because the foot (inset) does not receive the same tissue deformation and sensory stimulation as it does in the barefoot condition. Over time this may lead to a reduced demand on posterior chain muscles and a collapsing of the hip inwards in the frontal plane (above). Running using these mechanics is perhaps also more injurious because intrinsic foot muscles may be weaker from habitual footwear use (encouraging pronation; above) and lower limb muscles (especially posterior chain) may be less conditioned from modern sedentary lifestyles.

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