Though a recent meta-analysis found that increased vertical impact loading rate is a risk factor for tibial stress fractures,21 Nigg22 has questioned whether impact force peaks or loading rates are a significant contributor to running injury. It may be the case that 5-FU concentration the loading rates experienced by some rearfoot striking minimally shod runners are within a normal range of tolerance for the human body. A third possibility is that vertical impact force is not the only stimulus for foot strike change,
and that some other factor besides a need to reduce impact force contributes to the higher frequency of midfoot and forefoot striking in barefoot runners. For example, Robbins and Gouw23 proposed that gait modifications in barefoot runners may in part be associated with horizontal loads applied to the plantar surface. In the barefoot condition, gait adaptations may be required to reduce
shear forces between the foot and http://www.selleckchem.com/products/EX-527.html ground surface in order to protect the plantar skin of the foot. It seems reasonable to assume that the presence of even a minimally cushioned shoe sole would both reduce plantar sensation and provide protection from ground shear, and thus stimulus for gait change may not be as strong as when running fully barefoot. Differences in foot strike patterns observed here between barefoot and minimally shod runners may have implications with regard to running injury. Failure to allow a gradual adaptation to running in minimally cushioned shoes to accommodate gait and tissue adaptation could be potentially injurious. Giuliani et al.24 reported a case study of two runners who developed 2nd metarsal stress fractures after transitioning
to minimally cushioned shoes. Ridge et al.25 found that approximately 50% of runners who they studied developed marrow edema in at least one GBA3 foot or ankle bone in concert with a 10-week adaptation to running in minimally cushioned shoes (VFF). Two of their subjects developed stress fractures (2nd metatarsal for one, calcaneus for the other). This suggests increased remodeling of foot bones associated with a change to minimal footwear, which could progress to bone damage in the form of a stress fracture. Unfortunately, Ridge et al.25 did not report data on running form before or after the transition, and it is uncertain at which point in the gait cycle forces become potentially injurious for individual bones during a transition to minimal shoes (e.g., impact, midstance, toe-off, etc.). It is worth noting that Ryan et al. 26 gradually progressed runners into VFF over 12 weeks and found no elevated risk of injury compared to a conventionally cushioned running shoe (increased calf/shin pain was the only significant difference in the minimal shoe). Unfortunately kinematic data were not reported in that study so the role of form could not be addressed.