Athletic Foot Injuries Follow-up

Updated: Oct 11, 2018
  • Author: Timothy J Rupp, MD, MBA, FACEP, FAAEM; Chief Editor: Craig C Young, MD  more...
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Return to Play

As with all athletic injuries, the athlete's whole being must be considered before he or she returns to action. Athletes should practice before they play and essentially be pain free with all activity. Strength should be at least 90% of the unaffected limb, and proprioception should be restored so that the athlete can avoid recurrence. Mentally, the athlete must feel confident that the foot injury has healed; athletes should be able to compete without conscious awareness of the injury. The mental aspects of the injury are most accurately assessed in practice situations.



Barefoot and minimalist shoe running

Lieberman et al first observed that barefoot endurance runners landed on the forefoot or midfoot with a more plantar-flexed ankle, whereas shod runners landed on the hind foot with significantly higher collision forces. Increased proprioception, coordinative strategy, and improved intrinsic foot muscle strength have supportive evidence to suggest a benefit from barefoot running as well. [21]

Lieberman further explains that barefoot running, from an evolutionary perspective, may be hypothesized to avoid injury, as evidenced by the fact that humans have been running long distances barefoot for millions of years. [22] In an effort to reproduce the biomechanics of barefoot running with the protection afforded by running shoes, the use of minimalist running footwear has gained popularity among members of the running community. Biomechanical evidence suggests minimalist footwear favors forefoot or midfoot strike and allows for dispersion of impact forces more efficiently. Minimalist runners, moreover, generate smaller collision forces when compared with shod runners. [23] Proponents of modern running shoes believe that the cushioning and stabilization features are needed to protect the runner from injury. [24]

Future considerations include research to determine the benefits or barefoot and minimalist running include the appropriate manner with which to transition from shod running to barefoot or minimalist running and the long-term effects of barefoot and minimalist running on foot structure, muscle physiology, and bone and joint health.