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Barefoot Running, The Cure for Runners Knee?

Updated on March 25, 2015

Who has Runners Knee?

If you were to enter a discussion on the subject of running, the term 'knee pain' is bound to rear its ugly head. In any given year 70 percent of runners will experience an injury of some kind. One of the top 5 injuries experienced by runners is Patellofemoral Pain Syndrome, more commonly known as 'Runners Knee'.

Patellofemoral Pain Syndrome is caused by an overuse of the knee joint most commonly found in individuals who regularly engage in sporting activities that involve heavy use of the knee joint. The repeated action of bending and straightening the knee causes the patella to irritate the Articular Cartilage at the end of the Femur called the Femoral Condyle. If the condition is left to progress without treatment, wearing and tearing of the cartilage can occur, along with further pain and discomfort.

What to do if you get Runners Knee?

The first thing one should do when experiencing the pain of 'Runners Knee' is to reduce the amount of over-use the knee joint is receiving. For most runners this will mean cutting down the distances run. Try keeping weight off the knee, avoiding activities that involve impact to the area. This may involve changing to a low impact routine such as swimming. Cycling is an option due to its reduced impact on the body however if the symptoms of runners knee have progressed enough the repetitive action of cycling may sill be pain-full.

If the pain does not subside within a couple of weeks an appointment with a medical professional is recommended. An X-ray or MRI scan can show what damage has occurred to the knee joint. From here the patient would be advised if rest, therapy or surgery are required.


Why are Flat Feet bad news for knees?

In the same way a house needs a good foundation to build on, our feet quite literally form the foundation for our bodies. If our feet are out of alignment it puts our entire body out of alignment. In regards to knee problems, flat feet causes the whole leg to rotate inward towards our vertical centerline. Once this happens the patella (kneecap) is no longer facing straight ahead, but inward.

During the bending and extending of the leg during running the patella is put into an unnatural position and causes the abrasion mentioned earlier. The likelyhood for other injuries, such as 'Tarsal Tunnel Syndrome' & 'Archilies Tendonitis' is also increased.

Do I have Flat Feet?

About 20% of all adults have what's described as flat feet. Flat feet is where the inside arch of the foot is 'collapsed' and sits flat on the ground with the rest of the foot. To test weather you have flat feet is to wet your feet, then go stand on a hard flat surface such as concrete or paving. If a wet imprint is underneath your entire foot, including the arch of the foot, then you have flat feet.

Flat feet or fallen arches can be present from birth. It can also be caused from stretched and torn tendons in the foot, maybe from lifestyle choices or adopting a particular type of footware over a long period of time. With more than 100 muscles, tendons and ligaments in the human foot, if these do not have the correct alignment, condition and strength the foot cannot support an arch.

Foot Posture for Flat feet

One cause of fallen arches is the muscle memory of the individual is not developed enough to hold a correct foot posture or stance. In the same way we are told to stand and sit with a correct posture, flat feet require extra encouragement to form an arch in their foot.

If you have confirmed you have flat feet, either by using the 'wet foot' method mentioned above or though another means, try the following:

  1. Sit upright in a chair with your shoes off (can leave socks on) and place feet flat on a hard flat surface (concrete, wood etc).
  2. Raise your toes and front of the foot off the ground slightly, leaving the heel in contact with the ground.
  3. Slowly lower your foot back down to the ground, allowing only the outsides of the foot to make contact with the ground, not the arch. You may have to rotate your ankles slightly to accommodate. Finally allowing your toes to touch down.
  4. Stand up while maintaining this foot posture, walk around, all while holding the form of the arch and letting the rest of the footwork to support this.

You do not need to hold your foot solid like a clenched fist. Let the mechanics of the foot move and work as they need to to allow you to both hold your arch and walk at the same time. You should feel some different muscles engaging in both your foot and lower leg. If this is your first attempt at holding your arch the new muscles your using will probably fatigue and get sore quickly. However if you practice this foot posture whenever you walk you will eventually create the muscle memory required and it should become second nature.

You may even need to change your every day footwear to something that allows you to control the motion of the foot better and also assist with growing the strength of the foot. This is where 'Barefoot Running' comes in as its also particularly good at strengthening the foot as well as the closely associated lower leg muscles.


Barefoot Running for foot strength.

I know for some, the mention of this exercise conjures images of those shoes with the individual toes on them. If your someone who uses those shoes, more power to you! Barefoot running is about the 'style' of running rather than whether your shoes are on or off you feet. Technically you can barefoot run in nearly any type of 'runner' style shoe, but some shoes are better suited for it then others. A good shoe for barfoot running that wont make you look 'too keen' is the Merrell Pace Glove for Women, and Merrell Trail Glove for Men.

These are a 'Flat' shoe designed so you feel everything going on beneath your foot. It can feel strange at first particularly when you have gone from a runner with up to an inch of cushioning at some points in an effort to pad every heel strike. You have to re-learn how to run in a flat shoe. Heel striking will not be an option due to the lack of cushioning. Instead you will need to land on the ball of your foot. This will encourage the foot to work to keep the runner upright and increase the strength in the foot.

Making the switch from a big spongey runner to a flat shoe like this can be a game changer for your knees.
Making the switch from a big spongey runner to a flat shoe like this can be a game changer for your knees. | Source

Learning to run...again

The first time you go for a 'Barefoot Style" run you should only attempt a small run of around 100m or so. This may not sound like much but your working a whole new range of muscles so it does take a few sessions, gradually extending the range each time. You may not feel anything immediately after the run, but some delayed muscle pain will be present the next day. Start small and gradually increase the range. Most of all, give it time.

Typically a barefoot style runner cannot run as far as their 'heel striker' counterpart. Due to the extra muscles required fatigue sets in earlier, typically in the calf muscles. The benefit for the barefoot runner is that due to the added suspension of the ankle providing an extra pivot point, along with the correct alignment of the knee due to a stronger foot, the runner will experience less pain behind the patella over time. This means the runner needs to take less time out of their running regime for knee recovery.

Below is an informative video on the benefits of barefoot running.

The Way Forward

Barefoot running has not been around for long enough to generate any conclusive evidence that it will reduce knee pain directly. However due to its proven nature of using more of the joints in the leg for suspension of the body, the knee will experience less impact and less discomfort while running. The effect of strengthening the muscles in the foot has also been proven and for people with flat feet this will help the foot retain its arch and support the rest of the body. These 2 solutions could be the way forward for those who think flat feet & sore knees are just part of life for runners. It doesn't have to be.

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