Analysis: a new study has found that running barefoot on grass leads to a vast improvement in this painful and long-lasting heel condition

By Peter Francis, SETU

A new study has found that 19 out of 20 runners had an improvement in a very painful and long-lasting heel condition (plantar fasciitis) simply by removing their shoes and running barefoot on grass for 15 minutes every other day. These results are promising because there is no known cure for the condition which can last for two years or more in the general population.

Runners suffering from a diagnosis of plantar fasciitis were recruited to take part in the study which lasted for six weeks and was conducted at the Southeast Technological University (SETU). The average reduction in pain experienced by the runners at the six week point was almost 40%. When researchers followed up with participants six weeks after the study finished, this figure rose to almost 60%, leaving the average pain sore at a mere 1.5 out of 10 (10 being the worst pain imaginable).

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Not such a new cure

Humans and more specifically the human foot evolved to walk and run barefoot on a variety of natural surfaces over the course of millions of years. The recent invention of footwear and artificial surfaces represents a massive shift in the environment the foot has to cope with. Modern footwear weakens the muscles of the foot and the cushioning in shoes can encourage ‘heavier’ running mechanics.

This is added to by the fact that most runners now run on paved surfaces that are unyielding and lack variability. It appears that freeing the foot and allowing it to interact with a soft and variable surface helps to reduce symptoms in these patients.

Dr. Peter Francis, who directs the barefoot science group that conducted the study suggests, "it is not so much that we have found a new cure but more so, that we have gone back in time to understand why we might have been injured in the first place".

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It may seem counterintuitive to run in pain. Clinician and student Stephen Mac Gabhann, who carried out the study, agrees. "It is counterintuitive to most physiotherapists to prescribe running for a painful condition, often brought on by running, but after some initial hesitation, most runners are fairly pleased to discover that running will form part of their rehabilitation.'

Why does it help

The reason it seems to help runners is likely multifactorial. Running mechanics are known to change when running barefoot and when running on a variable surface due to the increased sensation the brain receives from the ground. This may reduce the repetitive and often heavy loading experienced by the foot when in shoes on a hard surface. Running on soft grass feels nice and may help to reduce pain perception by the runners in the same way a massage might.

A reduction in pain perception may encourage runners to run with more confidence. Finally, muscles are known to get stronger after six to 12 weeks of resistance training and this type of running is a real workout for the muscles of the foot. It is likely that after an intervention of this length, the foot is much stronger.

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A note of caution

Dr. Francis warns that this is just the beginning of a greater exploration in relation to this kind of treatment for runner’s heel pain. "Our study reported on 20-runners with heel pain, but we did not have a control group who did nothing or had a control intervention. This is required to truly assess the impact of the findings. That being said, we can have a degree of confidence in the findings given we know how long it normally takes to resolve and how ineffective most traditional therapies have proven"

He also suggests that if runners want to give this type of therapy a try, that they should use the cautious approach taken with the runners in the study. "I recommend no more than 15 minutes at a light intensity every other day. Time spent barefoot running needs to be built up gradually and I think access to the soft surface is key, something that is not a problem with the rain we get in Ireland".

The study can be read in full here.

Dr Peter Francis is a lecturer in the Department of Health and Sports Sciences at the South East Technological University (SETU). He is the author of Running from Injury.

The views expressed here are those of the author and do not represent or reflect the views of RTÉ