Minimalistic Footwear, Running, and How it Affects the Pelvic Floor

Ann is a 33-year-old who is a mom of 3. She originally sought out pelvic floor therapy to address urinary leakage that she was experiencing with coughing, sneezing, and running. She no longer experiences urinary leakage with these activities, which is wonderful! She plans to train for a half marathon and was wondering about the benefits of running with minimalist or barefoot shoes instead of her normal cushioned running shoes.

As with any change in training, it is always wise to incorporate changes in footwear gradually and purposefully especially when transitioning from “conventional” running shoes to minimalist or barefoot running shoes. This is due to the differences in how we run when using certain types of shoes. 

For example, 21 runners with experience using minimalist shoes were tested for 30 minutes at 80% of their maximum speed using minimalist shoes and conventional shoes. Minimalist shoes showed higher peak pressure on the bottom of the foot because of the change in how the foot lands on the ground (foot strike pattern), lower ground contact time, and lower contact area than conventional shoes. Minimalist shoes encourage midfoot and forefoot running as compared to conventional shoes, which is a more optimal running pattern. When fifteen experienced runners performed 3, 90 second runs on a treadmill with 3 different types of footwear: traditional running shoes (heavily cushioned heel, arch support, and a stiff sole), minimalist running shoes with minimal heel cushion and barefoot there were notable changes in their running patterns. Traditional shoes resulted in increased rearfoot strikes at 87% as compared to 67% with minimalist shoes and 40% when barefoot. The longest ground contact time occurred in heavily cushioned heeled shoes when compared to minimalist and barefoot runs. Due to reduced contact time and improved midfoot or forefoot gait, minimalist shoes and barefoot were found to provide more running efficiency than heavily cushioned traditional running shoes.

There is typically greater foot and ankle loading but smaller knee loading with minimalist shoes when compared to conventional. Minimalist shoes may increase knee flexion (bending) range which allows for greater knee shock absorption. These shoes typically increase ankle range of motion, improve ankle joint mobility, reduce foot stiffness, increase plantar flexion (calf muscle) strength, and reduce knee stiffness.4

Overall, minimalist shoes have been shown to improve running efficiency by increasing mid or forefoot stroke instead of rearfoot and increasing steps per minute. They can also reduce knee loading or shock absorption which can led to less knee pain or injuries; however, they can increase the loading on the foot and ankle which means it is very important to gradually increase mileage so as not to encourage a foot or ankle injury from overuse. Start with a shorter distance and/or time when transitioning to minimalist/barefoot running and gradually increase from there. If you are experiencing any pain or difficulty with the transition, please reach out to a physical therapist for further assessment. If you are experiencing difficulty with transitioning running shoes and also experiencing any bladder, bowel, or sexual concerns reach out to a pelvic floor therapist as there is a strong relationship between the pelvis, foot and ankle. Happy running!

Written by Jordan Schmidt, PT, DPT

References

1. Izquierdo-Renau M, Sanchis-Sanchis R, Priego-Quesada JI, Encarnación-Martínez A, Queralt A, Pérez-Soriano P. Effects of Minimalist Footwear and Foot Strike Pattern on Plantar Pressure during a Prolonged Running. Applied Sciences. 2022; 12(1):506. https://doi.org/10.3390/app12010506
2. Gillinov, S. M., Laux, S., Kuivila, T., Hass, D., & Joy, S. M. (2015). Effect of Minimalist Footwear on Running Efficiency: A Randomized Crossover Trial. Sports health, 7(3), 256–260. https://doi.org/10.1177/1941738115571093 
3. Sun, X., Lam, W. K., Zhang, X., Wang, J., & Fu, W. (2020). Systematic Review of the Role of Footwear Constructions in Running Biomechanics: Implications for Running-Related Injury and Performance. Journal of sports science & medicine, 19(1), 20–37.
4. Linares-Martín, J., & Rico-González, M. (2023). Influence of Minimalist Footwear in Middle and Long Distance Runners' Physical Fitness, Biomechanics, and Injury Incidence: A Systematic Review. Strength and Conditioning Journal, 45(3), 309-324.