Criteria For a Safe Transition to Minimalist Shoes or Barefoot Running: Thoughts From Jay Dicharry, PT

Big ToesA few weeks back I was talking on the phone with Jay Dicharry, a physical therapist and director of the Speed Lab at the University of Virginia. Jay is one of the most knowledgeable guys I know when it comes to questions about running gait and running injuries, probably because he combines a strong research background with a wealth of applied clinical experience treating injured runners. It doesn’t hurt that he also has at his disposal one of the most sophisticated gait labs in the world.

One of the questions I asked Jay while we were talking was whether he had any specific criteria that he felt were important in ensuring that a runner can make a safe transition into more minimalist, or barefoot-style running shoes. Jay indicated to me that there are three specific things that his clinic looks for before progressing someone into more minimal footwear or barefoot running. I’m going to give the short form of his answer here, then direct you to a blog post that Jay recently wrote that explains these things in much more detail.

Jay Dicharry’s 3 Criteria for a Safe Progression to Minimalist Running

1. You have to be able to isolate and control the flexor hallucis brevis, a muscle in the foot that flexes the big toe and helps to actively stabilize the medial arch (the photo at the top of this post shows this little muscle in action).

2. You have to have sufficient length in your Achilles tendon and plantar fascia. What that means is you have to be able to dorsiflex the ankle (tilt your foot up toward your shin) to 20-25 degrees, and you have to have 30 degrees of dorsiflexion in the big toe when the ankle is very slightly dorsiflexed so that you can roll over the toes during stance phase of the gait cycle.

3. You have to have good single leg balance, which is basically keeping the medial and lateral borders of the foot in contact with the ground for thirty seconds with your eyes closed. If you can do that, you’ve got a good amount of internal control to stabilize the foot and don’t need a lot of help from a shoe.

For more detail on each of these 3 criteria (with pictures), see Jay’s full post on the UVA Athlete’s Body Blog.

Jay indicated to me that they have been very successful using these criteria so far. In fact, he said that he hasn’t had anybody who has been evaluated under these rules have problems after starting either minimal or barefoot. In his excellent post, Jay also discusses how one might work to improve limitations if one of these tests is not passed – in a nutshell, stretching and strengthening work are critical. Again, his post on transitioning can be found here: http://uvaendurosport.wordpress.com/2011/07/09/less-from-your-shoes-more-from-your-feet/

I’ll finish here with a challenge. After Jay related these criteria to me I was curious to see if I could pass his one-foot balance test. I grabbed my wife and we took turns standing on one foot with our eyes closed. Now my wife is a long-time practitioner of yoga, so she spends a lot of time stretching and balancing, but I also know that she has a weakness that might give me an edge. She has a monstrous bunion on her right foot, and her big toe points inward at an almost 45 degree angle (she has had this as long as she can remember back to childhood, and I’d love to know if it was congenital). If she was going to fail, it would be on this foot because she can’t use her big toe on that side to effectively stabilize herself. Sure enough, I managed the full thirty seconds on each foot with my eyes closed. She did just fine on her left side, but while standing on her right foot, she flailed around and had to put her other foot down after a matter of seconds. That little test really cemented for me the importance of proper stabilizing function of the big toe.

Anyway, I encourage you to give the balance test a try – it’s not as easy as it might seem. If you do try it, leave a comment and let me know how it went!

Update 7/15/2011: Jay Dicharry just posted a follow up with more details on balance and proprioception for runners. You can read it here: http://uvaendurosport.wordpress.com/2011/07/14/proprio-what-a-deeper-look-at-balance-and-stability/.

About Peter Larson

This post was authored by Peter Larson. Pete is a recovering academic who currently works as an exercise physiologist, running coach, and writer. He's also a father of three and a fanatical runner with a bit of a shoe obsession. In addition to writing and editing this site, he is co-author of the book Tread Lightly, and writes a personal blog called The Blogologist. Follow Pete on Twitter, Facebook, Google+, and via email.



Comments

  1. That was funny!  I can pass the tests except for the balance with the eyes closed.  My constant injured side I lasted about 3 secs and the good side almost 15 secs eyes closed. 
    Just for fun I had my husband (non-runner) try the tests and he is the opposite.  He is lacking ROM but has no trouble balancing on either side with eyes closed. 
    Interesting post!

  2. I fail the first two Peter. Maybe that’s why I’m suffering from PF now. It started when running in huaraches. 
    I’ve been working on the balance for about 4 months now and can do the last one ok. 

  3. “You have to have good single leg balance, which is basically keeping the medial and lateral borders of the foot in contact with the ground for thirty seconds with your eyes closed. If you can do that, you’ve got a good amount of internal control to stabilize the foot and don’t need a lot of help from a shoe.”

    I’m calling BS on this one.  I’ve been in minimalist shoes for 5 years, I’ve run up and down Pike’s Peak in Vibrams, and I’ve never had an injury at a distance less than a 1/2 marathon.

    And I can’t do this on either foot.  One leg is much weaker than the other, and that leg has had all the injuries.  The stronger leg has never been injured, and I can’t do it on that leg.

    At what point in barefoot running is standing on one leg for 30 seconds with your eyes closed a requirement?

    Never, IMHO.

    • Pete Larson says:

      Tuck – like everything, just because you can’t do it does not mean you are
      guaranteed to get injured. It’s just a criterion that they use to screen
      people who might run into trouble, and their clinical experience working
      with a lot of runners suggests that it works. During stance phase in
      running, you are balancing on one foot, and the idea is that if you can keep
      your foot and ankle stable using your musculature rather than a shoe, you
      will have an easier time moving to less shoe than someone who has weak feet
      and legs (possibly from long term shoe use…). We talk all the time about
      strengthening the feet and legs by running barefoot and/or minimalist – do
      you consider improved balance and stability to be part of that?

      • A bunion impedes the proper mechanical function of the foot. The big toe is the primary means to transmit force to the ground, and as you well know, it’s one of the key anatomical features that distinguishes man as a running ape.

        So if that doesn’t work properly, then yes, that’s going to have an adverse impact on her ability to run.

        But not being able to balance as Jay describes in point 3 is not crucial to running. It may be useful on it’s own, but so what?

        What if I can balance for 30 seconds with my eyes open? That’s still not good enough? But I’m never going to run with my eyes closed…

        I understand where Jay’s coming from, I just think that this part of the criteria is a bit over-zealous.

        And yes, obviously strength and balance are important. But this particular excercise strikes me as similar to being able to balance on a bosu ball. Amusing, but probably doesn’t translate well to actual functional fitness, and not really a requirement for anything, other than being able to win a competition of balancing on a bosu ball.

      • Anders Torger says:

        It is something strange about this argument. Does the shoe really make the foot more stable? For me it has generally been the other way around. By removing cushioning I get closer to the ground and gain stability. My experience is that only the most heavy and stable shoes around can get on par with minimalist stability. More lightweight tradititional running shoes certainly reduces my stability, high profile, weak uppers, soft midsoles and poor ground feel is not great for stability.

        I suspect that you actually don’t need more balance for minimalist running, but rather the other way around. I could however see the balance test as some sort of test to see if the lower leg muscles are functioning, rather than actually a relevant test of running balance. Lower leg muscles will do more work in minimalist running. So perhaps it is more about strength than about manage to balance.

        The only time I’ve noticed that I would need more balance rather than less compared to shoes is when going complete barefoot and walk on really tough ground that kind of hurts (I don’t run barefoot other than on safe surfaces), then the body balances on the placed foot to put pressure on the parts that hurt the least. I actually use barefoot walking on uncomfortable uneven surfaces as a sort of training.

        • Pete Larson says:

          Anders,

          I’m tempted to try this in a bunch of my shoes and see how much it varies.
          Jay tends to believe in low heel, firm shoes, and I agree that excessive
          soft cushioning can actually make things worse. I filmed my wife running in
          Nike Free 5.0′s, and the side where she has the bunion caved in immensely -
          it was frightening to watch. I’m wondering if part of her success moving to
          the Vibrams over the winter is simply because they get her closer to the
          ground and actually thus allow for more stability than the Nike’s. I also
          wonder whether the toe pockets pread her big toe out just a bit. The great
          thing about posting things like this is that in the responses, we all learn
          from the exceptions to each rule. Stationary balancing may not be a perfect
          analogy for the stance phase of running, but it does give some sense about
          how well people can control the stability of the foot and leg, which is
          important during stance. The question of which shoes can actually help if
          one is weak is an open one, but would be easy enough to examine. I may just
          have to try my little experiment!

        • And just to be clear; I don’t think any of this is harmful, and Jay may well be right that if you can do all three you’re guaranteed success, but I don’t think they’re required.

    • Pete Larson says:

      Tuck – to counter your example of not getting injured despite not being able
      to do this, I’ll also point out that all of my wife’s problems are on her
      right side, which is the side where she fails this miserably because of her
      bunion. Don’t know if it’s causal, but everyone is a bit different.

  4. David J. Lesher says:

    I’ve been running barefoot for a little over a year with the bulk of my mileage occurring this year.  When I first tried this balance exercise . . . I couldn’t do it on either foot.  However, after removing myself from the carpet to the wood floor . . . I was able to accomplish the task bilaterally.  To me, this exercise reminds me of a neuorlogic exam.  We have three components to balance . . . eyesight, inner ear, and proprioception.  We need two of the three components for balance.  If there is any deficiency in either the inner ear or proprioception when you have your eyes closed . . . there is no way you’ll be able to pass this test.  Great post, Pete!

  5. Haley @ Climb Run Lift Mom says:

    Wow. That was a reality check… I could do the 30 seconds on the left foot, but after about a few seconds on my right I was flailing miserably. I did have surgery on my right ankle about 9 yrs ago and never properly rehabbed it so I wonder if that’s the reason. I’ve just been transitioning over to minimalist shoes so hopefully it doesn’t negatively affect me too much.

    • Nicole Lacoste says:

      Just wanted to say be careful. I tried the balance test, OK on the right foot, but could only stay 2 or 3 seconds on the left.  And I stress fractured the left cuboid during my transition running in mimimalist shoes.  Its a very unusual fracture to get in isolation and I think this difference in balance on the two sides had something to do with it.

  6. Ken Skier says:

    I run barefoot whenever I am running on a road or bikepath, (but I do wear shoes for trail runs.)  Last year I ran 20 races (5Ks mostly; one 5-miler and one 10K) barefoot.  So I consider myself a pretty experienced barefoot runner.

    However–

    I cannot stand on one foot with my eyes closed!  With eyes open, I can stand on my left foot for a minute, or my right foot for 30 seconds, but I am wobbly in each case.   Based on Jay Dicharry’s criteria, I am not ready for minimalist shoes–to say nothing of barefoot running!  But I run barefoot with no problem.

    BTW…on each foot, there is a big gap separating my big toe from the other four.  On my left foot, there is almost room for an EXTRA toe to fit between the big toe and the next one; my right foot there is more than enough room for an extra toe there.  (To visualize this, look at your hand.  See all the extra space between the thumb and the pointer finger? MUCH more space than you have between any other adjacent fingers.  My feet are like that: four toes close together, a big gap, and then the big toe.)

    I think this splayed foot is very helpful for my barefoot running.  I also suspect, but cannot prove, that it is a RESULT of several years of barefoot running…as my feet are now much larger than they were before I began barefootin’.   (Almost size 15 now, compared to the size 13 they used to be.)

    In any case, I’m glad I never saw Jay Dicharry’s criteria before I took up barefoot running.  I would still be wearing big shoes, and getting injured.

    • Pete Larson says:

      Ken,

      You have to keep in mind that Jay is a PT, and given his position as a
      medical professional, he’s very careful not to push someone quickly into
      something that might get them hurt. First do no harm, right? He’s not saying
      that if you fail test three you’re doomed to motion control shoes for life
      (which may or may not be better in terms of stability), or that it’s a
      guarantee that you can’t do it. He’s simply saying that based on his
      clinical experience, people who have stronger legs and feet, and better
      internal stability tend to manage a move to less shoe with fewer problems
      than those who don’t. Let’s be honest, lots of people do get injured in the
      transition, and his goal is to find criteria that help to screen out those
      more likely to have trouble, and if they don’t meet those criteria, suggest
      exercises that might help them to make the transition more smoothly (if that
      is what they choose, or if it’s what he feels makes the most sense for their
      issues). That’s the job of a physical therapist. My personal feeling is that
      if you have feet and legs that are used to being constantly in a shoe, your
      transition will most likely be more challenging than someone who has spent a
      lot of time barefoot or doing something that involves a lot of stability
      work.

      Pete

  7. Dan Forbes says:

    30 seconds is a long time!!!!

  8. Hi Pete,

    I didn’t see where it said you had to have your eyes closed to do the balance test on Jay’s blog.  Is it really necessary?

    • Pete Larson says:

      You’re right, he doesn’t say that in his post. He said that to me when I
      interviewed him. I think the eyes closed part may just be a more targeted
      test of proprioreception.

  9. Coreyscanucks says:

    I balanced for 30 secs on each foot. 

    But are we allowed to move our arms and the lifted leg to help with balance? 

    Obviously passing this test can be made a lot easier or harder by placing your body parts in different positions. For example try sticking you lifted leg out to the side as far as you can go, then try to balance.

  10. andy-1967 says:

    I recently stopped doing foot exercises because of a niggle and wanted to remove all strains off my feet while I cautiously continued with my barefooting. Then the thought occurred to me that my foot exercises were ADDING to the overall impact my foot bones/muscles! At the moment I’m considering not doing any foot exercises apart from the eccentric loading and just letting my feet get stronger from…

    Well, running

    - After all, won’t running itself strengthen the foot muscles enough? Minimalist or barefoot? Barefoot is more ideal but even if you make a transition from a padded shoe to something like the Aqua of KSO your foot muscles/bones will have to start working and as long as you make a slow transition why would you need additional foot exercises? They would adapt and strengthen themselves if given enough time…

    Good post, by the way. I still might do my foot exercises cause I enjoy them, if there is an underlying benefit then it’s a bonus!

    Andy from
    http://www.myrunningtips.com

  11. because i can do 2 and 3, it bugs that i can’t do 1 yet…now that i know i should, i want to, can i get some idea on how to work on that?

    • Pete Larson says:

      Try posting your question on Jay’s blog post that I referenced – he’s
      the expert on this stuff.

  12. Ken Skier says:

    All good points, Pete!  Change always carries risks, and you’re absolutely right that a PT or any medical professional should be very conservative in advising a runner to change his or her gait.  

    (I just thought I’d share my own experience, as one data point, that I am better at running barefoot than I am at standing on one leg with my eyes closed!  :)

  13. Ren Powell says:

    Wearing shoes for better balance seems counter-intuitive. Get yourself a few more inches off the ground and put your feet in desensitizing molds for better balance?

  14. Anders Torger says:

    I’m poor at isolating the big toe, and there’s some difference between left and right. On the left I can keep big toe on the ground and lift the other toes, on the right I can do the opposite. When I run in tough terrain I have noticed that my right foot is less stable than the left, but I guess that could be for any other reason. Would be interesting to know how to improve this toe control capability though.

    I believe in the ROM test, I have short Achilles tendon but have lengthened it through daily serious stretching and it seems to me that it have helped.

    I barely pass the balance test, but I’m a bit skeptical about that. Problem is that balance is very specific – you get good at what you train for. I usually suck at most balance tasks, but can still balance narrow kayaks that most would flip over just sitting down in them, since I’ve trained for that specifically. Standing on one leg is not the same as running. However if you happen to get good balance results due to wide foot and nice toe spread that is probably good.

  15. Alex Beecher says:

    I can spend all day on my right foot, and easily a minute on my left. But I could do this before I ran at all in minimalist footwear, and I’ve never done any yoga, really. I’d chalk this up to my strength training, if anything. Single leg deadlifts force you to develop functional stability and balance.

    • Pete Larson says:

      I’d say a single leg deadlift would be a fairly effective approach to
      stability :) It’s amazing to see how hard balancing is for some people – it
      would make a great little study to see how many people can pass this test.

  16. Phillip Stevenson says:

    I don’t know if you would count running in mt101s as minimal trail shoe but i switched from adren gts to them and straight away and haven’t looked back. The heel drop didn’t cause any problems. Not too sure if I got lucky, but after thinking about it there are some key elements I think that have kept my feet “minimal ready”

    Skateboarding – I did this (longboarding) intensively for about 2 years of cruising. As well as having one massive thigh and one massive calf (different legs) I can balance on either with no problem at all. If you haven’t skated before borrow one (maybe your kids) and have a go on flat tarmac and don’t forget safety gear. In 5 mins you’ll feel your feet muscles cramping because of the strain to balance. Give that a week or two and it will help get your feet ripped ^^

    Fashion – I know… but would you believe it but things like flat soles and very minimal/cheap shoes are popular just now and walking around for the day in plimsolls really does work and you look pretty awesome for the summer while you’re doing it! Also at work I wear flat soled shoes with 0 heel drop.

    lastly – outside of work I don’t particularly like wearing shoes in the house. So as soon as I am home the shoes come off and the toes come out.

    As for barefoot running, I’ve done about 3/4 miles on tarmac and while it might feel free and we were meant to run like this etc a bit of rubber between your toes and the tarmac goes a long way in preserving your feet and helps on the soap bills! ;)

    Algar

    • Pete Larson says:

      Great response. Funny, Jay told me the same thing about skateboarding and
      longboarding – he does both and said they are probably the two best
      activities for developing foot strength and internal stability. Personally,
      I’ve gone flat pretty much full time – barefoot or in Vivobarefoot Achilles
      sandals in the house, Vivobarefoot Aquas at work during the school year. I’m
      at the point where a traditional heel rise feels like standing on a steep
      slope to me!

  17. I just wanted to add a comment regarding #3, single leg balance with your eyes closed. In my case, a virus destroyed my inner ear a few years ago and as a result, I lost my balance completely. It has been a very long road to recovery so far, but what I can say without a doubt is that I have difficulty standing on one leg with my eyes closed not because my feet are weak but because my inner ear, which is the most important organ for balance, doesn’t work anymore. So that’s something to keep in mind. Good article, otherwise.

    • Pete Larson says:

      Absolutely, there is more to it than just strength. Equilibrium and
      proprioreception will also certainly play a big role. Deficiencies in any of
      things can impair balance, and none necessarily mean that you can’t run
      minimalist or barefoot, it’s just that Jay’s clinical experience working
      with runners suggests that it can be harder.

      • Anders Torger says:

        A question – is the test meant to test balance, or to test lower leg muscles? If you have exceptionally good balance, your lower leg muscles /foot will not need to work nearly at all when standing on one leg, since your body is perfectly balanced over the foot without shifting.

        When I did rehab exercises for a lower leg injury a while back the PT suggested one legged balance plate exercises and make them as difficult such that the foot would wobble on the plate, in order to give the msucles training. When I got too good at balancing the foot would not wobble and I had to raise difficulty by closing my eyes or holding a weight or similar.

        • Pete Larson says:

          I think it tests both. But, Jay did suggest that if the goal is to
          work strength, a balance board or some skateboarding/long boarding are
          much more effective.

    • Same boat for me. I have chronic vertigo and can’t balance well on one foot with eyes closed or open. Almost all of my running since I started in 2008 has been minimalist (I will use normal running shoes when there are a lot of puddles to avoid my feet getting wet so quickly). I didn’t realize there was a minimalist movement when I started. I just didn’t see a good reason to buy expensive shoes that need frequent replacement… :)

  18. Thanks Pete and Jay,

    We do this at our running shoe store Two Rivers Treads and give a handout on progression.  Have not had the runners coming back injured and most get it.  The test i think is a nice governor to reinforce the gradual transition. For those with hallux valgus like myself (link to trtreads.org…. a correction called Correct Toes is a miracle.  I wear them running barefoot and in shoes.

    All the best to healthier running
    Mark Cucuzzella MD

  19. I run my mileage in ZEMs or barefoot, neither of which have any sort of support or cushion.  I fail this test, but have not gotten injured in my quick transition a year ago.  I believe that you need better balance to run on top of an inch thick piece of foam, as this causes unbalance.  I’ve heard of people with balance disorders who simply fall over trying to run in shoes, but can move just fine barefoot.  Just listen to your body, and you will not get hurt.  I don’t mean to knock Pete (good writing by the way), but people who go out and run 7 miles in Vibrams the first time should get injured.  Here is the truth:  People who are not suited to run barefoot have been weeded out by natural selection thousands of years ago. Everyone is meant to run unshod, it is just a transition period in which your speed may suffer.  I thought it was very worth it to transition; I’s rather get a few blisters than shin splints.  

  20. Jt Clough says:

    I’ve suffered an achilles injury for over 10 years and last year began doing research on barefoot running.  Aside from breaking two toes on separate occasions, my achilles is getting better!

    Recently I moved to Hawaii and find myself walking all the time in bare feet.  I’ve gotten comments from my husband about how he doesn’t notice me limping anymore.  Your article does make me think that the fact I’ve started practicing yoga in the last 3 months, which includes balancing is also contributing to my improvement.  My achilles problem is on my left side… funny enough, I have a much harder time balancing on that leg.

    Great blog.  Glad I found it.

  21. Jay Mueller says:

    Pete,

    Upon reading this, I’d be highly curious to know if Jay has any suggestions to improve single leg balance, Achilles and PF length (dorsiflexion), and namely strength of the flexor hallucis brevis (FHB).

    For example, I can stand on one leg just fine, but I’m not sure about how well I meet the dorsiflexion criteria.  What’s most interesting, however, is that I have sufficient control of my big toe to wiggle my other 4 toes while holding the big toe stationary, and enough control to lift only my big toe if I wish (the opposite of the photo you posted).  Nonetheless, for some reason, I have no control in the opposite direction; I can’t lift all of the other four toes while keeping my big toe on the ground (per the picture above).

    Long story short, I’d be really interested to see what he’d suggest to improve foot strength, etc.  Also, the idea of the FHB controlling the medial arch makes me wonder if I could ultimately maybe reduce some pronation by strengthening this muscle because even having been in minimal shoes for a year now, I still have some inward roll; the scientist in me wants to know if pronation is something I can change.

    Cheers!

  22. Luis Manuel Cid says:

    Thanks Pete, finally found something I am good at! standing on one leg for 30 secs, LOL… 

    At first I was a little wobbly but then remembered a couple of BF Ken Bob’s lessons and things got much easier:1- bend  knees2- relaxTuck give it a try :-)Maybe my new-found skill (LOL again) has something to do with my relative absence of minimal footwear related injuries (knock on wood..).

  23. I had not tried this for years, not since a physio assessed me for a sprain and I lasted maybe 3 seconds. I have been transitioning slowly to zero-drop/barefoot for about 6 months and there is now quite a difference. I clicked the stopwatch, shut my eyes, opened them after a bit thinking it must be 30 seconds now – I had done 2 minutes. Swapped foot and got exactly the same time. That’s quite a difference.

  24. Dan Forbes says:

    30 seconds is a really long time!!!!

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