I am active in a couple of barefoot running forums, and I am linked in on a number of barefoot sites. I love the opportunity to share and learn from fellow barefoot folks like myself. Having an extensive background in running and training, I tend to get a lot of questions, which I also enjoy. It seems that a majority of the questions I get are about injuries. This has kind of always been the case even before I became a full-time barefooter, and I was a little surprised to see that it also translates to the barefoot community. There is however a big difference in injuries between the two worlds, barefoot and shod. That difference is that barefooters are getting injured because they are not transitioning properly, and my shod runners are dealing with injuries from poor form, improper shoes, or overuse. With that said I decided to create a section on the site that will address common injuries for all types of runners from beginners to pros, both barefoot and shod.

My first injury to address is one that a lot of barefoot runners face:

Top-of-the-Foot Pain

There seems to be a lack of talk online about why runners get this injury, and I believe that is because a shod runner will rarely have to deal with it. Barefoot running is considered a new running fad so a lot of the issues surrounding it are not yet well studied or explained.

We all know that the foot is an extremely complex mechanism that gets seriously underused while wearing conventional shoes. It is made up of a lot of muscles, connective tissues, and nerves that are constantly handicapped by the stiff and cushy soles of most shoes. When a person decides to let his feet out of those shoes he is essentially taking his foot out of a supportive structure. I won’t say “cast,” but it is close. So there has to be some adjusting done to the way you approach your feet in terms of how much they can take and how to alleviate pain issues. I have outlined a beginners’ transition period in other posts, and I recommend you read them if you are making the switch. I also recommend you go there if you are suffering from pains or injuries in your barefoot running quest. Injuries are signs of doing something wrong, and learning to correct those issues will make the switch easier.

When running in a conventional shoe, the foot comes down on the heel, which means the toe is up, and the calf muscles are lengthened. That lengthening of the calf muscle puts it in its weakest range, and other muscles will have to make up the difference. One effect of this calf lengthening is the shortening of the muscles and tendons in the top of the foot and front of the lower leg or shin. You might not notice any of this, but over time it is happening, and switching to a barefoot or minimalist shoe will reverse it. When landing on the fore- or mid-foot, the foot is pointing down as it approaches the ground. This will lengthen the foot muscles and flex the calf muscles. You have essentially changed the muscles that are being engaged at foot strike and every joint has a balancing act that it goes through to work and stabilize the joint. The difference in foot strike will make a change in the joint’s balance and start using the muscles in a different way.

The typical runner making the switch will usually complain of sore and tight calves after the initial barefoot runs. This is because the calf muscles are now being tightened and flexed. After that initial shock is gone and the calves begin to adapt, the same runners typically complain of pains in the tops of their feet. These pains are usually coming from two muscles and/or three tendons that run the length of the top of the foot, one of which actually starts along the tibia.

The two main foot extensor muscles are the Extensor Hallucis Longus muscle (EHL) and the Extensor Digitorum Longus muscle (EDL). The tendons from these muscles cross the front of the ankle, pass across the top of the foot, and attach into the big toe and lesser toes. These are the muscles that run along the top of the foot. There is also the Extensor Digitorum Brevis muscle, but it is more along the upper/outer part of the foot and not typically associated with this issue. Three tendons cover these muscles: the Extensor Digitorum Longus Tendons. These muscles and tendons all function to pull the foot upward and work with resistance from the Achilles tendon and the calf muscles (flexor muscle group) that pull the foot downward.

When these tendons are over-stressed they become inflamed and painful. Swelling may come with the inflammation but not always. Most commonly it is the extensor tendon to the big toe (EHL) that is affected. In other cases the extensor tendons to the lesser toes (EDL) are affected.

Top-of-the-foot pain is typically considered to be a form of tendonitis but can also just be a muscle strain. The most common factors that cause extensor tendonitis are excessive tightness of the calf muscles, over-exertion during exercise, and falling of the foot arch. A barefoot runner will not have to concern himself so much with the falling of arches as the forefoot strike most commonly strengthens and builds the arches. That would mean the barefoot runner would typically be dealing with calf tightness since he is now using the calf muscles more than before. So if you switch to a forefoot landing after years of heel striking, then you are suddenly activating the weak muscles opposite the strong muscles you have been using your entire life. The pain in the top of the foot is usually going to be some form of tendonitis as these tendons are not used to being pulled on and stretched. The other problem is that in switching to the fore/mid-foot strike you are also contracting the calves more than before, which will then cause stress on the opposing muscles and tendons in the top of the foot.

All of you who started out with calf pain transitioned to top-of-the-foot pain for that very reason. Your calves got extremely tight and sore. A lack of proper stretching and relaxing caused a counter balance problem, which manifested itself in the connective tissues in the top of the foot. Remember that every joint in the body is a balancing act between muscles, and the pain you feel is rarely coming from the spot you are feeling where you feel it.

With top-of-the-foot pain you should stretch the calves and arches as well as taking anti-inflammatory meds. Getting the calves to relax and loosen up should be the main focus, as this will allow the release of the muscles and tendons in the top of the foot. Icing the top of the affected foot will also help in the recovery process. As with any injury the main prescription is rest. This may be the toughest of all pills to swallow, especially for someone who has just learned the pure joy of running bare, but rest and time, stretching, and ice will heal this issue, allowing you to get back out there and do what you love.

If you have more questions check out the article on Treatment and Recovery