The Art and Science of Fitness | How best to avoid injury, with or without shoes

Heel landing in runners is thought to be injurious. I take you down memory lane — yours, mine and a man called Ed to decode this.

Born to Run, the book by Christopher McDougall, that has an almost cult-like status in the running world, has led to some unfounded beliefs, with facts being very conveniently overlooked. The book mentions that modern running shoes — ones with raised cushioned heels — were invented in 1972 by Bill Bowerman, co-founder of Nike, which enabled a runner to land on their heels and unnaturally lengthen their strides. This was suggested to be the main reason for most injuries in runners.

If you're ready to hit the pavement, make sure to take the necessary precautions and train your body properly. (Shutterstock)

Edward (Ed) H Ayres, founding editor and publisher of Running Times magazine, and importantly, the man who placed third in the first New York Marathon in 1970, blogged his opinion and experience in 2011. Back then, Ayres and I had been in touch, exchanging notes on what we thought about the master storyteller intermingling facts and fiction in Born to Run to make his case.

Ayres blogged:

Implicitly, it seemed, McDougall was blaming his own struggle with a painful foot injury on a guy who died years ago and who, if he'd ever been confronted by his accuser, would have pointed out that while he did indeed invent the waffle sole, he didn't invent the built-up rubber heel. That had been invented over half a century earlier. Claiming that Bowerman thought up the built-up heel caught my attention not only because I had been running with built-up rubber heels for years before Bowerman's presumed invention, but also because of a memorable incident in my first marathon, when I found myself pulling even with Ted Corbitt, whom the New York Times called the "godfather of American ultrarunning." At the time, I was "running on my toes," as my high school coach had taught, but Corbitt glanced at my footfall and suggested that I might run better if I let myself touch down on my heels. This was years before the first Nikes, and runners who wanted built-up heel cushioning could easily get it in shoes made by Adidas or Tiger. And the heel-running Ted Corbitt's multi-day and 50-mile performances are just as impressive, even today, as the Tarahumara's.

(I talk about Tarahumara in my last piece which you can read here).

In February 2010, on a Sunday, I ran an incredible 30 kilometres in my 5-year-old leather Clarks sandals, which were not even meant for running. At that time, my 3.5-year-old son Viren loved running barefoot and I was curious to observe how a child his age ran without being influenced by modern sedentary living or the marketing tactics of shoe companies. Despite being flat-footed, Viren had a smooth, natural running style, landing gently on his mid-foot and taking off gracefully. This experience reaffirmed my belief that footwear or the lack thereof is not the decisive factor, but rather the running style itself. I feel that the whole argument has been misguided.

A child with flat feet instinctively knows how to run without any training. This is true for most children. The interference of modern lifestyles is what corrupts our bodies and makes us forget how to use them correctly. Many of us become inactive and neglect our body's natural design. We wrongly blame our footwear and their manufacturers for our problems, despite our lack of knowledge about how to properly walk and run. As previously mentioned, minimalist shoe companies have distorted facts to promote their products.

Your running style and how you use your body, or even abuse it, is responsible for your running injuries. This can lead to muscle imbalances and poor posture over time. Additionally, overtraining accounts for more than 80% of injuries.

When our bodies are not yet affected by our modern environment, we can push ourselves to the limits without getting injured. However, if we haven't been active for a decade or more, our bodies quickly forget what we were naturally born to do. It becomes crucial to first address any muscle imbalances and posture issues before rushing into intense running again. This approach can help your body become more aware and prevent injuries, regardless of whether you wear conventional cushioned shoes, minimalist shoes, or go barefoot.

​​A key principle to follow is to gradually increase your running duration. It's not realistic to expect the same level of stamina you had as a young child. Aim to increase your time on your feet by no more than 10% a week. I advise against fixating on mileage for beginners, as it can lead to a focus on speed before the basics are established. Instead, focus on building your confidence by gradually increasing your time on your feet. It's important to address one aspect at a time, with speed being a secondary priority. Only after becoming comfortable with running, which may take several months, should you consider focusing on speed.

Ayres mentioned some historical facts in his blog that McDougall had ignored or didn’t know about:

… it wasn't just in the mid-1960s that some of our shoes had built-up heel rubber. In my collection of old running memorabilia, I have a hundred-year-old advertisement from a company called O'Sullivan Heels of Live Rubber, featuring a photo of the Olympic marathon champion of 1908, Johnny Hayes, shaking hands with the company's owner, Humphrey O'Sullivan. In the caption, Hayes is quoted as informing Sullivan that the shoes with which he had won the Olympic Marathon had the O'Sullivan Heels of Live Rubber, and that "I always wear your heels in my races."

What are Ayres's thoughts on McDougall's core argument that running injuries have proliferated since 1972?

I strongly suspect that here, McDougall has fallen into the very common trap of confusing correlation with causation. The fact that the rise of Nikes and other modern running shoes is correlated with a proliferation of running injuries does not mean they are the cause.

Further, barefoot running, the new craze that's taken the running world by storm, comes with new risks, including injuries that were once rare in runners who wore conventional shoes. It's easy to forget how to use our bodies properly when we live such sedentary lives, and our running technique often suffers as a result. While there's no one right way to run, those lucky few who have mastered proper technique can transition smoothly to barefoot running without worry.

But for newbies or those with bad technique, it's like driving without bumper guards — there's no room for error. Barefoot running demands precision and balance, and can result in disaster if attempted without proper preparation. It's important to work on muscle imbalances and become more body aware before jumping into this trend headfirst. And while it's assumed that barefoot running will force you to land on your mid-foot or fore-foot, studies have shown that many runners still land on their heels, and as Ayres shared from almost 80 years ago, it’s ok to do that too.

So, if you're ready to hit the pavement, make sure to take the necessary precautions and train your body properly. After all, sitting for long periods of time has been linked to early mortality, so it's time to stand up, put on your shoes (or not, *conditions apply), and go for a run!

Keep miling and smiling.

Dr Rajat Chauhan (drrajatchauhan.com) is the author of The Pain Handbook: A non-surgical way to managing back, neck and knee pain; MoveMint Medicine: Your Journey to Peak Health and La Ultra: cOuch to 5, 11 & 22 kms in 100 days

He writes a weekly column, exclusively for HT Premium readers, that breaks down the science of movement and exercise.

The views expressed are personal