I got a bad injury recently. After a 16-mile run that I ran a few weeks
ago in preparation for the NYC Marathon, I got a stress fracture in my fibula (the smaller bone
between the knee and the ankle - not the shinbone, but the bone that
runs up from the anklebone on the outside of the leg – see my nuclear bone scan image below, showing bright spot above my left ankle).
The obvious question that a lot of people have been asking me is, don't
you think the fact that you're running BAREFOOT might have something to
do with this?? Is this barefoot business perhaps just a lot of
Internet-fed foolishness after all?
The answer is, could be. But, at this point I still don't believe it is. Here's why:
First, stress fractures are an extremely common injury (among top five) among runners,
affecting 5-30% of runners annually. If barefooting was the cause of my injury, then what is causing all those OTHER
injuries out there among runners with shoes that have become far more
well-cushioned in the past 10 years than shoes have ever been cushioned
before in history of the species? Is it more likely that whatever caused
those injuries also caused mine, or that it was the barefooting?
Second, I had a less severe version of this same injury last year after running my first Half Ironman race – in shoes. (It went away after about two weeks on its own that time, and never got this severe.)
Third, I had a very bad ankle twist in 2001, which some tell me can
permanently stretch out your tendons (which supposedly are like rubber
bands that help your joints spring back into position & unlike
muscles which you don't want stretched). Being stretched out can create
additional stresses on the bone.
Fourth, studies have
found that actual measurements of impact on runners' legs are actually
no greater when barefoot, because, the theory goes, people use what
they feel with their feet (our soles having more nerve endings per inch
than any other parts of our bodies other than our hands and our sex
organs, a doctor friend tells me) to adjust how they run, with the result that greater cushioning
just leads people to land harder, and also with the result that running
injuries have not declined in recent years even as cushioning as
greatly increased. Evidence for the benefits of cushioning in preventing injuries is apparently "missing" and despite conventional wisdom injury rates are unrelated to training surface. These things are rarely conclusive and could all be wrong, but put it all together and it's pretty persuasive.
Fifth, it didn't happen on a 3-mile run, or even a 13-miler – it was a
16-miler, and in running it, I violated a cardinal rule among runners,
which is never increase your mileage by more than 10% a week. This was
my third marathon and I figured I didn't need to worry about that so
much any more. Whether I ramped up too fast based on my previous running experience, I have no idea (I keep logs of my runs and 
here is a graphic showing all my runs since I started doing them, if anyone should have any opinions on the matter). I do know no doctors batted an eye to hear I got a
stress fracture after a 16-miler, even not yet knowing about the
barefooting. Apparently, for me, at least, it was too much.
So for now my operative assumption is that I just need to build up more
gradually and strengthen my bones. Our bones, I have learned, are just
like our tendons and muscles: when stressed, they break down, and then
rebuild themselves stronger. But if you keep stressing them the damage
can outrun the healing and eventually you get a fracture (or
tendinosis, in the case of tendons). Runners have stronger bones than non-runners, exactly because of the additional stress placed upon them.
I'll tell you one thing, though: if I do conclude the barefooting caused
this, I'll put shoes back on faster than you can say "the natural is
not always better than the artificial."
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