There is a small, but very significant, subculture of serious runners who run barefoot. Most people, even runnings, do not realize that this culture exists. While you may expect to find these runners on the beach or in areas with a soft composite track, you'd be mistaken. These runners are training on asphalt and concrete and even competing in road races. There are marathon runners and triathletes who find that they have more stability and fewer injuries when running barefoot.

So what's the controversy? Why doesn't everyone go barefoot when they run? This is the dilemma I face: How in good conscience do I, a podiatrist focusing on runners and sports medicine, tell people that running on hard surfaces, without the protection of a shoe or support from an orthotic, is okay to do. This violates most of my training and certainly goes against common sense. A shoe, after all, absorbs shock and will cushion the blow of an unforgiving surface.

The most well-known barefoot runners are the Kenyans who are always front-of-the-packers at most international marathons. Inspired by these Kenyan athletes, Josh Stevenson made international news in February 2009 by racing and completing the grueling New Zealand Coast to Coast Multisport event while barefoot. It was his eighth time competing in the race and he went in with the attitude "If I can do it in bare feet, hopefully I can inspire other people to do it in shoes." He also said that he would not compete barefoot again.

Such is not the attitude of true barefoot runners. Barefoot runners will run in all weather. Some will wear waterproof socks in cold weather. Others will run barefoot despite the climate or surface. Many boast wonderful benefits of barefoot running, such as injuries decreasing, a visible increase in arch height. There are shoes, such as the Nike Free and Vibram Five Fingers that may be used to either ease people in to running barefoot or providing protection if an environment is just too dangerous to run in while barefoot.

Give barefoot running a try if it intrigues you? Well anything in moderation can't hurt. My recommendation is to give it a try on a controlled surface, such as a rubberized track, and see how you do. Barefoot runners will say that such a surface is not good and a smooth concrete surface is best. I respectfully disagree with that. Running barefoot will provide a very significant change in mechanics, so you need to ease into it. Shifting from shoes to barefoot running to quickly will expose you to injury.

There are those, however, who should not even attempt barefoot running. People, with diabetes, peripheral neuropathy, or other medical conditions that result in a numbness of the feet or a decreased immune system, should not run barefoot under any circumstances. One of the stated benefits of barefoot running is the runner having heightened sensation beneath their feet causing them to run "lighter." When there is a medical problem that causes a decrease in sensation, these benefits are negated. Furthermore, the inability of a runner to not acutely feel their surface will open them up to injury, as well as the added danger of stepping on a sharp object and not feeling it. This can lead to infection and puts the limb in danger.

Runners who have very significant mechanical issues or deformity, such as previous foot surgery on bones, clubfoot, injury to tendons, or even extremely flat or high-arched feet should exercise extreme caution if attempting barefoot running. The unique biomechanical conditions that exist in these situations put the barefoot runner at risk of further injury. Serious barefoot runners may disagree, but the mechanical imbalance in such feet will be exacerbated in barefoot running.

A more obvious concern with barefoot running comes with various surfaces. A looser gravel surface will run the risk of a more focal issue on your foot. A trail will have a surface of twigs and sharp rocks that can cut and imbed themselves in the foot. Even a safer and more even surface can have errant rocks and broken glass that may not be seen. Any place that you run or walk barefoot must be examined well to avoid such hazards.

As with any new activity, one should proceed in a slow and cautious way. In something as comparatively extreme as barefoot running, caution must be exercised. If you notice any problems along the way, be sure to visit your podiatrist.