In 2009, Chris McDougall's book Born to Run (Profile Books) shot around the world when word of mouth worked as fast as the barefoot runners who peopled its pages. McDougall wrote with infectious enthusiasm about his discovery that, contrary to all expectation and his own experience, running was not supposed to hurt – it should be fun. The day he mastered running on the balls of his feet rather than with a heel strike, he said, was the end of injury for him.
This was a powerful message. Tens of thousands of people ripped off their expensive running shoes and hit the road and thousands of them came home again with injuries – not to their tender, shoe-coddled feet, but to their legs, hips, backs and knees.
Leonie Joubert, author of The Hungry Season (Pan Macmillan), tried it and ended up with calves in agony: "I developed a rare injury that seems only to have been remedied by going back to normal shoes."
The problem, said Cape Town physiotherapist Rob Sims, was that people took the transition too fast – they wanted to run a few kilometres immediately. "Your body adapts to a specific gait," he said. "You need to relearn your gait to accommodate the forefoot strike rather than the heel strike." And that takes time.
Up and down the legs, into the butt, pelvis and back there are a myriad muscles, tendons and joints that have all become accustomed to working in a certain way, and all of them need to be re-educated before striking out on a long run.
"If your feet are not conditioned [to running barefoot], your intrinsic foot muscles will not be strong enough to absorb the shock," said Nelfrie Kemp, spokesperson for the Podiatry Association of South Africa.
She suggests deciding what kind of running you will likely end up doing: Do you want to do hardcore barefoot running, or are you interested in adopting a new category of shoe, known as a "minimalist" shoe, which gives the runner the all-important contact with the earth through a thin and very flexible sole, enabling him or her to do trails on which a totally bare foot might flinch from injury on stones and other obstacles?
Even in minimalist shoes, taking time to learn a new running gait was vital, said Roger Zeino of Branded Footwear and Clothing Company, local distributor of the famous Vibram Five Fingers minimalist range. There is no differential between the height of the heel and the front of the foot and that calls into play a gait that runners have not used since they were small children.
"Traditional footwear is doing a lot of the work that your own muscles should be doing," said Zeino. "So this is a totally new thing for your body."
But the potential of injury-free running – of fixing things such as plantar fascitis (pain under the foot) and ITB (iliotibial band syndrome, a common knee injury) – is real. Make the transition to barefoot or minimalist running in the long, slow and cautious way and you could yet experience the promised land.
A runner should first get assessed by a professional who understands gait and physical movement: a physio-therapist or a podiatrist. "I would look at your mobility – your joints need to be flexible," said Sims.
"If your ankles or toes are too tight, we'd start with exercises to achieve the right range of movement. I would also check muscle and fascial length – either could be too lax or too tight." He might also advise specific exercises (at least four times a week) to strengthen key muscles such as the glutes, which are crucial to balance.
The runner who wants to be extra cautious should start by walking around the house barefoot for an hour every day for two weeks, then progress to 30 minutes a day outside the house for several weeks. Then hit the road and run. The body needs to be listened to and patience is required.
"Start by choosing a smooth stretch of road and running 150m," said Sims. The body needs to learn from the hard surface. If the feet and all the dormant muscles are coddled by running on a soft surface such as grass, the learning will not happen. Part of that learning is not to come down on the heel, but to reach for the ground with the ball of the foot first. "But don't try to avoid touching the ground with your heel at all – that can cause injuries," said Sims.
The next day the runner should rest if feeling sore and do another 150m the day after – or, if not sore, skip the rest and continue running. After each day of running, assess the soreness and stiffness – remember, the concern is the joints, hips and back and leg muscles, rather than the feet. If the runner feels good, he or she can run the next day and over several weeks push the distance up in small increments of 100m a time.
Joubert may well end up barefoot. She has adopted the forefront-strike gait, which she described as a "short high cadence stride, keeping foot-strike below the body rather than a long loping stride, landing with the mid or front of the foot rather than on the heel". She said, despite running in shoes, it felt "sooooo good; it's like sucking in air".
Dr Ross Tucker of the Sports Science Institute in Cape Town said he "budgeted" a total of 15 or 16 weeks to get up to 40 minutes of solid running. The key, he said, was "to recognise that going from shoes to minimalist shoes or barefoot is a skill and involves a significant change. It's essential to respect the time that it will take to fully adapt to the different loading stresses associated with running barefoot or in minimalist shoes."
Pontsho Pilane explains why women may choose a Caesarean section over a vaginal birth, especially in the private sector.
A doctor shortage in war-torn Mozambique paved the way for a new breed of surgeons that have slashed deaths among new mothers.
A novel and easy way to disinfect water using freely available solar power is helping to combat the spread of disease in developing countries.
Bhekisisa means "to scrutinise" in Zulu
In South Africa, Zulu patients who would like to be thoroughly assessed by a doctor, would ask the physician to "bhekisisa" them.