Hatty Skinner talks gait analysis, human evolution, and barefoot shoes

Why were you drawn to this particular aspect of physio for runners?

Since my undergraduate degree in kinesiology, I’ve been really interested in lower limb injuries, specifically. I love biomechanics of all kinds. I’m very much a casual recreational runner and by no means competitive, yet! But I love working with athletes and runners. They make good clients!

My first ever placement was working with someone who saw a lot of patients with foot injuries, and I thought that was interesting. The human foot is really neat and very well-adapted to do things like running. During my undergrad, I took a few classes in evolution and learned about the human foot and what our bodies have evolved to do. We’re designed for long distances! Not only that, I’d argue that it’s because we’ve evolved to run long distances with our two feet that has enabled us to be successful as a species. I am now a total nerd for human evolution. I’ve read lots of books on how bodies evolved!

But despite our feet being adapted for running, injuries to feet are really common. I saw a lot of runners with foot injuries in my placements, and it made me wonder what was at the root of it all. Shouldn’t people have strong feet? There are a lot of factors in how people injure their feet, and training is a big one. Footwear can also make a difference.

You recently took a gait analysis course. What was one interesting takeaway?

The instructors focused a lot on the capacity of our bodies, with running: to increase the capacity of what your body is capable of, you have to load it properly. But if you overload it or load it too quickly, your capacity is reduced, and you’ll get injured. Our body’s capacity changes every day and is dependent on so many factors: how you sleep at night, how much stress you are carrying, and the quality of your nutrition all make a difference. Since taking the course, I’ve felt more confident asking clients about these factors, because they can impact gait and how well we can train.

We also learned that if you are working with an experienced runner (consistently running for one or more years), you don’t want to change a lot. They’ve already adapted and have optimized their own way to run. Changing something like their heel strike or telling them to run differently isn’t going to benefit them. The “trick” to being good at running is to run “efficiently,” which essentially means using energy well.

What was the purpose of the course?

The goal by the end was to be able to perform a running gait analysis, learn how to observe gait, and make suggestions for modifying it. The biggest suggestion we learned was to modify the cadence. 

Most people, when they’re running (especially those who are injured), are overstriding, which means their feet spend more time on the ground. A runner who is taking 140 steps per minute is overstriding, compared to a runner taking 180 steps per minute. The longer our feet spend on the ground, the harder our muscles have to work, and the harder the impact.

The more steps we can take per minute, the shorter our stride, and the more efficient we are. 

How can someone improve their running steps per minute?

One way is by listening to music that matches the beat you’re trying to achieve. There are many playlists out there that include songs at a frequency of 180 beats per minute. 

You’re into barefoot shoes! Why is that?

I don’t run in barefoot shoes yet, but I wear them for pretty much everything else. The course practitioners talked about barefoot footwear, which was validating because there are not a lot of perspectives in the mainstream footwear world for non-traditional shoes.

I’ve been wearing barefoot shoes for a while now, and quite a few people have asked about them. They also ask if I’d recommend them, and I always say, “Yes, but…” because I know that they are not something someone should jump right into. I’m curious about why barefoot shoes haven’t caught on with the mainstream and wonder if perhaps they became trendy, people jumped into them too quickly with no transition period, and then sustained injuries in them. 

How would one transition to barefoot shoes?

I usually recommend people spend more time going 100% barefoot around the house first (not even socks)! And, if they’re going to try barefoot shoes, it’s best to do it in the offseason, keeping the transition very gradual: a couple of minutes a day to start, eventually wearing them more and more. It’s a process! 

Tell us more about how footwear impacts our feet.

One thing I learned from a placement at university is that footwear can help or hinder our ability to train well. My preceptor was a big advocate for barefoot shoes. She’s a runner, and she runs in barefoot shoes (although I don’t know where her interest in that came from). She challenged my thoughts on why we promote shoes in general, when, from an evolutionary perspective, humans didn’t wear shoes for a long time. Nowadays, though, we have feet that need to be in shoes. A lot of the people I saw with injured feet did not have a lot of strength in their feet. When you grow up constantly wearing shoes, your feet can only be so strong.