Our feet need to be healthy and strong to endure high impact activities, such as aerobics, running or other sports, and the daily abuse of walking. When our feet weaken, they are at risk of injury, such as a fracture, tendonitis, or plantar fasciitis.
The purpose of shoes is to protect feet and provide warmth. Beyond these basics, some shoes are a fashion accessory, while others supposedly help us run faster, walk better, tone our legs, or even alleviate foot ailments.
Comparing the feet of people who did not and currently do not wear shoes with those who wore shoes and currently wear shoes provides insight into the consequences of wearing shoes.
1. Shoes Weaken Bones in Our Feet
According to renowned anthropologist Erik Trinkaus of Washington University, humans began habitually wearing shoes 40,000 years ago. He reached this conclusion by examining the toe bones of people who lived in the range of 10,000 to 100,000 years ago and found that at 40,000 years ago, the bones became less robust. That is, when humans began wearing shoes the bones in our toes (digits 2 to 5) became less thick and strong; or in other words, the toe bones became more delicate and smaller.
Bones adapt to the loads placed under them. In response to increased loads (or forces), bones become stronger and thicker. Conversely, if the loading on a bone decreases, the bone will become weaker and thinner (Wolff’s Law).
Wearing shoes changes how we walk and how weight (or the ground’s loading force) spreads out across the bottom of our feet. Trinkaus describes our toes as being large and robust for most of human history, but suddenly with the wearing of shoes, they became “wimpy.”
Essentially, shoes limit the peak force on our toes by distributing loading across the entire forefoot and shoes eliminate the traction role of our toes. The result is weaker bones, leaving them at increased risk for fractures or other problems.
Shoes don’t just limit the peak forces on toes, they change the way our feet work. The actually working of our feet is referred to as the foot’s biomechanics and within shoes, our feet function differently. Essentially, shoes alter the foot’s natural motion.
2. Shoes Limit and Alter the Normal Motion of Our Feet
Changing the way our feet work, can lead to problems. Earlier we discussed how supportive shoes obviate the need for many foot muscles to the point where, during normal walking, they are not used. Muscles that are not used weaken. Weak muscles on the bottom of our feet increase pronation motion (Headlee et al). Up to a point, foot pronation is normal. Too much pronation or over-pronation can cause foot pain, problems, and deformities.
Sebastian Wolf at the University of Heidelberg compared foot motion of children 8 years old when barefoot and in shoes and found significant differences in biomechanics. Wolf found that shoes impaired the foot’s normal motion and shoes limit the normal widening of the forefoot while walking.
Interestingly, Wolf found that the foot’s need to widen while walking was more limited in the average commercial children’s shoe than in a much thinner, more flexible shoe even though the width of both shoes in the forefoot was identical.
Previously, the culprit for many foot ailments (such as Morton’s Neuroma or hammertoes) has been the tight-fitting shoe. Based on Wolf’s findings, perhaps we need to add to add to “tight-fitting,” the inflexible shoe and the thick-soled shoe.
In October of 2009, foot and shoe data from the prestigious Framingham Study of 3,378 subjects over the years 2002 to 2008 found past shoewear use in women was associated with hindfoot pain. Meaning, even if a woman’s shoe is not causing foot pain now, it could later—even after the woman has long stopped wearing the shoe.
Specifically, the Framingham study states:
“Young women should make careful choice regarding their shoe type in order to potentially avoid hindfoot pain later in life.”
The Framingham study faults the use of high heel shoes and encourages women who persist in wearing these types of shoes to perform stretching exercises to decrease the likelihood of foot pain occurring later.
Beyond altering the normal motion of our feet, wearing shoes can actually change the normal structure and shape of our feet.
3. Shoes Deform Our Feet
Overwhelming evidence shows that wearing shoes deforms our feet. Foot deformities can potentially cause pain and other problems.
Udaya Rao at the Department of Orthopaedic Surgery, Kasturba Medical College, Karnataka, India compared flatfoot deformity in children (age 4 to 13) who wore shoes with those unshod. He found the incidence of flatfoot was 8.6% in those who wore shoes and 2.8% in those who did not wear shoes.
Further, Rao discovered that flatfoot occurred most often with children who wore closed-toe shoes and less often when children wore sandals, slippers, and least in those children who walked barefoot. He concluded that shoe wearing in childhood is detrimental to the development of the foot’s normal arch.
Simon Mays in the Physical Journal of Anthropology published a study on bunions. Bunions are painful protrusions of bone on the inside of our feet and are associated with the big toe drifting toward the other toes. Mays states that the majority of bunions result from wearing shoes; few are hereditary.
Mays says bunion deformities are rare in non-shoe wearing populations until the people start wearing shoes. Then the incidence of bunions rises sharply.
Further, Mays says that incidence of bunions in a population is related to the type of shoes worn. In populations wearing more constrictive Western-style shoes as opposed to loose-fitting footwear, the incidence of bunion deformities increased.
Kristiann D’Aout compared barefoot and shoe-wearing populations and found differences in both foot shape and the peak pressures under the foot. Barefoot peoples have wider feet and exhibit more equally distributed peak pressures. Shoe-wearing peoples had narrower feet and showed higher focal pressures at the heel, big toe and ball of the foot. These higher peak pressures put the foot at more risk for injuries, such as metarsalgia, capsulitis, fracture or tendonitis.
Further, Dr. Bernhard Zipfel at the University of the Witwatersrand has dedicated his academic career to the evolution of the human foot. Zipfel’s research paper “Shod versus unshod: The emergence of forefoot pathology in modern humans?” concluded that shoes were a factor in the development of foot pathology.
Ways to Protect Our Feet from Shoes
Dr. Lynn Staheli, Director of Orthopedics at Children’s Hospital and Medical Center in Seattle asserts that, optimum foot development occurs when barefoot.
Clearly, in general, shoes are not good for the development of our feet. The best shoe merely protects feet from the environment.
When it comes to toddlers and children, the best advice I can give parents is try to have their children go barefoot as much as possible. I cannot emphasize this enough!
Of course, going barefoot is not without risks. Parents must find areas where it is safe to walk without shoes. Further, when possible have your child walk barefoot on uneven terrain to encourage his or her feet to use as many muscles as possible.
During times when children must wear shoes, choose the most flexible, barefoot-like shoe you can find. If my child had to wear a shoe, I would put them in soft shoe or even a sandal or flip-flop before a big, stiff well-padded running shoe.
For the shoe-wearing adult who has healthy feet and no concomitant medical problems (i.e. diabetes or poor circulation), to stop wearing shoes suddenly, would likely cause foot pain and problems.
These adults should start by SLOWLY transitioning to less supportive, more barefoot-like shoes. They should look for shoes with a wide toe-box (wide around the toes) and less stiff, more flexible shoes. Some shoes that help simulate barefoot activity while providing some degree of protection include, Vibram Five Fingers, Nike Free and Terra Plana’s Vivo Barefoot.
In addition, adults transitioning out of stiff, supportive shoes should do foot strengthening and stretching exercises. Years of wearing supportive shoes will have weakened many of the small muscles in the arch, ball and toes of the feet, and these muscles need to get strong again. Gradually, these adults should begin barefoot activity.
Lastly, persons with foot problems, such as impaired sensation (i.e. diabetics), poor circulation or other problems or deformities should not go barefoot or try barefoot-like shoes without first checking with their podiatrist.
Where Do Podiatrists Stand on Shoes?
The American Podiatrist Medical Association (APMA) has issued a statement on going barefoot, entitled “Podiatrists Urge Americans to Think Twice Before Going Barefoot.” You can read the APMA’s statement by clicking HERE.
Final Thoughts on Shoes and Foot Problems
Podiatrists are quick to point out that there are people who have never worn shoes and suffer from foot pain and problems, including flatfeet, bunions, hammertoes and other problems. This is true.
Foot deformities and problems are not always due to wearing shoes, and can occur due to a myriad of reasons: congenital, ligamentous laxity, rheumatoid arthritis, obesity, structural factors within the foot (metatarsal head shape, first ray hypermobility), over-pronation, trauma, diabetes, polio, vascular problems and the list goes on.
When it comes to foot deformities and foot problems, shoes are one possible factor. Shoes may be part of the problem for a particular person or the whole problem.
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Headlee DL, Leonard JL, Hart JM, Ingersoll CD, Hertel J. Fatigue of the plantar intrinsic foot muscles increases navicular drop. J Electromyogr Kinesiol. 2008 Jun;18(3):420-5. Epub 2007
Mays SA. Paleopathogical study of hallux valgus. Am J Phys Anthropol. 2005 Feb;126(2):139-49.
Rao UB, Joseph B. The influence of footwear on the prevalence of flat foot. A survey of 2300 children. J Bone Joint Surg Br. 1992 Jul;74(4):525-7.
Staheli LT. Shoes for Children: a review. Pediatrics. 1991 Aug;88(2):371-5.
Trinkaus E. Anatomical evidence for the antiquity of human footwear use. Journal of Archaeological Science, Volume 32, Issue 10, October 2005, Pages 1515-1526.
Tinkaus E, Hong S. Anatomical evidence for the antiquity of human footwear: Tianyuan and Sunghir. Journal of Archaeological Science, 35(7):1928-1933.
Wolf S, Simon J, Patikas D, Schuster W, Armbrust P, Döderlein L. Foot motion in children shoes: a comparison of barefoot walking with shod walking in conventional and flexible shoes. Gait Posture. 2008 Jan;27(1):51-9. Epub 2007 Mar 13.
Zipfel, B., Berger, L.R. 2007. Shod versus unshod: The emergence of forefoot pathology in modern humans? The Foot. 17: 205-213