Check out the Latest Articles:


Do shoes contribute to knee pain, joint deterioration and arthritis? According to recent research published in the medical literature by Drs. Andy Oliver Radzimski and Gisela Sole at the prestigious University of Otago, and Dr. Annegret Mundermann at the University of Constance, Germany, in most cases the answer appears to be a resounding yes.

For many barefoot runners and walkers who have avoided or alleviated their painful knees by shunning supportive shoes, arch supports, and orthotics (custom made arch supports), this research is nothing new. The barefoot community has known for years that barefoot activity is good for our knees, but now science is catching up.

Dr. Radzimski and his co-researchers reviewed the scientific literature on the effect of footwear and arch supports/orthotics on the knee. They looked at the external knee adduction moment (EKAM) when we are wearing shoes and when we are barefoot. EKAM represents knee load distribution from the inside to the outside of the knee joint. The higher the EKAM is, the greater and faster the progressions of deterioration (osteoarthritis) of the knee joint. In simple terms, a high EKAM is bad for our knee, while a low EKAM is good for the knee.

These researchers stunning findings came about after looking at a grand total of 348 scientific articles and including 33 studies in their research. In plain English: these highly educated and respected scientists evaluated all current knowledge and scientific information on the effect of footwear on the knee joint of healthy people and those with knee disorders with regard to EKAM. This impressive analysis of the literature is important because the ardent lovers of supportive shoes believe that our feet need to be encased in footwear will have a difficult time refuting the voluminous amount of scientific research analyzed.

Remarkably, these researchers found that sneakers and running shoes increased EKAM when compared to barefoot walking and barefoot running. Specifically, the knee has a greater load on the inside of the joint when wearing shoes as compared to going barefoot. In fact, the authors of this astounding research say that shoes that provide “stability” (or support) create increased load on the knee joint (again when compared to simply going barefoot).

Radzimski and his co-writers conclude by suggesting that people with knee arthritis on the inside of their knee joint should consider walking barefoot when possible. I recommend this too. Not only will your knees thank you, but your whole body will too.

This new, groundbreaking research is not proof that barefoot is better than wearing shoes, but if you will excuse the pun, it is yet one more step (in fact, a big step) in that direction. I do not expect this amazing research will convince the tiny percentage of supportive-shoe-loving zealots out there to take a step without their feet firmly encased in their thickly-padded shoes, but for the vast majority of people with an open mind, I urge them to give this research a read. More importantly, give barefoot activity a try!

Note: if you do decide to make the leap to barefoot walking or running, begin slowly, read up on the techniques of giving up your supportive footwear or shoes, and if you have any medical problems, proceed only under the care of your physician.


Radzimski AO, et al, Effect of footwear on the external knee adduction moment – A systemic review, Knee (2011), doi:10, 1016/j.knee. 2011.05.013

Image Credit – Child running Photos by Pond5

  • Golden State Touch

    Thanks for bringing this to our attention, Dr. Nirenberg. And I think it’s great that one of the researchers is named “Sole” 

  • Barefoot Tyler Rusk

    Very well written article. It is being discussed at

    I love how you warn the people to take it slow and follow guides for barefooting.

    One thing you should mention when discussing barefooting, especially for the older crowd, is the risks associated with barefooting and diabetic neuropathy.

    Diabetic Neuropathy

    The loss of sensation with the onset of diabetic neuropathy
    significantly increases the risk of injury when running barefoot.
    Additionally, diabetics, especially those with neuropathy, may find that
    their feet are unable to adapt and repair themselves effectively after
    running barefoot, and that excessive weight bearing activity may
    exacerbate the progression of diabetic neuropathy. Even careful, short
    gentle barefoot runs, on soft surfaces like grass, should be avoided by
    those with diabetic neuropathy. With any loss of sensation in the foot,
    there is a risk that small cuts or bruises could go unnoticed and lead
    to more severe infections.

    If you have diabetes, and you want to try barefoot running, always
    check with your doctor first and follow their advice. Even if your
    doctor says you can give barefoot running a try, if your diabetes
    worsens, you notice increasing loss of sensation on your feet or other
    extremities, or you find that you have a high number of minor infections
    from damage to your feet, then you should stop running barefoot
    immediately and see your doctor again.” –

  • Chris Bloor

    Vibram 5-fingers provide useful protection to the feet, whilst delivering most of the benefits of barefoot running. However, I noticed that when Rin’dzin Pamo ran the 45-mile off-road Green Man Challenge around Bristol, England last Sunday (4th September), grass and thistles tended to accumulate between her toes. Also, there was a certain amount of bleeding from the toes due to impact with stones etc.

  • Chicago Podiatrist

    I think the barefoot trend is long overdue. I tell my patients who are starting the barefoot lifestyle to start gradually, for example, walking in the grass next to a jog path rather than starting to simply jog barefoot. The feet need time to reacclimate to using muscles not typically utilized with shoes as well as thicker skin for stepping on uncomfortable objects, so I am pleased the article covered this. Patients with neuropathy I encourage more caution since cuts and punctures are of greater concern, typically advising a barefoot imitating shoe to offer some protection as opposed to true barefoot activity. I encourage all patients to inspect their feet before and after a walk or run.