Your Pedicurist Could Be Your Foot's Best Friend

Pedicurists have had a bad rap lately. They have been accused of not sterilizing their instruments properly, leading to infections in their clients’ feet. When I heard about these pedicure-related infections, I contacted a local pedicure school. I quickly found—to my relief—that sterilizing instruments was not a problem. However, in talking with the teachers and students I realized that these professionals were on the front lines of looking at feet and were the ideal people to spot foot problems or cancer in the foot early.

Now, I lecture regularly to pedicurists on common foot problems to watch for, including certain kinds of cancer that may show up in the foot first.

For some people, their pedicurist looks at their feet more than anyone else–including themselves. In fact, some people have difficulty seeing between their toes or under their feet and the person best suited to check all these areas, is their pedicurist.

Checking your feet regularly for any suspicious moles, masses or other lesions is very important. A mole may be nothing to worry about or could be melanoma, a type of cancer.

Melanoma starts as a small mole, lesion, or freckle. When melanoma occurs on the foot it is usually not caught until it is too late, often resulting in the loss of the foot or leg, and even death. Each year more than 8,000 people die from melanoma—nearly one death every hour.

Fortunately, when caught early, most people with melanoma survive. Melanoma does not discriminate. It occurs in the young and old, in African-Americans and in Caucasians, and in males and females. Though, Caucasians or fairer-skinned people are at higher risk.

Always have any suspicious lesions, masses, pain, or swelling, thoroughly checked by a good podiatrist.   

Diabetics should watch their feet for any pain, sores, infections, abnormal sensation, or color changes. The smallest sore, blister, or infection can quickly accelerate to a severe problem or gangrene, and quickly lead to the need for amputation of a toe, the foot, or even the leg. Studies show that one in five diabetics will endure an amputation. Sadly, most of these amputations are preventable, if caught early. As a general rule, diabetics should have any foot or ankle problem checked by a podiatrist.

Recently, I was interviewed about my efforts to enlist pedicurists in spotting serious foot problems early. Read the whole story by CLICKING HERE.

Lastly, the next time you choose a pedicurist, you may want to find someone who a basic knowledge of foot problems. It could just save your life.

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Recently, EmpowHer invited me to write a column – here it is!

Pain and problems in the female foot are common—four times greater than for men. One study found that eighty-two percent of U.S. women report having foot pain, seventy-two percent have a foot deformity, and of all foot surgeries in the U.S., women undergo ninety percent of them.

Incredibly, it isn’t just the woman’s foot that leads in pain and problems. Females suffer with more ankle, leg, knee, hip, back, and neck problems. Clearly, when it comes to pain, this is one place women have too much equality!

Don’t despair! You can do simple things to prevent and alleviate pain now. Before I get to that, I want to explain why women are more prone than men to experience muscle-skeletal pain and ailments.

The Feet Are Our Body’s Foundation

Feet are your foundation—whether you are man, woman or child. Strong, well-functioning feet and ankles are essential for support and balance. Working in unison with the body, your feet rapidly adapt to maintain balance over a variety of surface, whether you are running, walking, jogging, carrying a backpack, baby, purse, or all three, or even recovering from a sudden stumble. Feet do it all.

Having incredibly dynamic feet is great until something with them goes wrong. The smallest imbalance in your feet shows up as larger problems up above—in your knees, hips, back, and/or neck. Thus, a misaligned foot leads to a misaligned hip and/or back and/or neck.

Our body depends on agonist-antagonist muscles pulling against each other around our dozens of joints, and any joint imbalance will cause weakness of the muscles on one side of the joint and tension and strain of the muscles on the other side. The result is pain.

Further, these muscle-skeletal misalignments are more likely to occur due to the unique shape of the woman’s “normal” foot.

How is Woman’s Foot Unique?

Compared with males, the female’s foot is generally shorter, narrower, and the length of instep is not as long. The average woman wears a size 8.5 (her foot is approximately twenty-four centimeters or 9.5 inches in length, about an inch shorter than the foot of the average male). The woman’s heel is narrower when compared to the ball of foot, which is wider and has a larger girth relative to the rest of the foot. 

Overall, the woman’s foot is flatter than the male foot. This lower (or more pronated) foot is the root cause of the many of the body’s structural problems.

When feet flatten more than necessary (or over-pronate), the legs compensate by rotating excessively inward. This increased internal rotation creates abnormal stress on the knees causing them to become painful and deteriorate (osteoarthritis). With the knees now strained and out of alignment, a “ripple effect” can occur, causing imbalances, pain and arthritis in the hips, back and neck  Since a woman’s foot is already on the flat-side, she is more predisposed to this painful cascade of events. (For those people whose feet are high arched (or supinated), a similar cascade of joint misalignment occurs leading to pain, imbalance and osteoarthritis.)

To make this chain-of-events even worse, a foot—male or female—that is on the flat side (excessively pronated) is more prone to become even weaker through a vicious downward foot-flattening cycle. Ultimately, this progressive flattening of the foot results in even more foot problems and more muscle-skeletal problems throughout the body.

What You Can Do About Foot, Knee, Hip, Back and Neck Pain

To restore normal alignment to your body, you need to restore balance. The best way to do this is by strengthening agonist and antagonist muscles around your major joints with the goal of improving posture.

This sounds complicated, but there is a very simple way to start: walk barefoot. Shoes act as braces for your feet, altering the alignment of your body and negating the need for many muscles to work at all. Walking barefoot or in minimalist footwear (very flexible shoes such Terra Plana’s Vivo Barefoot), allows your body to “feel” the ground. Do as much walking barefoot as safely possible.

Barefoot activity allows your body’s muscles to develop and remarkably, an innate biofeedback system kicks in that tells your body how to make subtle, unconscious adjustments in the way you walk (your gait). To walk correctly takes a lot of work and study, and is beyond this article, but barefoot walking is a great way to start.

When you must wear shoes, less is more. As mentioned, wear minimalist shoes or very flexible, thin shoes that provide basic protection but still let your feet sense the ground beneath them.

Final Thoughts on Muscle-Skeletal Pain

Now, you can begin to understand the effect of foot misalignment and other joint imbalances on your body. The simplest way to start to strengthen your muscles and rebalance your body is through your feet, and how by losing your shoes, you will be on your way to losing the pain.

If you have any questions or foot, ankle or walking-related topics you would like to learn about, please post in our Forum Section.

References:

Bingefors K, Isacson D. Epidemiology, co-morbidity, and impact on health-related quality of life of self-reported headache and musculoskeletal pain–a gender perspective. Eur J Pain. 2004 Oct;8(5):435-50.

Stubbs D, Krebs E, Bair M, Damush T, Wu J, Sutherland J, Kroenke K.Sex Differences in Pain and Pain-Related Disability among Primary Care Patients with Chronic Musculoskeletal Pain.

Khang YH, Kim HR. Gender differences in self-rated health and mortality association: role of pain-inducing musculoskeletal disorders. J Womens Health (Larchmt). 2010 Jan;19(1):109-16.

Terrier P, Dériaz O, Meichtry A, Luthi F. Prescription footwear for severe injuries of foot and ankle: effect on regularity and symmetry of the gait assessed by trunk accelerometry. Gait Posture. 2009 Nov;30(4):492-6. Epub 2009 Aug 25.

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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.  

Interesting Links:

Take Off Your Shoes and Walk

Parents for Barefoot Children

Naturally and Healthy Barefoot Activities

Why Shoes Make Normal Gait Impossible

Living Barefoot

References:

Dufour AB, Broe KE, Nguyen US, Gagnon DR, Hillstrom HJ, Walker AH, Kivell E, Hannan MT. Foot Pain: Is Current or Past Shoewear a Factor? Arthritis Rheum. 2009 Sep 29;61(10):1352-1358.

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

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Can Correct Toes Help You?

Invented by podiatrist Ray McClanahan, Correct Toes realigns your toes to their natural position to achieve optimal foot health, and in doing so, claims to prevent and cure foot problems (such as hammertoes and bunions).  

Correct Toes is a sturdy toe-spacer made of medical grade silicon that gently, painlessly positions your toes in a more natural, more correct position.

McClanahan states that he has before and after photos showing the success of Correct Toes and clinical proof, but did not provide that for this review. He also states he is in the process of doing a clinical study to prove Correct Toes effectiveness.

Lack of clinical data does not mean a product does not work; in fact, when it comes to foot products such as arch supports, most companies’ claim their supports are beneficial but rarely provide any proof. One would think with all the money Dr. Scholl’s has, it is about time they provided some proof of the benefits of Gellin.

Unlike other toe-spacing products such as Yoga Toes, Correct Toes doesn’t just stretch your toes apart but puts them in their normal, physiologic position. Correct Toes is also compact enough that you can wear it in shoes—albeit you will need a shoe with a large, wide toe box. Lastly, Correct Toes is less expensive than Yoga Toes.  

When I asked McClanahan’s associate, Dr. Robyn R. Friedman how Correct Toes work, this was her reply:

Dr. McClanahan’s treatment approach is based largely on his experiences in west Africa, where there are some of the world’s greatest runners.  Being a competitive runner himself, Dr. McClanahan was interested in their training methods.  He was amazed to note that these top-notch runners train predominantly barefoot or in minimal footwear, and also they experience  a very low rate of injury, estimated to be about 3% (versus 65-75% of runners in the US.)  This low rate of foot (and knee, hip, lower back) ailments is seen elsewhere in the world where people are predominantly unshod or use predominantly flip-flops or sandals. 

Among the many conclusions that Dr. M drew from his experiences, one of them was that have strong, spaced toes is essential to proper foot health and maximally efficient gait, and most Americans, who have spent a lifetime in footwear that has elevated heels and tapered toe boxes, have lost this essential structural integrity that we were born with. 

The goal of Correct Toes is to return the toes to their appropriate and correct positioning, which would be the very shape of the foot we were born with – widest at the ends of the toes, with the toes spaced, straight, and strong.

So the mechanism of action: Correct Toes work in a similar way to how braces work for the teeth.  They place the toes into alignment and slowly and progressively allow the muscles and other tissues to adapt and strengthen accordingly.  But unlike with orthodontia, we’re simply trying to return the feet the their natural shape, the shape that had at birth, and the shape that would have remained if we had spent a lifetime either barefoot or in shoes that were sufficiently wide (in the toe box) and flat.

How long does it take to see results?  This varies, depending on many factors, such as the patient’s age, tissue elasticity, extent of the deformity, level of compliance (with using Correct Toes, wearing only wide & flat footwear, doing extensor stretches and other relevant stretches), how often the product is used in weight-bearing activity, and so on. 

Patients usually report feeling different/better/slightly sore right away or within a few days.  To actually see physical changes (the angle of the hallux valgus improving, or hammertoes starting to straighten), may take 3-6 months, with continuously progressive change over a year or two.  I like to remind patients that it took many, many years of wearing footwear with tapered toe boxes and heel elevation for our foot architecture to change from the strong, spread toes we were born with to the current architecture, and as such, positive changes will also require some time.  But it’s worth it, because the approach has a life-time of positive implications.

Intuitively, I agree with much of McClanahan’s theory. Certainly, just forcing people to wear shoes with a wide, non-constrictive toe box is going to help let the toes spread out. Further, for most people, their foot problems are likely due to wearing ill-fitting shoes.

I found Correct Toes comfortable, but using them for a few days did not yield any significant, measurable results. But, I did not really expect to see changes in such a short time. Correct Toes is a long term, conservative, natural method of addressing foot pain and deformities of the toes.

Oddly, few clinical studies exist on using spacers, splints or splinting to affect change in adult feet and toes. In one study of a toe splint, after 3 months, pain decreased but there was no improvement in digital alignment.

McClanahan claims structural change can occur in 3 to 6 months of use. I am not sure if the analogy to our teeth is correct. Our toes and feet are composed of bones, ligaments, capsular tissues, and muscle. Teeth only have to contend with the gums to hold their position. Further, given that dental braces are worn for anywhere from one and half to three years, I suspect Correct Toes would probably need to be worn for much longer six months to see structural changes—though McClanahan does allude (above) to the fact that changes occur for one or two years.

Certainly, Correct Toes, in theory, can gently stretch tight ligaments and muscles, pushing them toward their more correct positions. Again, I would love to see a clinical study on Correct Toes—just to gain some insight into how long this process would take.

I do find the idea of repositioning the toes, non-surgically, fascinating, and I see nothing wrong with wearing Correct Toes for six months or even a year or more to avoid surgery. (McClanahan did not say if he expects people to wear Correct Toes when asleep.)

Final Thoughts on Correct Toes

Most people want instant gratification and sadly, will not put a spacer on their foot for 3 months, let alone a year or more. However, for those who are willing to persist with wearing Correct Toes, it may be a great, simple, non-surgical solution to their foot pain, problems, and deformities.

To learn more about Correct Toes visit NW Foot & Ankle.

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I have gone barefoot nearly my entire life. When I wear shoes, sandals or boots, my feet get so hot, sweaty and then start to swell until I am barefoot again. Often even sandals will make them sweat and swell. Other than get a doctors note to go barefoot, what else can I do?

Dr. Nirenberg replies:

I love that you have gone barefoot nearly your entire life! That is great, and generally, going barefoot is very healthy for our feet. Unfortunately, at some point, we are forced to wear shoes and for the sweat glands on our feet this is a problem.

Our feet are not meant to be confined to shoes–the more you are barefoot, typically the better.

When a foot is entombed in dark, secure shoe, the sweat of our feet has nowhere to go—it can’t evaporate. Often, bacteria can fester, leading to foot odor and infections. (Sweat in itself does not have a odor but the bacteria cause the odor).

In areas of the world where people do not wear shoes, sweaty feet and for that matter, foot odor, is rarely a problem.

Our feet our loaded with sweat glands. In fact, our feet have a higher concentration of sweat glands than any other part of our body. Some people’s feet can secrete up to half a pint of perspiration a day! The medical term for over-active sweat glands is hyperhidrosis.

Excessively sweaty feet (hyperhidrosis) can cause athlete’s foot, blisters, foot odor, infections, and can be just plain irritating.  

What Causes Our Feet to Sweat Too Much?

Excessively sweaty feet may be due to hormonal imbalance, thyroid problems, or your genetics. Hot weather can worsen sweaty, wet feet, though I have seen the problem occur in the winter too.

As mentioned above, shoes are a big part of the problem. Make sure your shoes are breathable as possible. In general, avoid shoes with synthetic materials such as vinyl, plastic or nylon. Wear leather shoes if possible.

How Can I Treat My Sweaty Feet?

1.Sprinkle a good foot powder, one with zinc, in your socks.

2.Use a good spray anti-perspirant on your feet, such as Gold Bond Foot Spray

3. Wash your feet daily. This doesn’t mean standing in the shower and letting the water hit your tootsies! Use antibacterial hand soap and wash your entire foot, including between the toes. Then dry your foot completely (and dry between the toes).

4. Wear good socks that wick moisture away from your feet, and change the socks twice a day.

5. Whenever possible, do not wear shoes or socks—go barefoot and let the air at your feet.

6. Wear different shoes each day–let the shoes air out, preferably in sunlight, and spray the inside of your shoes each day with Lysol. Lysol does not kill all germs, but it does kill many of them.

What Can a Podiatrist Do For Excessively Sweaty Feet?

If your sweaty feet persists, a podiatrist can prescribe topical medications to lessen the sweating.

If you have severe hyperhidrosis, some podiatrists will inject botox into your foot. Yes, you heard right! Botox can help your feet, though I doubt this is something our new, upcoming government run healthcare will pay for (or your current insurance). Botox does stop feet from sweating and it will last several months.

I hope this helps. Let me know how your feet do.

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Barefoot Running May Be Better

As a podiatrist, my teachers, professors and peers, espoused that feet need help, specifically they need good support, cushioning, and padding. But, more and more, I started reading about people and cultures that go barefoot and not only do they have fewer foot, ankle, knee and even back problems. Now, I am re-thinking everything I learned.

Was The Human Foot Designed to Walk and Run Barefoot?

The human foot is incredible, strong, dynamic and adaptable. For thousands of years our feet survived and functioned fine (maybe even better?) without elaborately padded, supported $100 Nikes. Further, persons without their hands can learn to drive and paint with their feet. Take a look at the masterpieces created by the Mouth and Foot Painter Artists association. Why can’t a runner learn to run barefoot?

Recently, Christopher McDougall has reinvigorated the barefoot running debate with his book Born To Run. Previously, some runners have had great success barefoot, including the late, great Abebe Bikila from Ethiopia.

Runners have been plagued with foot, ankle and knee problems. It comes with the territory: two to three times the weight of the runner’s body coming down on each foot with each stride. The advocates of barefoot running claim they can literally feel the ground and as a result, the biomechanics of their running gait changes to lessen the force of your foot landing.

Advocates of barefoot running contend that shoes worsen the chance of injury.

The scientific literature on barefoot running (and barefoot walking) is scarce, but at this point the published research leans toward running and walking barefoot, and I would have to agree—barefoot is better!

I just may be the first podiatrist to advocate running barefoot, but let me clarify this statement: I don’t believe barefoot running  is for everyone. I will discuss who and who shouldn’t run (or walk) barefoot in just a moment. First, let me talk briefly about the medical and scientific literature.

The scientific literature on barefoot running is sparse. But, what is out there supports more foot and ankle injuries in people wearing running shoes than in persons going barefoot. This is also true of plantar fasciitis, some knee problems, and other injuries. It appears that running shoes decrease sensory feedback, interfering with the body’s natural shock absorbing tendencies. Further, running shoes may actually decrease the runner’s awareness of their foot and the foot’s position, increasing the risk of injury.

Our feet have many muscles within each foot and many that attach to our feet that originate in the leg. Wearing running shoes may lessen or diminish the “firing” of some of these muscles. When the foot is not in shoes, it adapts—rapidly—to uneven surfaces, and in theory, forcing us to “use” all the muscles in our foot.

Who Should Run Barefoot (and who should not!)

Reasonably experienced runners in good condition with healthy feet should try barefoot running (when conditions and terrain warrant it). By “healthy feet” I mean their foot has a good, stable structure, and good sensation. Their foot does not have an excessively high arch or low arch and they are not diabetic. Further, their foot should be free of any significant deformities—no bunions, hammertoes, or other bone problems. Persons who are diabetic, have decreased sensation, or a foot that is not healthy or flat or high arched etcetera, likely needs corrective support, such as good running shoes and/or orthotics.   

Learning to Run Barefoot

Barefoot runners have a different gait than shoe-wearing runners. Learning to run barefoot takes time and training. I imagine not everyone will be able to teach themselves and their feet to adapt to barefoot running. Remember, some of the superstar athletes who run barefoot may have grown up in cultures where shoes were not the norm and as result, you have someone whose foot is more use to being bare than in a shoe. Further, persons who are in these “barefoot” communities may have a foot with genetic adaptations geared toward barefoot running—meaning, generations of going barefoot have essentially bred a foot that works better when bare.

What to Watch Out For When Running Barefoot

Barefoot running isn’t without risks. Start slow and build up gradually. Research the right way to build up proprioception reflexes in your feet, ankles and legs, and build up the muscles. Don’t run where you can injure your feet—avoid nails, rocks, broken glass etcetera.. (Part of the reason the medical community has strongly advocated shoes is because of the risk of puncture wonds. Every podiatrist has seen his or her share of glass and nails inside their patients’ feet. Further, cold weather can cause frostbite on unprotected feet.)

Vivo Barefoot Running Shoe

Vibram makes a shoe that increases the ability to feel the ground, as does Terra Plana and Nike Free (see links below). One scientific study does support that Vibram’s Five Finger’s reasonably simulates barefoot conditions.

I would be interested to hear about your experiences running barefoot. Specifically, I am curious if there are any successful barefoot runners who have a poor foot structure (i.e. flat foot, bunions, pronation etc.)

Resources for Barefoot Running

The point of this article is to get people thinking about barefoot running and decide for themselves if it is right for them. Here are some resources to help you learn more about barefoot running (and I would recommend reading Chris McDouball’s book Born To Run):

Running Barefoot

Society for Barefoot Living 

Wikipedia on Barefoot Running

Barefoot Runner

Living Barefoot

Vibram Five Fingers

Terra Plana

Go Barefoot

Enjoy Going Barefoot

Review of Nike Free

Nate Luzod – A barefoot runner’s journal

Barefoot Ted’s Adventures

Barefoot Running in Seattle

How to Begin Barefoot Running

Freeing the Captives… 2 Barefoot Soles at a Time

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Foot Articles on the Web

Here is my pick of the latest, greatest foot, ankle and podiatry related articles on the web:

Pregnancy is a bundle of joy, but not for your feet! Podiatrist Scott Kilberg has written a great review of the effects of pregnancy on our feet. Check out Foot Problems During Pregnancy and for more from Dr. Kilberg, visit his blog My Aching Foot.

Shin splints eventually affects just about every runner and Podiatrist Andrew Schneider has written a good synopsis on this common problem. His blog also has some of the best writing about our feet and ankles that you can find. Check out Dr. Schneider’s superb writing and and learn about shin splints HERE.

Bunions are among the top podiatry problems we see. Podiatrist Jennifer Feeny has written a good review – Bunions: A Pain in the Foot. Her blog can be found HERE. If you want to know when a Bunion is Not a Bunion, check out Dr. Marybeth Crane’s article HERE.

If you want to dance, you may have to pay the piper – or the podiatrist! Dance takes a toll on the feet. For a great introduction to foot pronation and how it can be the cause of your knee pain, read Lisa Howell’s How to Understand Overpronation and Knee Pain If You Have Flat Feet.  

Speaking of Flat Feet, there is a basic introduction to flat feet and Choosing the Best Running Shoes at the Running Shoe Guru.

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Ask the Foot Doctor Your Questions

Today we start a new feature: the chance to ask Dr. Nirenberg a foot or ankle question.

The Internet has changed how we learn and understand our world, and our medical problems and conditions—especially our foot and ankle problems. Information is now literally at our fingertips! I firmly believe knowledge is power. However, due to legal issues and restrictions on physicians practicing telemedicine, answers to questions are strictly for informational purposes. Readers will still be able to learn much by asking questions, but the answers are not a substitute for medical care (for a more medical detailed disclaimer read this site’s Terms of Use).

As for your questions, we are looking for great, fascinating foot and ankle questions that our readers will find interesting.

The questions can concern anything related to our feet and ankles, from simple warts or corns to arthritic or weak ankles, and everything in-between. Questions do not have to be strictly medical related. (For example, I was recently asked why our feet are ticklish, and soon I will post an entire article on this fascinating question.)  

So start asking your questions right now! Click Ask a Question.

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Feet talk. Of course, they don’t rattle on like some annoying relative. They do often mirror overall health, at times being the first place to show signs of serious medical problems.

Is That Pain in the Foot a Tumor in the Neck?

For example, when a 41-year-old man came to my office with pain and swelling in his foot, he thought he had injured himself playing baseball; instead, we discovered a tumor in his neck. The tumor was altering chemicals in his body. One of these, uric acid, was so severely elevated that it couldn’t be contained in his bloodstream and entered several joints in his foot, causing his pain. The patient had the tumor removed, and a month later his foot pain disappeared. This case was especially rewarding because had this tumor not been caught, it could have affected his heart, possibly becoming fatal. (Read more about it HERE).

Most instances of feet revealing medical conditions are not this dramatic, but many systemic problems often show up in our feet first.

Nailing Down Nails

Let’s start with our toenails. Nowadays, with MRIs, CT scans, and hundreds of blood tests to choose from, few doctors look at toenails. Sadly, some don’t even give feet a cursory glance. But in ancient times, examining the toenails was as important as having patients stick out their tongue.

A small change in our toenails’ color, shape and pliability may be the only indication of a more serious medical problem. Toenails that become rounded or “clubbed” may mean the person has lung cancer, emphysema, liver disease or a heart problem.

Brittle nails could signal poor circulation, an iron deficiency or a kidney or thyroid problem. Short, small nail beds may be a sign of heart disease, and grey nails may mean the person has glaucoma.

Don’t Forget Your Vitamins

If you’re not eating your vegetables, toenails can reveal that too. A spoon-like or flat nail could mean a lack of certain B vitamins. Splitting and fraying of toenails may signal a need for folic acid or vitamin C. Small white patches on toenails could signal a zinc deficiency. (Read more about vitamins and our feet HERE).

Is That Redness on Your Foot an STD?

A rash or redness on the feet could be a sign of infection, a circulation problem or a sexually transmitted disease. That’s right, STDs—in my practice, I’ve seen signs of AIDS, herpes, syphilis and gonorrhea show up in the foot.

People are usually surprised to hear about sexual diseases in the foot. But when feet, oftentimes the big toe, get involved in sexual activity they are just as susceptible as any other body part to infectious diseases. Some diseases, like AIDS, cause growths and other skin changes on the feet, and others, like herpes, spread to the feet when the person removes their underwear.

Are your feet swelling up? When only one foot swells, it often signals a problem within the foot itself, such as infection or a fracture. It might also be due to a blood clot or a circulation problem. If both feet swell, it could mean you have heart, kidney or liver failure.

Is it just Dry Skin or Something More?

The skin of our feet tells us a lot, too. Dry skin may be a sign of an under-active thyroid, diabetes, poor circulation or malnutrition. Sweaty skin could mean an overactive thyroid, menopause, anxiety or a psychiatric disorder.

Bone deformities, such as heel spurs or bunions, may be a clue that the person has certain types of arthritis. Your doctor should check for these, as many arthritic diseases can affect the entire body, including the heart.      

Final Thoughts on Reading Your Feet

So, feet can reveal quite a lot of information about a person’s overall health, even when the condition has nothing to do with feet. On the lighter side, feet reveal plenty about a person’s personality as well. People love to adorn their feet with toe rings, ankle bracelets and even tattoos.

The most interesting tattoo I’ve seen was a trail of black ants on a young man that began at his big toe and went up his leg, apparently to his groin—I didn’t check.

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Our feet take a beating.

We put in long hours, walking an average of seven to ten miles a day.

We tread on artificial surfaces such as asphalt, concrete and tile, often carrying a briefcase, purse, baby or laptop—and for some of us all four!

And with each step two to three times our body weight comes down on our feet, not to mention the strain of jogging, stair stepping or high impact aerobics.

So what can you do to keep your feet healthy, beautiful and strong enough to make it through the day?

I hear this question often as a podiatrist and more often from female patients, which doesn’t surprise me, since women experience four times more foot problems than men.

Fortunately, both men and women can do simple, inexpensive things to care for their feet, and when your feet feel great, your whole body will too. Consider the following five ”musts” for healthy, beautiful feet.

1. Use a good moisturizer

The skin of your feet is increasingly prone to drying out as you age. Dry skin is not only ugly but can crack open and possibly become infected, especially in diabetics or those with poor circulation. A good moisturizer can soothe dry skin.

The secret to finding a good moisturizer is not by price; more expensive doesn’t mean better.

Read the ingredients and avoid products with alcohol or alcohol derivatives.

Generally, lotions contain alcohol to make them absorb faster, but the alcohol hinders the product’s ability to moisturize your skin.

The best dry skin products tend to be creams without alcohol. These are gooier and absorb slowly, so I recommend applying them just before going to bed.

2. Keep your feet dry

This may seem to contradict using moisturizer, but dampness around your feet, specifically between your toes, can be a breeding ground for bacteria.

When washing your feet, be sure to dry them well, especially between the toes.

Towels can pick up bacteria or fungus, especially if they are damp or dirty, so wash them often with bleach or hot water and never use the towel that dried your feet on the rest of your body or face.

A good tip to keep feet, and especially toes, free from moisture is to use a foot powder enriched with zinc or menthol, or even both. A sprinkle a day will not only keep toes from perspiring, but also lessen odor.

3. Beware of nail polish and acrylic nails

Men can skip this tip, but women should heed it. Nail polish and acrylic nails trap moisture, increasing the chance of fungus infecting toenails, causing the nails to thicken and turn yellow or, in severe cases, black.

Toenail fungus can also infect the surrounding the skin and in some cases, particularly when the person is diabetic or has poor circulation, can lead to the loss of a toe or even the foot.

Some women who notice their toenails beginning to darken or yellow from fungus cover the nails with polish to hide them; ironically, this only makes the problem worse.

Am I saying you shouldn’t wear nail polish or acrylic nails? Not at all. Nail polish or acrylic nails can cheer up the ugliest of feet, don’t cost a lot and are generally among the safer pleasures for your feet.

When using nail polish or acrylic nails think of them like a dieter having a scoop of ice cream: occasionally it is okay, but not every day.

If you have a special event, feel free to wear nail polish or acrylic nails; just remove the polish or fake nails when you get home. The more your nails can “air out” the better.

4. Wear sensible shoes

This seems obvious, but many people choose style over comfort (one study showed that 88 percent of women have at some point knowingly squeezed their feet into shoes that were too small).

Like eating that fattening scoop of ice cream, wearing Jimmy Choos or other stylish shoes occasionally, for brief periods usually won’t cause problems.

However, wearing ill-fitting shoes too often can cause the toes to crunch up, possibly causing permanent deformities, pinched nerves, corns, calluses or other problems.

People with diabetes or poor circulation need to be especially careful, as these problems can result in serious infections.

The secret to making sure shoes fit properly is to shop for them late in the day when your feet are likely most swollen.

When you walk in the shoes you try on, try to avoid the soft, plush carpet found in most shoe stores. If you’re in a mall, leave the shoe store and walk on the mall’s tile floor.

Most importantly, if shoes hurt in the store they will hurt when you get them home–a shoe should never need to be “broken in.”

5. Check your feet daily

The last tip to taking care of your feet is more common sense than secret. Check your feet every day.

It’s amazing how many people don’t look at their feet; or if they do see a problem or have pain, they shove their foot into a shoe and try to forget about it.

When examining your feet, watch for any blisters, redness, swelling or open sores, and be sure check between the toes as this is a common area for infections to start. A good way to see the bottom of your feet is to use a mirror.

If you find a foot or ankle problem, see a podiatrist promptly.

Most foot and ankle problems are easy to take care of when caught early. The biggest complaint I hear from my patients is, “I wish I had come to see you sooner.”

Your lifetime of healthy, beautiful feet

Your feet work hard all day long, and they need a little care to remain strong.

When you use these tips to take care of your feet, they can be healthy, beautiful and ready to carry you anywhere.

To learn more about podiatry, podiatrists, and podiatric medicine, visit the website of the American Podiatric Medical Association

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