When did you last get really naked? Our feet are the most under-utilised part of our body and while we work to make the rest of our muscles and bones stronger are we at the same time sabotaging some of the most important ones we have?
I spend a large part of my day in one gym or another and I rarely see anyone making the most of their feet. We cover them up with leather, plastic and rubber. Then, just when we need them most, we head off for the gym or go running and cover them even more with thick, padded supportive trainers that make it harder for our feet to do the job they evolved to do in the first place. So why are feet so great? Well, for starters we use them to run, walk, jump, skip and do many other things whilst asking them, simultaneously and unconsciously to perform the equally complex task of helping us to balance and remain upright.
Just one pair of feet contains 52 bones, 66 joints, 214 ligaments, 38 muscles and tendons and over 14,000 nerve endings. That’s a lot of stuff to simply cover up and forget about but this is exactly what we do. We’ve become used to thinking that our feet need to be protected, supported and held like an unstable building needs scaffolding after an earthquake or a limb needs a cast after you break a bone. So when we work to make the rest of our muscles and bones stronger are we at the same time sabotaging some of the most important ones we have?
Since kicking off my own shoes several years ago I now enjoy pain free running and am much more confident of my abilities in the gym. As a result my feet have become stronger which in turn has helped my knees, hips and lower back too.
The barefoot podiatrist
Someone else who saw the light at roughly the same time as me is podiatrist Stephen Bloor who now spends 95% of his life with nothing on his feet. But what made him come away from the more commonly held beliefs within his profession?
SB: Some years ago I became involved in the design of a very successful range of foot orthoses (an insole prescribed to alter and support the function of the foot). At that time I believed, like many podiatrists, that approximately 80% of the World's population would be helped by wearing functional foot orthoses. The prevailing belief is that human beings function best when shod in protective & supportive footwear for almost all activities. Wearing shoes is seen by most in my profession as the norm.
Not once did I consider that human beings could safely live a barefoot lifestyle. Then I read an article in The Telegraph newspaper about Christopher McDougall and his experience learning to run barefoot with the Tarahumara Indians in Northern Mexico. I was totally surprised to discover that this indigenous American tribe could run long distances with little or nothing on their feet for protection or support. It became apparent to me some medical researchers have known for well over one hundred years that footwear always interferes with natural gait creating mechanical dysfunction, and eventually compensatory adaptions in almost everybody who wears them for prolonged periods of time. After giving this new information serious consideration I realised I needed to re-evaluate how I practised as a clinician.
Stephen discovered that feet could actually become stronger with the absence of footwear. Kartik Hariharan is a leading orthopaedic foot and ankle surgeon, lecturer and writer. When he did his own research he came to a similar conclusion.
KH: I had a paper published some years ago and we compared 50 males and females from Mumbai, who had never worn shoes in their life and 50 males and females from Newport in Wales, who spent all their lives in shoes. What we clearly found was that firstly the non-shoe wearing or unshod population we assessed had very much more pliable feet while weight bearing, even forgiving racial bias. We used a tensionometer to find out if pliable feet were also stronger which has a very significant connotation. If we can demonstrate the unshod foot is stronger we can then say wearing shoes actually weakens your feet. We measured muscles on the inside and outside edge of the foot and found there was a difference. The pliable foot is probably stronger although the study was incomplete (as only some muscles were tested).
It always seemed a little strange to me that I did all my exercising in the gym wearing supportive trainers and yet everyone practicing things like yoga, Pilates and martial arts were encouraged to take their shoes off. What were they doing differently that meant they had to be barefoot but I didn’t? The simple answer is nothing. Any skilled movement is going to be better barefoot and that’s thanks, in part, to something called proprioception.
SB: One of the most important functions of our feet is to sense the surface on which they are placed. The many thousands of highly specialised sensory nerve endings in the skin of our feet have evolved to expect intimate skin contact with the ground. The sensory information is necessary for optimal muscle function and postural alignment. The better the quality of that information, the more effectively our muscles can work to enable us to move as efficiently as possible, thus reducing the risk of musculoskeletal injury. The big problem with footwear of any type is they interfere with that sensory perception of the ground. Muffling and distorting the image our brains receive.
KH: The proprioception in your feet allows your body to unconsciously adjust itself so it recruits more and more muscle fibres and more receptors making your proprioceptive capabilities dramatically increased. Therefore walking, running or training barefoot will allow you to further enhance the capability of the foot.
Toes are pretty important things too and we tend to bunch those together in shoes and socks that radically limit their movement and therefore function. John Durkin is a sports podiatrist at Active Life Podiatry in London.
JD: A school of thought exists that bunching the toes into shoes and socks all together may render them less mobile and possible weak. I see many patients who have weak or poor toe movements which, in some cases I consider to be part of their problem. Studies have concluded that weak toe plantar flexors may be attributable to metatarsal stress fractures.
SB: Though the scientific research hasn't proven this conclusively yet, I believe that it makes sense from an evolutionary & a biomechanical perspective to maximise the number of bones & joints moving, as well as muscles contracting & relaxing for the best proprioceptive feedback. There is evidence that separating the toes increases the intrinsic muscle activity in the ball of the foot. Having strong muscles in the forefoot helps to protect against injury.
But before you throw your trainers in the bin and head for the gym a few words of caution. Firstly your club may not take kindly to your naked feet on their gym floor and may well quote some choice words from their health and safety manuals. However some gyms are more forward thinking so it’s better to check first. Secondly your feet may not be strong enough to begin with.
SB: The adverse effect of prolonged footwear use creates physical dependency on them. Most people have to be gently and slowly weaned off their supportive and protective footwear. And tragically for many people the physical adaptive changes to the foot and the whole lower-limb can be irreversible. These people would probably benefit from going barefoot more often, or wearing minimalist shoes, but they won't receive the full benefits because of the irreversible anatomical changes. Fortunately, I believe this to be true only for the minority of shoe wearers. There is possibly only one medical condition which could preclude someone from barefoot gait. This is sensory neuropathy. If you cannot sense the ground with your feet then you are in danger of traumatic injury.
The bottom line is this. Your feet are very useful. Covering them up and supporting them has been proven to weaken them and it makes perfect sense doesn’t it? If I held your arm up for you all day every day eventually your shoulder muscles would become weaker as I’m doing their work for them. The same applies to your feet. Stop them from functioning properly and they stop functioning properly. Bear in mind the crucial role they have to play in your ability to stand up and move, I’d say that’s a pretty bad thing.
SB: I'm convinced there needs to be a paradigm shift in thinking about our feet. Most people are completely oblivious to how their feet work, or don't work. They just stick them into shoes without any thought about what the shoes are doing to the function of their feet. It's a bit like everyone habitually sticking their hands into boxing gloves and then ignoring them day in, and day out. Eventually there would be repercussions.
Here are some of the more common problems associated with wearing shoes.
A bump on the side of the big toe caused by an enlargement of the bone or tissue around the metatarsal joint. You may experience irritated skin around a bunion, pain when walking and a possible shift of the big toe towards the other toes.
KH: We know that there is a very strong genetic link with the development of bunions that are often maternally acquired. Look at the incidence of bunions across the world. You'll find a shoe wearing population would have a higher incidence of symptomatic bunions.
An imbalance of the tendons (above or below the toe) which causes the toe or toes to curl. Wearing shoes that are too tight in the toe box or shoes with high heels can cause hammertoe.
This occurs when the thick fibrous band of tissue that connects your foot from your heel to your toes (the plantar fascia) becomes weak, irritated or swollen.
SB: I emphasise strengthening exercises and massage as the primary aspect of curative treatment, with some patients also using foot orthoses in the short term to give quick pain reduction almost as a first aid measure. The main aim of this rehabilitative approach is to stimulate an increase in foot & ankle muscle strength as well as to improve the hysterisis (elasticity) of the plantar fascia. The evidence is showing that the plantar fascia & arch muscles need to be used in a repetitive stretch/shortening cycle in order to keep them strong & pliable. In essence, to keep the foot healthy it needs to function in the way it was evolved to function - naturally.