Barefoot Walking and Minimalist Footwear: Is it a Good Idea?
Bare Feet and Minimalist Footwear
The practice of taking part in outdoor activities either bare-footed or wearing minimalist footwear is no new phenomenon. In 1960, Ethiopian athlete Abebe Bikila won the Olympic marathon running in bare feet. The ‘bare-foot’ movement, bare-foot running in particular, has grown in popularity in recent years, supported by media hype and advertising. Footwear manufacturers have responded with their various interpretations of the minimalist running shoe.
The rationale behind the movement, is that walking bare-footed acts to strengthen the intrinsic muscles and improve muscle activation through the legs and gluteal muscles. Bare-foot walking and minimalist footwear is also said to maximise sensory feedback from the feet and enhance proprioception (the awareness of the position and movement of the body). But is there really a good case for ditching our traditional footwear? Are shoes making our feet lazy and if so, does this lead to ‘fallen arches’ and an increased risk of injury?
What Shoes Actually Do and the Role of Podiatry in the Choice of Footwear
Before we step too deeply into our discussion, let us first consider the role of footwear as a means of protection. Shoes protect our feet from temperature extremes, uneven terrain, foreign bodies and infection. Let us also consider modern day challenges created by hard flooring, increased body weight and occupational health and safety. Supportive or cushioned footwear that protect our feet, serve as much more than a mere fashion accessory.
As a podiatrist my role is to educate my patients to help them make appropriate footwear choices. Many factors influence these choices, and unfortunately it isn’t always the underlying structural and physical limitations of a person’s feet and lower extremities that determines their decision. Social, environmental, financial, ethical and cultural factors all come into play. Ultimately it comes down to personal preference.
The Goals of our Shoe Store – Happy Fit Footwear
When I opened Happy Fit Footwear in January 2020, I was determined to make healthy footwear choices easier. We all want to look good, but it hasn’t always been easy for me to direct my patients towards comfortable shoes, that tick all the boxes. But what about minimalist footwear? Why do certain people request these and why have minimalist shoes become so popular? Is there a place for them in a podiatrist owned footwear store?
Footwear: A Brief History
Evidence suggests we first began to cover our feet around 40,000 years ago. The earliest shoes were made of soft, wrap-around leather and resembled sandals or moccasins. From these humble beginnings, footwear evolved to became the much sort after fashion accessory we know today.
Throughout history, shoes have been used as a symbol of wealth, freedom and power. In Roman times, slaves and prisoners were forced to go unshod, either as punishment or as evidence of their inferiority. In many cultures, removing your shoes prior to entering a home or a place of worship is a sign of courtesy and respect. High-heeled shoes were popularised by Louis XIV (in the 16th century) as a demonstration of wealth and power. Such shoes were so impractical that to walk or work in them, was virtually impossible, without the assistance of at least two servants.
With the emergence of advanced rubber and synthetic materials since the 1950’s, limitless shoe designs have become possible. Shoes have become more sophisticated in their design, with manufacturers continually striving to improve the performance of their footwear. Athletic shoes in particular, have undergone marked modification over the years. In October of last year, Eliud Kipchoge, the world’s greatest marathon runner, wore a pair of highly specialised Nike runners to became the first person to break 2 hours for the marathon. His time of 1:59:40 was heralded as a historic ‘Neil Armstrong’ moment… a once in a life-time achievement. It is claimed his Nike-Zoom Runners contributed from between 1-4% to his performance.
Minimalist Footwear – Supposed Benefits in Adults and Children
Minimalist shoes are designed to remove/reduce the influence of shoes on gait and foot function. Key features of minimalist shoes include: zero pitch heels; minimal padding; ultra-thin soles; flexible upper materials; minimal arch support and a wide toe box. The first minimalist running shoes, called ‘racing flats’ appeared in 1977. The Nike-Free renewed the interest in minimalist and partially minimalist footwear, when it hit the shelves in 2005. Since then, other manufactures have followed suit, with their own versions. Sketchers are another example, open to the general non-athletic population and have become hugely popular due to their soft, light weight construction. The most extreme example of minimalist shoe on the market today, is the ultra-minimal Vibram Five-Finger running shoe. Wearing this shoe is about as close as you can get to actually being bare-footed. In 2012, a class-action was taken against Vibram for promoting the unsubstantiated benefits of the bare-foot movement.
There is, however, a general agreement among health professionals regarding the benefits of minimalist footwear in young children. It is largely accepted that simulating barefoot walking as little feet develop (by wearing flexible, lightweight footwear) maximises sensory feed-back and proprioception, whilst protecting them from harm. (Happy Fit Footwear stocks a range of Bobux shoes for early walkers, which are ideally suited for the unique demands of each stage of childhood gait development. Please refer to a recent blog by my colleague Romany Vonarx for a detailed discussion on this topic).
The Barefoot Runner
When I am asked by my patients if it is ok for them to run ‘bare-footed’, I am always interested in finding their motivation for ditching their traditional running shoes. Are they a seasoned athlete looking for a new challenge? Perhaps they are bored of their current training regime and running shoes. Do they have a chronic injury that won’t get better… or are they simply chasing the latest craze?
Other factors for consideration include their age, weight, current activity and fitness levels and whether or not they are used to going barefooted. Physical assessment includes evaluation of core, gluteal and leg strength, effectiveness and efficiency of the quads and hamstrings, balance, proprioception (the ability to know where your body is in space) and ability to perform single leg heel raises on each side. Has the patient undergone a total joint replacement or are there any issues with the lumbo-sacral spine?
It is important to consider that barefoot running first emerged as a new training method among the elite running community. It was intended as a method of training and conditioning which could be added once a week to stimulate the feet and increase athletic performance. The Nike Free running shoe was originally designed for this purpose. When running, the feet must support between 2.5 and 3 times your body weight. So unless you have the body frame of the leading athletes in the City to Surf, minimalistic footwear such as the Nike Free, are probably not such a good idea. If you are over-weight or untrained your risk of injury will be very high. Most people strike the ground with their heel, but to run barefooted you must change your technique and land on your forefoot. Because of the lack of heel cushioning, minimalist shoes have been associated with an increased incidence of heel (calcaneal) fractures, especially in high arched, rigid foot types.
If there is no history of metatarsal stress fracture, plantar heel pain or Achilles issues, barefoot running can serve to vary the stresses on the feet and lower extremities. But start off slowly and make this no more than 10% of your total training. As form and function change, and joints and muscles are worked either more or less, your injury patterns will change.
Minimalist Footwear in Podiatric Practice
I am not a running coach. The majority of people I treat are not 65kg elite runners. Athlete or not, I first need to understand the motivation for a person to move towards barefoot or minimalist footwear, and what their goals are. Consideration should be given to their biomechanics or and lower extremity structure. With over 20 years-experience as a podiatrist, I say with some confidence, minimalist footwear is a major contributor to the onset of many foot injuries. Being overweight, detrained or having some underlying structural or functional limitation (including loss of bone density; common in women over the age of 65) pose additional problems. A history of metatarsal stress fractures (and other forefoot injuries), plantar fasciitis, arch strain, posterior tibial tendonitis, Achilles tendinopathy and calf muscle strain are conditions which may not respond to minimalist footwear, especially if over used.
It is no surprise that the increasing popularity of minimalist footwear among the general population is creating an increase in the presentation of these injuries. The incidence of heel pain, in particular, appears to be on the rise. Remember, the origins of minimalist footwear, was associated with use from lightweight athletes. As such, they are not suitable as an everyday shoe for the average person.
But there is a case for minimalist footwear for some very specific patient groups. The benefits in minimalist shoes is that they encourage a different gait pattern, so you to land on your forefoot rather than your heel. Whilst this increases stress through the ankle joint, Achilles tendon and forefoot, the counter effect is that it reduces forces through the knee joint. Several randomised controlled trails and Cochrane reviews have identified the benefits of non-heeled, minimalist footwear in elderly women, with knee osteoarthritis. After 6-months of use, knee pain and overload reduced in elderly women using these types of shoes and overall functional capacity was improved. So again, it is a case of appropriate selection of shoes for the specific needs of the person.
Are Foot Strengthening Exercises Effective?
Foot strengthening exercises and minimalist footwear have both been found to be effective in increasing the size and strength of the intrinsic foot muscles. But to my knowledge, there is yet to be any quality evidence to support the benefits of these exercises, in the treatment or prevention of foot pathology. At this time foot exercises should be considered as an adjunct to other types of treatment.
When people come to see me, athlete or not, they are in pain. By this stage such pain has begun to have an impact on the persons ability to carry out their normal daily activities. As a practitioner, my role is to perform an examination to diagnose and treat effectively my patient’s foot and lower extremity concern. I aim to do this in a timely and cost-effective manner. Mobility associated with the feet, is after all vital to both physical and mental health and hence quality of life. The longer a person’s activity levels are compromised due to pain, the greater the risk of weight gain, loss of conditioning, depression and so on.
I focus my treatment regimes around the best practice and the current evidence available. I use professional consensus along with my clinical experience, as the basis for each treatment plan. Whilst stretching and strengthening often form part of my treatment regimens, they are rarely prescribed in isolation.
Still Want to Give Minimalist Footwear a Go?
Walking at home on the carpet is a good place to start if you are looking at introducing barefoot walking. You may progress to wearing minimalist shoes. But take it slowly and listen to your body. There is nothing natural about leaping from your couch, ditching your Asics Kayapo’s and heading off for a 5km walk on concrete ‘bare-footed’ or in a pair of thin-sole, highly flexible shoes! You will damage your feet, and potentially cause overuse injuries to your legs as well. As with any new exercise program, you need to give yourself time to adapt to the rigors and additional work of barefoot walking or less supportive shoes. If you have any sensory loss (for example have diabetic nerve damage) you should always wear enclosed footwear to avoid unnoticed foot trauma.
There is a place in this world for most ideas and innovations. The key however, is to place these into perspective. In regards to walking in bare feet, sure, give it a go, but allow time for your body to adapt. Keep away from concrete and bitumen and don’t compare yourself with that wafer-thin athlete, you saw on television running without shoes! Adapt and walk on surfaces, which are designed for the unshod foot, such as grass or sand. There is absolutely nothing wrong and likely benefit in walking some of the time in bare feet, but to do this predominantly, for the average person, on the hard, unforgiving surfaces (the realities of a modern society), isn’t going to do them any good. Most people don’t have a perfect body structure, designed to walk on flat hard surfaces. Most people carry some weight and might have a health issue (such as arthritis, back pain, possibly diabetes), which should contraindicate the bare foot state. Minimalist footwear can be used by most people, but again in a balanced way, being worn only some of the time.
Good quality shoes consisting of a firm heel cup, a sensible heel height (about 2-3cm), a stiff shank (or mid-section of the sole), a flexible forefoot and with some type of retaining device (ie- lace-up, Velcro, buckle) will keep your feet protected, supported and comfortable, for most of your day-to-day activities. Minimalist footwear and a small amount of time in bare feet, is a nice way to supplement your daily footwear use, possibly assisting with improved proprioception and intrinsic muscles strength…and let’s face it, sometimes it simply feels nice to feel the grass beneath your feet!