Studies? We Don't Need No Stinkin' Studies (to Live Barefoot)!

One bit of opposition I keep hearing from podiatrists and other experts who oppose barefoot activity is that there isn't enough evidence to support it. Studies have not been able to show that going barefoot is better for you than wearing shoes.

Now wait just a minute.

Photo: Podiatry Today

Does anyone ever say "We don't have enough research to prove it's better to breathe environmental air rather than from an oxygen tank."

No one ever says "The evidence is inconclusive whether living without a neck brace is better than regular use of one."

Ever heard someone say, "Until we have evidence that going barehanded is more beneficial, best practice will be to recommend regular use of gloves."

See where I'm going with this?

I was in a Twitter conversation today with a barefoot supporter who said of the lifestyle, "We just need hard science to back it up, not just anecdotes." Many barefooters feel this way. My response?

No, actually we don't.

Really, since when do we need scientific evidence to use an inborn part of our bodies? How in the world did our society's thinking about feet become so "bass ackwards" that footwear supersedes our natural condition when it comes to the scientific burden of proof?

The feet we were born with are the baseline, friends. Why should we be forced to prove that we should be able use them the way they are?

We don't have studies showing why we should go barefoot, but we really don't need them. Barefoot is what we already are.

The onus is on those who claim we can't go barefoot. If footwear makes feet so much safer against injury, prove it. If arch supports improve the long-term health of the feet versus feet that never wear shoes, prove it.

This method of showing proven benefit over our innate condition has worked in other areas of the body:

• Prescription glasses and contact lenses alter our natural condition and improve our sight.
• Orthodontics effectively straighten the teeth and assist with their proper alignment.
• Cochlear implants give hearing ability to those who've lost it or never had it.
• Hip or knee replacement surgery gives pain-free mobility back to those who suffer from degeneration in these joints.

These results are proven. What's more, doctor's don't recommend those therapies above if you have 20/20 vision, straight teeth, you can hear, and/or your joints are fine.

On the flip side, listed below are a few widely-accepted results of healthy people regularly wearing footwear (and, I think, reasons that "experts" are reluctant to approach foot health from the baseline of our human condition):

• Footwear -- even sandals -- raises the temperature of the feet, causing sweating and providing optimal conditions for fungal growth.
• Shoes often squeeze or rub the feet in harmful ways, exacerbating or causing conditions such as bunions, hammer toes, neuromas, corns, blisters, and more.
• The soles of footwear block the feet from feeling textures and objects on the ground below (exteroception), eliminating our natural safety mechanisms and altering our ability to sense where our feet are in space (proprioception).

So we have a good idea about why we shouldn't wear shoes. Despite those issues above and so many more, podiatrists and other experts around the world still recommend that people regularly wear shoes and "avoid going barefoot."

"BUT WAIT!," you may shout. "What if we do find a problem with the feet that needs fixing? What if someone goes barefoot all of the time and still has fallen arches, plantar fasciitis, bunions or something else that orthotics or surgery could help with?"

In those cases, yes, research to discover the best therapy would be warranted -- and those data exist. Even still, it seems to me that the goal would be to use whatever physical therapy, bracing, taping, orthotics, or even surgery that can help rehabilitate their feet so that that going barefoot can continue as the default condition.

"BUT WAIT ONE MORE TIME!," you may shout. "Those with peripheral neuropathy and Raynaud's clearly shouldn't go barefoot in certain conditions because it could create a health risk for them. Footwear is the only therapy that can't prevent serious problems."

Look, I get it that living barefoot isn't the end-all be-all for everyone. I get it that it truly isn't advisable for some select people to be barefoot in specific circumstances.

The bottom line is that the burden of proof lies with those who think footwear, orthotics, arch supports, braces, taping, etc. is inherently better for everyday living than our own two feet. While these things can provide therapeutic relief from specific medical conditions, they should not be considered for long-term, everyday use. What's more, everyday use of footwear has been shown to be detrimental and each person should think critically about whether remaining barefoot -- the human condition -- might be the best option until proven otherwise.

Shoe Claims Are All Backwards: Brief Thoughts About Recent Settlements

The sound of heads shaking is echoing throughout the barefoot/minimalist community after news of Vibram's settlement of a class-action lawsuit accusing them of making baseless claims that their Fivefingers line of minimalist footwear could reduce injury and strengthen foot muscles. Now the company has put aside $3.75 million dollars to pay back customers who didn't see such results.

This is what happens when you sell products, folks. If you're going to be taking people's money, you'd better be darned sure that what you claim it can do is scientifically valid. When it comes to footwear, we've seen this before with Sketchers Shape-up line of shoes and FitFlop's sandals.

I'm sure so many podiatrists are laughing about all of this. The most vocal of them take great pleasure in getting on their anti-barefoot-running Websites, their Twitter accounts, and other outlets to essentially say, "See?! The evidence isn't there that minimalist shoes are good for you! We've been saying it all along!"

I totally get it. It's academically dishonest to make claims that using a product aids the feet in reducing injuries and getting stronger when there's no evidence. That makes sense.

As I type this, I'm wearing one of my FOUR pairs of Vibram Fivefingers. Why? Because I have to wear closed-toe shoes for my job. Otherwise I'd be barefoot.

Bare feet are the human condition. Let's all keep remembering that. We were born with bare feet. People have lived for millenia with no shoes and done fine.

In everything we do, going barefoot should be the baseline and any shoes should be added only as necessary. Any claims about what those shoes or orthotics or braces or whatever can do should be based around improving the human condition and they should be backed by evidence.

So instead of:

"Vibram Fivefingers strengthen the feet and reduce injuries" (compared to standard shoes) ...

The claims should be:

"Vibram Fivefingers increase traction on many surfaces and protect the feet while preserving most of the foot's natural function."

See the difference? It's easy to get into legal hot water with the first statement -- obviously, because it happened. It's a lot harder with the second.

I wear Vibram Fivefingers, among other brands of minimal footwear, when I need something on my feet for protection, warmth, or to fulfill a policy when it's not okay to challenge the system. I wear them because they add little to the feet -- NOT because they are so much less bulky or injurious than normal shoes.

As the Barefoot Alliance says in it's main hashtag, #BarefootIsHuman. Let's stop making baseless claims that hurt the underlying intent of the barefoot/minimalist movement and start behaving as if shoes add to the feet instead of barefoot being the subtraction of shoes.

It's more accurate all around, and more honest.

Thoughts on a Podiatrist's Facebook Post

This week I was taken aback by a post that a podiatrist put on Facebook and subsequently tweeted:

Post by Hai-En Peng, DPM.

What I find most shocking is that every single one of those ailments certainly happened because shoes caused those pathologies in the feet.

Dr. Steve Bloor, barefooter and podiatrist in the UK, has said on a number of occasions that he thinks a significant amount of foot pathology is caused or exacerbated by shoes.

Yet podiatrists often recommend that people never go barefoot. They claim that feet need support, bare feet will acquire athlete's foot or nail fungus, and unprotected feet are simply at too great a risk of injury.

I don't have a problem with podiatrists and their profession. I think they serve an important purpose, but how about we, as a society, give our own bare feet a chance to be strong and flexible on their own. If injury occurs, then podiatrists can help us get back on our own two (bare) feet.

Dr. Bloor, told me in an interview a few years ago that, "I now believe the foot is well designed for supporting itself and the rest of the body if it is given a chance to do so without being hindered by footwear."

The answer to foot problems like bunions, neuromas, hammer toes, and the like is not fixing them, then putting those feet back into shoes. As the Barefoot Alliance says, "Barefoot is human." Constant shoe use is not a characteristic of how we are made to function.

Things That Make You Go Hmm...: The Barefoot Edition

One of the most frustrating things for me as a barefooter is that so many of the claims criticizing barefoot activity are made without the critics giving any thought to what they are actually saying. I know that the following observations are a bit snarky and pointed, but they're worth thinking about:

Lots of people have told me that they successfully went barefoot "all the time" as a kid, playing on rocks and gravel, in dirt, and around all kinds of dangerous things. Then they insinuate that the flat, smooth surfaces of the adult world (e.g. concrete, asphalt, tile, linolium and carpet) are too dangerous for going barefoot.

Hmm...

There's a prevalent thought that going barefoot is terribly unsanitary and can spread disease, yet most diseases are spread through direct contact from our hands to our faces, or from face to face. Still, no one insists that we all wear surgical masks and gloves during the height of flu season and no one polices public restrooms to make sure that we've all properly washed our hands when leaving.

Hmm...

Lots of people think it's "gross" or "disgusting" to go barefoot, but then put shoes on that their feet have sweated in day after day and which act as incubators for problems such as athlete's foot and toe fungus.

Hmm...

Going barefoot in a store is supposedly very unsafe and a high risk for injury, yet high heels -- which put 20,000 women a year into hospital ERs and often have no traction at all on their soles -- are acceptable footwear.

Hmm...

Many people claim that they "hate feet" and can't stand the sight of them, yet they're fine when others wear open-toed shoes. It's only when the small amount of shoe material is removed that the sight of the feet is offensive. The exception: bare feet are rarely hated at the pool.

Hmm...

Countless women have told me that they don't go barefoot because they have "sensitive" feet, yet are willing to wear shoes which cause regular pain and blistering in and on their "sensitive" feet.

Hmm...

Podiatrists and other experts say that there's no evidence to support claims that running barefoot leads to less injury. There is also no evidence to support claims that running with standard cushioned shoes causes less injury, yet they are fine recommending those.

Hmm...

Many people think that going barefoot puts feet at a high risk of injury, yet many people regularly close car doors, use sharp steak knives and scissors, light matches and more without wearing protective gloves.

Hmm...

Naysayers claim that there's loads of broken glass, sharp rocks, nails, and even hypodermic needles strewn about all over the place, yet they can never point out where any of it is when asked.

Hmm...

Though many podiatrists say that our bare feet aren't capable of properly supporting us, countless athletes successfully compete barefoot in gymnastics, martial arts, dance, running and more.

Hmm...

Some people believe it's inappropriate for someone to shop a store barefoot, yet customers are regularly allowed with offensive shirts and tattoos, bad body odor, loud children and more.

Hmm...

A common thought is that bare feet may make business floors excessively dirty. A person who regularly goes barefoot cleans their feet at least once a day. People who wear regularly wear shoes rarely, if ever, clean the soles of their footwear.

Hmm...

You know who -- or what -- is allowed barefoot into a store? Service animals. It may be "no shoes, no service" for people, but guide dogs are allowed on the very same unsafe floors AND they cannot be made by management to wear protective booties, per a blog post I wrote a while back.

Hmm...

Speaking of bare feet being inappropriate, it used to be that women should only wear skirts, children should only speak when spoken to and flip flops were only for the pool or shower room. My, how things change.

Hmm...

Do these things also make you go "Hmm..."? Does it give you a different perspective on bare feet? What would you add to the list? Am I off base with some of them? Please leave your comments in the section below.



Image: graur codrin / FreeDigitalPhotos.net

If the Tables Were Turned: Hypothetical Reactions to the New 'Fad' of Shoes

I got to thinking: What if bare feet were the norm and a "fad" got started up in which a small, vocal group of people started wearing shoes all the time. What would experts and the public say about that? Here's what I think:

A business owner: "We don't allow shod customers in our store. There's too much potential for people to get injured, and we would be liable if that happens. What if a woman in those "high-heeled" things rolls her ankle while shopping here? What if someone wearing shoes with a slick sole slips on a wet spot on the floor? I also have to think that those shoes would hurt the exposed toes of someone whose feet got stepped on. Have you seen how big and heavy some of those things are?! I've got to look out for my customers' safety. (Question) What's that? Broken glass? You know, I've worked in this business 12 years and I can't say that a barefoot customer has ever seriously cut themselves. Usually we clean up anything that's dangerous so it's not a big deal. I think we've had one or two customers that got a little piece stuck in their sole like a big splinter, but they just took it right out and went on their way. No bleeding or anything. If they did we'd give them a band-aid. Anyway, the other problem we have with shoes is that nobody ever cleans the outside of them! At least barefoot customers wash their feet every day. Who knows if or when a shod customer has ever cleaned the soles of them? Who knows what they stepped in that's collected on their shoes ever since they bought them? Gross, and my employees have better things to do than constantly clean the floors of all the dirty stuff that shoes drag in."

A running expert: "Adding a shoe to the foot and landing on the heel totally changes the dynamics of running. There's no evidence to suggest that a heel strike is more preferable to a forefoot or midfoot strike when running. It could even be a problem for the joints of the ankles, knees, hips and back, as all of those forces would travel up the skeletal system. I also see a problem with cutting off the sensations from the soles impacting the ground. There are thousands of nerve endings in the feet and these shoe people want to just cut those off? Sounds ridiculous to me. What next? Should we just run with horse blinders on? And paying more than $100 every few months to replace shoes when they wear down seems sketchy. I know a lot of runners that aren't going to make that kind of investment. It just sounds like a scheme from the shoe companies trying to make lots of money."

A podiatrist: "While I think there might be benefits for short periods of time in wearing shoes -- for protection from certain dangers, for example -- there's no research that shows they are better for your feet than simply going barefoot. There's a lot of evidence to the contrary, actually. Some of the shoes that people are wearing pinch the toes together or cram them into the front of the shoe. We're seeing an uptick in our practice of bunions, hammer toes, corns and other afflictions...and they're all from people wearing shoes. We're also seeing a lot of ankle and knee problems because shoes artificially raise the heel of the foot in completely unnatural ways. Lots of our patients -- most of them actually -- also complain of foot soreness, pain and even weakness because the shoes they're wearing are completely inflexible and essentially cast their feet while they have the shoes on. Wearing shoes also provides the perfect environment for growing fungus and other bacteria that need a warm, moist environment to thrive. Finally, wearing shoes on an uneven surface could lead to the shoe catching on the ground and the ankle to roll, causing soft tissue damage or a fracture. I definitely don't recommend that my patients wear shoes unless they have a medical need to or if they need them for protection from some activity they'll be participating in or bad weather. Even then, though, I don't see why a simple, thin sole wouldn't be enough for most things."

Your everyday citizen: "Shoes are so disgusting! Look, people were born barefoot for a reason. We've got all of those joints and bones in our feet and shoddies want to just stick those in a box? Plus, their feet in shoes are always sweaty and it usually causes their feet to stink. Cramming all of my toes together to the point of pain because it "looks good?" Whatever. And who needs protection all the time? It's not like there's broken glass just laying around everywhere. Paranoid weirdos. Just look where you're walking and you'll be fine. And if you step on something that cuts your foot, it's not like our feet are all that fragile or that they can't heal. Oh, here's my biggest thing: Who wants to spend hundreds of dollars constantly buying new shoes?! My feet don't cost anything and they never wear out. I'll spend my money on something else, thanks."

So what do you think? Is this how many people would react if the tables were turned and bare feet were the norm? Do you think I'm way off base with something I wrote? Please let me know your comments in the section below.

Should Podiatrists Give Away High-Heeled Shoes?

I was more than a bit disturbed to discover that a California podiatrist is holding a contest to give away "designer" shoes. On her blog The Shoe Expert's Blog, Michele Colon, DPM, has posted the guidelines for someone to win a pair of shoes from Jimmy Choo or Christian Louboutin by the end of this year, "making one shoe lover’s New Year’s celebration one to remember!"

What's most upsetting is that the shoes she displays on her site are not flats or even low heels. They are VERY high heels that may be stylish, but certainly can't be good for the feet or ankles. Here's a screen capture of the images:

Image from The Shoe Expert's Blog, captured Jan. 13, 2011

I'm not here to pick a fight or disparage Dr. Colon, and I also don't know if the shoes displayed on her blog are the ones she intends to give away. Given the evidence showing how bad high heels are to the feet, however, it seems highly inappropriate for a podiatrist to hold a contest if such shoes will be the prize. To me, it seems like someone who makes a career from healing those with foot and ankle problems should not give away devices that CAUSE foot and ankle problems.

On another front, a podiatrist giving away such dangerous footwear seems like a potential conflict of interests. What if a woman were to wear these, fall, sprain her ankle and then go to Dr. Colon as a patient? That doesn't look good, to say the least.

I recommend that Dr. Colon rethink this contest and her promotion of these kinds of shoes to her patients.

UPDATE (12:24 p.m. CST, Jan. 13, 2011): After becoming aware of this blog entry, Dr. Colon replied back to me on Twitter with the following: "The designer shoes don't have to be high heels. They can be the Jimmy Choo UGGs or other ones. Those were just examples."

Maybe so, but I replied back that just giving the option of high heels seems inappropriate. I also asked that, given that she's in Southern California, how likely is it that the winner would choose flats over high heels? I stand by my previous statements.

An Interview with a Podiatrist and 'Barefoot Advocate,' Dr. Steve Bloor

While there are many of us lay people out there who embrace unshod living, it's rare to find people in the medical profession who are supportive of such activity. Medical providers like podiatrists and sports orthopedists tend to have a very shoe-centric way of thinking about the role of feet and our locomotion.

A while back I ran across the Twitter account of Steve Bloor, DPodM, SRCh, HPC, a podiatrist in the United Kingdom. Using the Twitter handle @NaturalFeet, Dr. Bloor was posting "tweets" that promote barefoot activity as a way to have healthy feet. How refreshing! After getting to know him a bit, I asked if he'd be amenable to an interview on this blog. He graciously accepted.

The following are his responses to my questions. I think they offer an interesting insight into the field of podiatry and how it approaches feet and barefoot activity. (Note: Responses in large type are emphases added by me.) Enjoy:

Tell us a little about yourself, your education, certifications, etc.

I am 46 years old and been in Podiatry for 25 years. I am married to Liz and we have 4 children. Two boys and two girls. Our oldest is 18 and youngest 10 and they keep us young. I trained to degree level back in the mid-80s and after graduating in Podiatric Medicine specialized in Musculo-skeletal Podiatry dealing with orthopaedic lower-limb and back problems associated with poor biomechanics. About 12 years ago a Podiatry colleague and friend, Andy Horwood, and I were the lead designers of a range of customisable foot orthoses which are widely used in the UK and also other parts of the world. We both regularly lectured and taught workshops, throughout the UK, on the biomechanics of lower-limb function and the prescription and fitting of functional foot orthoses. As founder members of the British Podiatric Biomechanics Group we helped to set-up what is believed to be the first Masters Degree programme in the world in Clinical Podiatric Biomechanics. Andy went on to become one of the main lecturers on this Masters Programme which runs at Staffordshire University, England. I continued to lecture around the UK as guest lecturer for Healthy Step UK and Bailey Instruments who are major suppliers to the British Podiatry Profession. Our customisable foot orthotic devices are now used by over 80% of UK NHS Podiatry Departments as well as many private practices.

What made you want to get into the field of podiatry in the first place?

My initial interest in Podiatry as a profession came through my own personal experiences with running injuries. I realized that my own legs and feet were extremely important to my running career and since I was injured I could empathise with injured athletes. So it became a personal mission to help other athletes to run without injury and help injured athletes overcome their injuries wherever possible. I became fascinated in the single most complex human activity - human gait. Of course I also enjoyed treating non-athletes too. I developed my clinical practice to the point where I could specialise exclusively in Musculo-skeletal Podiatry; one of the first to do so in the UK.

In your schooling and training, what was the general philosophy behind the practice of podiatry? What role did feet play in the body's overall health?
In my schooling as a podiatrist and at post-graduate level there was, and is, a general understanding that our role in foot medicine and surgery is to help the patient ambulate, in footwear, without pain. To assist the body to function in gait as near to the optimum norm as possible. Normal gait is always considered to be with footwear.

Although we knew that our job was to negate the damaging effects of shoes, never once did it occur to me, nor was it ever discussed, that the patient could ever choose between barefoot and shoes.

Our goal was to advise the patient to choose "sensible shoes" so as the foot could work at its optimum. We also believed that at least 70% of the world's population had poor bio-mechanical function of their feet and legs and therefore needed our podiatric foot orthoses. That most people are born with "broken feet". That evolution/creation made a big mistake and we function best in footwear. Never once did we consider that the human foot could cope on its own. We believe that we, as podiatrists, have the answer to most people's foot and lower-limb problems. One eminent paediatric podiatrist even went so far as to openly advise that all children should wear foot orthoses to optimise foot and ankle development. We believed that the foot developed better if supported in a correct alignment by foot orthoses and supportive "sensible" shoes. It is believed that only a few very special people have "perfect biomechanics" of their feet and legs, and these are the only ones who can run without supportive running shoes, the majority of us needing stability shoes and orthoses in order to prevent injuries. We believed the foot cannot and should not support itself or it would suffer long-term damage. Amazingly, we never studied true natural, barefoot, primal gait. We only ever studied shod gait or the barefoot gait of people who have always worn shoes, which I now realise is different from true natural gait.

Our medical philosophy is based around the foot playing a very important role in the health of the rest of the body because of its unique position as the first and only part of the body to hit the ground. It is therefore believed that like a tall building, whatever the foundations do affects the rest of the body. So every part of the body is affected somewhat by the foot due to its mechanical function as the structural foundation. We acknowledge also the fact that other structures distant from the foot can likewise affect the foot. So abnormal muscle function farther up the leg and back can cause compensatory motion in the foot. We assess the mechanical function of the pelvis and lower-limb joints and muscles all the way down to the foot joints looking for abnormalities. We assess stance and gait looking for structural and functional abnormalities and their compensations. Of course, we also assess neurology and circulation to the lower-limb as well as checking the health of skin and nails.

Would you consider yourself a barefoot-friendly podiatrist? Why or why not?

I now consider myself not just a barefoot friendly podiatrist, but a Barefoot Advocate. I now believe very strongly that most feet, given a chance, can support themselves. That feet function best without the hindrance of shoes. I believe that every shoe compromises foot function and that with chronic, long-term wear they damage the muscles, joints, nerve pathways and other structures within the foot. I now believe that supportive shoes, and orthotics when worn, create a dependency which worsens with time. I now advocate, and actively promote, barefoot walking and running as a preventative as well as a rehabilitative tool. I am proud of being a Barefoot Podiatrist, both in action and word. I promote barefoot walking and running to my patients by a "Barefeet Welcome Here" sign in the clinic window, folders of Barefoot news articles and research papers in the waiting room as well as copies of The Barefoot Book by Daniel Howell for patients to read whilst waiting for their consultation. I sell The Barefoot Book and the book Born to Run as part of the treatment advice to patients. I teach rehab exercises to strengthen the feet and ankles and have a barefoot website www.naturalfeet.co.uk to give my patients further advice and encouragement. I also sell 'Minimalist Footwear' for those patients who will not, or cannot go the whole way to becoming completely barefoot. I sell therapy products for bare feet like moisturising creams and rough skin files to smooth any rough dry skin on heels. And finally I walk and run barefoot 24/7 to set the example (apart from at church where I cover my feet out of respect for my church leaders' requests).

Have your approaches to podiatry and the way you treat patients changed over the years? How so and why?

My approach to treatment has changed dramatically over the last few years as I have incorporated more rehabilitation into the treatment programmes and not relied so much on orthoses for continued postural and functional control. However, over the last 6 months that change has become a massive paradigm shift in thinking as I now believe the foot is well designed for supporting itself and the rest of the body if it is given a chance to do so without being hindered by footwear.

I also believe that most people do not have significant bio-mechanical mal-alignments, but rather weakened muscles and poor postural control due to over-reliance on footwear.

Most osseous bio-mechanical problems are irrelevant in barefoot walkers & runners. So I now place most emphasis on rehabilitation rather than orthotic control and also encourage my patients to walk & run barefoot as much as possible. I will often mobilise or manipulate stiff joints to improve foot and leg function then teach patients exercises to maintain and increase that movement, along with barefoot exercise. Sometimes I will tape the feet to encourage better function. As we live on a beautiful peninsula jutting out into the Atlantic Ocean I prescribe barefoot beach walking and running to strengthen weak foot and leg muscles and to mobilise stiff joints. I also refer patients to our clinic physiotherapist and personal fitness trainer where needed to aid rehabilitation. I still prescribe foot orthoses sometimes, though only temporarily when tissue stress relief is required to aid healing the injured structures and to re-educate the muscles by improving postural alignment.

How do your patients react when you recommend barefoot activity? Do they embrace it well or are many hesitant to bare their feet for better health?
Surprisingly, quite a few patients (mainly over 40 years of age) used to walk barefoot as children and are very accepting of the concept. Because we live in a coastal area with lots of seaside resorts and beaches most people here are okay with barefoot walking in these areas and around their houses and gardens. Most do not want to walk barefooted in public areas in town or shopping centres. I have very little problem persuading patients to go for barefoot walks up & down the local sandy beaches as part of their rehabilitation exercises. The majority of my patients are really excited to discover that they won't have to wear orthotics for the rest of their lives if they strengthen their feet. Some prefer to wear minimalist shoes like Vibram FiveFingers and Vivo Barefoot shoes to help with strengthening the foot during walking and running. None have become barefooters to the extent they go out in public except at the beach, though in time that may happen as a few people have been keen enough to buy Daniel Howell's The Barefoot Book and Born to Run. I have only been practicing Barefoot Podiatry for about 4 months. It took me a couple of months to come to terms with barefoot walking being better than shod and rethinking all my old podiatric bio-mechanical theories of gait. During that time I had many sleepless nights whilst I adjusted my thinking. Some days I even began to believe I would have to give up working in my profession because it didn't fit with my new beliefs about barefoot gait. I have now become comfortable with my new Barefoot Podiatry paradigm. And am excited to have a new professional focus. I feel I am on a mission to help other health professionals understand the barefoot gait paradigm. At the end of this month I will be lecturing to podiatrist in our county and in November I am lecturing for 7 hours at the British School of Osteopathy on Barefoot Podiatry.

If someone were interested in more barefoot activity, what recommendations do you have for them to get started?
When a patient is keen to do some barefoot walking or running I tend to start them off with foot strengthening exercises first, because most of my patients are already injured (I reckon 90% of patients attending podiatrists' clinics are injured by the chronic wearing of shoes). I warn them to be cautious about getting carried away with enthusiasm and advise a slow, careful transition into barefoot activities by going for short walks at first and gradually increasing the time spent barefoot walking. I also prescribe barefoot beach walking or running, and encourage them to walk barefoot around their home and garden. If they are amenable to the idea of barefoot hiking I get them to do that too. Some of my patients buy The Barefoot Book &/or Born to Run and I advise them to use my naturalfeet website to learn more about barefoot activity. For those patients who believe in the barefoot concept yet won't or can't go barefoot, I advise and sell them Minimalist Footwear.

What role do you believe footwear should play in our lives, if any?
I believe footwear should play an important, but infrequent role in our lives for protection just like we use gloves for our hands. And just like gloves we should remove the footwear as soon as the purpose for them as been achieved. There are times when we need to protect our feet from extremes of cold and heat just like when our ancestors first started to wear leather shoes thousands of years ago. And of course when carrying out jobs where there is a risk of physical injury to our feet. Some people, though not needing them for physical protection, wrongly will need to wear shoes for their employment due to cultural expectations of their employer or clients. In these cases I would advise they wear minimalist shoes to reduce the negative effects on their feet and of course go barefoot whenever they can. In saying that shoes may be needed for protection, I believe this is actually very rare. Most barefooters become more aware of their physical surroundings by being barefooted and so are naturally more careful. It seems that the sensory perception of the surrounding environment is enhanced by being barefoot so most of the risks of physical harm are never actually realised, just like we don't routinely hurt our hands during the day even though we may place them at risk of harm during the course of our work or recreation. So I actually think most people could go barefoot more than they at first believe. I believe the biggest barrier to barefoot activity is psychological!

Are there any types of people for whom you believe barefoot activity is inadvisable or a lost cause?

The biggest barrier to barefoot activity is psychological! Some people will never enjoy barefoot activity because their minds cannot or will not accept it. On the other-hand there are sadly a few people who would like to enjoy barefoot activity, but cannot or should not try to walk barefoot much or at all, especially outdoors. These few people would find it difficult or impossible because of physical disabilities within the foot and leg. Some of these disabling problems are minor & others more serious. There are some people who have weakened or damaged their feet so much through chronic overuse of shoes that their feet have become dependent on footwear. Some of these problems include atrophy (thinning) of the plantar fat pad , arthritis of the foot joints (particularly mid-foot joints) & damaged muscle tendons through chronic flat-footedness. Other people may have muscle disease which affects their ability to rehabilitate, or a neurological disease which inhibits their tactile sensory perception, like diabetic neuropathy. I would like to make the distinction here between those who have diabetes mellitis with no sensory neuropathy and those with damaged nerves in their feet; the former are perfectly safe to carry out barefoot activities whilst the latter are obviously at risk.

Many podiatrists seem very hesitant to recommend barefoot activity due to concern over liability if patients end up cutting their feet or otherwise getting hurt by it. There are also arguments that recommending barefoot activity goes against "best practices" and that there's no scientific evidence to back up such a recommendation. How would you respond to that?
In the UK patients are not as litigious. They view barefoot activity as a risk they take upon themselves. When I explain how we are evolved/created to walk and run barefoot and I explain some of the anatomical features which make barefoot activity natural, they see the logic in it and they can very easily understand and believe it. Very few see the logical need for shoes, though most are reluctant to walk barefoot in public due to social stigmas and cultural expectations. As far as being in compliance with best clinical practice, in the UK currently the vast majority of podiatrists preach that supportive shoes are required, but there is no 'Best Practice' policy of which I am aware. I would have no qualms about defending myself if anyone did take issue with me preaching the barefoot line.

There is more than enough scientific research to back up our barefoot position and very little if any to back up the shod position as being healthy!

You just have to look at the references in Professor Howell's book to see that. In fact, I believe it is the podiatrists who preach that shoes are required for maintaining healthy feet that are in a difficult scientific position. This is part of the reason I have taken my barefoot stance because I was unable to defend that position any more. Rather like the Tobacco industry should have been more open about the risks of cancer from smoking cigarettes, I feel that as a podiatrist I need to warn my patients about the risks from shoes. I believe in doing what is right and letting the consequences follow!

Finally, as well as believing that natural barefoot gait should be the norm I tried the experiment myself. I was challenged by a physiotherapy friend to do what I believed. So in July I did. I have been barefoot 24/7 ever since (apart from a couple of times at church out of respect for my church ministers wishes -- but he now understands and is more accepting -- and also when I perform nail surgery in order to protect my feet from blood and chemicals). I am now barefoot at work in my clinic, out hiking through the woods and on the cliff paths. I have also started running again after 20 years, this time barefoot. I have run up to 3 miles so far, with none of the problems which stopped me running when I wore running shoes. The personal experiment has worked for me and is working for my patients too. What is so satisfying is having the ability to heal my patients from injuries which have resisted treatment with orthotics and shoes prior to introducing barefoot strengthening exercises, but now they are doing well.

Final thoughts?

The future is exciting for barefooters. It is wonderful to see the growing acceptance of people in our modern shoe-oriented Western Societies beginning to realise the fallacy and misuse of footwear. It is great to see some enlightened shoe manufacturers starting to make shoes which allow more of the natural function of the feet with minimalist footwear. The ball has been cut and is rolling, it is gathering speed and cannot be stopped. It is a blessing to be involved in this great cause! To be able to improve people's health through enlightening them of the dangers of the overuse of shoes. For the first time in my 25 year career I feel I really understand the cause of foot problems and now have a tool to cure people. Primal Gait! Let's sound the warning cry to the world to "Eschew Shoes!"

I thank Dr. Bloor for his enthusiastic willingness to participate in this interview and his very interesting, informative responses. Please understand, however, that his answers should not be used as medical advice and Dr. Bloor and I waive all liability from your use of the information in his responses. I personally recommend that my readers seek out medical advice from their own medical providers to make sure that you are physically fit enough to begin barefoot activity and to rule out any other diagnoses that otherwise could complicate or detract from a barefoot lifestyle -- or even be aggravated by going barefoot.

What do you think of Dr. Bloor's responses? Does this give you a new outlook on barefoot activity? What, if anything, have your medical provider(s) said to you about barefoot activity? Please leave your responses in the comments section below. Thanks for reading.

Are Your Dress Shoes and Flip Flops Causing Your Running Injuries?

Pardon me for this post. I had a sort of epiphany a while back and I need to "think out loud." Please read this with the understanding that I don't have many answers, just questions. But sometimes you have to ask the right questions to get the right answers, don't you?

I've talked a lot on Twitter and in this space about barefoot running. I, as a barefooter and barefoot runner, subscribe to the idea that running without footwear -- or at most, minimal footwear -- is the best thing at preventing injuries from running.

But what if all this talk about a forefoot strike vs. heel strike, pronation, arch support, etc. pitting running shoes against feet is missing the mark? What if the core reason for most running injuries has very little to do with what a runner wears on their feet or how they land? After all, there are runners who are happy to step forward and say that they've never been hurt while wearing trainers. There are people who can go for months at a time wearing the same kinds of running shoes before they get hurt. What's with that?

Could it be that running shoes -- or lack thereof -- are NOT a major factor in runners getting hurt?

What if runners get injured because of all their shoes? It's entirely possible that stuffing our feet into stiff, constricting dress shoes with elevated heels at work five days of the week -- six if you dress up for church -- wearing gait-altering flip flops when it's nice out and any other various kinds of footwear put your feet in unnatural situations can have a collective effect on our bodies.

Consider this: A young woman who eats healthy has a full-time job that requires her to dress in business attire. She goes to work five days a week and usually wears a pair of high heels. Her health is important to her, so after work three days of the week she heads out for a run and averages about five to six miles per run. She varies her courses, from trails to the high school track. After work one Friday, she goes straight home to prep for a night out shopping with the girls instead of running. She dresses casually and throws on a pair of flip flops. Saturday morning is her long run while training for a half marathon that's still a few weeks away. She runs a steady seven miles before donning her flip flops again to run errands. Not long after this, she ends up with really painful plantar fasciitis (PF) that nags her for a very long time. She ends up running the half, but she hurts through most of it.

The big question: What caused the PF?*

A podiatrist, sports doctor or magazine might tell you that she increased her mileage too fast, has poor foot structure and/or that she's wearing the wrong running shoes. The recommended course of treatment might be to keep the running shoes but add an orthotic and have her wear a night-time splint while she sleeps.

In this fake scenario and so many other real-life situations, maybe the running shoes aren't the problem at all. It could be that the combination of her toes being smashed together in heels at work all week, her achilles being shortened by the angle of her ankle wearing the heels, and the biomechanics involved in keeping flip flops on her feet while walking all have a cumulative effect in messing her body up so that when she runs in trainers it hurts. Maybe all that stuff is what really caused the PF and then the mechanics of running made it jump to the fore.

A magician (intentionally) does this kind of thing all the time. While you're watching him make a fuzzy ball disappear in his left hand, you're not paying attention to the fact that he's already putting it in his jacket pocket with the right hand. Your attention is in the wrong place. It sure seems like he made the ball disappear when there was actually something else going on out of sight and out of mind the whole time.

Now, I don't want to imply that podiatrists, sports doctors and so many other experts are using medical sleight of hand to make money when they know full well what the "real" problem is. I'm actually wondering if we're all just missing the big picture here. Maybe what we see happening is an unintentional diversion from what's happening just out of our vision.

It could be that fixing a problem with the foot by conventional means doesn't address the real problem: All the various footwear that we put on our feet on an everyday basis could have a cumulative effect in messing us up. If you really think about it, it seems reasonable that you can't consistently shove your foot into a cramped, stiff space or make it do unnatural stuff most every day of your life and expect it to come out perfect when you want to really make it perform.

As you probably know, I recently finished up treatment for a stress fracture in my left heel. I was non-weight-bearing and wore a cast boot for the good part of six weeks to fix it. I did physical therapy to get me back to the point where my body can now run again. I needed that therapy because I was not properly balanced. My left leg atrophied a lot due to my injury.

Scratch that. No, it didn't.

I didn't go through PT because of my stress fracture. I did it because of the effects of the treatment for my stress fracture. Being off my foot and keeping my lower leg so immobilized caused my leg muscles to atrophy and my whole body to be out of whack.

If that happened to my leg because of consistent use of crutches and the boot, doesn't it make some sense that regular use of restrictive, gait-altering footwear could throw our bodies out of whack as well? I realize that we're talking various degrees and types here. Someone who is non-weight-bearing will have different negative effects than a woman who wears heels every day to work. The point is that it's probably incredibly short-sighted to just blame running shoes for running injuries.

I'm sure that there are many podiatrists and other doctors who address these lifestyle issues when someone comes in for treatment. I know that there are podiatrists who realize the negative effects of high heels on women's feet. But I've also read comments from many experts who essentially throw their hands up and say, "Well, women are going to wear heels so we have to find creative ways to address their foot problems."

To me that seems like telling a smoker, "We know you're going to smoke, so here's cigarettes that aren't as bad for you," when we should be shouting from the mountaintops, "STOP SMOKING! It is bad for you! Don't do it!"

Maybe we, as a society, need to stand up and say that heels, stuffy shoes and flip flops aren't worth it. Our feet are too important to keep screwing them up all the time in the name of fashion, protection or any of the other excuses we've come up with for needing stupid shoes all the time.

It's possible that after looking further into this, we might find that people who don't get injured as much while running don't subject themselves to confining shoes on a regular basis. We might find that all the nasty shoes we wear are the actual cause of many bio-mechanical problems with our bodies when running.

I admit that it would be nearly impossible to ever scientifically prove these theories to be true. There's too many variables. You couldn't compare apples to apples since each person works different jobs, walks on different surfaces, wears different shoes, weighs different weights, has different sized feet and the list goes on. Measuring long-term effects under controlled conditions would be infeasible.

That said, there is one constant for each person: Our own two feet. We wake up and go to sleep with the same feet each day. We've had them since we were born and, barring terrible circumstances, we'll have them until we pass away. Doesn't it seem like it's at least worth considering that our own two feet are optimized for each one of us and should generally stay free of shoes? Doesn't it make sense to do as little as necessary to protect or adjust them, but otherwise let them act on their own accord? Many barefooters including myself would answer yes to both of those questions.

Barefooters have discovered that we in civilized society really don't need shoes all the time. The surfaces on which we walk aren't covered in as much broken glass, used needles, viruses, feces or other nasty things as many people would like to believe. The man-made carpet, tile and paved surfaces that so much of our world is covered in is really very safe to walk on without shoes. Our green spaces are usually well kept and free of hidden dangers. If cuts or other injuries occur, our feet are very resilient at healing and moving on.

Have you run successfully for a long time while wearing trainers? If so, what do you wear when you're not running? Is it possible that the shoes most people wear on a regular basis are the cause of running injuries and NOT the sneakers themselves? Are the best "shoes" for us no shoes at all? Is it possible to turn the tide on terrible footwear like high heels and convince people to take better care of their feet through better footwear or no footwear at all? I welcome your comments below.

* - I realize that this scenario is fictitious. I realize that you may not agree with how the scenario played out. My point was to come up with a story that could happen at some point in Anytown, USA to use for illustrative purposes. Don't miss the bigger picture of the post by getting hung up on, "That wouldn't actually happen."