Are Your Shoes Causing Foot and Ankle Dysfunction?

July 15th, 2009

BarefootDespite how much we depend on our feet every day, few of us give much thought to their complexity or importance. Nearly everything we do involves some form of walking or running and it’s our feet that are responsible for absorbing the resulting ground impact and keeping us upright. Ironically, the shoes we wear to protect our feet inhibit their natural function, and in turn, can promote muscle and joint problems throughout the body.

Our Amazing Feet

The foot contains more than 20 bones, 30 joints, 100 muscles, tendons, and ligaments, and 200,000 nerve endings. In fact, the feet contain a quarter of the bones in the human body, and as such, deserve more of our attention.

By landing mostly on the ball of the foot when walking or running, the complex structure of the foot is able to absorb the resulting impact. This absorption capability is a major reason why our prehistoric ancestors were able to hunt and flee from danger without shoes and why Abebe Bikila was able to win the 1960 Olympic marathon running barefoot. While you might cringe at the thought of running barefoot, our highly evolved feet are perfectly capable of making it possible.

Problems Associated with Shoes

Although shoes provide many conveniences, they impair the natural function of our feet.1 The padding that’s common on most shoes encourages us to land on our heels rather than the ball of the foot. Because the heel lacks the absorption capabilities of the forefoot, much of the impact is instead transferred to the ankles, knees, hips, and spine which is obviously undesirable. Shoe padding also impairs the body’s awareness of ground contact and foot orientation which disrupts the neuromuscular feedback loop that controls our gait, and in turn, alters walking and running mechanics.2

Research shows that contrary to popular belief, an increase in shoe cushioning doesn’t reduce the amount of impact transferred from the foot to the rest of the body during running or walking.3,4 In some cases, the amount of impact actually increases as the amount of cushioning in the runner’s shoe also increases.5 This is believed to be a result of the loss of sensation of ground contact caused by the cushioning.6,7,10 Finally, it has also been shown that even on a hard surface, barefoot runners who land on their forefoot generate less impact force than those who run in shoes but land on their heels.8

The stiffness of a shoe’s sole is another concern. Unrestricted dorsiflexion of the metatarsophalangeal joints, which are the joints that join the toes to the forefoot, is important for natural arch support and efficient propulsion. The sole of a shoe, especially if stiff, has been found to reduce this dorsiflexion by half.11

The Advantages of Going Barefoot

Although there may be additional factors involved, populations that walk and run barefoot have healthier feet and fewer foot and ankle injuries.6 Because shoes restrict the foot’s natural function, they cause muscles, tendons, and ligaments to weaken, and in turn, increase susceptibility to injury.

In 1905, Dr. Phil Hoffmann analyzed the foot structure of primitive populations and concluded that wearing shoes causes deformations that inhibit the foot’s function and restrict the movement of its joints. According to this research, the toes of people who never wore shoes were spread apart and provided more stability and balance while the toes of people who wore shoes were crowded and less functional.9

Going barefoot as often as possible will promote strong and healthy feet, reduce the chance of pain and injury, and also improve physical function.

A Practical Compromise

While being barefoot all the time would promote excellent foot function, it’s certainly not practical, and in many cases, it’s not safe either. Fortunately, shoe manufacturers are paying more respect to the importance of proper foot mechanics and are designing shoes that minimize the restriction of natural foot function.

Here are a few options that will allow you to get as close to going barefoot as possible without actually doing it.

Nike Free

Nike Free 3.0Nike Free shoes are probably the most popular option because of the Nike brand name and the fact that they closely resemble regular sneakers. However, unlike other Nike shoes, the Nike Frees are specifically designed to replicate the freedom of walking and running barefoot. Each model is rated on a scale of 0 to 10 with zero being barefoot and 10 being a standard shoe. Most of the Nike Free models are either rated 3.0, 5.0, or 7.0 with most of the 3.0 and 5.0 models being running shoes and the 7.0 models being cross trainers.

Hoping to get as close to barefoot as possible, I chose the 3.0 model pictured above. Although they’re definitely much less restrictive than regular sneakers, they still have a notable amount of padding in the heel which I’m not pleased with.

Here’s the full line of Nike Free shoes. You’ll likely be able to find older models at a cheaper price if you search on eBay.

Vibram Five Fingers

Vibram Five Fingers ClassicThe Vibram Five Fingers are a very popular choice among the most dedicated health and fitness enthusiasts, but they require a bit of a rebellious personality to wear them in public. For obvious reasons, they’re bound to draw attention, and although I could do without this aspect, my dislike for the heel on the Nike Frees convinced me to order the pair shown to the right.

Although the Vibram shoes have the funny looking appearance of gloves for your feet, I think this may be one of their most important features. Because this design spreads your toes apart and allows them to function more independently, perhaps it could help to reduce and maybe even reverse the toe crowding and dysfunction described earlier that results from wearing shoes.

Here’s the full line of Vibram Five Finger shoes.

Vivo Barefoot

Vivo BarefootAlthough expensive, the Vivo Barefoot shoes appear to be a great choice for situations where shoes that look like gloves, or even sneakers, aren’t appropriate. I think they’d especially be a great choice for anyone who has an office job and has to wear casual business attire on a regular basis. I’d like to eventually get the style shown to the right.

Here are the many different styles of Vivo Barefoot shoes to choose from.

[1. Frederick EC. "Kinematically mediated effects of sport shoe design: a review." Journal of Sports Sciences. 1986. 4(3):169-184.]
[2. Robbins S. Waked E. "Factors Associated with Ankle Injuries: Preventive Measures ." Sports Medicine. 1998. 25(1):63-72.]
[3. Clarke TE, Frederick EC, Cooper LB. "Effects of shoe cushioning upon ground reaction forces in running." International Journal of Sports Medicine. 1983. 4(4):247-251.]
[4. Bergmann G, Kniggendorf H, Graichen F, Rohlmann A. "Influence of shoes and heel strike on the loading of the hip joint." Journal of Biomechanics. 1995. 28(7):817-827.]
[5. Shorten MR. "The Myth of Running Shoe Cushioning." 4th International Conference on The Engineering of Sport. 2002.]
[6. Robbins SE. Hanna AM. "Running-related injury prevention through barefoot adaptations." Medicine and Science in Sports and Exercise. 1987. 19(2):148-156.]
[7. Wartburton M. "Barefoot Running." Sportscience. 2001. 5(3).]
[8. Lieberman DE, Venkadesan M, Werbel WA, Daoud AI, D’Andrea S, Davis IS, Mang’Eni RO, Pitsiladis Y. "Foot strike patterns and collision forces in habitually barefoot versus shod runners." Nature. 2010. 463:531-535.]
[9. Hoffmann P. "Conclusions Drawn from a Comparative Study of the Feet of Barefooted and Shoe-wearing Peoples. The American Journal of Orthopedic Surgery. 1905. 3(2):105-136.]
[10. Robbins SE. Gouw GJ. "Athletic footwear: unsafe due to perceptual illusions." Medicine and Science in Sports and Exercise. 1991. 23(2):217-224.]
[11. Bojsen-Moller F, Lamoreux L. "Significance of Free Dorsiflexion of the Toes in Walking." Acta Orthopaedica. 1976. 50(4):471-479.]

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