Barefoot or Not?

We should get back to basics and use our bodies as they were intended. Let’s run free and barefoot! Let’s get stress fractures! There are definitely two camps when it comes to walking and running barefoot.

“Barefoot running is definitely becoming more popular,” admits podiatrist Louis Aquino of Foot and Ankle Center. “The concept is good, but I disagree entirely with the reality.” He is a firm believer in orthotics (prescription arch support inserts) for correcting deficiencies in foot function, and says the reality of starting to run barefoot after years of wearing shoes is asking for tendonitis, plantar fasciitis and stress fractures.

Aquino thinks running in general is an overuse of the foot. “It’s great cardiovascular exercise, but it takes its toll on the feet, bones, joints and the lower back,” Aquino says. “In early childhood, beginning walkers use the bare foot as a sensory organ to help them learn their place in space. Once that is accomplished, shoes should be worn. Anywhere you go, there are hard surfaces, and runners can’t run on those surfaces without consequences.”

Biomechanically, walking exerts three times your body weight with each step. Running jumps that pressure on the foot to 10 times body weight. With a big person, that force can be significant. Aquino believes that some barefoot walking in a controlled environment can help strengthen the foot, but it would have to be a biomechanically balanced foot to reap any benefit. Extremely flat feet or those with high, rigid arches are always better off with support, he says.

Dr. Amy Balettie with Foot Healers says she sees many injuries in barefoot runners. “The Masai of Africa run barefoot, but these people also are not obese, have a shorter lifespan and don’t sit behind a desk all day,” she points out. “They are out working in their fields, using all their muscles.” In runners who have been running on the sides of roads on uneven surfaces and through trash, she sees cuts, fractures, strains and tendonitis from not supporting the foot. She reports that with most patients who have been exercising in shoes, it’s not the shoe causing the problem, it’s the foot structure and not having it supported enough.

Balettie says about 80 percent of the population has flexible flat feet, but when these are strained by exercise, injuries happen. Only about 10 percent have a normal arch, and five percent have high arches that need additional support. She says there are some times when it is appropriate to go barefoot. Being barefoot is important in doing yoga, for instance, because you want to stretch all the toes and tendons without the restriction of shoes—but that’s a controlled environment. It’s also generally OK to walk barefoot around the house, she says, except for diabetics or anyone who gets pain from going barefoot. Diabetics should always wear a supportive slipper or sandals in the house, something to cushion and protect the feet. And they should check their feet frequently. “Older diabetics who can’t see the bottoms of their feet often injure them and don’t know it. They shouldn’t be walking barefoot anywhere,” Balettie says.

If you want to try barefoot running, she suggests one of the best places is on the hard, smooth sand near the water on a beach. “But be aware that there is a different style or stride in barefoot running, and if you plan to do a lot of it, you should see a barefoot running coach,” she advises. “The stride is more on the ball of the foot, rather than the heel.”

Dr. John Holtzman of Missouri Foot and Ankle reports drastic missteps in patients with diabetes. He has seen a hypodermic needle embedded in a foot and burns from hot concrete on the soles of feet, since diabetics suffer from neuropathy, a lack of feeling in the foot.

Beyond toddlers, people who want to walk and run barefoot should build up with the proper training, he advises. “We’ve seen stress fractures in our office from barefoot running, or running in barefoot-like shoes,” says Holtzman. “The interest started with Nigeria and the Nigerians who have won marathons in the U.S. Those runners have always run barefoot, but they have different mitochondria and foot structures,” Holtzman explains. “They are also very lean and have been doing it all their lives. Most people who aren’t used to barefoot running have to build up to it or they will experience trauma.” He suggests running on grass, dirt or the new spongy tracks, but not pavement.

There are special shoes being marketed for barefoot runners to protect the sole of the foot from foreign objects without interfering with the foot’s natural movement. Some are very thin with toe slots. The only specialty shoe Holtzman recommends mimics barefoot running by making the foot run more on the ball, rather than the heel. He uses it for patients with Achilles tendonitis or heel pain. “Some of my colleagues are huge proponents of barefoot running and want all their patients in barefoot running shoes,” he says. “Can it be helpful? Maybe. You can build stronger intrinsic muscles that can do a better job of supporting the foot, but you’d have to build up and work on it, especially if you’ve been in shoes your whole life.”