blog by Andy Bryant, podiatrist

I am a podiatrist with 25 years of experience in private practice. 18 years into my practice I started a personal yoga practice. Up until then I had scoffed at foot rehabilitation. We had been taught at university that the muscles and other soft tissues in the foot were too small to successfully isolate to rehabilitate. I had worn custom made orthotics for an old running injury (unsuccessfully treated!) when I was at uni and then left them in place for 20 years!

So it was with amazement that I found my feet changing and adapting to the new movements and loads that I was using them for in yoga whilst barefoot. I noticed people at the gym training barefoot and researched that and then thought about getting back into running. Podiatrists, me included, had sniggered and shook their heads when there was an influx of barefoot runners a few years earlier, so it was huge leap for me to give that a try. My calves burnt!

Rather than throw the baby out with the bathwater, I persevered, researched and learnt more. If my feet could change with movement and strength work, why couldn’t I help others do exactly the same.

Foot exercises can be boring and fiddly. I soon realised that the ultimate way to strengthen and rehabilitate feet was through changing the foots environment…shoes! I have since used barefoot shoes in my practice to help clients rehab on a daily basis.

Complex presentations are often best addressed with simple solutions. I believe and have clinical success with simple solutions revolving around changing to minimalist footwear.

PROBLEMS A BAREFOOT SHOE BEGINNER MIGHT ENCOUNTER, 

WHY THEY ARISE, AND HOW THEY CAN BE IMPROVED.

People new to wearing barefoot shoes often encounter problems with the process.

Generally speaking this is because they are unaccustomed to their feet being in a shoe that does not provide support, cushioning and a raised heel.

Barefoot shoes ask our feet (and attached bodies!) to work more than they might be used to. They ask our feet to move more, to do some of the shock absorbing for our body, to propel us forward as we push off the ground. When conventional shoes have been helping our feet with these functions, our feet can get lazy. So when feet are asked to perform the functions they’re evolved and designed to, without the help of modern shoes, they might complain. This doesn’t mean it’s bad for our feet…on the contrary, they can end up getting stronger than ever before.

This can be likened to any other part of our musculoskeletal body doing a new activity. It may get sore and if continued at the same rate, even injured.

Most of the issues spoken about here are solved by slowing down the process of getting accustomed to wearing barefoot shoes. Problems can be avoided by taking the transition process very slowly. Increasing time in the new shoes by small increments every day and starting out wearing them for activities where you are either not moving a lot or moving mindfully. Examples of this are wearing them around home, to the local cafe, at the gym, or going for short walks.

That said, there are specific things that can help specific problems and we are going to dive into that here.

BACK OF THE HEEL AND CALF PAIN

Conventional shoes almost all have heel pitch, that is, the heel is elevated more than the forefoot. Barefoot shoes are flat from heel to toe. When wearing a shoe with heel pitch, the muscles and tendons on the back of the foot and leg are held and function in a shortened position.


compared to

When we go to a barefoot shoe that is flat from heel to toe, the muscles that were previously held in a shortened position can feel tight and with use, sometimes even sore.

We are meant to stand on a foot that is not pitched forward, so with time, we should become accustomed to the new flatness.

Problems in these areas might show up with pain in the achilles (large tendon attaching calf muscle to back of heel bone) and/or general fatigue, cramping and tightness in the calf muscles.

To help with these complaints and the process of getting more used to wearing a flat shoe, we can be strengthening, stretching and massaging the calves, sole of foot, hamstrings, buttocks and lower back.

In some cases it can be helpful to put a small heel lift in the shoes, to alleviate the new stress in the short term.

In the long term, our achilles and calf can become stronger and more resilient thanks to the wearing of the shoe that makes them do the work they are designed for.

BOTTOM OF THE HEEL PAIN

Most conventional shoes have lots of cushioning on the heels. This gives us a lack of feedback on our feet striking the ground and so we can hit our heel heavily without it hurting. This can become a normal pattern of walking. This is not an efficient pattern of walking. Our heel is designed to be landed upon during walking but not with our leg a long way out in front of us or with a heavy heel strike. A gentle rolling motion with the leg closer to under our centre of mass (body) is more efficient.

When we change to a barefoot shoe, often our gait doesn’t immediately change to this efficient pattern of not hitting the ground so hard. We continue to use the less efficient gait pattern, hitting the ground hard but now with a shoe that doesn’t give us the protection that let us get away with this.

The long term “cure” is in the wearing of the barefoot shoe. Our bodies are often quick to learn and with discomfort being a great teacher, our gait will slowly adjust to be less heavily heel striking.

In the short term, adding some cushioning in the form of a soft insole can be helpful. The wearing in process might include more walking on softer or variable surfaces over pounding the hard, flat pavement to start with.

Walking mindfully without any shoes can also be a useful practice.

FOREFOOT PAIN and SENSITIVE SOLES

A true barefoot shoe has a thin sole, enough to provide protection against sharp objects and the elements of hot and cold but importantly allowing our feet to feel the grounds variation and texture. Our feet are supposed to give our brains a fuller picture of our environment by letting the rest of the body know what the surface of the environment we are travelling through is like.

Obviously a stiff and thick sole doesn’t give us the ability to have this feedback and so our feet can become to some extent, “detuned”.

This is on both a neurological level but also locally, the padding on our feet is more likely to be lessened if we’ve not exposed the sole to deep pressure and texture.

When faced with wearing barefoot shoes, the forefoot and general sole surface can find the experience quite overwhelming. The sole can be sensitive to all the new feelings and the lack of cushioning in the shoe (and possibly the foot) can leave the feet feeling raw and bruised if we do too much, too soon. In time, the foot will naturally get stronger and more resilient to these sensations, even adding more natural cushioning to our own sole.

Simple insoles can help soften this experience. Many Saguaro models have insoles that provide some minor cushioning to help with this process. They are almost always removable, giving us the option to use them or not, maybe depending upon the surfaces, distances and intensity we are planning for an activity

In the long term, this ground feel that a barefoot shoe provides is wonderful for our foot and whole body function, but just may take some getting used to.

Again, slowly working into wearing barefoot shoes and wearing them on soft and/or variable surfaces really is the best way to get through or even better, avoid, these teething issues.

GENERAL FOOT FATIGUE and ARCH PAIN

The foot has 26 bones and 33 joints. It is designed to move. Most footwear is stiff and although our foot can still move in these shoes, it’s generally not nearly as much as the foot can move. When we have a joint that doesn’t move as much as it can, the soft tissues crossing it, the muscles, tendons and ligaments are not exposed to the stimulus to be strong and supple.

This is most evident in the medial longitudinal arch (arch on the inside of the foot) that many people believe needs to be supported. This arch is designed to move with our movement, lowering and lifting depending upon how our body above is interacting with the ground below.

You might imagine that if we wear stiff shoes or arch support, the usual movement of the arch can be restricted and the body becomes accustomed to this. Minimalist shoes do not provide arch support at all and therefore ask our feet and arches to do more movement and therefore more work. This can in turn create pain and/or fatigue.

The human body is an adaptation machine. When it is exposed to a new stimulus, on a micro level, tissue breaks down and repairs in a stronger way. When we measure the dose of the stimulus the body can adapt without getting injured.

This is the process of slowly acclimating your feet to their new shoes. The end result is stronger, more resilient feet! They will have stronger bones, muscles, tendons and ligaments.

PAIN IN OTHER PARTS OF THE BODY

When some people go into barefoot shoes for the first time, they feel like they are falling backwards. This is because when a shoes is put on, their bodies are so accustomed to adjusting for a positive heel pitch that it still does this, but without a positive pitch results in the feeling of falling backwards!

When in a positively pitched shoe, our ankles, knees, hips, lower back, thoracic, even all the way to our neck adjusts our posture to keep our head above our rear foot/ heels. So when we change to a flat shoe, these areas of our skeleton and the muscles and other soft tissues that attach to them, can take some time getting used to the new position. This is more unusual in those that have spent lots of time habitually barefoot because their bodies are already accustomed to these changes.

Generally speaking, the adaptations in the rest of the body to the flatness of the shoes are very quickly made. It’s taking our body back to it’s natural position.

In summary, in most circumstances, barefoot shoes are better for the long term health of our feet. Issues can arise in wearing them initially because it’s a change for our feet and bodies. These issues are most easily combatted by taking the transition into wearing this type of footwear gently. Wearing barefoot shoes increases muscle size and strength, bone density and joint mobility and stability.