Foundations Built on Foam
Your guide to going barefoot and its benefits
Photo by AXP Photography Source
I have previously mentioned that increased time barefoot or in minimalist shoes (or shoes that are more minimalist than normal for you) is likely universally beneficial for most people (and promised an article on how - so here you are, and given it’s length you understand the delay, so thanks for your patience). The obvious caveat being those currently injured, specifically those with overuse type injuries of the foot, ankle or lower leg. But for the rest of us, there’s likely some benefits in time with less support, and working towards barefoot time.
Some folks may end up moving a little towards barefoot and being happy, others may end up all the way down the spectrum, your life and goals will obviously dictate this. That said, moving down the continuum from fully shod to barefoot is a LONG process, more likely measured in years that weeks so be patient and prepared for this.
As a caveat, right up front, I will say that if you do have an extensive injury history, talk to a professional before starting anything like this. I will also say that I will refer to barefoot time a lot, whilst there’s specific benefits here which I will cover, most benefits are on a continuum from truly barefoot through to shod in conventional shoes. So whilst I will make some benefits clear to be predominantly isolated to truly barefoot time, generally I will use the term barefoot as short hand for ‘in something further along the continuum towards barefoot than you are habitually’ (and now you understand why).
Why Go Barefoot?
Time barefoot is important for appropriate stimulus of your foot and ankle complex. In comparison to conventional footwear, there are greater range of motion and strength requirements as well as increased proprioceptive input.
Proprioception
An interesting fact on this; the Dutch word for gloves is “handschoenen” which directly translates to “hand shoes” - this speaks nicely to the reduced proprioceptive input your feet get when wearing shoes (think about how much dexterity and touch you lose when you wear gloves).
The sole of your foot is one of the most sensitive and innervated part of the body (as can be seen below in the ‘sensory homunculus’ and the somatosensory map representations of the amount of the cortex which is devoted to each part of the body from a sensory standpoint).
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These nerves are much more down regulated when in shoes and socks - this is the way the nervous system works, otherwise you’d go insane due to overstimulation. It’s the same mechanism by which we can’t feel our shirt once we’ve been wearing it a while unless we think hard about it. This does mean, though, that we need to stimulate these nerves, which will help improve balance and spacial awareness. I previously mentioned single leg balancing whilst brushing your teeth here, serving a similar purpose. You may think your balance is fine (and it may be) but don’t forget that balance has numerous components and contributors and just as the brain adapts in those who lack eyesight to emphasise other senses (and devote more of the cortex to them via what is called ‘neuroplasticity’) your balance can have stronger or weaker contributors. This is very common post ankle sprain for instance, where some of the proprioceptors in the ankle ligaments may still be readjusting, in these cases (and maybe yours) whilst the peripheral proprioceptors may be doing less, the central factors may be picking up the slack so to speak. Specifically, your visual system and vestibular system (inner ear) - this is why balancing with your eyes closed is hard.
Range of Motion
The range of motion used and required (remembering that the body is “use it of lose it”) is significantly more when barefoot. Specifically at the sagittal plane joints (ankle, toes joints etc as opposed to joints that move in other planes) which are offloaded and limited in their range by heel height and toe spring (explained visually below).
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Without catastrophising, which is common in this area, (and is hard to evaluate for accuracy if I am honest - understanding true consequences here is super hard given timelines are measured in lifetimes not decades) limiting range of motion can cause significant issues when this range is then subsequently required. This can shift stresses to places that are less than ideal and cause compensatory patterns which can cause their own issues. And before the ‘no worries I will just keep wearing shoes’ I can comfortably tell you this won’t be the case when it matters most (when you are elderly and at highest falls risk, which can be modified in part through lower profile shoes and is exacerbated by lack of range of motion - you get the point).
For athletes specifically, ‘tight calves’ or a lack of range of motion at the ankle is a huge headache. It can increase forces at the knee (the compensation for a restricted joint is usually and the joints above and below) and increase risk of knee injuries. This is exacerbated in field sports where boots (or cleats) are usually without a heel and then when standing on a soft field this can even create a negative heel due to the heel digging in slightly.
*yes playing these sports constitutes something very close to barefoot time (with the exception of the proprioceptive aspects of being barefoot) - see the barefoot shod continuum below.
Strength
The strength of the intrinsic foot muscles (those which do not extend beyond the foot) is of the utmost importance for performance, health and longevity. From a longevity standpoint, it serves as part of avoiding falls (a key source of mortality and morbidity), whereas from a health standpoint it serves as a potential means of preventing some fairly significant potential pathologies such as plantar fasciitis (we won’t get into the detail here but it probably isn’t truly a fasciitis for the record). When we look at performance settings, the feet serve as the interface with the ground, adapting and transferring force (thus they need to be flexible enough and strong enough). Enter the concept of the ‘foot core’ - akin to the ‘core’ we talk about in the trunk but in the foot.
Anecdotally, when I started applying more barefoot type stress to my body I started noticing some significant hypertrophy (increased muscle size) of my intrinsic foot muscles and shank (aka calf region) muscles (not this was over a period of long months to years). Whilst I hate saying the phrase ‘this makes sense’ - sometimes it’s true and helpful. Regular readers would note that strength and hypertrophy are not 100% correlated, but that hypertrophy tracks fairly well with volume - which is what you get walking around a bunch with increased load. Interestingly, a recent article noted that calf size was correlated with mortality (though in an older population) which probably reflects a mixture of functional capacity, disuse and illness related muscle wasting. It’s probably worthwhile not having small calves, it may make you a little LESS efficient as a runner though (it’s a physics thing, don’t worry too much - it’s less controllable than many would think, see below discussion on load in the lower limb).
Falls Risk
Whilst I have already touched on this, it does deserve some more air time. Yes, I have a very warped view of this given my time as both a podiatrist (trying to prevent falls) and a doctor (seeing the consequences of falls) but avoiding falls should not be understated. Mortality and morbidity post fall is significant as I touched on in my article on bone health.
Feet that can better adapt (mobility) and overcome (strength) challenges from the surface you are on are two aspects of limiting falls risk. Likewise, proprioception is part of this, though this is largely about avoiding diseases, such as diabetes, causing peripheral neuropathy (loss of sensation in the feet) and footwear (or lack thereof) choice. On this note, if choosing footwear for those at risk of falls, it is pertinent to avoid shoes that are high off the ground (or high heeled), choose those have good grip (one reason being barefoot can be a problem and is a falls risk in the elderly is slipping), and fit & fasten well. Ideally they should be fairly light too (to be honest in footwear there is never an advantage of being heavy, though it may be a worthwhile tradeoff in certain circumstances).
The Barefoot-Shod Continuum
The ends of this continuum likely don’t need much explanation as much as exclamation/being made explicit. They are, of course, being truly barefoot with the other end being business/formal footwear (men’s business shoe or lady’s high heel).
The features that colour the continuum between these include:
Heel height (sometimes called ‘pitch’), specifically the delta/difference between heel and forefoot.
Stack height (sole thickness in essence - think platform shoes vs high heels; the former has more stack regardless of the pitch).
Shape, in running shoes this is sometimes called an ‘anatomical toe box’ or similar. It effectively boils down to the shape of the shoe allowing your foot to splay, especially the forefoot (the opposite of most formal shoes which are pointy).
Flexibility, this is as you’d imagine. How stiff are the shoes and in what planes? This includes the upper and features like a heel counter (stiff, often plastic, cup that sits behind the heel of many running shoes but other shoes too).
Features. This is a bit of a ‘catch all’ and quite specific to the running shoe market but I am sure other examples exist. It refers to features that by design or inadvertently look to change foot motion or function (we don’t get into the merits of this or whether it’s possible). Traditionally this may have been features aimed at preventing ‘pronation’ (inward rolling of the feet), often using a higher density foam on the inside of the shoe (see many shoes from around 2 decades ago). More recently this may be features like carbon fibre plates.
It is extremely difficult to place any one shoe on the continuum or quantify the role one of these factors plays compared to another. The likelihood is that each individual will find certain aspects more or less stressful to their own individual situation, for example those with tight calves/reduce range of motion at the ankle will find the pitch to be the most stressful factor. Thus if trying to move down the continuum, these individuals will likely tolerate other changes better than changes in pitch. Thus there are arguments to start by change heel pitch first (it will have the most impact) or the other stuff first (you can tolerate more stress from those changes) - the good news is you’re an adult and you get to choose.
How to Start Going Barefoot
A quick note here; I am not your practitioner and don’t know your situation. I am trying my best to create a resource that enables you to understand things and make some decisions and/or work with your practitioner. This is intentionally broad to try help you - ‘give a man a rod’ and all that...
Firstly, where your start is dependant on a number of variables:
What your normal footwear is
How much time you currently spend in footwear that is close to barefoot
Age
Injury history
Range of motion
Where you get most of your load from (ie work/life vs training)
Based on these and your preferences, there are broadly two ways to go about things:
Progressively move down the continuum from where you are towards more ‘barefoot’ types of footwear.
Start exposing yourself to barefoot (or much more barefoot on the continuum) time.
Progressively using more ‘Barefoot’ Footwear
This approach effectively means purchasing, and progressively using, shoes further down the continuum towards barefoot. This may be a habitual daily shoe for work or indeed a training shoe (or both). It is certainly worth considering relative durations and intensities here, that is, a nurse working 40 hours a week on her feet and running 3 times a week has a majority of load accumulated during work hours, not training and vice versa a desk worker may accumulate much more load casually or in training.
This approach may have a component of alternation too, for example, instead of a straight swap of work footwear you may start rotating in shoes that are closer to barefoot slowly over time.
In essence, the more gradual and progressive you can make this approach the better, stepping back (metaphorically) if you have any issues from a stiffness or pain perspective.
Progressively using more Barefoot Exposure
In this approach you progressively collect more time without (or in minimalist) footwear. I’d recommend building this up by a measure of mins/day (maybe 5-10min blocks) and progressing it as infrequently as weekly or monthly. So functionally something like 10mins/day for this week or month, 15mins/day for next week or month.
As with the previous approach, any soreness, stiffness etc may be a good sign to have a day off or not progress for a while.
The Problem with Load and Lower Limb
The above may seem overly cautious and that’s a very fair point. Ignoring the need for this given that it is general advice, one of the reasons is around load quantification which is very difficult as I touched on here. Beyond quantifying the load (either in general or of the added load) one challenge with the lower limb is deloading. In essence, what I am saying is that in the lower limb putting the metaphorical toothpaste back in the tube is SO HARD! In working with athletes I would often need to modify load and doing so in the upper body (for a shoulder for instance) was quite simple, as the majority was sporting related. The lower limb, however, could be exceedingly difficult. Think about the nurse scenario I mentioned above, how would one reduce lower limb load for that individual? You get the point.
This means that an overly cautious approach is pertinent, the cost and nuisance of doing too much vastly outweighs the cost of doing too little or the benefit of progressing slightly quicker.
Special Cases
There are a couple of specific scenarios to touch on that deserve some air time and probably in a stand alone section like this, rather than elsewhere.
Orthotics
Be they ‘off the shelf’ or customised, prescribed by a practitioner or self-prescribed, these will generally change the forces applied to your foot and lower limb in one way or another - this could get technical quick, so let’s leave it there. Given this, they’re in effect, a step further AWAY from barefoot and mean that extra care should be taken to go barefoot or towards it. They probably warrant approach 1 rather than 2 above and mean you should be working with the prescribing practitioner if there is one. In taking approach 1 it may be pertinent to use a mix of time without the orthosis in your normal shoe and time with it in one further down the spectrum towards barefoot.
Flip Flops
Also known as ‘Jandles’, ‘Thongs’, ‘Pluggers’, ‘Slides’, etc etc etc. These tick a lot of boxes towards being more towards the barefoot continuum. Generally they’re flexible, flat and are pretty close to being barefoot. All of this is true BUT, they also require you to work to hold them on. That is unless you’re wearing crocs in sport mode, or have some other fastening mechanism for the heal. As a result the muscles of your feet have to work HARDER than being barefoot and this can cause issues in itself. Enough so that many clubs in the Australian Rules Football (it’s a crazy game with SOOO MUCH running - watch this if you aren’t familiar and are interested) have banned flip flops!
A quick note on Birkenstocks - astute readers would probably have already deduced these are somewhere between everything; flat, but with some arch support and are fairly stiff. Don’t get too in the weeds or worry too much about nuances here but yes, they’re less barefoot than most alternatives.
Does this mean you should or shouldn’t wear flip flops?
You’re all adults, you get to choose - the goal of this piece was empowering you to make your own decisions. Much like diet, perfection may not be attainable or necessary for many (or most) so something that looks, sounds or feels like ‘balance’ to you is probably the goal.
Thankfully, barefoot time and use of minimalist footwear is no longer an obscure fascination of mine as much as it is part of the current zeitgeist. So feel empowered on the how, encouraged by the why and inspired by the when.
References
Dan Robbins. Muscle biomechanics in Human Orthopaedic Biomechanics, 2022.
McKeon PO, Hertel J, Bramble D, et al. The foot core system: a new paradigm for understanding intrinsic foot muscle function. British Journal of Sports Medicine 2015;49:290.
Sullivan J, Pappas E, Burns J. Role of mechanical factors in the clinical presentation of plantar heel pain: Implications for management. Foot (Edinb). 2020 Mar;42:101636. doi: 10.1016/j.foot.2019.08.007. Epub 2019 Sep 3. PMID: 31731071.
Xu J, Saliba SA, Jaffri AH. The Effects of Minimalist Shoes on Plantar Intrinsic Foot Muscle Size and Strength: A Systematic Review. Int J Sports Med. 2023 May;44(5):320-328. doi: 10.1055/a-1908-8867. Epub 2022 Jul 25. PMID: 35878616.
Kelsey JL, Procter-Gray E, Nguyen US, Li W, Kiel DP, Hannan MT. Footwear and Falls in the Home Among Older Individuals in the MOBILIZE Boston Study. Footwear Sci. 2010 Sep;2(3):123-129. doi: 10.1080/19424280.2010.491074. PMID: 22224169; PMCID: PMC3250347.
Ceolin, C., Acunto, V., Simonato, C. et al. New Perspectives in the Association between Anthropometry and Mortality: The Role of Calf Circumference. J Frailty Aging 13, 108–115 (2024). https://doi.org/10.14283/jfa.2024.4