Stepping on Nails

Feet from the Barefoot Hikers of VA

A wonderful article on barefoot living entitled Living Without Shoes appeared on ABCNews.com today. Overall, I thought the writer (Meg Wagner) did a fantastic job of finding the right people to interview (myself excluded) and presenting an accurate picture of why many of us choose to go barefoot. Reporters, however, seem to have a genetic need to balance every position with a counter-position (I'm not neccessarily opposed to that) and so Wagner interviewed a podiatrist to give the standard barefoot-is-dangerous warning from the medical community. Unfortunately, the podiatrist Wagner interviewed didn't even provide scientifically sound reasons for keeping your shoes on.

Podiatrist Dennis Frisch says that he is not anti-barefoot and that barefooting has its place, but "outside isn't that place." He says that "a blister or corn caused by wearing an uncomfortable shoe will take a couple of days to heal on its own. But a cut caused by stepping on undesirable material while barefoot could potentially become infected and be a severe medical problem."

Okay, here is where I have my problem.

Any cut has the potential to become infected and be a severe medical situation, but which is better... cutting a shod foot or a bare one? Is it better to step on a nail barefoot or wearing a sneaker?

A number of scientific studies have been published on the subject (references below). In all of them the conclusion is definitive: shoes increase the risk of infection, particularly infection by pseudomonas bacteria.

Pseudomonas does not live on human skin, but it thrives in shoes (indeed, pseudomonas is the cause of that notorious stench). It's thus not surprising that in one study it was found that roughly 50% of children wearing shoes acquired a pseudomonas infection but zero barefoot children did. It should be noted that a pseudomonas infection can be seriously dangerous, even fatal, especially when delivered deep into the body in a hard-to-clean puncture wound. In addition, I've had more than one doctor tell me that it's not uncommon for a millimeter-sized piece of shoe sole to get embedded in a puncture wound when wearing shoes. Having a foreign object buried a half-inch into your body is rarely a good thing.

So, based on the scientific evidence, Dr. Frisch should be warning us that 'stepping on undesirable material [while shod] could potentially become infected and be a severe medical problem.'

Oh, well.

References:
1.Fisher MC, Goldsmith kJF, Gilligan PH. Sneakers as a source of pseudomonas aeruginosa in children with osteomyelitis following puncture wounds. J Pediatr 1985; 106: 607-09.
2.Green NE, Bruno j. Pseudomonas infection of the foot after puncture wounds. South Med J 1980; 73( 146-49).
3.Jacobs RF, McCarthy RE, Elser JM. Pseudomonas osteochondritis complication puncture wounds of the foot in children. A 10 year evaluation. J Infect Dis 1989; 160: 657-61.
4.Jarvis JG, Skipper J. Psedomonas osteochondritis complicating puncture wounds in children. J Pediatr Orthop 1994; 14: 755-9.
5.Johanson PH. Pseudomonas infections of the foot following puncture wounds. JAMA 1968; 204: 170-72.
6.Laughlin TJ, Armstrong DG, Caporusso J, Lavery LA. Soft tissue and bone infections from puncture wounds in children. Western Journal of Medicine 1997; 166( 2): 126-8.
7.Niall DM, Murphy PG, Fogarty EE, Dowling FE, Moore DP. Puncture wound related pseudomonas infections of the foot in children. Irish Journal of Medical Science 1997; 166( 2): 98-101.
8.Verdile VP, Freed H, Gerard J. Puncture wounds to the foot. J Emerg Med 1989; 7: 193-99.