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.

A Letter From Belgium

Dear Dr. Howell,

As soon as I heard about your book I decided it was a Must to read and tried to obtain it. Living in Belgium it took me nearly four months to acquire it through Amazon. It was worth every second of the wait. As soon as I got it I read it through a first time in four hours. WONDERFUL !!!

I find it amazing and a great quality that a scientist is able to get all the scientific information across in simple words that everybody can understand.

The BFB explains so well and in such detail how the human foot functions or is supposed to, and how shoes interfere with the functioning of nature’s creation.

It was, and still is, great to read what shoes are doing to you, from just a benign blister, ouch, to deformities that may require surgery. I never gave a thought to the quantity of chemicals that go into the production of shoes and remain there.

Thank you for debunking the myths, although laws and regulations here in Europe may be different from those in the US, I don’t believe that there are any laws over here that make walking or driving barefoot illegal, but as in the US it’s a widespread belief.

I have been barefoot myself for the last 38 years, that is for about 95% of the time and I still find it a wonderful way of living, walking, hiking. I have been working as a nature guide for the last couple of years and work barefoot for most of the time. This usually raises eyebrows and provokes comments and questions to which I respond to the best of my knowledge. I’m sure that your book will be most helpful in the future to be able to better explain the “why” question.

The only negative comment I could mention about your wonderful book is that it’s pretty hard to obtain it on the old continent. None of the major bookstores could obtain it.

Thank you for your kind comments, dear reader in Belgium! I'm glad it was worth the wait.

[Note: The Barefoot Book is now available for nook and soon for the kindle and other electronic devices. That should make global access much easier!]

Skechers Gets Sued

UPDATE: Skechers is getting into more legal trouble as even more people are getting injured by these shoes. Read about it here.

Skechers, the maker of Shape-Ups toning shoes, is being sued by a woman who claims the shoes severely injured her body. Holly Ward wore the shoes at work and during her leisure time for five months before developing severe pain in her hips. It turns out she obtained stress fractures in both of her femur bones. The femur, incidentally, is the largest and heaviest bone in the body; fracturing that bone is no small feat.

I warn of the dangers of these types of shoes in The Barefoot Book.

Skechers Shape-Ups are modeled after the MBT shoe. Both shoes possess a rounded sole that purportedly offers a workout just by wearing them. Scientific studies have shown that MBT shoes work muscles differently, but there’s no evidence that these shoes ‘tone’ your body, especially the buttocks which are undoubtedly the focus of consumers. However, it is obvious (or at least should be obvious) to anyone who knows anything about the biomechanics of human ambulation that these shoes are dangerous. Not only are MBT and Skechers unstable to the point of risking falls, they alter the human gait so dramatically that injuries are bound to happen. Just ask Holly Ward.

How do toning shoes alter the human gait? They convert the natural stepping motion into a rolling motion. Unfortunately, this is not really unique to toning shoes; virtually all shoes make this conversion, but toning shoes take the ‘rolling step’ to the extreme.

I hope this lawsuit will educate more people to the hazards of toning shoes. Perhaps this will move us one step closer to having warning labels put on shoes that dramatically alter gait.

Now, if only one of those 20,000 women per year put the hospital by high heels would sue their shoe-maker!

The Answer To The Question.

I recently received a question from a woman who wants to go barefoot more often but finds it painful. Rather than responding directly to her I want to respond publicly because I think her real issue is not with her feet but with our culture. Consequently, it’s an issue all of us who want healthy, shoeless feet must deal with. Before I respond, let me share with you her comment in its entirety:

“I have very pronate feet, fairly wide hips, and an abnormally large Q angle. When I have gone almost an entire day barefoot, my back, hips, knees and feet are aching and painful for the next day after - there have been nights where I have had trouble falling asleep because of how much discomfort going barefoot inflicted on my body. In other words, for me going barefoot HURTS! I've worn orthotic inserts since I was about ten years old and this has affected the types of shoes I've worn: I have to find wide shoes that accommodate my inserts, I can't wear dress shoes with heels, and I can't wear sandals. Would going barefoot more often help someone like me, in your opinion? Because all it's ever brought me is more pain and discomfort.” – Kaje

Let me start by focusing on the phrase “When I have gone almost an entire day barefoot…”

Walking barefoot is natural; walking in shoes is unnatural. Shoes demonstrably (and negatively) change the way we stand, walk and run and thus create a host of foot problems, not the least of which is muscle atrophy and skeletal deformation since the shoe is essentially a binding cast. Shoes affect more than the feet: the elevated heel found in virtually every shoe demands postural adjustments all the way up the body and the narrow toe box, toe spring, arch support and elevated heel conspire to encourage over-pronation, which also affects your ankles, knees and hips. In addition to shoes, this dear woman has worn orthotics since she was ten years old, but… she has never spent a full day barefoot. What Kaje is saying it similar to: "When I take the cast off my arm for almost an entire day my elbows and shoulders hurt." Unfortunately, this situation describes most of us in ‘civilized’ society and there is no hope that we can ever have strong, healthy feet if that’s the case.

The daily wearing of shoes has wrecked our feet. If you’ve worn orthotics your feet are doubly-wrecked. Our feet have literally been debilitated by footwear and healing can only come by removing the shoes and rehabilitating our feet by miles and miles and miles of barefoot walking and running. For better or for worse, the brutal truth is that the damage done by thousands of hours of shoe wearing cannot be undone by going barefoot a few hours here-and-there on nights and weekends.

Kaje, you say your feet hurt if you spend too many hours barefoot. I predict the pain would subside if you could stay out of shoes for an entire month or two, but can you do that? If you could, your feet would become rehabilitated and stronger and healthier than ever. Will your circumstances permit you to remain barefoot for weeks or months at a time? Will your feet hurt during the rehab process? Probably yes. The soreness you presently feel from going barefoot stems from the fact that you are using muscles in ways you don't use them in shoes; it's similar to the soreness you would feel after a day of skiing. However, if you could commit to spending just several months barefoot [1], your feet will strengthen, your gait will correct itself and your entire body will benefit. (Indeed, with rehabilitated feet and gait your wide hips and Q-angle will probably not be an issue). At the end of the rehab process, putting on shoes will feel so obviously unnatural and awkward you will likely not do it. Welcome to full-time barefooting.

And this is why we as a society must allow bare feet back into the public square. There is a growing number of people who are fed up with the ill-effects of shoes on their bodies and they want to exercise the healthier option of living without shoes as much as possible. Consequently, our culture must adjust. I think our culture will adjust because the barefooting ‘movement’ is growing rapidly and once you’ve experienced the benefits of going shoeless there is no going back! Personally, I’m at a place where I snub the social pressure and refuse to let anyone make me put on shoes [2]. More and more people are adopting this attitude.

Finally, I want to add that it’s high-time podiatrists took the blame for our wrecked feet. Society has told us to wear shoes, but podiatrists have done nothing to oppose this and have in fact endorsed shoe wearing and – even worse – carelessly promoted orthotics. It’s time for podiatrists to apologize [3] to Kaje and inform the public of the many negative consequences of wearing shoes and endorse and promote barefoot living for healthier feet.

So Kaje, the answer to your question – as always – is to ditch the shoes. I hope you can keep them off long enough to rehabilitate your feet and reap the benefits. Let me know how it goes!

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1. I say “just” several months barefoot because, after all, you’ve spent years in shoes.
2. The only exception being my boss because – other than the shoe rule – I really love my job. If I didn’t love Liberty University, believe me I would ditch the job and move; there are hundreds of colleges out there that would let me teach barefoot.
3. There is a place for orthotics and maybe Kaje genuinely needs them, but orthotics should always be the exception, not the rule.

I Have A Dream

A few weeks ago we celebrated Martin Luther King, Jr. day. We paused to remember the (peaceful) struggle of American blacks against an oppressive, discriminatory society. We took a day to celebrate a man who dreamed America could be different. I have tremendous respect for MLK, Jr., for his accomplishments and for his daring vision. On MLK day I gathered with my wife and three children around a computer screen to watch his “I have a dream” speech on YouTube. It is with utmost respect for the man and it’s in the spirit of his vision that I modify his words to apply them to my own dream, my own vision of an America free of oppressive discrimination.

You see, I have dream that Americans will one day be free to live barefoot. My dream may seem trivial, but it is not. It is not trivial because at its core it is a struggle against an oppressive attitude toward differences. It is a dream that we will stop shunning those who think outside the box. We say we celebrate such thinking, but we lie. In truth we actively oppress innovative thinking and it’s only through much toil and sweat on the part of such thinkers that real change ever happens among the masses.

I am white. I am educated. Indeed, I am privileged to be among the small portion (less than 1%) of the population with an esteemed doctorate degree – in biochemistry no less, one of those hard sciences that has obtained almost idolistic authority in Western thought. As ‘Dr. Howell, university professor’ I am a respected member of my community. As a barefooter, I have felt the sting of blatant and hateful discrimination: I have been called derogatory names; I have been denied a table at a restaurant; I have been forced off an airplane; I have been escorted by security to the nearest exit. Most ironically, I have been denied a seat on a bus by a black female driver. But I have a dream that one day doing something as healthy – and legal – as going barefoot will be acceptable to my fellow Americans.

I have a dream that little white children and little black children can play together barefoot in the gymnasium. I have a dream that one day employees will be recognized for the quality of their work rather than the price of their wingtips or pumps. I dream of a day when the ‘barefooter’ is applauded for making the more natural and healthier choice to shun her shoes; a choice made not only for the health of her feet but maybe because she also refuses to subvert herself to the role of temptress in high heels in order to be a corporate player.

Truly, I dream of a day when shoes (or the lack thereof) are a non-issue.

They say you can tell a lot about a man by his shoes, but I long for a day when we will be judged by our hard work, our commitment to excellence, our creativity and ingenuity… by the content of our character and not by the shoes on our feet.

Am I insulting Dr. King? Am I trivializing his dream or making a mountain out of a molehill? I don’t think so because ultimately my dream is not about feet, it’s about the end of discrimination in all its forms. It’s about acceptance. It’s about seeing the world a little more like God himself sees it, for we know that “man looks at the outward appearance, but God looks at the heart.” (1 Samuel 16:7).

So yeah, I have a dream. Won’t you join me? Together we can not only free our feet but we can enlarge our hearts to embrace all people despite our differences.

The Difference A Worldview Makes

A largely unknown reality of scientific research is that facts do not speak for themselves. Rather, they are interpreted within a framework called a paradigm, or worldview. Everyone has a worldview, and our worldview flavors the way we interpret information. Our worldview is largely formulated by the culture in which we find ourselves living. Scientists, though trained to be unbiased, are not immune to their culturally-induced worldviews.

For example, in a 2008 study researchers at Auburn University concluded that flip-flops were orthopedically hazardous.* While the research they performed was top-notch, I believe their conclusions were erroneous because their starting assumption – derived from their worldview – was mistaken.

What is their faulty assumption? That walking shod is natural. While they don’t explicitely state this assumption in their reports, it appears evident to me based on their conclusions.

The Auburn team observed that wearing flip-flops causes “sore feet, ankles and legs.” Indeed, this is often true when shoe-wearing people switch to flip-flops in the summer (it’s sometimes called ‘flip-flop-itis’). Auburn researcher Justin Shroyer notes, “We found that when people walk in flip-flops, they alter their gait, which can result in problems and pain from the foot up into the hips and lower back.” Mr. Shroyer is absolutely correct in that wearing flip-flops alters the human gait; what I believe he fails to recognize is that the alteration is a change back to the natural. Constant shoe-wearing had previously altered the subject’s gait to an unnatural one. Switching to flip-flops does cause pain in some people because the walker is returning to a more natural gait – one to which s/he is not accustomed.

Mr. Shroyer and his colleagues also observed that walking in flip-flops led to shorter steps (i.e., shorter stride lengths) compared to wearing athletic shoes. And he found that, in flip-flops, walkers’ heels hit the ground with less vertical impact force and they tend to grip more with their toes during push-off. These findings are consistent with those of other researchers in the field of foot biomechanics; however, the changes were considered abnormal and negative by the Auburn research team. Scientists are now realizing that these barefoot (and flip-flop) induced changes in walking lead to lower impact forces and less stress to leg joints than shod walking (due primarily to shock absorption by the arch and gait adjustments from tactile feedback), and this is generally recognized as a good thing. In addition, the Auburn researchers imply that it’s unnatural to use the toes for push-off and they don’t acknowledge that chronic shoe-wearing is responsible for the shortened tendons and weak muscles that cause the pain flip-flop users feel in the first place. Instead, because they apparently regard the shod gait as natural, they label flip-flops as “bad” and caution folks against wearing them. This is a logical conclusion if you start with the assumption that walking in shoes is natural. If instead you assume that barefoot walking is the natural condition, then the conclusion you draw from their study is very different.

The Auburn study was performed in 2008. In 2011 we now realize that comparing the 'flip-flop' gait to the 'shod' gait is the wrong comparison. Instead, we should be comparing the 'flip-flop' and 'shod' gaits to the 'barefoot' gait. When we do that, we see that walking in flip-flops is more like walking barefoot and is therefore the healthier shoe option.

Different Assumptions = Different Conclusions

Observation	Interpretation #1 (assuming shod gait is natural)	Interpretation #2 (assuming barefoot gait is natural)
1.  wearing flip-flops resulted in pain in feet, ankles, hips and legs	walking in flip-flops causes abnormal & painful changes in gait	walking in flip-flops mimics barefoot walking & reveals unnatural shoe-induced changes in gait
2. wearing flip-flops resulted in shorter stride lengths	long strides should occur (predominantly in front of the body’s center of gravity?)	short strides should occur (predominantly below and behind the body’s center of gravity?)
3. wearing flip-flops resulted in less heel impact forces	gait pattern should be heel-to-toe and heel should take most impact (like in a shoe)	gait pattern should be short leading to landing flatter on arch which absorbs impact forces (as when barefoot)
4. wearing flip-flops resulted in more toe-gripping action	the body should roll on the forefoot into the next step.  (function of the toe appendages?)	the toes grip the ground as the body is pushed into the next step; flip-flops may induce unnatural toe gripping

* http://education.auburn.edu/news/2008/june/flipflop.html

2011 - The Year of Barefoot Living?

Last year was a banner year for barefooting. Although Christopher McDougall’s Born to Run was released in 2009, I think it had its biggest impact on the world in 2010. This is probably because the book was published in July; people spent the next few months (i.e., the winter 2009) reading the book and then put it into practice in spring 2010. That summer several more related books hit the market: Jason Robilliard’s The Barefoot Running Book and Michael Sandler’s Running Barefoot continued the running-barefoot-is-best theme, but my book, The Barefoot Book, took the concept a step further and demonstrated how shoes are not just harmful when running but also when walking, standing and when just plain wearing them. Like Born to Run, The Barefoot Book was published in the summer. Will the public, after a year of experimenting with barefoot running and a winter to contemplate barefoot living, be ready this summer to take barefooting beyond exercise and into daily life? I believe the answer is YES.

If 2010 was the Year of Barefoot Running, then I believe 2011 will be the Year of Barefoot Living. Maybe I’m just filled with New Year wishful thinking, but I truly believe the tide will turn this year with respect to going barefoot in public. I base this hope on several observations:

1/ The Barefoot Book is generating a lot of conversation. Since the release of the book, I have been interviewed by The Washington Post, Popular Science magazine and dozens of radio shows from New York to New Zealand. I’ve appeared on national and cable television, the Drudge Report and even a documentary in Korea. Clearly, people are interested in the topic of barefoot living and the mainstream media is picking up the conversation. Wow! [Most of these can be found at www.thebarefootbook.com]

2/ Positive comments are on the rise. Every now and then an article appears online about some ‘barefooter’ or living barefoot. In keeping with the popularity of the subject, those articles usually generate a lot of reader comments. In 2010, there appeared to be more articles than ever on the subject and the comments seemed more positive than in the past (I haven’t done a rigorous study on this). My Washington Post article written by Daniel De Vise, for example, generated over 150 comments in just 48 hours. By contrast, the ten following articles written by De Vise obtained no more than 14 comments. The Today Show article about me garnered 128 comments and most of them were positive.

Online articles about barefooting still receive negative comments, but they are the same old comments we’ve seen for years (e.g., broken glass, dog poop, etc.). This time, however, those negative comments are being overwhelmed with intelligent responses debunking the myths. And when the article itself is negative, it gets slammed! The article “Poly students should eliminate barefoot trend” quickly received 26 responses, all which were critical of the article and in favor of barefooting.

3/ Barefoot running precedes barefoot living. In my own experience and that of many barefoot runners I know, barefoot running led to more barefoot living. It’s an obvious and natural next step. Once you experience the thrill of running barefoot you want to experience the thrill of driving barefoot, shopping barefoot and just living barefoot. No one denies that barefoot running went main stream last year. Will all those runners start going to the mall barefoot? No, but some will and all of them will be more open to the idea. And even those who don’t run see others running barefoot and so the idea that bare feet are okay in public is gaining traction.

The days are getting longer (in America) and summer is coming. Let’s make 2011 the Year of Barefoot Living!