By Michael Buttgen on Barefoot and Grounded – October 4th 2010
While there are many of us lay people out there who embrace unshod living, it’s rare to find people in the medical profession who are supportive of such activity. Medical providers like podiatrists and sports orthopedists tend to have a very shoe-centric way of thinking about the role of feet and our locomotion. A while back I ran across the Twitter account of Steve Bloor, DPodM, SRCh, HPC, a podiatrist in the United Kingdom. Using the Twitter handle @NaturalFeet, Dr. Bloor was posting “tweets” that promote barefoot activity as a way to have healthy feet. How refreshing! After getting to know him a bit, I asked if he’d be amenable to an interview on this blog. He graciously accepted. The following are his responses to my questions. I think they offer an interesting insight into the field of podiatry and how it approaches feet and barefoot activity.
Q: Tell us a little about yourself, your education, certifications, etc.
I am 46 years old and been in Podiatry for 25 years. I am married to Liz and we have 4 children. Two boys and two girls. Our oldest is 18 and youngest 10 and they keep us young. I trained to degree level back in the mid-80s and after graduating in Podiatric Medicine specialized in Musculo-skeletal Podiatry dealing with orthopaedic lower-limb and back problems associated with poor biomechanics.
About 12 years ago a Podiatry colleague and friend, Andy Horwood, and I were the lead designers of a range of customisable foot orthoses which are widely used in the UK and also other parts of the world. We both regularly lectured and taught workshops, throughout the UK, on the biomechanics of lower-limb function and the prescription and fitting of functional foot orthoses. As founder members of the British Podiatric Biomechanics Group we helped to set-up what is believed to be the first Masters Degree programme in the world in Clinical Podiatric Biomechanics. Andy went on to become one of the main lecturers on this Masters Programme which runs at Staffordshire University, England. I continued to lecture around the UK as guest lecturer for Healthy Step UK and Bailey Instruments who are major suppliers to the British Podiatry Profession. Our customisable foot orthotic devices are now used by over 80% of UK NHS Podiatry Departments as well as many private practices.
Q: What made you want to get into the field of podiatry in the first place?
My initial interest in Podiatry as a profession came through my own personal experiences with running injuries. I realized that my own legs and feet were extremely important to my running career and since I was injured I could empathise with injured athletes. So it became a personal mission to help other athletes to run without injury and help injured athletes overcome their injuries wherever possible. I became fascinated in the single most complex human activity -human gait. Of course I also enjoyed treating non-athletes too. I developed my clinical practice to the point where I could specialise exclusively in Musculo-skeletal Podiatry; one of the first to do so in the UK.
Q: In your schooling and training, what was the general philosophy behind the practice of podiatry?
What role did feet play in the body’s overall health?
In my schooling as a podiatrist and at post-graduate level there was, and is, a general understanding that our role in foot medicine and surgery is to help the patient ambulate, in footwear, without pain. To assist the body to function in gait as near to the optimum norm as possible. Normal gait is always considered to be with footwear.
Although we knew that our job was to negate the damaging effects of shoes, never once did it occur to me, nor was it ever discussed, that the patient could ever choose between barefoot and shoes. Our goal was to advise the patient to choose “sensible shoes” so as the foot could work at its optimum.
We also believed that at least 70% of the world’s population had poor bio-mechanical function of their feet and legs and therefore needed our podiatric foot orthoses. That most people are born with “broken feet”. That evolution/creation made a big mistake and we function best in footwear.
We believe that we, as podiatrists, have the answer to most people’s foot and lower-limb problems. One eminent paediatric podiatrist even went so far as to openly advise that all children should wear foot orthoses to optimise foot and ankle development. We believed that the foot developed better if supported in a correct alignment by foot orthoses and supportive “sensible” shoes.
It is believed that only a few very special people have “perfect biomechanics” of their feet and legs, and these are the only ones who can run without supportive running shoes, the majority of us needing stability shoes and orthoses in order to prevent injuries. We believed the foot cannot and should not support itself or it would suffer long-term damage.
Amazingly, we never studied true natural, barefoot, primal gait. We only ever studied shod gait or the barefoot gait of people who have always worn shoes, which I now realise is different from true natural gait.
Our medical philosophy is based around the foot playing a very important role in the health of the rest of the body because of its unique position as the first and only part of the body to hit the ground. It is therefore believed that like a tall building, whatever the foundations do affects the rest of the body. So every part of the body is affected somewhat by the foot due to its mechanical function as the structural foundation.
We acknowledge also the fact that other structures distant from the foot can likewise affect the foot. So abnormal muscle function farther up the leg and back can cause compensatory motion in the foot. We assess the mechanical function of the pelvis and lower-limb joints and muscles all the way down to the foot joints looking for abnormalities. We assess stance and gait looking for structural and functional abnormalities and their compensations. Of course, we also assess neurology and circulation to the lower-limb as well as checking the health of skin and nails.
Q: Would you consider yourself a barefoot-friendly podiatrist? Why or why not?
I now consider myself not just a barefoot friendly podiatrist, but a Barefoot Advocate. I now believe very strongly that most feet, given a chance, can support themselves. That feet function best without the hindrance of shoes. I believe that every shoe compromises foot function and that with chronic, long-term wear they damage the muscles, joints, nerve pathways and other structures within the foot.
I now believe that supportive shoes, and orthotics when worn, create a dependency which worsens with time. I now advocate, and actively promote, barefoot walking and running as a preventative as well as a rehabilitative tool. I am proud of being a Barefoot Podiatrist, both in action and word.
I promote barefoot walking and running to my patients by a “Barefeet Welcome Here” sign in the clinic window, folders of Barefoot news articles and research papers in the waiting room as well as copies of The Barefoot Book by Daniel Howell for patients to read whilst waiting for their consultation. I sell The Barefoot Book and the book Born to Run as part of the treatment advice to patients. I teach rehab exercises to strengthen the feet and ankles and have a barefoot website http://www.naturalfeet.co.uk to give my patients further advice and encouragement.
I also sell ‘Minimalist Footwear’ for those patients who will not, or cannot go the whole way to becoming completely barefoot. I sell therapy products for bare feet like moisturising creams and rough skin files to smooth any rough dry skin on heels.
And finally I walk and run barefoot 24/7 to set the example (apart from at church where I cover my feet out of respect for my church leaders’ requests).
Q: Have your approaches to podiatry and the way you treat patients changed over the years? How so and why?
My approach to treatment has changed dramatically over the last few years as I have incorporated more rehabilitation into the treatment programmes and not relied so much on orthoses for continued postural and functional control.
However, over the last 6 months that change has become a massive paradigm shift in thinking as I now believe the foot is well designed for supporting itself and the rest of the body if it is given a chance to do so without being hindered by footwear.
I also believe that most people do not have significant bio-mechanical mal-alignments, but rather weakened muscles and poor postural control due to over-reliance on footwear. Most osseous bio-mechanical problems are irrelevant in barefoot walkers & runners.
So I now place most emphasis on rehabilitation rather than orthotic control and also encourage my patients to walk & run barefoot as much as possible. I will often mobilise or manipulate stiff joints to improve foot and leg function then teach patients exercises to maintain and increase that movement, along with barefoot exercise. Sometimes I will tape the feet to encourage better function.
As we live on a beautiful peninsula jutting out into the Atlantic Ocean I prescribe barefoot beach walking and running to strengthen weak foot and leg muscles and to mobilise stiff joints. I also refer patients to our clinic physiotherapist and personal fitness trainer where needed to aid rehabilitation.
I still prescribe foot orthoses sometimes, though only temporarily when tissue stress relief is required to aid healing the injured structures and to re-educate the muscles by improving postural alignment.
Q: How do your patients react when you recommend barefoot activity? Do they embrace it well or are many hesitant to bare their feet for better health?
Surprisingly, quite a few patients (mainly over 40 years of age) used to walk barefoot as children and are very accepting of the concept.
Because we live in a coastal area with lots of seaside resorts and beaches most people here are okay with barefoot walking in these areas and around their houses and gardens. Most do not want to walk barefooted in public areas in town or shopping centres. I have very little problem persuading patients to go for barefoot walks up & down the local sandy beaches as part of their rehabilitation exercises.
The majority of my patients are really excited to discover that they won’t have to wear orthotics for the rest of their lives if they strengthen their feet. Some prefer to wear minimalist shoes like Vibram FiveFingers and Vivo Barefoot shoes to help with strengthening the foot during walking and running. None have become barefooters to the extent they go out in public except at the beach, though in time that may happen as a few people have been keen enough to buy Daniel Howell’s The Barefoot Book and Born to Run. I have only been practicing Barefoot Podiatry for about 4 months. It took me a couple of months to come to terms with barefoot walking being better than shod and rethinking all my old podiatric bio-mechanical theories of gait. During that time I had many sleepless nights whilst I adjusted my thinking. Some days I even began to believe I would have to give up working in my profession because it didn’t fit with my new beliefs about barefoot gait. I have now become comfortable with my new Barefoot Podiatry paradigm. And am excited to have a new professional focus.
I feel I am on a mission to help other health professionals understand the barefoot gait paradigm.
At the end of this month I will be lecturing to podiatrists in our county and in November I am lecturing for 7 hours at the British School of Osteopathy on Barefoot Podiatry.
Q: If someone were interested in more barefoot activity, what recommendations do you have for them to get started?
When a patient is keen to do some barefoot walking or running I tend to start them off with foot strengthening exercises first, because most of my patients are already injured (I reckon 90% of patients attending podiatrists’ clinics are injured by the chronic wearing of shoes). I warn them to be cautious about getting carried away with enthusiasm and advise a slow, careful transition into barefoot activities by going for short walks at first and gradually increasing the time spent barefoot walking. I also prescribe barefoot beach walking or running, and encourage them to walk barefoot around their home and garden. If they are amenable to the idea of barefoot hiking I get them to do that too.
Some of my patients buy The Barefoot Book &/or Born to Run and I advise them to use my naturalfeet website to learn more about barefoot activity.
For those patients who believe in the barefoot concept yet won’t or can’t go barefoot, I advise and sell them Minimalist Footwear.
Q: What role do you believe footwear should play in our lives, if any?
I believe footwear should play an important, but infrequent role in our lives for protection just like we use gloves for our hands. And just like gloves we should remove the footwear as soon as the purpose for them as been achieved.
There are times when we need to protect our feet from extremes of cold and heat just like when our ancestors first started to wear leather shoes thousands of years ago. And of course when carrying out jobs where there is a risk of physical injury to our feet. Some people, though not needing them for physical protection, wrongly will need to wear shoes for their employment due to cultural expectations of their employer or clients. In these cases I would advise they wear minimalist shoes to reduce the negative effects on their feet and of course go barefoot whenever they can.
In saying that shoes may be needed for protection, I believe this is actually very rare.
Most barefooters become more aware of their physical surroundings by being barefooted and so are naturally more careful. It seems that the sensory perception of the surrounding environment is enhanced by being barefoot so most of the risks of physical harm are never actually realised, just like we don’t routinely hurt our hands during the day even though we may place them at risk of harm during the course of our work or recreation. So I actually think most people could go barefoot more than they at first believe. I believe the biggest barrier to barefoot activity is psychological!
Q: Are there any types of people for whom you believe barefoot activity is inadvisable or a lost cause?
The biggest barrier to barefoot activity is psychological! Some people will never enjoy barefoot activity because their minds cannot or will not accept it.
On the other-hand there are sadly a few people who would like to enjoy barefoot activity, but cannot or should not try to walk barefoot much or at all, especially outdoors.
These few people would find it difficult or impossible because of physical disabilities within the foot and leg. Some of these disabling problems are minor & others more serious.
There are some people who have weakened or damaged their feet so much through chronic overuse of shoes that their feet have become dependent on footwear. Some of these problems include atrophy (thinning) of the plantar fat pad , arthritis of the foot joints (particularly mid-foot joints) & damaged muscle tendons through chronic flat-footedness. Other people may have muscle disease which affects their ability to rehabilitate, or a neurological disease which inhibits their tactile sensory perception, like diabetic neuropathy.
I would like to make the distinction here between those who have diabetes mellitis with no sensory neuropathy and those with damaged nerves in their feet; the former are perfectly safe to carry out barefoot activities whilst the latter are obviously at risk.
Q: Many podiatrists seem very hesitant to recommend barefoot activity due to concern over liability if patients end up cutting their feet or otherwise getting hurt by it. There are also arguments that recommending barefoot activity goes against “best practices” and that there’s no scientific evidence to back up such a recommendation. How would you respond to that?
In the UK patients are not as litigious. They view barefoot activity as a risk they take upon themselves. When I explain how we are evolved/created to walk and run barefoot and I explain some of the anatomical features which make barefoot activity natural, they see the logic in it and they can very easily understand and believe it. Very few see the logical need for shoes, though most are reluctant to walk barefoot in public due to social stigmas and cultural expectations.
As far as being in compliance with best clinical practice, in the UK currently the vast majority of podiatrists preach that supportive shoes are required, but there is no ‘Best Practice’ policy of which I am aware. I would have no qualms about defending myself if anyone did take issue with me preaching the barefoot line. There is more than enough scientific research to back up our barefoot position and very little if any to back up the shod position as being healthy! You just have to look at the references in Professor Howell’s book to see that.
In fact, I believe it is the podiatrists who preach that shoes are required for maintaining healthy feet that are in a difficult scientific position. This is part of the reason I have taken my barefoot stance because I was unable to defend that position any more. Rather like the Tobacco industry should have been more open about the risks of cancer from smoking cigarettes, I feel that as a podiatrist I need to warn my patients about the risks from shoes.
I believe in doing what is right and letting the consequences follow!
Finally, as well as believing that natural barefoot gait should be the norm I tried the experiment myself. I was challenged by a physiotherapy friend to do what I believed. So in July I did. I have been barefoot 24/7 ever since (apart from a couple of times at church out of respect for my church ministers wishes –but he now understands and is more accepting –and also when I perform nail surgery in order to protect my feet from blood and chemicals).
I am now barefoot at work in my clinic, out hiking through the woods and on the cliff paths. I have also started running again after 20 years, this time barefoot. I have run up to 3 miles so far, with none of the problems which stopped me running when I wore running shoes. The personal experiment has worked for me and is working for my patients too.
What is so satisfying is having the ability to heal my patients from injuries which have resisted treatment with orthotics and shoes prior to introducing barefoot strengthening exercises, but now they are doing well.
Q: Final thoughts?
The future is exciting for barefooters. It is wonderful to see the growing acceptance of people in our modern shoe-oriented Western Societies beginning to realise the fallacy and misuse of footwear.
It is great to see some enlightened shoe manufacturers starting to make shoes which allow more of the natural function of the feet with minimalist footwear.
The ball has been cut and is rolling, it is gathering speed and cannot be stopped. It is a blessing to be involved in this great cause! To be able to improve people’s health through enlightening them of the dangers of the overuse of shoes. For the first time in my 25 year career I feel I really understand the cause of foot problems and now have a tool to cure people. Primal Gait!
Let’s sound the warning cry to the world to “Eschew Shoes!”
I thank Dr. Bloor for his enthusiastic willingness to participate in this interview and his very interesting, informative responses. Please understand, however, that his answers should not be used as medical advice and Dr. Bloor and I waive all liability from your use of the information in his responses. I personally recommend that my readers seek out medical advice from their own medical providers to make sure that you are physically fit enough to begin barefoot activity and to rule out any other diagnoses that otherwise could complicate or detract from a barefoot lifestyle –or even be aggravated by going barefoot.