Interview with Podiatrist and Barefoot Advocate Steve Bloor

Interview with Podiatrist and Barefoot Advocate Steve Bloor

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.

Enjoy:

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.

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Barefoot Lifestyle Interview

Barefoot Lifestyle Interview

Paul Mumford, an internationally respected Personal Fitness Trainer, interviewed me for his article in Ultra-Fit Magazine June 2014 from which he used excerpts from our interview. You can read Paul’s article on his own blog here: “Time To Get Naked”

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Below is our interview in full.

1. Firstly, how would you like to be described?

I’m a Musculoskeletal Podiatrist.

My focus is on natural barefoot gait as the basis for optimal foot & lower-limb health and movement. Understanding more about how the natural human foot functions barefoot on natural surfaces, informs & modifies my treatment choices as I consider the effects of all the unnatural influences exerted on the foot by footwear and man made surfaces which modify human gait.

I’ve been nicknamed by others as “The Barefoot Podiatrist” due to my practice of being unshod for 95% of the time.

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2. Your approach to podiatry has radically changed over the last few years. Can you explain what brought about this change and how this has altered the way you treat your patients?

I’ve been qualified for 26 years this Summer & in the profession for 29 years. From about 14 years ago I became involved in the design of a very successful range of foot orthoses for the correction of gait abnormalities with a company called Healthy Step.

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At that time, & up till about 4 years ago, I believed, like many podiatrists, that approximately 80% of the World’s population would be helped by wearing functional foot orthoses.

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The prevailing belief is that human beings function best when shod in protective & supportive footwear for almost all activities. Wearing shoes is seen by most in my profession as the norm. Not once did I consider that human beings could safely live a barefoot lifestyle.

In fact, as I stated above, not only did I believe that humans need footwear for optimal gait, but that approximately 80% of people also need foot orthoses to avoid injuries to their lower-limbs & backs.

I not only believed in prescribing foot orthoses for patients with musculoskeletal lower-limb injuries and pathology, but also using them for preventing problems from occurring.

Then, just over 4 years ago, I read an article in The Telegraph newspaper “Why expensive trainers could be worse than useless” about Chris McDougal and his experience learning to run barefoot with the Tarahumara Indians in Northern Mexico. I was totally surprised to discover that this indigenous American tribe could run long distances with little or nothing on their feet for protection or support. I was so intrigued by this incredible feat of human achievement that I became obsessed with researching more about them, as well as other habitually unshod races around the world. I spent four months reading everything I could find about barefoot gait in the orthopaedic and podiatric literature.

It became apparent that some medical researchers have known for well over one hundred years that footwear always interferes with natural gait creating mechanical dysfunction, and eventually compensatory adaptions in almost everybody who wear them for prolonged periods of time.

It is also very well understood that footwear dramatically increases the risk of developing foot deformities like bunions and hammer toes.

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After giving this new information serious consideration I realised I needed to revaluate how I practised as a clinician.

I changed my practise philosophy from emphasising longterm support of the foot and leg with corrective orthoses and stabilising footwear, to one where I promote rehabilitation and prevention.

I now advise exercises and lifestyle changes, including going barefoot more often, particularly on uneven surfaces.

I believe, just like the rest of our bodies, our feet are more healthy if given plenty of fresh air, exercise and sunshine.

I encourage my patients to strengthen & mobilise the joints and muscles of their feet with spiky massage balls daily, as well as to walk or run barefoot on natural uneven surfaces as often as possible.

Foot orthoses are still very useful, but should be seen more often as a short-term tool to support an injury whilst the patient rehabilitates than as a permanent necessity.

Many foot and lower-limb problems can be more appropriately and effectively addressed by rehabilitative muscle exercises, mobilisations, massage and lifestyle changes.

I give many patients a choice between rehabilitation with and without orthoses, or treatment just with orthoses. Realising that orthotic supports have been shown to create dependency, I try my best to help my patients avoid the problem of relying on foot orthoses as a panacea, rather than properly rehabilitating.

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3. What are the most common problems people come to you with and how do you treat them?

I’ll briefly discuss three of the most common injuries presenting in my clinic. Plantar fasciitis, metatarsalgias and shin splints.

The most common problem I see in my clinic is plantar fasciitis (fasciosis), followed by various types of metatarsalgias. I also see quite a few cases of anterior knee pain and shin splints of various types.

My treatment for plantar fasciitis has changed dramatically due to my new philosophy. I now emphasise strengthening exercises and massage as the primary aspect of curative treatment, with some patients also using foot orthoses in the short term to give quick pain reduction, almost as a first aid measure. For most of my more able-bodied patients I also recommend barefoot beach walking using a short stride with forefoot strike (followed by gentle heel placement) onto the soft-sand for 10-20 minutes 3-5 times a week. The main aim of this rehabilitative approach is to stimulate an increase in foot & ankle muscle strength as well as to improve the hysterisis (elasticity) of the plantar fascia. Footwear advice is given to my patients because I believe the evidence is clearly showing that stiff, supportive shoes, acting like braces, cause muscle weakness & atrophy, along with joint stiffness. The evidence is showing that the plantar fascia & arch muscles need to be used in a repetitive stretch/shortening cycle in order to keep them strong & pliable. In essence, to keep the foot healthy it needs to function in the way it was evolved to function – naturally! Stiff supportive footwear don’t allow this.

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As far as metatarsalgias are concerned, apart from some rather uncommon problems with fat pad atrophy, most pathologies in the ball of the foot are caused directly by wearing shoes over prolonged periods of time, leading to disruption in the normal plantarflexion of the toes causing a muscle imbalance between the long extensors & flexors of the toes, as well as between the extrinsic foot muscles & the intrinsic muscles of the foot. In the case of many forms of metatarsalgia there is also the pathological effect of lateral compression of the forefoot causing a disruption in the relative positions of the metatarsals & also the plantar digital nerves, making Morton’s neuroma very common, along with capsulitis of the metatarso-phalangeal joints.

( A brilliant explanation of the causes of metatarsalgias is found here, written by my good friend & co-designer Andy Horwood: Mechanically Caused Metatarsalgias )

My treatment is always aimed primarily at trying to restore natural position & function, wherever possible. So plantarflexion exercises to mobilise the joints & stretch contracted soft-tissues are used. Plus I use strengthening exercises for the intrinsic foot muscles. Osteopathic mobilisation techniques of the foot, including the cuboid, are also very helpful. Orthotic foot supports are frequently used in my clinic to off-load the pressure areas & reduce the inflammation in the soft-tissues. Sometimes orthoses are used short-term, but quite often long-term because many patients end up with permanent adaptive deformities associated with the long-term over-use of shoes.

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When it comes to treating shin splints my treatment philosophy has changed completely. It seems to me that most types of shin splints, but particularly medial tibial stress syndrome and anterior compartment syndrome, are associated with poor running technique. Over the years of treating runners with these all too common running injuries, the single most successful treatment approach has been to get patients to change their foot plant from a rearfoot to a forefoot strike. So I also teach barefoot/natural gait running technique & drills which incorporate a gentle forefoot strike, along with advising on going barefoot or using minimalist shoes.

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4. Can everyone be ‘fixed’ by simply taking off their shoes?

The short answer is sadly NO!

Mainly because some patients’ problems have been left till its too late. In some cases barefoot walking or running is no longer possible comfortably.

UnfortunateIy, some people I see cannot fully rehabilitate. This is due to irreversible arthritic changes to the joints, or permanent adaption of the soft-tissues.

Also, the simple act of “taking off their shoes” is not enough for most people any way. The adverse effects of prolonged footwear use creates physical dependency on them. Most people have to be gently and slowly weaned off their supportive and protective footwear.

And tragically for many people the physical adaptive changes to the foot, and the whole lower-limb can be irreversible. These people would probably benefit from going barefoot more often, or wearing minimalist shoes, but they won’t receive the full benefits because of the irreversible anatomical changes.

In some few cases, those changes to the physical anatomy of the body are so widespread and so well established, that changing their gait to a more natural style is not an option which would be beneficial at all, but would actually cause more problems. Fortunately, I believe this to be true only for the minority of shoe wearers.

There is possibly only one medical condition which could preclude someone from barefoot gait. This is sensory neuropathy. If you cannot sense the ground with your feet then you are in danger of traumatic injury. (I would now add some others: see future blog post for update)

The biggest problem though is the psychological/socio-emotional dependency. Most people just cannot imagine ever walking or running barefoot. And certainly not in public. This is treatable with the introduction of new information which can change our attitudinal paradigms to feet and their use.

I consider my clinic to be almost like an addiction recovery clinic. Only, the drug is shoes.

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5. Why is it so important to feel the ground beneath your feet? (could you explain a little about proprioception here?)

One of the most important functions of our feet is to sense the surface on which they are placed. The many thousands of highly specialised sensory nerve endings in the skin of our feet have evolved to expect intimate skin contact with the ground. There are touch, pressure and vibration mechano-receptors which function to give vital information to our brains so our brains know precisely what we are standing on and how are feet are interacting with that surface. The sensory information is necessary for optimal muscle function and postural alignment. The better the quality of that information, the more effectively our muscles can work to enable us to walk and run as efficiently as possible, thus reducing the risk of musculoskeletal injury.

The big problem with footwear of any type is they interfere with that sensory perception of the ground. Muffling and distorting the image our brains receive of our interaction with the ground.

Minimalist footwear designs go some way to improving the amount of proprioceptive feedback, but with evolution only giving us just enough sensory nerve endings for optimal proprioception, nothing is as good as totally barefoot.

Some minimalist footwear are better than others for various reasons. The main criteria I think are important are the thickness of the material under the sole of the foot, combined with how pliable that material is. The other is: does the footwear allow natural foot movements, with individual toe function very high on the list.

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6. Let’s talk about toes. Is it OK to bunch them all together in socks and shoes or is there a real benefit in allowing them to move independently and spread? Why is it so important to have strong toes?

Though the scientific research hasn’t proven this conclusively yet, I believe that it makes sense from an evolutionary & a biomechanical perspective to maximise the number of bones & joints moving, as well as muscles contracting & relaxing for the best proprioceptive feedback. From experience in my clinic over the last four years I’ve found people who wear Vibram FiveFingers seem to have less foot injuries than those wearing minimalist shoes with toes all bunched together.

There is evidence that separating the toes increases the intrinsic muscle activity in the ball of the foot. Having strong muscles in the forefoot helps to protect against injury.

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7. Finally, what do you think needs to be done in order to change the way we treat our feet? Why have we got it so wrong for so long?

I’m convinced their needs to be a paradigm shift in thinking about our feet. In fact, we just need to think about our feet. Most people are completely oblivious to how their feet work, or don’t work. They just stick them into shoes without any thought about what the shoes are doing to the function of their feet. It’s a bit like everyone habitually sticking their hands into boxing gloves and then ignoring them day in, and day out. Eventually there would be repercussions.

The biggest challenge, I think, is that the overuse of shoes in our society has become so normal, so expected by social convention that people don’t consider that shoes could actually be causing their foot, ankle, knee, hip or back problems. It’s because wearing shoes is the norm, & has been for many years, that very few people consider the risks. Children grow up without a choice of whether or not to wear shoes when they go outside. No-one makes a choice, they just do what society has programmed them to do – wear shoes!

The problem with the over-use of shoes is not normal for all societies, mainly Western European & American. Australians & New Zealanders are much more relaxed & comfortable about going barefoot outside & in public.

The main reason for obsessive shoe use in Europe is believed by historians to be related to the class system going back to the Renaissance when the aristocracy wore shoes to set them apart from the peasantry. When you wore shoes you were “well-heeled!”

After that the lower classes aspired to become like the upper and middle classes, and wearing shoes was part of the image they desired.

Since then, wearing shoes just became a tradition. Most people don’t consider why they wear shoes, they just do.

However, just like in other fields of medicine, where once a cause for pathology is discovered lots of effort is put into educating the population about healthier lifestyle choices, the same is true for feet.

In dentistry, once sugary foods in our diets were discovered to be a major cause of took decay, the dental profession gave advice about better diets.

Once doctors discovered that smoking causes lung cancer, health promotion campaigns encouraged people to give up the dangerous habit.

Now that we know that sedentary lifestyles increase our risk of developing diabetes & heart disease, exercise for health is encouraged.

In a similar way, now we know footwear can be harmful to our bodies, we should inform & educate the population about the risks of shoe wearing & encourage people to make healthier lifestyle choices. At the very least we can teach people that they have a choice.

The biggest hurdle is challenging social convention. The general population need to become more accepting of seeing a bare human foot in public.

Just as a bare hand is normal for human beings, so should a bare human foot be!

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Please visit my podiatry clinic website for more information: StepFree.co.uk

Transition to Barefoot

Spring is an excellent time to start exploring the natural environment, & what better way can there be than taking off our shoes & using our feet the way nature intended.

I started my personal barefoot transition in the spring just five years ago.

The biggest lesson I’ve learned is that human feet are for more capable than most people imagine.

And the best advice I can give is to “take your time!”

Don’t rush the transition & do more than your body can cope with too soon!

If you want to go on barefoot hikes & take it carefully, you’ll soon be amazed at what you can achieve.

Here is a blog post I wrote in 2011 about transitioning to barefoot.

Natural Feet Blog

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There are many adjustments for the body to make if shoes have been worn for many years.

Firstly, the tender skin on the soles of the foot needs to thicken and toughen up. The skin on the soles of our feet (and palms of our hands) is unique in that it has the ability to form protective layers. It responds over a period of weeks and months of gradual exposure to rough surfaces. It is best to walk barefoot in the house initially. Then starting outside with soft natural surfaces like sand, soil, leaves, moss and grass. Then increasing the roughness of the surface, including tarmac, and also try to increase the size of the gravel you walk on, till you can tolerate almost any surface.

Depending on how many years you have been in shoes your feet will vary in how long they take to adapt. Some people need…

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Should We Not Be Foot Focused Rather Than Shoe Focused

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I have lots of problems with this poster which is endorsed by my professional organisation.

Rather like a doctor who promotes a certain brand of cigarettes.

In reality all shoes can cause foot problems and I believe we should be honest with people.

All shoes alter foot function adversely! ALL shoes! There is no such thing as a good shoe when it comes to foot mechanics. Only less bad shoes.

Shoes are always a compromise.

And that’s not even considering the increase in bacterial and fungal infections from shoe use.

The more people realise that, the better their footwear buying decisions will be.

Connect to Nature with The National Trust

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Something to inspire you as Spring approaches.

National Trust Barefoot Hiking dates:

5 April – Trenow to Cudden Point – (overlooking St. Michaels Mount)

31 May – Chapel Carn Brea – (overlooking Lands End)

28 June – Bosigran Castle – (near Zennor)

26 July – Godolphin Estate

30 Aug – Secret location

20 Sept – Trenow/Cudden

11 Oct – Porthcurno

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“Rediscover the Sense of Touch in Your Feet & Feel Better All Over” ~ Darren Richardson

Walking Barefoot is Human & Natural

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“Walking Barefoot is Human and Natural. It reminds us of who we really are, and where we come from. Who created us.

“Walking Barefoot connects us to our Mother Earth and to our ancestors who walked primally upon it.

“Walking Barefoot is the default human means of locomotion. It is anatomically perfect for our species. It teaches our bodies good posture, form and function.

“Walking Barefoot makes us vulnerable and respectful. It teaches us to be gentle to ourselves, other people, the Earth and her other creations. 

“Walking Barefoot is emotional. It enhances our senses making us more aware of our surroundings. It makes us ecstatic with joy at being alive and part of nature all around us.

“Walking Barefoot is Human and Natural.” ~ Stephen Bloor