The feeling of sand between your toes, soft grass under your barefeet, or even a warm pool deck can garner feelings of summer, vacation, or foot freedom that you feel you miss while your pals are holed-up in your shoe of choice during a busy working day.
So what’s wrong with giving your feet a little taste of the great outdoors and going barefoot? Might further foot injuries be lurking in the grass?Well, for many people, maybe nothing. But there are numerous pathologies commonly affecting the lower extremity that the general population does not associate with going barefoot.
Going Barefoot can Exacerbate Existing Foot Injuries
A variety of foot, ankle, knee, hip or back problems are commonly worsened by barefoot activity. Common foot injuries worsened by this practice include: plantar fasciitis, Achilles or posterior tibial tendinitis, metatarsalgia, neuroma, plantar plate injury, heel or forefoot contusion, cuboid syndromes, iliotibial band syndrome (just to name a few).
So how can one make these claims? Without getting into the great debate over barefoot versus shod, particularly with regards to running trends, I will answer this with a simple response. Shoes. It is what human beings spend the majority of their waking and weight-bearing time in, or some other relative such as a sandal. Our bodies are adaptive and over hours, years, and decades…centuries, our feet have been in shoes. So when we do not have the raised heel, extra cushion, arch support, firm heel counter, or other amenities we take for granted in a standard sneaker, then all of a sudden many things change. Our heel sits lower compared to our forefoot-placing strain on the Achilles and other tendons; for many, the arch falls further inward subsequently creating stress and imbalance between the rearfoot, midfoot, and forefoot as we complete the gait cycle; the bones of the forefoot are not as protected and the nerves and soft tissues become sensitive to the added pressure, causing inflammation to the bursae and irritation to the nerves. When we wake up in the morning and our feet are killing us, we often have difficulty making the connection.
I see many patients whom are diligent with wearing proper motion control shoe wear or custom orthotics for their daily activities at work or out of the house, only to return home and spend the entire late afternoon and evening on their feet, walking around home barefoot or in a poor quality flip-flops. These essentially undermine the prior biomechanical balance they had achieved the first part of their day (half of it often sitting at a desk or behind the wheel of a car). Overuse foot injuries, soft tissue strain, and many conditions will not improve unless one is consistent with their care. Only wearing your orthotics or supportive shoes during your two-hour workout doesn’t help extensively when you compare it to the 500-15,000 steps you took the rest of the day without them.
Now for the Obvious Risks when going Barefoot.
We are talking about cuts, bruises, and foreign bodies, which affect all people of any age, gender, or health condition. Certainly neuropathic, poorly controlled diabetics, and immuno-compromised populations warrant more specific diligence.
As podiatrists, we commonly treat burns from concrete, asphalt, and synthetic decking material that has been heated by the sun, injuries from small foreign bodies like pieces of glass, wood, metal, thick hair, etc.; we have seen it all. Cuts and lacerations open the possibility for infection. Retained foreign bodies have the same problem and can cause pain and difficulty with removal as they are often small and migrate through the tissue planes, many not readily identified on x-ray. Obviously, the skin on the bottom of the foot is sensitive; this is designed for your protection, so unnecessary abuse should be avoided as large calluses and scars can cause more chronic pain. Don’t forget about your indoor enemies; sewing needles, tacks, and staples which are easily hidden in the carpet, awaiting your tootsies; I have removed many of these from people’s feet that felt their home was a safe environment to walk barefoot.
At the beach; buried objects in the sand, glass, stingrays (shuffle those feet in Southern California), shells, urchins, barnacles, and hot sand are all common culprits of soft tissue injury to the bare foot.
At the pool; burns from the concrete, glass, splinters, abrasive pool bottoms, tinea pedis (foot fungus among us) and plantar warts in showers, locker rooms, and common areas are abundant.
Personally, I love to be barefoot. But pick and choose when to, in order to avoid some problems. If the bio-mechanical issues haven’t gotten you….yet, you may have more freedom. Then, just do some risk assessment and let those toes be free.
I used to readily walk the busy streets of Southern California barefoot on the way to my local surf break; dodging the obvious broken glass, and other things you wouldn’t want your feet to touch. Yes, I did have to dig glass out of my feet a couple times, but that is part of my job so I have better instruments and access to prevent infection. What got me to stop was nagging knee pain. Now I routinely wear something on my feet with good support and preferably with an orthotic, whether in the house or headed to the beach, so I can maintain optimized bio-mechanics which prevent my previous recurrent injury.
Sure, there will always be those that feel you can build the strength in your feet; intrinsic musculature and other lower extremity muscles to improve your gait and mechanics- which is true to an extent. However, most people do not have an ideal foot type for repetitive loading without external support, whether from a shod lifestyle for the duration of their life, or the genetics they were dealt. I will always marvel the Copper Canyon natives, some Kenyan super athletes, and others that continue to beat the street with their feet, but, for the majority of the population, I will see you at the neighborhood shoe store…which is another topic on its own.
If you have any questions regarding your lower extremity health with regards to sports injuries and performance enhancement, or foot type and shoe wear recommendations, we encourage a consult with one of our foot and ankle specialists; (877) 877-9110 or visit us at www.footankleinstitute.com.
His next academic stop was Washington DC where he completed a post-bacc in biological and chemical sciences at American University, then off to the Big Apple to earn his DPM at the New York College of Podiatric Medicine.
Serving as chief resident, Dr. Volkmann completed a three-year surgical residency program in Los Angeles through the Department of Veteran’s Affairs. There, he was trained in all manners of foot and ankle care, although he took a special interest in sports medicine and surgical management.
Dr. Volkmann is available for consultation at our Valencia office.
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