We’re passionate about a lot of topics here at The Proactive Athlete.  You can probably engage us in a debate or discussion on almost anything that can affect your musculoskeletal system or more broadly your physical health.  But if you really want to get us fired up…ask us about footwear!!

 

And for good reason don’t you think?  Our feet are in almost constant contact with the ground.  The first physical interaction between our body and the earth.  

 

If a moderately active person takes approximately 7500 steps a day and maintains this until they are 80, this computes to 216,262,500 steps in a lifetime.  

 

Hard to argue the posture, positioning and loading of each one of those steps isn’t important.  Add in some jumping, running, cutting and climbing activities (to name a few) periodically through your life and your foot is quite pivotal in your physical health.  Just ask someone who has had a significant injury or surgery on their foot how challenging it is just to accomplish the basics in life (personal hygiene, getting up and down stairs or getting outside for a walk) without the normal use of their foot.

 

What happens at the foot, sets the stage for every joint, muscle and tendon above it.  We have critical gait reflexes that are activated by adequate extension and activation at the big toe for example.  How our mid foot and rearfoot accommodates ground reaction forces dictates whether the stress is absorbed by soft tissues such as muscle and tendon or bony tissue.  The structural and functional system we were born with in our foot is nothing short of impressive.  

 

But why then do we tend to direct so little time and energy towards training or maintaining our feet?  

 

When is the last time you did exercise for your foot?  I mean when did you, with intention, do something to make your foot stronger, more mobile or more functional?

 

When I rhetorically ask this to patients in clinic, it often gets an eye raise, a blank look, and silence.  As if to say, ‘I didn’t know I needed to do anything specific for my feet’.  

 

We have a warm up process for our shoulders, or a rehabilitation or strengthening plan for our back or some stretches we do for our hips or neck for example.  But very few patients who come to our office have a specific strategy for their foot health.

 

And potentially the most impactful decision we can make for our feet, is what to put on (or not put on!) them for the 200+ million steps they might endure in our lifetime.

 

Quite simply Pete and I have long believed that our feet function best without any footwear at all.  Enable your foot to figure out how to accommodate the forces placed on it and the muscles in particular will adapt over time to continue to be able to do its job well.  It’s a simple evolutionary biology rationale that aligns with the notion that using braces for any type of support (think back, knees etc) will create a form of dependency on said support.  Your body gets used to that extra support and becomes lazy over time, adapting in a negative way.

 

If this negative adaptation process makes sense for orthopedic braces…now apply that simple logic to your feet.  Look at the heavily cushioned, rigid support most people put on their feet everyday.  

 

The pronation (or motion control) shoe with a well supported arch remains the mainstay of the majority of the shoes manufactured and available at local shoe retailers today.  

 

It is largely a marketing message from the shoe manufactures dating back to the 70’s that told us pronation is the enemy.

 

That pronation control message has shifted slightly towards a more customized approach for running shoe selection now: a person with a low arch (flat foot) requires a motion control running shoe, a medium arch requires a stability (slightly less motion control) running shoe and a high arch requires a neutral running shoe (still heavily cushioned, but less pronation control).  

 

But several studies, including testing military recruits and marathon runners, found that assigning shoes based on arch types did not significantly reduce the rates of injury.

 

Check out this article we published back in 2019 supporting the notion that the most comfortable running shoe is the one you should run in.But even that message is short sighted.  Should immediate comfort be our primary concern?  Let’s return to this later.

What is a barefoot or minimalist style shoe?

Barefoot or minimalist shoes have a thin, flexible sole (or last) that provides less support for the foot.  There is generally no lift or extra height in the heel of the shoe (zero drop from heel to toe) and there is generally a wide toe box for plenty of space for your forefoot.  Here is a video we made outlining the key features we look for in minimalist shoes. 

 

Minimalist shoes are intended to permit free motion of the foot to achieve as close to a barefoot interaction with the ground as possible, while still providing protection from sharp objects, debris, and rough surfaces for example.

 

Do minimalist shoes matter (or is it all theoretical and more marketing propaganda?)

 

A recent meta-analysis found that minimalist shoes do in fact increase the size and strength of the muscles of the bottom of your feet in healthy individuals.  There were 9 studies included in this review and the range of expected change can be quite significant (from 9%-57% increase in strength gains).  The outcome of strength improvements in the muscles of the bottom of your foot appears clear, but the specifics on who this works best for and under what conditions and limitations needs to be explored much further.    

 

In kids the adaptation in response to minimalist shoes may be even more profound.  A recent randomized controlled trial on healthy 9-12 year olds demonstrated increased muscle size and toe flexor strength along with improvements in some measures of balance and jumping after 9 months of minimalist shoe wearing for school.  It is important to note that the statistical significance was not reached on all of the outcome measures tested, however the direction of the signal looks clearly in favour of minimalist shoe wear for this age group to improve strength, balance and function.   

 

Is going barefoot important for older adults?

Fall prevention is a significant concern of aging, with quality of life known to drastically decline after significant traumatic consequences of falls, such as a broken hip. 

  

A recent Japanese study demonstrated that decreased toe grip strength is also associated with higher rate of falls in those with knee osteoarthritis.  

 

Going cold turkey to a minimalist shoe or full time barefoot approach in an older demographic comes with a large range of complexity and should be approached with an abundance of caution.  It is the hardest demographic to make a shift towards a barefoot approach, but like building lean muscle mass and bone mineral density, it is never too late to start!

 

 

Where can I find minimalist shoes?

One of the most common complaints we hear from patients is that it is not easy to find or buy minimalist shoes.  And we agree.  Unfortunately most of these brands are available only through online purchasing.  I wish more retailers would carry minimalist options, but I also understand the philosophical sales pickle carrying these brands might put their staff in.

 

When I asked a local, well known independent Burlington shoe retailer why they didn’t carry minimalist or barefoot shoes, their manager tried to rationalize that it was a liability issue for them because too many people were getting injured.  I smiled and moved on.

 

We do not endorse (or have any affiliation with) any one brand; but we have bought and experimented many of them over the past decade for ourselves and our kids. 

  

Minimalist shoewear brands include vibram 5 finger , Vivo, Splay, FeelGrounds, Xero, leguano, Freet

 

Love a barefoot brand not listed here?  Please do reach out and let us know!

 

We certainly have opinions on where to start depending on how you intend to use them, style and price point.  But those types of discussions are best in person :).

 

What about the opposite end of the shoewear spectrum: super shoes, or supramaximalist shoes?

The world would be so much simpler if we could definitively declare minimalist shoes = good and supramaximalist shoes = bad.  But the reality is there may be a time and a place for these heavily cushioned shoes with a rockered sole too (although, I would argue a much smaller range of conditions and circumstances compared to the utility and necessity for minimalist footwear).

 

For example studies have shown that there is significantly decreased ankle work and ankle bend (dorsiflexion) in these shoes compared to traditional footwear.  This could reduce stress on the achilles tendon for example in someone who is struggling with an acute achilles issue   

 

There is also evidence that we alter our shock absorption strategies in these shoes, with runners showing a stiffer landing strategy compared to traditional shoes.   Generally this would be considered unfavourable, however clinically sometimes you are searching for a way to shift biomechanics quickly, and experimenting with a supramaximalist shoe can be an option.

 

There is a growing anecdotal belief among runners that the delayed onset muscle soreness after a hard run training session, for example after longer distance runs, is decreased.  The science here is limited, but common sense would suggest that this increased cushioning could be having an immediate tissue mitigation effect that would be reducing the muscular effort and thus post exercise soreness effect.

 

A rotation of shoes might be a consideration if you have high, consistent loading volume (ie distance running) and need to shift the tissue stressors.  There is some preliminary research suggesting that a rotation of shoes may decrease injury risk.

 

With all this considered, the popular advice for incorporating in a supramaximalist shoe seems to be to use these shoes only for long runs.  I can support this theory or any other reasonable short term strategy to shift biomechanics, but I cannot support the notion that these shoes are best for everyday use.

 

Resist comfort and start them young

We know going barefoot is better.  Better for foot muscle strength, size and function.  So please help us shift the narrative when it comes to shoe selection.  Think of shoes as an opportunity to train your feet instead of a cushion to protect them.  By starting your kids early in barefoot shoes (or letting them play barefoot wherever possible) you will provide a stimulation rich environment to maximize their physical development.  It is much easier to start early than to try and convert later in life.