The vast majority of medical conditions people have with their feet are caused by shoes or shoe wearing. And even the very few ailments that shoes themselves did not directly or indirectly cause are usually made worse by continuing to wear shoes while the condition exists.
Nine out of ten foot ailments are caused or made worse by shoes or other footwear
Research reveals that at least 90% of foot pathologies are directly or indirectly caused by or exacerbated by shoes or other footwear. This would not include accidental injuries or trauma to the feet, and generally would not include congenital foot conditions, that is, foot problems that someone is born with.
The figure of 90% is an estimate, as no actual comprehensive studies or surveys have been made reviewing all possible foot ailments suffered by humankind all over the world. But that figure is probably as realistic as can be reasonably determined based on the known facts.
Medical experts confirm that nine out of ten foot ailments are caused or made worse by footwear
At least two medical experts on foot issues have publicly stated the 90% estimate.
Stephen Bloor, DPodM, (UK) recently stated, “An estimated 90% of all foot & lower-limb problems seen in my clinic are either directly caused, made worse, or facilitated by footwear.”
Daniel Howell, PhD, author of The Barefoot Book, stated in 2011 in a blog article, “As far as I can tell, shoes are responsible for at least 90% of the foot maladies we suffer from in America.”
And in another blog article in 2017, Dr. Howell wrote, “Shoes are unhealthy; at least 90% of our foot problems in this country can be traced back to our shoes, including athlete’s foot, toenail fungus, hammer toe, bunions, hallux valgus, flat feet, corns and blisters.”
Evidence that shoes damage human feet was documented 115 years ago
One of the oldest studies available relating to how shoes damage human feet was done back in 1904 by Phil. Hoffmann, MD. In 1905, his study was reported in The American Journal of Orthopedic Surgery in an article entitled, “Conclusions Drawn from a Comparative Study of the Feet of Barefooted and Shoe-Wearing Peoples.”
Hoffmann examined the feet of 186 individuals who were taking part in the Louisiana Purchase Exhibition, also known as the St. Louis World’s Fair. These were people from the Philippines and Central Africa who had never worn shoes in their lives. Hoffmann’s study focused mainly on the shape, general condition, and functionality of the feet of the participants, rather than any specific medical conditions. He found their feet to be strong and very healthy.
Hoffmann then compared the feet of those individuals to the feet of 300 shoe wearers in the U.S. He concluded that most modern shoes not only ignored the natural shape of the human foot, but also ended up permanently distorting that shape and natural function that humans were born with.
A more recent landmark study reveals that living barefoot is much healthier than wearing shoes
A study on human foot issues reported in 1949 was much larger and more comprehensive than the previous Hoffmann study. Samuel B. Shulman, Pod.D., reported his findings in The Journal of the National Association of Chiropodists in an article entitled, “Survey in China and India of Feet That Have Never Worn Shoes.”
While serving in the U.S. Army during World War II, Dr. Shulman had the opportunity to examine 5,128 people living in China and India who lived barefoot and had never worn shoes. He specifically looked for common foot ailments and pathologies often suffered by regular shoe wearers.
He found very few, and as the chart in his article shows, the feet of only 9.01% of the persons examined showed any indications of those problems.
In his conclusion, Shulman stated:
People who have never worn shoes acquire very few foot defects, most of which are painless and non-debilitating. The range of their foot motions are remarkably great, allowing for full foot activity. Shoes are not necessary for healthy feet and are the cause of most foot troubles. Children should not be encouraged to walk prematurely and should not wear any footgear until absolutely necessary. Footgear is the greatest enemy of the human foot.
Here is a list of 40 foot ailments suffered by humankind and their relationship to shoe wearing
The following list puts into perspective the vast majority of possible foot ailments and pathologies by showing how each relates to shoes or shoe wearing. The 40 foot maladies listed are almost all the known medical issues involving feet that exist in the world (sure, there could be others that may exist or can be found, but they would likely be quite rare). The list does not include congenital foot defects and does not include foot problems that may be part of a disease that affects the whole body, such as rheumatoid arthritis or muscular dystrophy. The list also does not include foot issues due to accidental injuries.
40 afflictions and pathologies affecting human feet
The list can be broken down into four categories related to shoe wearing
- Directly caused by shoes.
- Indirectly caused by shoes.
- Aggravated or made worse by shoes.
- Not caused or made worse by shoes.
Indirectly caused by shoes means that shoes are the proximate cause of the problem. For example, athlete’s foot is directly caused by a fungus, tinea pedis. But if it were not for wearing shoes, the fungus could not live and grow on the feet, and athlete’s foot infection would not occur.
The American Academy of Dermatology, in an article on athlete’s foot in its publication Dermatology Insights (vol. 3, no. 1, Spring 2002), stated:
Athlete’s foot does not occur among people who traditionally go barefoot. It’s moisture, sweating and lack of proper ventilation of the feet that present the perfect setting for the fungus of athlete’s foot to grow.
Aggravated or made worse by shoes means that, though shoes themselves don’t directly or indirectly cause the foot problem, once someone does acquire the foot problem, wearing shoes usually makes it worse. Conversely, going barefoot usually helps relieve the discomfort and facilitates healing.
Not caused or made worse by shoes means the disease or condition is apparently unrelated to shoe wearing, either by causing it or making it worse.
90% is a conservative estimate; most likely shoes account for a greater number of foot problems than that
You may notice that, of the 40 afflictions listed, only three fit the category of not caused or made worse by shoes, leaving 37 classified as directly or indirectly caused by or exacerbated by shoes – or 92.5%.
That 92.5% is based on a simple average, or arithmetic mean, that is, dividing the total number of ailments listed into the total number of shoe-related ailments listed. A much more accurate percentage of the negative role that shoes play in foot problems would be a weighted average (weighted arithmetic mean), with greater weight being given to the foot issues that occur more often or affect more people.
Determining which foot ailments occur more often than others is fairly easy. Just an internet search for “common foot problems” will reveal the ones most people are afflicted with most often. The same foot problems seem to come up over and over on the various sites that cover foot issues. The problem is that there are no statistics available (at least that I’ve have been able to find) that show actual numbers of occurrences of these more common foot problems, much less the number of occurrences of all of those on the list above.
If the information were available to determine a more a accurate weighted average to compare all foot ailments, the percentage caused or made worse by shoes would be higher than the simple average of 92.5% based on the list above – and certainly much higher than the 90% estimate that’s been used by some experts.
Therefore, the estimate of 90% of foot ailments being caused by or made worse by shoes appears to be fairly conservative, as the actual number is most likely much higher.
Since shoes cause the vast majority of foot ailments, wouldn’t not wearing shoes prevent those?
Not wearing shoes would indeed prevent the vast majority of foot problems from happening. That fact was clearly established in Dr. Shulman’s study, “Survey in China and India of Feet That Have Never Worn Shoes,” mentioned before in this article.
People who can live completely barefoot will likely never suffer from most of the maladies mentioned in the list above. Not everyone can do that, of course, but the less time your feet are spent in shoes, the healthier and disease-free your feet will be.
Very informative and educational. From an occupational health and safety perspective, it’s clear that employers who enforce footwear in situations where there are no extreme hazards are demonstrating a disregard for their employees. And if we pursue that to its logical extension, employers who are motivated to ensure the health of their employees would actively encourage bare feet in the work environment in circumstances where there is an absence of extreme danger or hazard.
I completely agree, Grant. I’ve always felt that, not only shoes, but many PPEs required in certain types of businesses are more for show than for any practical purpose.
A very good article that articulated what many of us in the barefoot community have known for years. I have never had a single issue with my feet and I have gone barefoot for decades. Going barefoot has allowed my feet to move freely and naturally while at the same time has toughened them and acclimated them to a wide variety of textures as well as temperatures. People are always looking down at my feet and asking questions in winter or when I’m walking on gravel or hot asphalt. They tend to think I just have tough feet and that’s… Read more »
Thanks for the comment, Neil. Very well said, and I totally agree.
As a barefoot enthusiast I want to agree fully with you, however the actual literature does not support the level of claims you are making – unfortunately. I am currently writing a proposal for my dissertation about the benefits of being barefoot for foot and ankle health, and reading through the hundreds of papers, I am yet to find one that claims what you are claiming about 90% of deformities being caused by shoes. Unfortunately blog articles do not count as evidence based as they are not peer reviewed and screened for bias when it comes to actual studies on… Read more »
Thanks for your comment. I am curious as to what literature you are referring to that does not support the “level of claims you are making.” I have done extensive research into this topic (which was the basis for the article), and could find no particular literature that directly addressed the causes of medical problems of the feet, other than to look at the 40 most common medical foot ailments individually that human beings suffer and analyze what effect shoe wearing logically has as to the direct cause or exacerbating effect on that ailment. Those medical conditions were further broken… Read more »