You Should Probably Wear Shoes

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Here we are-the year 2010. We don't even know if we should be wearing shoes to exercise.

Is it any wonder we can't agree clinically much less politically on health care reform? You're still shaking your head. "No shoes?" Yes, and barefoot running isn't just running in bare feet. It's a lifestyle.

Yet how could we possibly go on without the promises of shoe companies? Just last week a toning shoe dropped by the house to cook chicken fricassee before performing an adorable puppet show for the kids.

I'm not a (distance) runner and I don't obsess over foot literature like I do in some other areas. But these "toning" shoes do have me a bit fired up.

Have you seen these clunky foot tanks? Now don't get me wrong. Rockerbottom shoes have been prescribed for people with specific ankle and foot impairments long before I was around. In the clinic I've had people who swear that Crocs or Doc Martins or Clogs or high heels or low heels are THE thing for their feet.

One buys fluffy warm Crocs so they won't have to go without them in the winter. The next gets months of achilles tendinitis after one day walking New York City in Crocs. Some tolerate running only in New Balance while others need new knees after running in New Balance. I could go on with real examples.

What are we shooting for, anyway? Manufacturers promote shoes for increased and decreased muscle activity. So do we want increased muscle activity (Sketchers promo), working harder to do the same amount of work, like walking in sand all day? Or would we be better with decreased activity (Reebok promo), with inevitable more loading to the joints, like wearing big spring boots?

Toning shoes will surely make your muscles work harder, all else being equal, because they MAKE any fairly normal foot less efficient. They change the mechanics of the entire lower extremity and decrease the foots ability to provide sensory feedback to the brain. They'll probably throw in a dash of bursitis or tendinitis if you wear them enough, which is not the best way to a toned and chiseled anything.

Cinder blocks "promote" increased muscle activity.

If you want efficiency and increased muscle activity for toning, try working more and/or faster in the way that your body was designed to function. Getting there may likely require mobility work and corrective exercises for the trunk, hips, lower legs, and ankles.

I don't want to hear expert testimonials about magic age defying shoes that prove they lack basic understanding of the windlass mechanism. Did anybody ask if balance training on unstable surfaces was ever any good to begin with, before they made the unstable shoes? And by the way, pronation is not the enemy.

Doesn't it make sense to think that the foot is inherently durable; not some fragile sack of glass? One way or another, feet were fearfully and wonderfully made. How do you suppose we could add anything that would improve and not detract from the complexity and fine tuning of the nervous system with the entire "kinetic chain" of the lower extremity?

Sophisticated enough?

Many authors have observed how overuse injuries have only multiplied alongside the technological development in shoes of today (1, 3, 4). We may have nothing to show for all the shoe sophistication, except awesome web design. On the whole, un-shod populations hold up to running just fine (5), unless you count stepping on porcupines and cactuses.

Modern cushy shoes with all their air cells, shocks, and zigs promote striking the heel first when running, whereas people intuitively strike down on their midfoot when running shoeless (1, 3, 5). Not only does the heel strike pattern cause deceleration at ever step, like driving with the parking break on, it also amplifies shock to the joints (2, 3, 4). So we do have some evidence that modern shoes may be the problem.

So with all my roasting of shoes, why do I generally recommend them?

First, minimalist shoes are an option. They're not promoted very well, though Nike still manages to charge an arm and a leg for basic foot protection. Also, it is possible to get more traditional shoes that are not overblown monuments to razzle dazzle. It's certainly possible to gradually reform your gait to run in such shoes without the heel strike pattern.

Importantly, many do have issues with foot structure and function. My genu varum (bow legs), for example, combined with high impact sports have absolutely pounded the (transverse) arch across my foot. Years of playing hoops on cement courts without shoes would not have fixed that, though it would have have made me famous as the "Crazy No Shoes Guy."

It's gotta be the shoes. Always.

Whereas general arch supports make my specific foot issues worse and give me lateral knee pain, a large metatarsal pad in the bottom center of my foot feels wonderful and helps with my efficiency.

If the long arch of your foot is really low or really high, the correct shoes for your foot type may be essential. A modest amount of cushion also makes sense for standing on cement all day at work. If you're overweight and try exercising in minimalist shoes, you can expect plenty of pain without the gain. Just remember that you don't have to run, as running is probably not the best way to "fix" the problem of being heavy or out of shape.

In summary, keep it simple because more is not better when it comes to shoes. Get your body in shape to do what it is you want to do. Even though there's really no agreement about shoes, and they won't fix your front porch swing or get you a pretty little thing or a diamond ring...

Yeah, for the most part, you should probably wear shoes.

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1. Kurz MJ and Stergiou N. Does footwear affect ankle coordination strategies? J Am Podiatr Med Assoc. 2004 Jan-Feb;94(1):53-8.

2. Robbins, S. and Waked, E. Factors associated with ankle injuries. Preventive measures. Sports Med. 1998 Jan;25(1):63-72.

3. Divert, C., Mernieux, G., Baur, H., Mayer, F., Belli, A. Mechanical comparison of barefoot and shod running. Int J Sports Med. 2005 Sep;26(7):593-8.

4. SE Robbins and GJ Gouw. Athletic Footwear and Chronic Overloading. Sports Medicine, 1990; 9(2):76-95.

5. Is your prescrpition of distance running shoes evidence based? Br J Sports Med, 2008, 5:1136-53.