Maybe it’s time I did a listicle.
Yesterday, over at Barefoot and Grounded, Michael Buttgen had an excellent and interesting posting that got me thinking. The posting was Studies? We Don’t Need No Stinkin’ Studies (to Live Barefoot)!.
In it he addresses the fact that so many (mostly podiatrists) who are against going barefoot keep saying there isn’t enough evidence to support the idea: “Studies have not been able to show that going barefoot is better for you than wearing shoes.” He points out that that is totally backwards. As he puts it
Really, since when do we need scientific evidence to use an inborn part of our bodies? How in the world did our society’s thinking about feet become so “bass ackwards” that footwear supersedes our natural condition when it comes to the scientific burden of proof?
Go read the whole thing.
But that got me thinking. Just why is it that so many podiatrists are convinced that going barefoot is so bad? Why do they think that feet need support and that without shoes they would just become puddles of goo?
So, here’s a list I came up with. You might be able to think of items that ought to be added, so feel free to comment.
Note: for the purposes of this I will be cavalier about using absolutes to describe things, just because I’m too lazy to properly qualify each and every one. Thus, when I say “podiatrists say”, what I really recognize and mean to say is “most podiatrists say”, or “many podiatrists say”. I realize they are not all the same (and that every now and again we convert one). Or I will write “never” when in truth it is really “seldom” or something similar.
And it’s more fun to write it this way.
So, here’s the list.
11. Shoes are the default.
Shoes have become such a ubiquitous part of our daily lives that podiatrists don’t even stop to consider that there is another possibility.
10. They are trained that way.
Podiatrists spend a lot of time in med school learning about the physiology of the foot (all those cool bones and ligaments and tendons) and then the pathologies. But they are mainly learning how to deal with fixing things that have gone wrong, and an awful lot of what has gone wrong can be attributed to shoe-wearing. Also, all that training leads to a certain amount of (often justified) arrogance that they know better. But they don’t know where that training hasn’t been based on real evidence.
9. Much of their technique is folklore.
If you look back at the literature, many of the remedies come from case studies in which a doctor reports on a single case saying, “I did this and it worked.” So that becomes part of their bag of tricks without anybody actually testing whether it is truly effective (or even more effective). For instance, when it came to stents for arteries, they became all the rage before a real comparative study was done, and they we got articles like this one from the New York Times: No Extra Benefits Are Seen in Stents for Coronary Artery Disease.
8. They don’t see their failures.
If I go to a podiatrist with foot pain, an orthotic is often the prescription. But if the orthotic doesn’t work, often the patient doesn’t go back.
For instance, my mother had awful flat feet and got special, expensive orthotic shoes. She hated them. So she came to the conclusion that orthotics didn’t work and just dealt with her feet by trying something different, and without telling the podiatrist.
The podiatrist never found out that his vaunted orthotic didn’t work.
7. The studies never compare a treatment to going barefooted.
If you look for studies about orthotics, they all compare some new, improved orthotic against either an older orthotic or against wearing shoes without any orthotics. So then podiatrists become convinced that orthotics work! But they’ve never compared wearing an orthotic to going barefoot regularly (and society does not encourage that!), so they think that all feet need to be shod with orthotics.
6. They see the results of sudden transitions.
When barefoot running and minshod running took off, podiatrists saw a lot of patients who injured themselves during the transition. As a result, they became convinced, not that you need to transition better, but that bare feet (or minshod) were the problem. We see the same thing with the flip-flop warning that occur every spring—we’re told about all these newly flip-flopped feet that podiatrists are suddenly seeing.
But that’s like saying you shouldn’t do any weight training, building up your muscles at all, because some couch potato suddenly decides to start bench pressing 150 pounds and then for some reason his arm muscles are hurting him. In that case you wouldn’t conclude that good arm muscles were bad for you, but that’s exactly what the podiatrists do when it comes to going barefoot.
5. They don’t see the successes of bare feet.
Podiatrists only see those with problems. They only see the flip-flopper who comes to them with pain; they don’t see all the ones who are going about minimally shod (or even barefooted) who have no problems at all. The podiatrists don’t realize just how biased their sample is.
They also don’t see the ways bare feet really help, like sprained ankles. Since going barefoot I have never sprained my ankle (and it happened occasionally when I used to go shod). Bare feet don’t have the fulcrum of the heel that you need to really put a lot of strain on an ankle with it goes over on an uneven surface. Doctors don’t see this; who goes to a doctor for not spraining their ankle? So they see none of the evidence supporting the idea of going barefooted.
4. They never test their assumptions.
All too often we see podiatrists seeing some sort of correlation and then making a “recommendation” based upon that. That “recommendation” then becomes “accepted medical wisdom”, but they’ve never tested the correlation to see if there is any causation involved.
The best example of this comes from plantar fasciitis. Podiatrists will tell you not to go barefoot if you have plantar fasciitis. Why? Because they’ve noticed that those with plantar fasciitis have the most footpain when they get out of bed, barefoot, in the morning.
But almost all our pains are worse in the morning before our bodies have had a chance to warm up and stretch out. I have some tennis elbow at the moment—it’s worst when I get up and then eases throughout the day. What I need to do is rest it more, not immobilize it. (Tennis season is over—I way playing through it but am going to stop for a bit to let it heal up.)
3. They attribute to bare feet injuries that would also happen in shoes.
My favorite study for discussing this is Soft tissue and bone infections from puncture wounds in children. It looked at nail punctures in the feet of children in San Antonio. Some of the punctures happened to bare feet. Others of them, though, went right through the soles of their shoes. (And the ones that went through the shoes picked up nasty bacteria from inside the shoe and injected them deep into the foot.)
From the podiatrists point of view, if you get a foot puncture while barefoot, it is obviously the fault of going barefoot. But if you get one while shod, well, these things sometimes happen.
2. They’re human.
There is a lot of press lately showing that people hate to change their minds. Logic and evidence simply don’t work. See, for instance, I don’t want to be right.
Podiatrists are human, too. It’s really hard to get them to consider and accept something new.
And, the number 1 reason podiatrists dislike bare feet:
1. Podiatrists have never seen a natural foot.
Because of our culture, podiatrists have no idea what a natural foot looks like. All they ever see are feet that have been shaped and distorted and damaged by shoes. When they fix something in a foot they think they are fixing a foot problem when all too often it is a shoe problem. They don’t know what feet can do when left unencumbered. They see a weakness (e.g., flat feet) and think that feet are naturally weak, not realizing that regularly barefooted cultures don’t have a problem with flat feet. They see a disease (e.g., athlete’s foot) and think it is a foot disease instead of a shod disease, not realizing that athlete’s foot is virtually unknown among barefooted cultures.
Podiatrists never see natural feet as a baseline (which gets back to Michael’s point) because they never . . . see . . . natural . . . feet.
It’d sure be nice if we could wake up a few more podiatrists.