Man has gone barefoot for millennia. All of a sudden, we decided to wear heeled shoes and sneakers for every daily activity. If you think that this has no implications on your body, then it is better that you read this!

Humans have engaged in endurance running for millions of years, but the modern running shoe was not invented until the 1970s. For most of human evolutionary history, runners were either barefoot or wore minimal footwear such as sandals or moccasins with small heels and little cushioning, if not present at all like the shoe in Figure 1.

Figure 1 – Probably the oldest man’s shoe. It was made of a single layer of cowhide covering all the foot. (From [29])
Modern running shoes now have a significant amount of cushioning and stabilization incorporated, marketed for comfort, injury protection, and correcting movement patterns. This brings us to an important question: in all this comfort and protection, why do we often get injured running?

Shoes do make a difference in our body and the consequences are much bigger than what the general public thinks. First of all, putting soles under our feet affects how we land on the ground and thus how the force is distributed. As Figure 2 highlights, it has been proved that habitually barefoot runners have a fore-foot strike before bringing down the heel. In contrast, habitually shod runners have a rear-foot strike, facilitated by the elevated and cushioned heel of the modern running shoe [1,2,3].

Figure 2 – This runner leg is positioned in the same way at foot strike, whether running barefoot or in shoes. When barefoot, this runner fore-foot strikes, while he has a rear-foot strike in shoes. Without any apparent change in the position of the leg or foot, the shoe’s sole affect the foot contact on the ground. (From [30])
The different landing also brings different impact forces: as Figure 3 shows, barefoot runners have a fore-foot strike that implies no impact transients, that are instead present in shod running (notice the first peak on the right graph). Also, notice the steeper slope of the curve for shod running, meaning a higher shock to absorb for the body.

Figure 3 – On the left, strike forces running barefoot. On the right, strike forces running shod. Notice the high-impact collision while running shod, marked by the impact transient and the steeper slope of the curve. (From [1])
Furthermore, barefoot running is associated with a shorter stride length and higher cadence than in typical shod running with a rear-foot strikers pattern [4,5]. This reduced stride length results in lower loads experienced by the body and protect the runner from impact-related injuries [6,7,8].

There is also another important aspect that is affected with a sole between the foot and the ground: as Figure 4 suggests, our feet are full of nerve terminations that are sensory input to the  neuromuscular system. When loading becomes unexpectedly high, the plantar surface of the foot provides sensory input that elicits an avoidance response, indicated by rapid hip flexion and resulting in a quick unloading [9].

Figure 4 – Representation of nerves (in yellow) and blood vessels (in blue and red) in our lower arms. (From [31])
So far so good, but we are still missing the most important thing: the bigger picture! In a holistic approach, the feet cannot be seen in isolation from the rest of the body: if whatever happens to the head affects the feet (in a descending way), the opposite is also true (in an ascending way, from the feet to the head).

First of all, an increased joint torque is observed at the ankle wearing shoes [11]. Then, it has been widely proved that heeled-shoes induce an increase in compressive forces at the knee [11,12,13]. So, it comes with no surprises that:

  1. The knee is the most common site of injuries for shod runners [14].
  2. Although in barefoot conditions there is no gender differences in joint knee torque [15], osteoarthritis of the knee is twice as common in women as in men. Indeed, women wear shoes with higher heels that causes increased joint torque at the knee [16,17].

Going up, wearing shoes affects the hips as well [11,17]. And, if you think that it ends here, you are wrong: spinal posture changes as well. While in the short term it looks like heeled shoes decreases the lordotic curve [18,19], in the long term, they cause a forward rotation of the pelvis, with the body forced to compensate with an increased lordotic curve [18,20,21,22], with then all the consequences that spread to the head.

Figure 5 – Pelvic anteversion. In the long term, wearing heeled shoes cause the pelvis to rotate in a forward direction. Then the spine compensates with an increased lordotic curve. (From [32])
So, being barefoot is the way nature intended for us. Its increased sensory input results in greater static and dynamic stability [23,24,25], with reduced impact on certain zones of the body, preventing many modern injuries.

Also foot shape is completely changed with modern shoes: as Figure 6 highlights, considering the effect of bone remodeling, frequent shoes wearing causes the feet to develop differently from what nature intended for us. Barefoot walkers have wider feet and more equally distributed peak pressures. Habitually shod subjects have relatively short and slender feet, with non-homogeneous pressure distribution [26]. So, it is not surprising that many foot disorders are typical only of shod populations [27,28], such as flatfoot and fallen arches, bunions and hallux valgus, hammer toe, blisters, corns and calluses.

Figure 6 – Difference in the foot shape between barefoot and high-heeled shoes. Over long time, this causes deformities from the ideal natural shape of the foot. (From [33])
Nature gave us the best possible tool for standing, walking and running: the foot! We evolved going barefoot for millennia, so why changing now? The impact on our body integrity is huge, so go barefoot as much as possible and when buying a new pair of shoes remember: the less, the better!


[1] Lieberman, Daniel E., et al. “Foot strike patterns and collision forces in habitually barefoot versus shod runners.” Nature463.7280 (2010): 531.

[2] Hasegawa, Hiroshi, Takeshi Yamauchi, and William J. Kraemer. “Foot strike patterns of runners at the 15-km point during an elite-level half marathon.” Journal of Strength and Conditioning Research 21.3 (2007): 888.

[3] Larson, Peter, et al. “Foot strike patterns of recreational and sub-elite runners in a long-distance road race.” Journal of sports sciences 29.15 (2011): 1665-1673.

[4] Divert, C., et al. “Mechanical comparison of barefoot and shod running.” International journal of sports medicine 26.07 (2005): 593-598.

[5] Hamill, Joseph, et al. “Impact characteristics in shod and barefoot running.” Footwear Science 3.1 (2011): 33-40.

[6] Edwards, W. Brent, et al. “Effects of stride length and running mileage on a probabilistic stress fracture model.” Medicine & Science in Sports & Exercise 41.12 (2009): 2177.

[7] Heiderscheit, Bryan C., et al. “Effects of step rate manipulation on joint mechanics during running.” Medicine and science in sports and exercise 43.2 (2011): 296.

[8] Hobara, H., et al. “Step frequency and lower extremity loading during running.” International journal of sports medicine 33.04 (2012): 310-313.

[9] Robbins, Steven E., Adel M. Hanna, and Gerard J. Gouw. “Overload protection avoidance response to heavy plantar surface loading.” Med Sci Sports Exerc 20.1 (1988): 85-92.

[10] Altman, Allison R., and Irene S. Davis. “Barefoot running: biomechanics and implications for running injuries.” Current sports medicine reports 11.5 (2012): 244-250.

[11] Kerrigan, D. Casey, et al. “The effect of running shoes on lower extremity joint torques.” Pm&r 1.12 (2009): 1058-1063.

[12] Kerrigan, D. Casey, Mary K. Todd, and Patrick O. Riley. “Knee osteoarthritis and high-heeled shoes.” The Lancet 351.9113 (1998): 1399-1401.

[13] Kerrigan, D. Casey, et al. “Moderate-heeled shoes and knee joint torques relevant to the development and progression of knee osteoarthritis.” Archives of physical medicine and rehabilitation 86.5 (2005): 871-875.

[14] van Gent, Bobbie RN, et al. “Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review.” British journal of sports medicine (2007).

[15] Kerrigan, D. Casey, et al. “Knee joint torques: a comparison between women and men during barefoot walking.” Archives of physical medicine and rehabilitation 81.9 (2000): 1162-1165.

[16] Kerrigan, D. Casey, Jennifer L. Lelas, and Mark E. Karvosky. “Women’s shoes and knee osteoarthritis.” The Lancet357.9262 (2001): 1097-1098.

[17] Shakoor, Najia, and Joel A. Block. “Walking barefoot decreases loading on the lower extremity joints in knee osteoarthritis.” Arthritis & Rheumatology 54.9 (2006): 2923-2927.

[18] Opila, Karen A., et al. “Postural alignment in barefoot and high-heeled stance.” Spine 13.5 (1988): 542-547.

[19] Draus, Carolyn, et al. “Comparison of Barefoot vs. Shod Gait on Spinal Dynamics Using DIERS Formetric 4D and DIERS Pedoscan Systems.” Open Journal of Therapy and Rehabilitation 3.03 (2015): 70.

[20] de Oliveira Pezzan, Patrícia Angélica, et al. “Postural assessment of lumbar lordosis and pelvic alignment angles in adolescent users and nonusers of high-heeled shoes.” Journal of Manipulative & Physiological Therapeutics 34.9 (2011): 614-621.

[21] Kulthanan, Teerawat, Sith Techakampuch, and Natee Donphongam. “A study of footprints in athletes and non-athletic people.” JOURNAL-MEDICAL ASSOCIATION OF THAILAND 87.7 (2004): 788-793.

[22] Snow, Rebecca E., Keith R. Williams, and George B. Holmes. “The effects of wearing high heeled shoes on pedal pressure in women.” Foot & ankle 13.2 (1992): 85-92.

[23] Rose, William, et al. “Effect of footwear on balance.” American Society of Biomechanics Annual Meeting. Long Beach, CA. 2011.

[24] Shinohara, Junji, and Phillip Gribble. “Five-toed socks decrease static postural control among healthy individuals as measured with time-to-boundary analysis.” State College, PA: American Society of Biomechanics (2009).

[25] Squadrone, R., and C. Gallozzi. “Effect of a five-toed minimal protection shoe on static and dynamic ankle position sense.” The Journal of sports medicine and physical fitness 51.3 (2011): 401-408.

[26] D’AoÛt, Kristiaan, et al. “The effects of habitual footwear use: foot shape and function in native barefoot walkers.” Footwear Science 1.2 (2009): 81-94.

[27] Engle, Earl T., and Dudley J. Morton. “Notes on foot disorders among natives of the Belgian Congo.” JBJS 13.2 (1931): 311-318.

[28] Zipfel, B., and L. R. Berger. “Shod versus unshod: The emergence of forefoot pathology in modern humans?.” The Foot 17.4 (2007): 205-213.

Other websites 

[29] The world’s oldest shoe found in Armenian cave, by Smbat Minasyan

[30] Running Before the Modern Running Shoe, by Daniel Lieberman

[31] Medically Accurate Vector Illustration Of Human Feet, by Cartoon Dealer

[32] The 5 Most Common Posture Related Problems, by Growing Taller Guide

[33] The Human Guidebook For Switching to Barefoot Footwear, by TFC Barefoot Education