tag:theconversation.com,2011:/uk/topics/podiatry-948/articlesPodiatry – The Conversation2023-08-22T01:04:38Ztag:theconversation.com,2011:article/2078062023-08-22T01:04:38Z2023-08-22T01:04:38ZBallet flats are back. Here’s what the research says about how they affect your feet<p>Ballet flat shoes – those thin-heeled lightweight slip-on shoes – are making a fashion <a href="https://www.vogue.com/slideshow/ballet-flats">comeback</a>. And it’s not hard to see why: they’re versatile, easy to wear, soft, flexible and often worn by celebrities.</p>
<p>We have often been warned of the dangers of high-heeled shoes, so you might think ballet flats are problem-free.</p>
<p>When you look at the research, however, a complicated picture emerges. There’s no definitive evidence to show ballet flats are generally harmful to foot health in the long-term. But ill-fitting ballet flats can be a problem.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/541170/original/file-20230804-25-22wyvj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/541170/original/file-20230804-25-22wyvj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/541170/original/file-20230804-25-22wyvj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/541170/original/file-20230804-25-22wyvj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/541170/original/file-20230804-25-22wyvj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/541170/original/file-20230804-25-22wyvj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/541170/original/file-20230804-25-22wyvj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/541170/original/file-20230804-25-22wyvj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Ballet flats are back.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/do-high-top-shoes-actually-reduce-ankle-sprain-risk-heres-what-the-research-says-202852">Do high top shoes actually reduce ankle sprain risk? Here's what the research says</a>
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</em>
</p>
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<h2>Make sure it fits, especially in the toe box</h2>
<p>An estimated <a href="https://pubmed.ncbi.nlm.nih.gov/30065787/">70%</a> of the population are wearing ill-fitting shoes. This mismatch between foot and shoe shape can increase foot pain, <a href="https://pubmed.ncbi.nlm.nih.gov/17507530/">reduce stability</a>, and can mean more blisters, corns and calluses. And habitual wearing of tight shoes has been <a href="https://www.sciencedirect.com/science/article/pii/S0958259207000533">associated</a> with bone changes in the toes and feet over time. </p>
<p>Many flats feature a shallow and narrow toe box (the part of the shoe where the toes go). A too-small toe box often doesn’t align with the shape of a foot and ends up squishing the toes. It can also <a href="https://www.sciencedirect.com/science/article/pii/S0958259206000770">increase</a> pressure on top of and under the foot, and <a href="https://jfootankleres.biomedcentral.com/articles/10.1186/1757-1146-6-28">restrict</a> the movement of the forefoot during walking.</p>
<p>But a too-big toe box is also a problem. Too much foot movement within the shoe can cause pressure and friction on the skin, which can also lead to calluses, corns, blisters, and wounds. </p>
<p>A poorly fitting toe box can also cause micro trauma to toenails which, ultimately, can change <a href="https://www.researchgate.net/profile/Anuva-Bansal/publication/347522694_Traumatic_Nail_Disorders/links/60d6135592851ca94487df7e/Traumatic-Nail-Disorders.pdf">their look and thickness</a>. </p>
<p>So if you’re wearing flats, make sure you choose a shoe with the right sized toe box.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/541177/original/file-20230804-20-wejf60.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/541177/original/file-20230804-20-wejf60.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/541177/original/file-20230804-20-wejf60.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/541177/original/file-20230804-20-wejf60.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/541177/original/file-20230804-20-wejf60.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/541177/original/file-20230804-20-wejf60.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/541177/original/file-20230804-20-wejf60.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/541177/original/file-20230804-20-wejf60.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Flats are often accused of lacking support.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>What about the heel?</h2>
<p>Health professionals often recommend a small heel over a completely flat shoe. Very flat shoes can <a href="https://pubmed.ncbi.nlm.nih.gov/27498844/">place</a> <a href="https://www.sciencedirect.com/science/article/pii/S0268003307002082">more</a> strain on the soft tissues that support the foot arch – specifically, the plantar fascia.</p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/27498844/">Research</a> has shown moving from a completely flat shoe to a small, raised heel reduces the tension force on the plantar fascia during standing activities.</p>
<p>On the other hand, other <a href="https://journals.lww.com/jpojournal/Fulltext/2009/01000/Effects_of_Shoe_Heel_Height_on_the_Roll_Over.7.aspx#:%7E:text=The%20roll%2Dover%20shapes%20seem,without%20a%20change%20in%20alignment.&text=Photographs%20of%20the%20prosthetic%20feet,shapes%20of%20these%20feet%20superimposed">research</a> has shown most people will adapt their ankle and knee motion to accommodate shoes of different heel heights.</p>
<h2>What about support?</h2>
<p>Ballet flats tend to have very flexible, thin soles and heel counters (the part, coloured red in this picture, that hugs the heel and the back part of the foot).</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/541151/original/file-20230804-19-mbsltw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/541151/original/file-20230804-19-mbsltw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/541151/original/file-20230804-19-mbsltw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/541151/original/file-20230804-19-mbsltw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/541151/original/file-20230804-19-mbsltw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/541151/original/file-20230804-19-mbsltw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/541151/original/file-20230804-19-mbsltw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/541151/original/file-20230804-19-mbsltw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The heel counter here is coloured red.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>These thin and flexible structures mean flats are often accused of lacking support. But debate rages among foot and shoe experts about how important support is in the first place.</p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/27729290/">Research</a> on barefoot-style shoes has shown walking in these types of shoes significantly reduces some loads on the knee compared to more stable supportive shoes. </p>
<p>Minimalist shoes have also been found to <a href="https://pubmed.ncbi.nlm.nih.gov/30102872/">increase strength</a> in certain foot muscles used when we push off during walking, running or jumping.</p>
<p>However, other research found stable supportive shoes can <a href="https://pubmed.ncbi.nlm.nih.gov/33428439/">improve knee pain</a> when walking more than flat flexible shoes.</p>
<p>The thin soles in flats mean there is little cushioning under the foot. While more cushioning can improve comfort, and reduce stress and strain on your foot sole <a href="https://www.sciencedirect.com/science/article/abs/pii/S0021929011001758?casa_token=gecXFCMi0LcAAAAA:TazyTd8TRaAl_bG0jprifYIUIlWRDwEH6bVeymBYTWups2iDGMuUjLs2gaNqsiNGHVJhHC3J9AdB">skin</a>, there is no evidence it reduces loads across the lower leg.</p>
<p>In fact, walking in cushioned shoes has been shown to <a href="https://pubmed.ncbi.nlm.nih.gov/20191571/">increase</a> the load on the knee compared to flat, flexible shoes.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/541179/original/file-20230804-25-l1wjd7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/541179/original/file-20230804-25-l1wjd7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/541179/original/file-20230804-25-l1wjd7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/541179/original/file-20230804-25-l1wjd7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/541179/original/file-20230804-25-l1wjd7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/541179/original/file-20230804-25-l1wjd7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/541179/original/file-20230804-25-l1wjd7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/541179/original/file-20230804-25-l1wjd7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">We have often been warned of the dangers of high-heeled shoes, so you might think ballet flats are problem-free.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>So, what’s the verdict?</h2>
<p>The verdict is mixed. Yes, there’s evidence poorly fitting shoes and a flat heel can be detrimental, with consequences seen in the <a href="https://www.sciencedirect.com/science/article/pii/S0966636221000199">rearfoot</a> (around the ankle) and <a href="https://www.sciencedirect.com/science/article/pii/S0966636218300687">knee</a>. </p>
<p>But there’s also no hard evidence ballet flats cause long-term foot health problems.</p>
<p>What matters is choosing a well-fitted shoe to suit your foot shape and needs.</p>
<p>If you’re shopping for ballet flats, try to:</p>
<ul>
<li><p>choose a pair with a toe box that does not cramp your toes and has a sole at least as wide as your foot</p></li>
<li><p>choose flats that offer at least some structure and support</p></li>
<li><p>choose a pair with a small heel rather than being completely flat.</p></li>
</ul><img src="https://counter.theconversation.com/content/207806/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kristin Graham is affiliated with Australian Podiatry Assocaition. </span></em></p><p class="fine-print"><em><span>Saravana Kumar Is a member of Physiotherapy Association of Australia, Services for Australian Rural and Remote Allied Health and Health Services Research Association of Australia & New Zealand. </span></em></p><p class="fine-print"><em><span>Helen Banwell does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The verdict is mixed.Kristin Graham, Lecturer in Podiatry, University of South AustraliaHelen Banwell, Lecturer in Podiatry, University of South AustraliaSaravana Kumar, Professor in Allied Health and Health Services Research, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2028522023-05-16T00:22:13Z2023-05-16T00:22:13ZDo high top shoes actually reduce ankle sprain risk? Here’s what the research says<figure><img src="https://images.theconversation.com/files/523978/original/file-20230503-21-w1vpab.jpg?ixlib=rb-1.1.0&rect=0%2C27%2C5943%2C3944&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Ankle sprain is one of the most common musculoskeletal injuries, particularly in sports like netball, basketball and football where jumping, landing on one foot and sudden direction changes are part of the game.</p>
<p>Ankle sprains can be painful, debilitating and may result in ongoing ankle problems. In fact, people with a history of a previous ankle sprain are <a href="https://theconversation.com/why-do-i-sprain-my-ankle-so-often-and-how-can-i-cut-the-risk-of-it-happening-again-190751">more likely</a> to sprain an ankle again in future.</p>
<p>Prevention is key. In an effort to reduce sprain risk, many people look for “high-top” shoes, where the section around the side of the shoe (also known as the “collar”) extends up closer to the ankle.</p>
<p>But what does the research say? Do high-top shoes actually reduce your sprain risk?</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/523959/original/file-20230503-22-a7yuex.jpg?ixlib=rb-1.1.0&rect=0%2C18%2C6230%2C4128&q=45&auto=format&w=1000&fit=clip"><img alt="A person wears high top shoes." src="https://images.theconversation.com/files/523959/original/file-20230503-22-a7yuex.jpg?ixlib=rb-1.1.0&rect=0%2C18%2C6230%2C4128&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/523959/original/file-20230503-22-a7yuex.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/523959/original/file-20230503-22-a7yuex.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/523959/original/file-20230503-22-a7yuex.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/523959/original/file-20230503-22-a7yuex.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/523959/original/file-20230503-22-a7yuex.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/523959/original/file-20230503-22-a7yuex.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">In an effort to reduce sprain risk, many people look for high-top shoes.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-do-i-sprain-my-ankle-so-often-and-how-can-i-cut-the-risk-of-it-happening-again-190751">Why do I sprain my ankle so often? And how can I cut the risk of it happening again?</a>
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</p>
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<h2>High-tops don’t always help – and can sometimes harm</h2>
<p>Plenty of research exists on this topic but unravelling the truth is complicated by inconsistency between studies. Researchers may have different ways of investigating the issue, of measuring the shoes success, or even different ways of defining a “high-top” shoe. </p>
<p>For example, the reported difference in collar height between “high-top” to “low-top” shoes was considerable, ranging from 4.3 to 8.5cm across <a href="https://journals.sagepub.com/doi/pdf/10.1177/2210491720950325">different studies</a>. </p>
<p>That said, the trend in the current research literature suggests the ankle protection provided by high-top shoes may not be enough to significantly reduce sprain risk while playing sport. </p>
<p>In fact, this design may also reduce athletic performance, and increase the risk of ankle sprain in some people.</p>
<p><a href="https://journals.sagepub.com/doi/pdf/10.1177/2210491720950325">Research</a> does support the idea high-top shoes provide good stability when outside forces may cause an ankle sprain when the person is stationary (for example, when a person standing still is knocked from the side and starts to topple over, putting stress on the ankle).</p>
<p>However, once you start moving it’s a different story. In fact, some research suggests high-top shoes may even increase the risk of ankle sprain in some activities. </p>
<p>This may be because these shoes can change the way we use the muscles in our ankles and legs.</p>
<p>Specifically the muscles on the <a href="https://jfootankleres.biomedcentral.com/articles/10.1186/1757-1146-7-14">outside</a> of the lower leg may start firing later and not work as strongly to stiffen the ankle when your’re wearing high top shoes (compared to low top shoes).</p>
<p>To reduce ankle sprain risk, it is important the muscles on both sides of the legs <a href="https://www.sciencedirect.com/science/article/pii/S0021929016311563?via%3Dihub">work together</a> at the same time.</p>
<p>Tellingly, delayed and weaker activation of the muscles on the outside of the lower leg is <a href="https://pubmed.ncbi.nlm.nih.gov/23899892/">greater</a> in people with chronic ankle instability. This finding suggests high-top shoes may not be the best choice for anyone with a history of ankle sprain. </p>
<p>There is also some <a href="https://www.tandfonline.com/doi/abs/10.1080/026404197367146">evidence</a> wearing high-top shoes may impede athletic performance by reducing jump height and increasing shock transmission to other parts of the body.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/524264/original/file-20230504-26-jbv9o5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/524264/original/file-20230504-26-jbv9o5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/524264/original/file-20230504-26-jbv9o5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/524264/original/file-20230504-26-jbv9o5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/524264/original/file-20230504-26-jbv9o5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/524264/original/file-20230504-26-jbv9o5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/524264/original/file-20230504-26-jbv9o5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/524264/original/file-20230504-26-jbv9o5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">What is crucial when selecting footwear is good fit and good function.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Getting the right fit</h2>
<p>External supports such as tape and braces are effective in both uninjured and previously injured ankles. But they’re <a href="https://meridian.allenpress.com/jat/article/54/6/650/420871/Prevention-of-Lateral-Ankle-Sprains">most effective</a> when used in combination with preventive exercise programs.</p>
<p>What is crucial when selecting footwear is good fit and good function. Footwear should fit the foot in length, width and depth, with a thumb’s width between the end of the longest toe and the tip of the shoe. You should have enough space across the ball of the foot for it to not be pulled tight when standing. </p>
<p>However, around <a href="https://jfootankleres.biomedcentral.com/articles/10.1186/s13047-018-0284-z">70%</a> of people are wearing shoes that are not fitted appropriately. Women and girls more often have shoes that are too narrow, and older males often wear shoes that are too long. </p>
<p>Ill-fitting footwear <a href="https://www.sciencedirect.com/science/article/pii/S0966636221001478?via%3Dihub">can</a> increase falls, induce greater levels of osteoarthritis and impedes natural foot function in adults and children. </p>
<p>Make sure you’ve got the right shoe for the job. Form must suit function.</p>
<p>As an example, there’s merit in wearing a well-fitted high-top sneaker during static, standing based activities.</p>
<p>However, a low-top sneaker may be more beneficial during sporting activities that require frequent stopping, jumping, sudden changes in direction or for people with a <a href="https://jfootankleres.biomedcentral.com/articles/10.1186/1757-1146-7-14">history of ankle sprains</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/running-shoes-may-cause-injuries-but-is-going-barefoot-the-fix-135264">Running shoes may cause injuries – but is going barefoot the fix?</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/202852/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kristin Graham is affiliated with Australian Podiatry Association. Non executive member. </span></em></p><p class="fine-print"><em><span>Helen Banwell has received in-kind support from ASICS Oceania and Skobi in the last two years. Neither funded the relevant studies – just gave us the shoes. I am currently involved as an external ‘content expert’ on a study with Monash with Bobux shoes but the study has been on hold since Covid started and I’m not receiving any monies for my involvement. </span></em></p><p class="fine-print"><em><span>Ryan Causby receives funding from Australasian Podiatry Education Research Fund. He is a Director on the Australasian Council of Podiatry Deans and a member of the Australian Podiatry Association.</span></em></p><p class="fine-print"><em><span>Lewis Ingram and Saravana Kumar do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The ankle protection provided by high-top shoes may not be enough to reduce sprain risk significantly. In fact, this design may reduce athletic performance, and increase risk of ankle sprain for some.Kristin Graham, Lecturer in Podiatry, University of South AustraliaHelen Banwell, Lecturer in Podiatry, University of South AustraliaLewis Ingram, Lecturer in Physiotherapy, University of South AustraliaRyan Causby, Dean of Programs (Allied Health), University of South AustraliaSaravana Kumar, Professor in Allied Health and Health Services Research, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1943312023-01-03T22:54:28Z2023-01-03T22:54:28ZWho is and isn’t suited to barefoot running? And if I want to try, how do I start?<figure><img src="https://images.theconversation.com/files/498602/original/file-20221202-22-kredno.jpg?ixlib=rb-1.1.0&rect=0%2C85%2C4388%2C2276&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>You might have noticed a buzz on social media about barefoot running, with many proponents breathlessly describing it as the most natural way to run. </p>
<p>But not everyone is a fan. The claims made about going barefoot can range from, “It’s the best thing I’ve ever done” to “I tried it and now I’m in terrible pain.”</p>
<p>So what does the research say about how to drop your usual runners and take up barefoot running, and why it seems to work for some people and not for others?</p>
<p>Our new <a href="https://journals.lww.com/acsm-msse/Abstract/9900/Transitioning_to_Barefoot_Running_Using_a.188.aspx">paper</a>, published in <a href="https://www.acsm.org/education-resources/journals/medicine-science-in-sports-exercise">Medicine & Science in Sports & Exercise</a>, tested a new way of switching from traditional shoe to barefoot running, and investigated why some runners may not tolerate barefoot running. We identified two key characteristics of runners who failed to transition to barefoot running.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/498628/original/file-20221202-24-haemsi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A man grips his barefoot while sitting." src="https://images.theconversation.com/files/498628/original/file-20221202-24-haemsi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/498628/original/file-20221202-24-haemsi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=264&fit=crop&dpr=1 600w, https://images.theconversation.com/files/498628/original/file-20221202-24-haemsi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=264&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/498628/original/file-20221202-24-haemsi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=264&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/498628/original/file-20221202-24-haemsi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=332&fit=crop&dpr=1 754w, https://images.theconversation.com/files/498628/original/file-20221202-24-haemsi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=332&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/498628/original/file-20221202-24-haemsi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=332&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Barefoot running is just not for everyone.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/children-should-spend-more-time-barefoot-to-encourage-a-healthier-foot-structure-100289">Children should spend more time barefoot to encourage a healthier foot structure</a>
</strong>
</em>
</p>
<hr>
<h2>What we did and what we found</h2>
<p>We studied 76 runners who transitioned to barefoot running over 20 weeks – using a minimal running shoe as an intermediate phase between traditional shoe and barefoot running. </p>
<p>The runners ran in traditional running shoes for the first four weeks. For the next four weeks, they increased their time in minimal running shoes by no more than 20% of their total running volume each week. </p>
<p>After running full-time in minimal shoes for another four weeks, they then spent the next four weeks gradually increasing their time running barefoot by no more than 20% per week. </p>
<p>Finally, they ran barefoot for a further four weeks. </p>
<p>We also asked the runners to do some calf and foot strengthening and stretching, to assist the muscles in the move from traditional shoe to barefoot running.</p>
<p>Using this strategy, 70% of runners were able to successfully transition to barefoot running over 20 weeks.</p>
<p>Pain in the calf when running in minimal shoes and pain in the foot when running barefoot were the main reasons for not being able to switch to barefoot running. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/498633/original/file-20221202-22-plrjho.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two people run barefoot on a beach." src="https://images.theconversation.com/files/498633/original/file-20221202-22-plrjho.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/498633/original/file-20221202-22-plrjho.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/498633/original/file-20221202-22-plrjho.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/498633/original/file-20221202-22-plrjho.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/498633/original/file-20221202-22-plrjho.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/498633/original/file-20221202-22-plrjho.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/498633/original/file-20221202-22-plrjho.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Barefoot running tends to increase stress in the tissues of the foot and calf.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/an-elderly-man-and-a-woman-jogging-at-thebeach-8637985/">Photo by Kampus Production/Pexels</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>So why doesn’t barefoot running suit some people?</h2>
<p>We identified two features that were present in runners who failed to transition to barefoot running. </p>
<p>Contacting the ground first with the heel while running was one, and the other was very mobile feet (which means the arch is more flexible when the foot is bearing weight).</p>
<p>Why? It’s too early to say for sure, but we do know barefoot running tends to increase stress in the tissues of the foot and calf. </p>
<p>Our findings seem to indicate this tissue stress was not well tolerated in those who habitually contact the ground with their heels and/or have very mobile feet when they run barefoot or in minimal shoes.</p>
<p>This may result in pain and eventually injury. We also know <a href="https://journals.sagepub.com/doi/10.3113/FAI.2012.0262">from</a> <a href="https://bjsm.bmj.com/content/48/16/1257">other</a> <a href="https://bjsm.bmj.com/content/50/8/476">studies</a> that running barefoot or in minimal shoes will result in higher rates of foot injury (such as stress fractures of the bones of the foot) and pain in the shin and calf. Traditional shoes usually provide more support and cushioning.</p>
<p>It seems runners who habitually contact the ground with their heel while running find it difficult to switch to contacting the ground with more of their midfoot or forefoot, which is what barefoot running tends to promote. </p>
<p>Those with mobile feet may need their muscles to work harder to stiffen the foot when pushing the foot off the ground while running.</p>
<p>Perhaps a more gradual transition period during which the limit is 10% (not 20%) weekly increase of running in minimal shoes or barefoot spread over a longer period (such as 40 weeks) would enable those wishing to run barefoot to do so without pain or injury. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/498634/original/file-20221202-19-yz54vc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A person stretches their foot." src="https://images.theconversation.com/files/498634/original/file-20221202-19-yz54vc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/498634/original/file-20221202-19-yz54vc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/498634/original/file-20221202-19-yz54vc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/498634/original/file-20221202-19-yz54vc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/498634/original/file-20221202-19-yz54vc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/498634/original/file-20221202-19-yz54vc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/498634/original/file-20221202-19-yz54vc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">If you want to try barefoot running, transition gradually.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Top tips for successful barefoot running</h2>
<p>If you’re keen to try barefoot running, keep these tips in mind:</p>
<ul>
<li><p>transition gradually over at least 20 weeks. Take longer if needed</p></li>
<li><p>use a minimal shoe as an intermediary, if possible</p></li>
<li><p>limit any increase in running in minimal shoes or barefoot to no more than 20% of total running distance per week</p></li>
<li><p>use pain during and in the 24 hours after running as a guide – especially if you feel the level of severity is unacceptable</p></li>
<li><p>consult a sports and exercise health care professional (such as a physiotherapist or podiatrist) if you experience pain or require assistance in transitioning – especially if you have previous injuries</p></li>
<li><p>consult a qualified run coach to assist with your running program</p></li>
<li><p>when barefoot running, protect your feet by running in well-lit conditions so you can see obstacles, and avoid excessively hot, cold or sharp surfaces</p></li>
<li><p>mix it up – people who run in lots of different types of footwear report fewer injuries than those who only run in one type of shoe.</p></li>
</ul>
<p>It may also be that some runners are just not able to switch from their traditional running shoes to barefoot running. </p>
<p>Barefoot running may not be for everyone. It will not make you faster or reduce overall injury rate, and there is no evidence running barefoot burns more calories than running with shoes. </p>
<p>But if you’re thinking of giving barefoot running a go, transitioning gradually – using a minimal running shoe as an interim step – is more likely to result in a successful transition, and keep you running.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/eliud-kipchoge-broke-the-mens-marathon-record-by-30-seconds-how-close-is-the-official-sub-2-hour-barrier-now-191421">Eliud Kipchoge broke the men's marathon record by 30 seconds. How close is the official sub-2 hour barrier now?</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/194331/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Natalie Collins has received funding from the National Health and Medical Research Council, Medical Research Future Fund, and Arthritis Australia. New Balance provided all shoes used in this study, free of charge, through the New Balance Global Scientific Award. New Balance had no input into the design of the study or interpretation of the results.</span></em></p><p class="fine-print"><em><span>Bill Vicenzino has received funding from New Balance Global Scientific Award.</span></em></p><p class="fine-print"><em><span>Kathryn Mills has received in-kind support from the New Balance Global Scientific Award. She is the current chair of the International Footwear Biomechanics Group, which is a volunteer role. </span></em></p>Thinking of trying barefoot running? We investigated a new strategy to switch from traditional shoe to barefoot running, and why barefoot running may work for some runners but not others.Natalie Collins, Senior Lecturer in Physiotherapy, The University of QueenslandBill Vicenzino, Professor and Chair in Sports Physiotherapy, The University of QueenslandKathryn Mills, Senior Lecturer, Macquarie UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1821292022-06-15T03:16:47Z2022-06-15T03:16:47ZWhat did COVID do to my feet? How to fit back into shoes after wearing ugg boots at home and piling on the kilos<figure><img src="https://images.theconversation.com/files/460506/original/file-20220429-24-7onmgt.jpg?ixlib=rb-1.1.0&rect=2%2C0%2C995%2C667&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/men-shoes-fashion-wedding-231404761">Shutterstock</a></span></figcaption></figure><p>If you’ve been spending a lot of time at home in ugg boots, not doing so much exercise and stacking on the coronakilos over the past two years or so, you may have noticed something strange going on with your feet.</p>
<p>They may not fit back into leather shoes. Or if you do manage to squeeze them in, your shoes feel really stiff and look set to give you blisters.</p>
<p>What’s going on? Have your feet expanded? Is this permanent? Do you need to buy new shoes?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-is-toe-jam-from-harmless-gunk-to-a-feast-for-bugs-177454">What is toe jam? From harmless gunk to a feast for bugs</a>
</strong>
</em>
</p>
<hr>
<h2>Can your feet really widen?</h2>
<p>Our feet are flexible structures and adapt over time to our footwear – or lack of shoes. </p>
<p>That’s what happened during COVID lockdowns and long periods of being at home, when many people swapped regular shoes for comfortable options such as thongs, slides and ugg boots. Our feet responded by spreading out and becoming wider.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/465418/original/file-20220526-19-exrty3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Row of ugg boots in different colours" src="https://images.theconversation.com/files/465418/original/file-20220526-19-exrty3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/465418/original/file-20220526-19-exrty3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/465418/original/file-20220526-19-exrty3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/465418/original/file-20220526-19-exrty3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/465418/original/file-20220526-19-exrty3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/465418/original/file-20220526-19-exrty3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/465418/original/file-20220526-19-exrty3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Still wearing ugg boots?</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/warm-fuzzy-sheepskin-australian-boots-many-257592871">Shutterstock</a></span>
</figcaption>
</figure>
<p>That wasn’t a big surprise for podiatrists like us, health professionals who specialise in looking after people’s feet.</p>
<p>We’ve long known that people who walk barefoot – or wear wide shoes that give the foot plenty of room to spread out – have a <a href="https://jfootankleres.biomedcentral.com/articles/10.1186/1757-1146-6-28">much wider</a>
front of the foot (forefoot) than people who wear narrow shoes.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/466528/original/file-20220601-48874-mecx69.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Bones of the feet, showing metatarsals" src="https://images.theconversation.com/files/466528/original/file-20220601-48874-mecx69.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/466528/original/file-20220601-48874-mecx69.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/466528/original/file-20220601-48874-mecx69.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/466528/original/file-20220601-48874-mecx69.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/466528/original/file-20220601-48874-mecx69.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/466528/original/file-20220601-48874-mecx69.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/466528/original/file-20220601-48874-mecx69.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Your metatarsals (in red) have freedom to align normally when you go barefoot or wear ugg boots.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/metatarsal-bones-metatarsus-group-five-long-2135243299">Shutterstock</a></span>
</figcaption>
</figure>
<p>That’s because the lack of pressure from shoes allows the five, long <a href="https://www.kenhub.com/en/library/anatomy/metatarsal-bones">metatarsal bones</a> in each of your feet to align normally; each metatarsal head (end of the metatarsal bone) takes the load as you walk. </p>
<p>Once your forefoot becomes wider, it stays like this unless you force it <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5342900/">to adapt</a> by wearing narrow shoes.</p>
<p>How much wider a foot becomes, if given the space, depends on how elastic your ligaments are. Some people are “<a href="https://www.hypermobilityconnect.com/">hypermobile</a>” and have very “loose” joints because their ligaments are more stretchy. </p>
<p>Some people have described this as “<a href="https://www.urbandictionary.com/define.php?term=Flintstone%20feet">Flintstone feet</a>” or “<a href="https://www.abc.net.au/news/2020-06-05/are-feet-copping-it-while-working-from-home-in-slippers/12314970">ugg boot foot</a>”.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1382659198983548930"}"></div></p>
<h2>What else is going on?</h2>
<p>Being less physically active and leading a more sedentary lifestyle while at home for long periods may have also led to weaker core muscles. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3806175/">Core muscles</a> are the ones around our buttocks, hips, abdomen and lower back. They are particularly important in controlling the position and function of our legs and feet.</p>
<p>If you lose core fitness, your legs can rotate internally (your knees face each other), causing your feet to roll in (or pronate).</p>
<p>As this happens, your feet can become <a href="https://www.youtube.com/watch?v=iwX4_G6JZ_0">flatter</a>, changing their shape to become longer and wider.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/core-strength-why-is-it-important-and-how-do-you-maintain-it-160358">Core strength: why is it important and how do you maintain it?</a>
</strong>
</em>
</p>
<hr>
<h2>How about the coronakilos?</h2>
<p>Many of us have also put on coronakilos (also known as COVID kilos or quarantine kilos) during the pandemic. In fact, one in three Australians <a href="https://www1.racgp.org.au/newsgp/clinical/one-in-three-australians-have-gained-weight-during">gained weight</a> during this time.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1517789108134813697"}"></div></p>
<p>An increase in body weight creates more force on the feet. If your feet have a normal or low arch, your feet will become flatter (will pronate more), creating <a href="https://jfootankleres.biomedcentral.com/articles/10.1186/s13047-017-0214-5">increased pressure</a>, particularly under the mid-foot. </p>
<p>So if you put on weight, your feet can become longer and wider.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/covid-kilos-why-now-is-the-best-time-to-shed-them-171933">COVID kilos: why now is the best time to shed them</a>
</strong>
</em>
</p>
<hr>
<h2>Why won’t my work shoes or boots fit?</h2>
<p>We’ve seen how, over time, our feet adapt to our shoes (or lack of shoes). But shoes can also adapt to our feet. This depends on what the shoes are made of.</p>
<p>Leather shoes are flexible and gradually mould to the shape of your feet. That’s because they absorb sweat from our feet and soften. But when we take a break from wearing them, the leather gradually dries and they harden.</p>
<p>So if you haven’t worn leather shoes or boots for a while, you need to “wear them in” again to soften them and avoid blisters.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1423550410942468098"}"></div></p>
<p>If you’ve been storing your shoes in a hot, dry environment, the leather will also gradually dry out and your shoes will feel much tighter when you next wear them.</p>
<p>Shoes made from <a href="https://www.comunitymade.com/blogs/posts/what-are-the-best-materials-for-shoes">synthetic materials and textiles</a> or <a href="https://www.peta.org/living/personal-care-fashion/what-is-vegan-leather/">vegan leather</a> made from polyurethane, recycled plastic, cactus or <a href="https://www.theguardian.com/science/2021/dec/02/californian-firm-touts-mushroom-leather-as-sustainability-gamechanger">mushrooms</a> tend to keep their shape, even when you don’t wearing them for some time. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/vegan-leather-made-from-mushrooms-could-mould-the-future-of-sustainable-fashion-143988">Vegan leather made from mushrooms could mould the future of sustainable fashion</a>
</strong>
</em>
</p>
<hr>
<h2>Any tips for my feet?</h2>
<p>Getting back into your work shoes might take a bit of time, particularly if your feet have changed shape during the past two years. </p>
<p>It’s unlikely you’ll need new shoes unless they are damaged from drying out, you have put on a significant amount of weight, or your shoes were very narrow or a size too small pre-pandemic.</p>
<p>Here are some suggestions to build foot strength and ensure your shoes don’t damage your feet:</p>
<ul>
<li><p>make time to exercise your feet and ankles. You can try this <a href="https://orthoinfo.aaos.org/en/recovery/foot-and-ankle-conditioning-program/">conditioning program</a> or watch these <a href="https://freedompah.com.au/foot-strengthening">videos</a> of foot strengthening exercises </p></li>
<li><p>focus on your core strength to improve your posture when sitting, standing and walking. Here’s a ten-minute <a href="https://www.youtube.com/watch?v=6Q-crQuxME0">workout</a> for beginners</p></li>
<li><p>visit a shoe store to measure your feet accurately. Some <a href="https://jfootankleres.biomedcentral.com/articles/10.1186/s13047-018-0284-z">63-72%</a> of the population are wearing shoes the wrong length or width</p></li>
<li><p>invest in a pair of good quality shoes, runners or work boots and look after them well, rather than buying lots of cheap footwear that <a href="https://www.podiatry.org.au/foot-health-resources/incorrectly-fitted-shoes/incorrectly-fitted-shoes">might cause</a> foot deformity and a lifetime of <a href="https://jfootankleres.biomedcentral.com/articles/10.1186/s13047-018-0284-z">pain</a>.</p></li>
</ul><img src="https://counter.theconversation.com/content/182129/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Caroline Robinson is affiliated with the Australasian Council of Podiatry Deans and the Australian Podiatry Association.</span></em></p><p class="fine-print"><em><span>Emma Baker does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>No, you’re not imagining it. Your feet may be wider or longer and your shoes stiffer.Caroline Robinson, Associate Professor Podiatry, Charles Sturt UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1774542022-04-22T01:35:23Z2022-04-22T01:35:23ZWhat is toe jam? From harmless gunk to a feast for bugs<figure><img src="https://images.theconversation.com/files/456809/original/file-20220407-14-flir0u.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C664&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-girls-toes-healthy-beautiful-wellgroomed-1371423317">Shutterstock</a></span></figcaption></figure><p><a href="https://www.healthline.com/health/all-about-toe-jam">Toe jam</a> can be a source of fascination, disgust or barely noticed. It can be a sign you need to wash your feet or rethink your choice of footwear. It can also lead to major health issues.</p>
<p>Toe jam, the gunk and debris between your toes, has even made it to a Beatles song.</p>
<p>But it was unlikely John Lennon was thinking about foot hygiene when he wrote the lyrics to the second verse of <a href="https://genius.com/The-beatles-come-together-lyrics">Come Together</a>:</p>
<blockquote>
<p>He wear no shoeshine, he got toe-jam football</p>
<p>He got monkey finger, he shoot Coca-Cola</p>
<p>He say, ‘I know you, you know me’</p>
<p>One thing I can tell you is you got to be free.</p>
</blockquote>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/uSM5MpKSnqE?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Yes, The Beatles really mentioned toe jam in Come Together (YouTube).</span></figcaption>
</figure>
<h2>What is toe jam, actually?</h2>
<p>Toe jam isn’t a medical term. There is no formal medical term to describe the dead skin cells, sweat, sock lint and dirt that combine in the small and often cramped spaces between our toes.</p>
<p>Toe jam can have the consistency of soft cheese or cake crumbs. It can smell or be odourless. And its colour can range from white to grey-brown.</p>
<p>You’re more likely to create toe jam if you wear closed-in shoes when it’s hot, or gumboots that don’t allow sweat to evaporate.</p>
<p>Poor foot hygiene will certainly make it more likely you’ll develop toe jam. That’s because sweaty debris accumulates in between the toes if you don’t pay attention to cleaning these areas in the shower or bath.</p>
<p>Toe jam may also be more likely if your feet sweat a lot for other reasons. For instance, we know <a href="https://www.racgp.org.au/afp/2009/september/sweaty-smelly-hands-and-feet">sweaty feet</a> can be a problem for children and adolescents, who have more active sweat glands. And some people have a serious medical condition called <a href="https://www.sweathelp.org/index.php">hyperhidrosis</a>, where they sweat excessively.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/anhidrosis-why-some-people-apparently-like-prince-andrew-just-cant-sweat-127280">Anhidrosis: why some people – apparently like Prince Andrew – just can't sweat</a>
</strong>
</em>
</p>
<hr>
<h2>Is toe jam like athlete’s foot?</h2>
<p>The collection of sweat and dead skin between toes provides bacteria living naturally on our skin the chance to thrive. </p>
<p>These bacteria, which include ones in the genus <em>Brevibacterium</em>, feed on sweat, releasing molecules that give the characteristic “cheesy” <a href="https://theconversation.com/why-do-feet-stink-by-the-end-of-the-day-125037">smell of sweaty feet</a>. Brevibacterium is also used to ripen some cheeses.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/457034/original/file-20220408-19484-ox4ymj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Soft cheese, cut in slices" src="https://images.theconversation.com/files/457034/original/file-20220408-19484-ox4ymj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/457034/original/file-20220408-19484-ox4ymj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=436&fit=crop&dpr=1 600w, https://images.theconversation.com/files/457034/original/file-20220408-19484-ox4ymj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=436&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/457034/original/file-20220408-19484-ox4ymj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=436&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/457034/original/file-20220408-19484-ox4ymj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=547&fit=crop&dpr=1 754w, https://images.theconversation.com/files/457034/original/file-20220408-19484-ox4ymj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=547&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/457034/original/file-20220408-19484-ox4ymj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=547&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">No wonder your feet smell cheesy if you don’t wash them properly.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cheeseboard-sliced-yellow-limburger-cheese-top-1343151806">Shutterstock</a></span>
</figcaption>
</figure>
<p>This warm and damp environment is also a perfect site for <a href="https://www.healthdirect.gov.au/tinea">tinea pedis</a>, a fungal skin infection you might know as athlete’s foot. </p>
<p>Signs of tinea might be soggy white skin between your toes, which can be itchy, and red areas, a sign of skin damage. <a href="https://dermnetnz.org/topics/athletes-foot">Damaged skin</a> between toes might develop small fluid-filled blisters and may also bleed if the weak skin is torn.</p>
<p>So while toe jam isn’t the same as tinea, it might provide the perfect conditions for the fungus to grow.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-do-feet-stink-by-the-end-of-the-day-125037">Why do feet stink by the end of the day?</a>
</strong>
</em>
</p>
<hr>
<h2>How serious is toe jam?</h2>
<p>Generally, toe jam is a minor health problem. You can <a href="https://www.racgp.org.au/getattachment/233c1fdf-8802-471e-9828-f792110c30d1/Sweaty-smelly-hands-and-feet.aspx">manage it</a> with good foot hygiene. And if you develop tinea, you can use a short course of an anti-fungal treatment you can buy from a pharmacy (see below).</p>
<p>It is quite a different prospect, however, for a person living with a chronic disease such as diabetes, someone who has poor vision (so can’t see toe jam or its complications developing), or who may be unable to reach their feet due to limited mobility.</p>
<p>Diabetes not well controlled with diet and exercise, or drugs, increases the <a href="https://www.diabetesfeetaustralia.org/">risk</a> of a person having reduced blood flow (peripheral arterial disease) and reduced feeling in their feet (sensory neuropathy). </p>
<p>Broken skin between the toes caused by tinea can become infected rapidly, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3248359/">increasing the risk</a> of:</p>
<ul>
<li><p>infection spreading to the foot and leg (cellulitis)</p></li>
<li><p>infection of the bone (osteomyelitis)</p></li>
<li><p>gangrene (dead tissue caused by lack of blood flow)</p></li>
<li><p>amputation of a toe, part of the foot or leg. </p></li>
</ul>
<p>So early identification of tinea in a vulnerable person is especially important to prevent complications.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/life-on-us-a-close-up-look-at-the-bugs-that-call-us-home-25754">Life on Us: a close-up look at the bugs that call us home</a>
</strong>
</em>
</p>
<hr>
<h2>4 ways to avoid problems</h2>
<p>Here are our four tips to avoid problems with toe jam, including developing tinea and its complications:</p>
<ol>
<li><p>wash the spaces between your toes and dry them carefully after a shower or bath, and after swimming. Gyms and swimming pools are a common place to pick up a fungal infection on your feet so it’s a good idea to wear thongs to reduce the risk of tinea</p></li>
<li><p>if possible, avoid wearing footwear that doesn’t allow sweat to evaporate (such as closed-in shoes made of synthetic material and gumboots). Going barefoot, when there is no risk of injury, will also allow sweat to evaporate</p></li>
<li><p>treat sweaty feet by using an <a href="https://www.racgp.org.au/afp/2009/september/sweaty-smelly-hands-and-feet">anti-perspirant</a> containing aluminium chloride. More severe cases of hyperhidrosis may be managed using drugs, such as <a href="https://www.dermcoll.edu.au/atoz/plantar-hyperhidrosis/">Botox</a> injections to the feet. Fungal infections (<a href="https://dermnetnz.org/topics/tinea-pedis">tinea</a>) should be treated using over-the-counter antifungal creams such a terbinafine or clotrimazole. Resistant infections might require a course of prescribed antifungal medicines</p></li>
<li><p>pay attention to <a href="https://www.healthline.com/health/all-about-toe-jam#when-to-see-a-doctor">signs</a> indicating an infection is spreading from the foot. These could be pain and swelling in the toes, or red streaks along the foot and up the leg. This requires an urgent visit to a podiatrist or doctor.</p></li>
</ol>
<h2>Footnote</h2>
<p>Lennon mentions a “walrus gumboot” in verse three of Come Together. The final line of verse two says “you got to be free”. The cover of The Beatles album Abbey Road shows Paul McCartney walking barefoot (second from the left).</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/457039/original/file-20220408-18-vvxes4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Beatles album Abbey Road propped up behind turntable playing a record" src="https://images.theconversation.com/files/457039/original/file-20220408-18-vvxes4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/457039/original/file-20220408-18-vvxes4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/457039/original/file-20220408-18-vvxes4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/457039/original/file-20220408-18-vvxes4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/457039/original/file-20220408-18-vvxes4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/457039/original/file-20220408-18-vvxes4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/457039/original/file-20220408-18-vvxes4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Maybe The Beatles were onto something.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/naples-italy-10032019-fabulous-beatles-depicted-1334880947">Imma Gambardella/Shutterstock</a></span>
</figcaption>
</figure>
<p>Maybe the Beatles did know a thing or two about toe jam and foot health.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/beatles-abbey-road-at-50-is-a-marker-of-how-pop-music-grew-up-in-the-1960s-124433">Beatles: Abbey Road at 50 is a marker of how pop music grew up in the 1960s</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/177454/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Caroline Robinson is affiliated with the Australasian Council of Podiatry Deans and the Australian Podiatry Association.</span></em></p><p class="fine-print"><em><span>Luke Donnan is affiliated with the Australasian Council of Podiatry Deans and the Australian Podiatry Association.</span></em></p>Toe jam was mentioned in a song by The Beatles. Maybe they knew a thing or two about foot hygiene.Caroline Robinson, Associate Professor Podiatry, Charles Sturt UniversityLuke Donnan, Lecturer in Podiatry, Charles Sturt UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1766732022-02-23T03:24:40Z2022-02-23T03:24:40ZBest evidence suggests most children’s flat feet will be fine<figure><img src="https://images.theconversation.com/files/447234/original/file-20220218-13-4dtamk.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5760%2C3837&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>A recent article in The Conversation <a href="https://theconversation.com/no-children-dont-magically-grow-out-of-flat-feet-treatment-is-key-to-avoid-long-term-pain-176026">raised unnecessary alarm</a> about children’s flat feet.</p>
<p>The article isn’t supported by the best evidence and may have worried parents.</p>
<p>The <a href="https://pubmed.ncbi.nlm.nih.gov/30987983/">most</a> <a href="https://pubmed.ncbi.nlm.nih.gov/29604617/">recent</a> <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006311.pub4/full">evidence</a> confirms it’s normal for young, healthy and active children to have flexible flat feet, and these flat feet will get less flat over time. </p>
<p>Flat feet require assessment if they hurt, look different left and right, or if they occur in older children, with few requiring treatment.</p>
<h2>Children’s flat feet reduce as they grow</h2>
<p>Approximately <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006311.pub4/full">15-20%</a> of healthy children have flexible flat feet.</p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/18822155/">Studies</a> have consistently shown a higher prevalence of flat feet in younger children, fewer flat feet in older children, and a return towards flatter feet in older adults.</p>
<p>A <a href="https://pubmed.ncbi.nlm.nih.gov/30987983/">2019 study</a> looked at over 3,000 children’s feet. It found the normal foot posture across childhood is flat (also known as “pronated”) and children’s flat feet tend to get less flat as they get older.</p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/29604617/">Another study</a> published in 2018 followed more than 1,000 healthy children for three years. It shows foot posture does “straighten” with time, so there are fewer flat feet in older children.</p>
<p>This study also found high arch feet (the opposite of flat feet) are unusual. So, children with high arch feet are the ones to watch.</p>
<figure class="align-center ">
<img alt="Child flat feet" src="https://images.theconversation.com/files/447950/original/file-20220223-25-19foz6f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/447950/original/file-20220223-25-19foz6f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/447950/original/file-20220223-25-19foz6f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/447950/original/file-20220223-25-19foz6f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/447950/original/file-20220223-25-19foz6f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/447950/original/file-20220223-25-19foz6f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/447950/original/file-20220223-25-19foz6f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Children’s flat feet get less flat as they get older.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>When to investigate flat feet</h2>
<p>Flat feet that are likely to become problematic can now be <a href="https://pubmed.ncbi.nlm.nih.gov/33956150/">better identified</a> in children.</p>
<p>It’s worth having your child assessed <a href="https://pubmed.ncbi.nlm.nih.gov/29148191/">if they have</a>:</p>
<ul>
<li><p>foot pain </p></li>
<li><p>differences between the left and right feet</p></li>
<li><p>feet getting flatter with age</p></li>
<li><p>or if they’re not walking by 18 months.</p></li>
</ul>
<p>Normally, children with flat feet have no pain and have two feet that look similar and are flexible. The magnitude of flatness also generally reduces with time. </p>
<p>Children’s gait development should not be impeded by flat feet, nor should flat feet delay meeting expected milestones. Unexplained difficulty with walking, running and sports should be checked. </p>
<p>Keep family history in mind. If a child’s parents, grandparents or siblings have painful flat feet, it’s reasonable to raise suspicion and monitor foot development and gait over time.</p>
<h2>How do you treat problem flat feet?</h2>
<p>Any treatment requires sound justification, and is usually quite simple.</p>
<p>Footwear is always the first thing to get right. Well-selected shoes alone <a href="https://pubmed.ncbi.nlm.nih.gov/21244647/">make a difference</a> and can be the only “treatment” required.</p>
<p>Other treatments may include:</p>
<ul>
<li><p>exercises, such as muscle stretches and strengthening</p></li>
<li><p>foot orthotics (shoe inserts) </p></li>
<li><p>specific physical activity, like hopping, swimming and balancing.</p></li>
</ul>
<p>In terms of foot orthotics, the good news is low-cost, off-the-shelf orthotics are usually sufficient. In the absence of pain, there’s <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006311.pub4/full">no evidence</a> to support the use of more expensive, customised foot orthotics.</p>
<p>It’s very unlikely for healthy children with flexible flat feet to need surgical treatment. All surgery carries risk, and generally will only even be considered when good non-surgical care fails. Rigid flat feet are very unusual in children, and usually associated with other diagnoses, such as cerebral palsy.</p>
<p>In this era of <a href="https://www.bmj.com/content/358/bmj.j3879">over-medicalisation</a>, it’s important to avoid unnecessary treatment which is not evidence-based.</p>
<figure class="align-center ">
<img alt="Doctor with patient trying foot orthotics" src="https://images.theconversation.com/files/447947/original/file-20220222-21-jmj87q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/447947/original/file-20220222-21-jmj87q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/447947/original/file-20220222-21-jmj87q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/447947/original/file-20220222-21-jmj87q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/447947/original/file-20220222-21-jmj87q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/447947/original/file-20220222-21-jmj87q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/447947/original/file-20220222-21-jmj87q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Off-the-shelf foot orthotics are usually enough, which are cheaper than custom made versions.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>We need to rely on the best evidence</h2>
<p>Confusion about flat feet has occupied the community for decades. There has been a misleading mix of fact and folklore.</p>
<p><a href="https://jamanetwork.com/journals/jama/article-abstract/266180">One study</a> often quoted was written over 70 years ago. At the time, the study’s author observed many army recruits with foot pain had flat feet, and suggested flat feet caused pain. </p>
<p>However, what was also observed at the time, and since overlooked, was that many soldiers with flat feet had no pain.</p>
<p>So, by omission, flat feet became overly associated with pain. We know some adults with foot pain do also have flat feet, while many others function pain-free.</p>
<p>We need to ensure we’re relying on the best scientific evidence on this issue. The best evidence comes from systematic reviews, and the weakest from untested opinions.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/is-this-study-legit-5-questions-to-ask-when-reading-news-stories-of-medical-research-117836">Is this study legit? 5 questions to ask when reading news stories of medical research</a>
</strong>
</em>
</p>
<hr>
<p>Children aren’t mini-adults. They’re growing and developing, and expected to have flexible flat feet that do not hurt and that reduce as they grow up.</p>
<p>Remember, probability is on your side. Most healthy children with flexible flat feet will be fine.</p><img src="https://counter.theconversation.com/content/176673/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Angela Evans is affiliated with Walk for Life Clubfoot in Bangladesh, Director of Australian Podiatry Association.
Angela Evans is an author of Cochrane library reviews (2010, updated 2022) pertaining to intervention for paediatric flat feet.</span></em></p>Recent evidence suggests it’s normal for young, healthy and active children to have flexible flat feet. And these flat feet will get less flat over time.Angela Evans, Adjunct Senior Lecturer, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1760262022-02-03T00:28:46Z2022-02-03T00:28:46ZNo, children don’t magically ‘grow out’ of flat feet. Treatment is key to avoid long-term pain<figure><img src="https://images.theconversation.com/files/443919/original/file-20220202-23-wyl9dy.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C3968%2C2976&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Every day, parents around the world are told their child’s flat feet are normal and they will grow out of it.</p>
<p>This isn’t true – they just grow up and out of their paediatricians’ practice. </p>
<p>There’s no evidence children’s flat feet correct themselves with time.</p>
<p>Failure to intervene when problem flat feet are identified is a disservice to the child. Research shows they <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7026255/pdf/fped-08-00019.pdf">don’t get better</a>, and usually get worse.</p>
<p>Most flat feet are correctable early in life. But when left untreated, they hinder a child’s development, exert adverse pressure on their feet and the rest of the body, and result in <a href="https://www.hmpgloballearningnetwork.com/site/podiatry/case-study/pediatric-overpronation-treat-or-monitor">permanent adverse structural change</a>.</p>
<p>This can <a href="https://link.springer.com/article/10.1007/BF00844680">cause and aggravate life-long</a> issues with their posture.</p>
<p>A child’s flat feet <a href="https://pubmed.ncbi.nlm.nih.gov/6536405/">should be treated early</a>, aggressively, and for the appropriate length of time required to achieve correction.</p>
<h2>Feet don’t unflatten</h2>
<p>Experts agree painful adult flat feet usually arise from <a href="https://pubmed.ncbi.nlm.nih.gov/7319430/">pre-existing flat feet</a> <a href="https://pubmed.ncbi.nlm.nih.gov/2731836/">in childhood</a>.</p>
<p>Children rarely complain of foot pain because their bones are soft and forgiving and their body weight is low, resulting in minimal degrees of stress. They do, however, complain of leg, knee, and “growing” pains. Some also begin to <a href="https://www.hmpgloballearningnetwork.com/site/podiatry/case-study/pediatric-overpronation-treat-or-monitor">avoid physical activity</a>. Many parents say their child won’t stand up straight no matter how many times they are reminded.</p>
<p>Once grown up, they may not experience pain <a href="https://www.hmpgloballearningnetwork.com/site/podiatry/case-study/pediatric-overpronation-treat-or-monitor">until their teens or twenties</a>, or sooner if there are increased stresses, such as participation in sports.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/teenage-pain-often-dismissed-as-growing-pains-but-it-can-impact-their-lives-62827">Teenage pain often dismissed as 'growing pains', but it can impact their lives</a>
</strong>
</em>
</p>
<hr>
<p>The claim children’s flat feet spontaneously resolve isn’t supported by any long-term studies. To the contrary, there’s published data suggesting <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7026255/pdf/fped-08-00019.pdf">children’s flat feet get flatter with time</a> and eventually lead to painful adult flat feet.</p>
<figure class="align-right ">
<img alt="A flat foot compared to a normal foot" src="https://images.theconversation.com/files/443928/original/file-20220202-19-gtfo1k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/443928/original/file-20220202-19-gtfo1k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/443928/original/file-20220202-19-gtfo1k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/443928/original/file-20220202-19-gtfo1k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/443928/original/file-20220202-19-gtfo1k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/443928/original/file-20220202-19-gtfo1k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/443928/original/file-20220202-19-gtfo1k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A flat foot compared to a normal foot.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Why many clinicians claim children’s flat feet get better was originally based on a <a href="https://pubmed.ncbi.nlm.nih.gov/13472025/">1957 study</a> evaluating the heel-to-arch width ratio of two- and ten-year-olds. The authors found the width of the foot reduced by 4% in relation to their age. They concluded this to mean flat feet would resolve by age ten.</p>
<p>But their data didn’t take into account the child’s bone alignment, and the results lacked the significance to conclude that flat feet resolve over time. And it wasn’t a long-term study.</p>
<p>Children with flat feet also have a <a href="https://www.frontiersin.org/articles/10.3389/fped.2020.00019/full">lower quality of life</a> and a higher body mass index (BMI) compared with their peers.</p>
<p>Research confirms flat feet lead to <a href="https://pubmed.ncbi.nlm.nih.gov/21323297/">abnormal stress and compensations in movement</a>, resulting in further issues and pain in the knees and hips as children progress into adulthood.</p>
<h2>The benefits of early intervention</h2>
<p>Justin Greisberg MD, orthopedic surgeon and chief of the foot and ankle service at Columbia University Irving Medical Center, <a href="https://www.hmpgloballearningnetwork.com/site/podiatry/case-study/pediatric-overpronation-treat-or-monitor">said</a> </p>
<blockquote>
<p>the most important treatment for the adult flatfoot is prevention. If the at-risk foot can be identified, early intervention might prevent the deformity.</p>
</blockquote>
<p>Simply occasionally observing a child’s flat feet without intervening (as some doctors and podiatrists do) is a clinical mistake and makes later treatment difficult or impossible.</p>
<figure class="align-center ">
<img alt="Doctor looking at patient's flat feet" src="https://images.theconversation.com/files/443922/original/file-20220202-19-886yv6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/443922/original/file-20220202-19-886yv6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/443922/original/file-20220202-19-886yv6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/443922/original/file-20220202-19-886yv6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/443922/original/file-20220202-19-886yv6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/443922/original/file-20220202-19-886yv6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/443922/original/file-20220202-19-886yv6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Early intervention can prevent issues in adulthood.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Early intervention encourages the development of the foot’s correct shape in a way similar to, for example, <a href="https://www.hmpgloballearningnetwork.com/site/podiatry/case-study/pediatric-overpronation-treat-or-monitor">getting braces</a> for your teeth.</p>
<p>This idea has been used successfully for decades in the correction of other foot posture issues, <a href="https://www.physio-pedia.com/Ponseti_method">such as club feet</a>.</p>
<p>This doesn’t mean all flat feet need to be treated, but a skilled clinician <a href="https://pubmed.ncbi.nlm.nih.gov/33956150/">must identify</a> those with the potential to become problematic immediately.</p>
<p>Occasionally monitoring a child’s flat feet leaves the condition to develop and fester, making it <a href="https://pubmed.ncbi.nlm.nih.gov/6536405/">unresponsive to later treatment</a>.</p>
<p>This approach also contradicts research showing <a href="https://pubmed.ncbi.nlm.nih.gov/21323297/">early treatment</a> <a href="https://www.hmpgloballearningnetwork.com/site/podiatry/case-study/pediatric-overpronation-treat-or-monitor">is key</a> to achieving successful results.</p>
<p>Treatments can include orthotics, strengthening exercises, ballet and surgery.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-it-means-when-kids-walk-on-their-toes-59081">What it means when kids walk on their toes</a>
</strong>
</em>
</p>
<hr>
<p>In the child’s flat foot, we face a complex assortment of loose ligaments, young muscles and nerves, and an immature and poorly aligned skeletal system. </p>
<p>It’s from this framework that children derive their adult foot structure and function. </p>
<p>Failure to intervene is a failure to recognise the long-term consequences of excessive flat-footedness not only on the feet but <a href="https://www.hmpgloballearningnetwork.com/site/podiatry/case-study/pediatric-overpronation-treat-or-monitor">the entire body</a>.</p><img src="https://counter.theconversation.com/content/176026/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Steven Edwards works in private practice in Melbourne, Australia.</span></em></p>There’s no evidence problem flat feet correct themselves with time. They should be treated early.Steven Edwards, Adjunct Associate Lecturer, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1060682018-11-22T18:49:26Z2018-11-22T18:49:26ZTennis, running, netball: do I really need a specific shoe for a specific sport?<figure><img src="https://images.theconversation.com/files/246357/original/file-20181120-161612-qyma92.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Parents can fork out big bucks for different shoes for different sports for their children. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/running-children-young-athletes-run-kids-772039159?src=5DS5OducNQY4fwmCHqKwTA-1-15">from www.shutterstock.com </a></span></figcaption></figure><p>Over the past 40 years the “modern” sports shoe has evolved from the all-purpose sneaker to an abundance of sport-specific shoes. Given we have so much choice – and with encouragement from big brands and keen shop assistants – it seems logical to select footwear designed specifically for each activity. </p>
<p>But what does the evidence say? Do we really need to wear a unique shoe for each activity we participate in?</p>
<p>The answer is a little less clear than you might imagine. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/children-should-spend-more-time-barefoot-to-encourage-a-healthier-foot-structure-100289">Children should spend more time barefoot to encourage a healthier foot structure</a>
</strong>
</em>
</p>
<hr>
<h2>What you want in a shoe</h2>
<p>Before we look at the evidence, let’s think about what we want from our sports shoes. </p>
<p>For me, there are three key considerations that can help guide the shoe selection process: </p>
<ol>
<li>the selected shoe should minimise the risk of injury in light of the sports it will be used for, and with respect to the uniqueness of the person wearing it</li>
<li>our sports shoe should allow us to maximise our athletic performance, but not at the expense of increasing injury risk (let’s face it, if you get injured then your athletic performance is likely to decrease anyway!) </li>
<li>our shoes should be comfortable – this may sound obvious, but some of the world’s most esteemed footwear researchers suggest that increased footwear comfort is associated with <a href="https://bjsm.bmj.com/content/49/20/1290.long">fewer injuries and improved sporting performance</a>.</li>
</ol>
<p>With this in mind, we need to consider the unique physical demands of each sport and what shoe features are required to help prevent injury and maximise performance. </p>
<p>For some sports, the benefits of using a specific shoe are quite obvious. Most would agree that football boots with built-in spriggs will help maintain traction while avoiding a tackle, while a stiff-soled cycling shoe will help power production through bike pedals during a hill climb. </p>
<p>However, the benefits of using a sport-specific shoe during other activities may not be as apparent. For example, is there really that much difference between netball, basketball and tennis shoes? </p>
<h2>Court shoes versus running shoes</h2>
<p>With the exception of basketball shoes typically having a “high-top” upper, all other features of court shoes can be quite similar – they all aim to provide support, cushioning and traction during multi-directional movements. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/246366/original/file-20181120-161624-1784hjh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/246366/original/file-20181120-161624-1784hjh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=388&fit=crop&dpr=1 600w, https://images.theconversation.com/files/246366/original/file-20181120-161624-1784hjh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=388&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/246366/original/file-20181120-161624-1784hjh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=388&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/246366/original/file-20181120-161624-1784hjh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=488&fit=crop&dpr=1 754w, https://images.theconversation.com/files/246366/original/file-20181120-161624-1784hjh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=488&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/246366/original/file-20181120-161624-1784hjh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=488&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">My high tops sure do look good.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/2xvOUe__syg">Gold Chain Collective/Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>To achieve this, common features among court shoes include having a re-enforced toe, a slightly “flared” forefoot, a relatively flat sole, and being made from strong and durable materials in the uppers and outsoles (the base). </p>
<p>In contrast, running shoes are traditionally designed for repetitive straight line movements performed over long distances. So running shoes are generally lightweight and have a highly cushioned midsole – which is intended to dampen impact forces – while also being flexible through the forefoot to assist with propulsion.</p>
<p>These differences in shoe design all sound good in theory, but are they actually effective in reducing injury and maximising performance? </p>
<p>Unfortunately the science on this topic is scarce, but let’s look at what we know. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/sustainable-shopping-how-to-rock-white-sneakers-without-eco-guilt-85989">Sustainable shopping: how to rock white sneakers without eco-guilt</a>
</strong>
</em>
</p>
<hr>
<h2>The evidence is scarce</h2>
<p>A clinical trial found using high-top shoes for basketball does not help <a href="https://journals.sagepub.com/doi/abs/10.1177/036354659302100416">prevent ankle sprains</a> – and a separate <a href="https://shapeamerica.tandfonline.com/doi/abs/10.1080/026404197367146#.W_OB8xMzY0p">study</a> found that high-top shoes actually decrease vertical jump height and running performance.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/246368/original/file-20181120-161612-1w8v4w4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/246368/original/file-20181120-161612-1w8v4w4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/246368/original/file-20181120-161612-1w8v4w4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/246368/original/file-20181120-161612-1w8v4w4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/246368/original/file-20181120-161612-1w8v4w4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/246368/original/file-20181120-161612-1w8v4w4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/246368/original/file-20181120-161612-1w8v4w4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Some of these shoes may be ok for running - mostly depending on whether you find them comfortable or not.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/collection-various-sport-summer-shoes-56407381?src=MdMmGZHF-gVZbfFk47v0uQ-1-35">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>Based on these studies, I rarely recommend that people seek out a high-top shoe for court sports (but I don’t avoid them either). The priority should be on selecting a court shoe that fulfills the needs of each individual (current and past injuries must be considered) and their sport. All court shoes – irrespective of whether they are labelled a tennis, basketball or netball shoe – should be looked at. Much of this process is guided by theory and comfort given the lack of research in this area.</p>
<p>With respect to running, you may be surprised to learn that choice of running shoes for prevention of injury is also still largely theoretical. </p>
<p>Over the past decade there has been an increase in research focused on determining the features of running shoes that are most important for the prevention of injury, but none have investigated how running shoes compare to other <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=logical+fallacies+running+shoe">sport-specific shoes for this purpose</a>. </p>
<p>Although there is uncertainty around the benefits running shoes provide for the prevention of running injuries, we do know that running performance is <a href="https://www.ncbi.nlm.nih.gov/pubmed/28483557">improved as shoes get lighter</a>. As running shoes are generally lighter than all other footwear options, using them will likely result in greater athletic performance compared to non-running shoes.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/from-tech-to-fetish-shoes-in-fairy-tales-are-a-mark-of-status-93948">From tech to fetish, shoes in fairy tales are a mark of status</a>
</strong>
</em>
</p>
<hr>
<h2>Can I buy all-purpose shoes?</h2>
<p>A common question is whether a single all-purpose sports shoe is OK. </p>
<p>Science can’t answer this without the right evidence. But in general terms, an all-purpose shoe (i.e. something branded as a “cross-trainer” in the shops) will generally be fine for someone who participates in an array of activities, particularly if being completed at low intensities. </p>
<p>However, if you’re playing sports at a competitive level, or doing the same activity regularly, then it makes sense to wear sport-specific shoes – although more research is needed to confirm this recommendation. </p>
<p>It’s also worth stating that if you have been injury free in your current sports shoe, and you’re performing at a level you are happy with, then you may already have the right shoes on your feet. </p>
<p>And don’t forget, make sure your shoes are comfortable!</p><img src="https://counter.theconversation.com/content/106068/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Daniel Bonanno does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>If you’ve been injury-free in your current sports shoe, and you’re performing at a level you are happy with, you may already have the right shoes on your feet.Daniel Bonanno, Lecturer (Teaching and Research) and PhD Candidate, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1002892018-08-02T10:43:11Z2018-08-02T10:43:11ZChildren should spend more time barefoot to encourage a healthier foot structure<figure><img src="https://images.theconversation.com/files/230231/original/file-20180801-136652-qcpgci.jpg?ixlib=rb-1.1.0&rect=25%2C74%2C973%2C552&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/1112093552?src=sutxeCn1jO4u3xRr4V8Khg-1-15&size=medium_jpg">berez_ka/Shutterstock.com</a></span></figcaption></figure><p>Humans have gone unshod for <a href="https://www.ncbi.nlm.nih.gov/pubmed/22257937">millions of years</a>; it is only in the last few centuries that people have started wearing shoes. However, a recent <a href="https://www.ncbi.nlm.nih.gov/pubmed/28808276">survey</a> shows that shoe wearing among young boys isn’t universal. German children and teenagers spend most of their day in shoes, while about 90% of their South African counterparts go barefoot.</p>
<p>Aside from the obvious climate differences, it is tempting to think that South Africa’s <a href="https://www.gfmag.com/global-data/economic-data/worlds-richest-and-poorest-countries">lower economic ranking</a>, compared with Germany’s, is the main reason for the absence of footwear. But this reasoning has been challenged by results from our recent <a href="https://jfootankleres.biomedcentral.com/articles/10.1186/s13047-018-0285-y">survey</a>. </p>
<p>We gathered information on the footwear habits of 714 boys attending a secondary school in a wealthy part of Auckland, New Zealand. Almost half of the students (45%) spent most of their time barefoot. Many of the students in this study were even willing to run distances of 100 to 3,000 metres on a hard track surface without shoes.</p>
<h2>Foot structure</h2>
<p>Differences in foot structure between those who have never worn shoes and those who are usually in shoes have been described for over a century. In one seminal <a href="https://www.tuhykorinek.cz/wp-content/uploads/2016/12/1905hoffman.pdf">1905 study</a>, Phil Hoffman, warned how putting the fashionable desires of customers over the health of their feet had led to shoe design “that more or less crowds the front of the foot”.</p>
<p>The main developmental result of growing up in shoes appears to be a <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0057209">narrower foot</a> and a <a href="https://www.ncbi.nlm.nih.gov/pubmed/1624509">lower arch</a>. The result of this is more <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0057209">concentrated pressure</a> at the heel and the ball of the foot during movement. </p>
<p>By contrast, those who grow up barefoot have <a href="https://www.tandfonline.com/doi/abs/10.1080/19424280903386411">wider feet</a> and have a more <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0057209">even distribution of pressure</a> towards the outside edge of the foot and across the toes. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/230235/original/file-20180801-136649-nfd19m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/230235/original/file-20180801-136649-nfd19m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=300&fit=crop&dpr=1 600w, https://images.theconversation.com/files/230235/original/file-20180801-136649-nfd19m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=300&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/230235/original/file-20180801-136649-nfd19m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=300&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/230235/original/file-20180801-136649-nfd19m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=377&fit=crop&dpr=1 754w, https://images.theconversation.com/files/230235/original/file-20180801-136649-nfd19m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=377&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/230235/original/file-20180801-136649-nfd19m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=377&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/667255279?src=xWdImHuLt8xMqz59Um2VSQ-1-18&size=huge_jpg">Sakurra/Shutterstock.com</a></span>
</figcaption>
</figure>
<h2>Running as nature intended</h2>
<p>We don’t know what effect growing up in shoes has on the development of movement skills, or the risk of injury in sport, but logic suggests that growing up barefoot is a good thing. </p>
<p>The heel of the foot is <a href="https://www.ncbi.nlm.nih.gov/pubmed/8406251">highly sensitive to pain</a>, meaning that when people run barefoot they tend to avoid landing on their heel and instead defer the pressure to the mid and forefoot. This allows a broader surface area to absorb force. </p>
<p>In order to avoid a heel strike, the foot must never be too far in front of the body. As a result, barefoot runners tend to have a <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=A+Comparison+of+Stride+Length+and+Lower+Extremity+Kinematics+during+Barefoot+and+Shod+Running+in+Well+Trained+Distance+Runners">shorter stride</a>. A shorter stride needs less leg extension, which is why barefoot runners have greater <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=A+Comparison+of+Stride+Length+and+Lower+Extremity+Kinematics+during+Barefoot+and+Shod+Running+in+Well+Trained+Distance+Runners">bend at the knee</a> and a more pointed foot toward the floor. These joint positions allow muscles around the knee to help control landing and allow the ankle to behave in a more spring-like fashion. </p>
<h2>The problem with shoes</h2>
<p>Covering the heel of the foot reduces the sensation it experiences when coming into contact with the ground. The running shoe, containing a cushioned heel, allows the runner to land on the heel of the foot with an extended leg. This is perhaps why <a href="https://www.ncbi.nlm.nih.gov/pubmed/17685722">about 75%</a> of runners nowadays are heel strikers. </p>
<p>Running using an extended limb (overstriding) results in force being absorbed through the heel, bony structures and joints, with less assistance from muscle. This may be one of the reasons most <a href="https://www.ncbi.nlm.nih.gov/pubmed/22827721">running injuries</a> are to structures that are not designed to absorb force (shins, feet and knees). Interestingly, when people remove their shoes, most <a href="https://www.ncbi.nlm.nih.gov/pubmed/28728130">revert to middle and forefoot</a> striking.</p>
<p>Children and teenagers who grow up mostly barefoot appear strong enough to run quickly and for long distances without shoes. The prevalence of leg pain in the New Zealand students we studied was at the lower end of that reported <a href="https://journals.lww.com/acsm-essr/Citation/1997/00250/14_Physical_Activity,_Adolescence,_and_Health__An.16.aspx">globally</a> in students of a similar age. This finding, combined with an absence of evidence for the role of shoes in the prevention of injury, makes it seem reasonable to suggest that children should spend as much time as possible barefoot. </p>
<p>Social acceptability is a barrier to barefoot activities in many Western countries, as a result, adults who did not grow up mostly barefoot may not have the same foot structure and leg strength to transition to barefoot activities quickly. </p>
<p>Gradually building time spent walking and running in bare feet is key for people who are new to barefoot activities. The increasing availability of shoes that mimic the structure of the foot (minimalist shoes) and have little cushioning other than to cover the foot, may help people transition to being barefoot. The improving design of these shoes may also help to tackle the issue of social acceptability.</p><img src="https://counter.theconversation.com/content/100289/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Peter Francis does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Many children in New Zealand grow up barefoot. Should all children follow this model?Peter Francis, Director of the Musculoskeletal Science Research Group, Leeds Beckett UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/820652017-08-28T04:52:54Z2017-08-28T04:52:54ZExplainer: what is a bunion and do I need to get mine treated?<figure><img src="https://images.theconversation.com/files/180965/original/file-20170804-17911-163olz1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Bunions are more than just a cosmetic issue. </span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p>While most people don’t like the sight of bunions, they’re much more than a cosmetic issue. A bunion can cause pain and impact physical function, as well as <a href="https://www.latrobe.edu.au/news/articles/2011/article/study-finds-bunions-more-common-in-women">affecting general health</a>, mental health and social function. Limitations on what footwear can be comfortably worn due to bunions reduces social activities and physical activities.</p>
<p>Scientifically named hallux valgus, a bunion is an enlargement of the inner portion of the joint at the base of the big toe. The enlargement is due to a misalignment of the big toe joint and, in some cases, there is additional bone growth caused by inflammation. The misalignment causes the big toe to point outward towards the other smaller toes. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/180966/original/file-20170804-5649-1bq21xv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/180966/original/file-20170804-5649-1bq21xv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=500&fit=crop&dpr=1 600w, https://images.theconversation.com/files/180966/original/file-20170804-5649-1bq21xv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=500&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/180966/original/file-20170804-5649-1bq21xv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=500&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/180966/original/file-20170804-5649-1bq21xv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=628&fit=crop&dpr=1 754w, https://images.theconversation.com/files/180966/original/file-20170804-5649-1bq21xv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=628&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/180966/original/file-20170804-5649-1bq21xv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=628&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Bunion can also occur in the fifth toe. This is called a bunionette, or ‘tailor’s bunion’.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<h2>What are the symptoms?</h2>
<p>Symptoms can include the joint becoming inflamed with redness, tenderness, and pain. This is due to a small fluid-filled sac called the bursa, which is adjacent to the joint, also becoming inflamed. This is called bursitis.</p>
<p>A deeper joint pain may occur in later stages of the deformity if localised arthritis develops. Over time, the deformity will increase, although the symptoms may not increase.</p>
<p>The pain of bunions and the difficulty finding comfortable footwear impacts on <a href="http://lermagazine.com/article/bunion-research-focuses-on-patient-quality-of-life">people’s ability to exercise</a>, resulting in reduced physical and mental health. There are also effects on self-image, with patients being uncomfortable with others seeing their feet.</p>
<h2>Who is affected?</h2>
<p>A <a href="https://www.latrobe.edu.au/news/articles/2011/article/study-finds-bunions-more-common-in-women">recent Australian study</a> found a surprising 36% of participants had this condition, with women and older people more likely to be affected. </p>
<h2>What are the causes?</h2>
<p>There are a few factors that can lead to bunions including a genetic component. They are caused by faulty foot structures such as <a href="https://theconversation.com/what-are-flat-feet-in-children-and-are-they-something-to-worry-about-60365">having flat feet</a>, excessively flexible ligaments, or abnormal bone structures that lead to the development of bunions.</p>
<p>The <a href="http://onlinelibrary.wiley.com/doi/10.1002/acr.22040/full">Framingham Foot Study</a> found bunions and lesser toe deformities are often inherited in white men and women of European descent. </p>
<p>Shoes also play a significant part, including shoes that are too narrow or <a href="https://theconversation.com/health-check-how-high-heels-harm-and-how-to-make-it-better-22498">wearing high heels</a> for prolonged periods, hence women being over-represented.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/180967/original/file-20170804-5618-1bvb5j0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/180967/original/file-20170804-5618-1bvb5j0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/180967/original/file-20170804-5618-1bvb5j0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=480&fit=crop&dpr=1 600w, https://images.theconversation.com/files/180967/original/file-20170804-5618-1bvb5j0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=480&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/180967/original/file-20170804-5618-1bvb5j0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=480&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/180967/original/file-20170804-5618-1bvb5j0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=603&fit=crop&dpr=1 754w, https://images.theconversation.com/files/180967/original/file-20170804-5618-1bvb5j0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=603&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/180967/original/file-20170804-5618-1bvb5j0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=603&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Wearing shoes that are too narrow can cause bunions.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<h2>Do bunions need to be treated?</h2>
<p>Not all bunions <a href="http://www.healthline.com/health/bunion-removal#overview1">need to be operated on</a>. Conservative treatment is recommended first and then if this doesn’t alleviate the condition (you are unable to walk more than a few blocks and medication and rest don’t reverse the swelling and pain) you may be advised to have surgery. </p>
<p>The severity of the deformity will dictate the extent of the surgical procedures required. There are a number of surgical techniques currently practised. </p>
<p>Bunionectomy is the removal of the inflamed fluid sac from between the skin and bone. Osteotomy is the repositioning of the metatarsal, the big bone in the toe that’s affected. The surgeon may hold the repositioned bone in place with screws, wires, or a metal plate. In severe cases, an artificial joint will be used to replace the existing badly damaged joint. This procedure is called arthrodesis.</p>
<p>Newer minimally invasive surgical techniques are <a href="http://journals.sagepub.com/doi/10.1177/1071100716656440">showing positive results</a> for mild to moderate bunions. The <a href="http://www.jointhealth.com.au/articles/minimally-invasive-bunion-correction-surgery-a-game-changer-in-forefoot-surgery">advantages to this approach</a> to osteotomy compared to traditional osteotomy are that healing time is minimised and scarring is decreased. The tissues that cross the big toe joint are not damaged in the newer approach, which means there is no joint stiffness after surgery. </p>
<p>If surgical treatment isn’t advised, there are still things you can do to alleviate the condition.</p>
<p><strong>Choice of footwear</strong>: your choice of footwear is important. Shoes that are flat, supportive and give you plenty of width for your toes are the best choice. Orthotics may also ease the condition.</p>
<p><strong>Exercises</strong>: a podiatrist can recommend specific exercises to treat your symptoms of bunion. These might include going barefoot around the house as this activates the muscles in your big toe joints.</p>
<p><strong>Medication</strong>: anti-inflammatory medication may help, and some people receive steroid injections, such as cortisone. These injections reduce the inflammation, and may relieve pain temporarily. Caution is advised as there are many side effects such as infection and bleeding, especially if used frequently and at high doses.</p>
<p><strong>Maintain a healthy weight</strong>: this reduces the pressure on your foot joints.</p>
<p><strong>Padding</strong>: use of over-the-counter pads can relieve the pressure on your bunions.</p>
<h2>What should I do for my bunion?</h2>
<p>The best way to find the right treatment for you is to ask your general practitioner or a podiatrist for their advice. The information in this article is general in nature, and your specific case will have to be examined.</p><img src="https://counter.theconversation.com/content/82065/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah Lausberg does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A bunion is an enlargement of the inner portion of the joint at the base of the big toe. Does it need to be removed?Sarah Lausberg, Sessional Academic - Health Promotion, Public Health, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/672972016-12-22T03:47:47Z2016-12-22T03:47:47ZShould I worry if my child is pigeon-toed or duck-footed?<figure><img src="https://images.theconversation.com/files/147700/original/image-20161128-22735-10hdkuj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There are many treatments recommended for rotational deformities, but do they work and are they necessary? </span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p>Babies regularly have their feet, legs and hips checked by their doctor in hospital, or at maternal and child-health nurse visits. </p>
<p>As children grow, parents are often concerned about their feet pointing inwards when they walk (also called in-toe or pigeon-toed walking) or outwards (also called out-toe walking or duck-footed).</p>
<p>These walking positions, commonly called “rotational deformities”, often cause parents to seek the opinion of an orthopaedic surgeon, physiotherapist or podiatrist for more specialised assessment.</p>
<h2>Rotational deformities</h2>
<p>When the leg or foot faces inwards or outwards during walking, it may be from a number of typical changes in the leg or foot. </p>
<p>When a baby is born they often have bowed or curved legs. This is thought to be because of the position of the baby <a href="http://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/fetal-development/art-20045997?pg=2">in the womb</a>. </p>
<p>This position can remain and seem more obvious when the child begins to walk. It may appear as if the feet face inwards. Sometimes children may appear to trip or fall over their own feet. </p>
<p>In-toe walking may come from a curved foot (metatarsus adductus) or an inwards twist in the leg bones (tibial or femoral torsion). </p>
<p>Similarly, out-toe walking may appear from the foot or leg. A foot that is very rolled in or “<a href="http://www.mayoclinic.org/diseases-conditions/flatfeet/basics/causes/con-20023429">pronated</a>” may appear as if it is pointing outwards. A leg may also turn outwards from the leg bones or the hip. </p>
<p>The flexibility of a child’s joints or the way they use their muscles could also cause in-toeing or out-toeing. A twist in their bones is one possible contributing factor to in-toe or out-toe walking.</p>
<h2>Curved feet</h2>
<p>Metatarsus adductus is the most common foot deformity in infants. In metatarsus adductus, the foot has a curved or banana-shaped appearance. In <a href="http://journals.lww.com/pedorthopaedics/Abstract/1997/01000/Foot_Deformities_at_Birth__A_Longitudinal.7.aspx">95% of cases</a>, the foot corrects itself with no treatment. </p>
<p>In the past, it was recommended to put shoes on the wrong feet. This is no longer recommended as it may cause further foot deformity. </p>
<p><a href="http://onlinelibrary.wiley.com/doi/10.1111/jpc.12219/full">Sometimes treatment is needed</a>. Plaster casting or splinting may be required to help the foot straighten if it doesn’t on its <a href="https://www.ncbi.nlm.nih.gov/pubmed/24248551">own</a>. </p>
<p>Parents should see a health professional if their child’s foot is curved, stiff and unable to be straightened, or isn’t straightening as their child gets older. </p>
<h2>Twisted shin bones</h2>
<p>Tibial torsion is where the lower leg or tibia turns in or outwards. An inward-turned tibia is common in children under the age of three. It usually straightens after this age and sometimes even slightly turns outward with no treatment. These changes occur in <a href="http://journals.lww.com/jpo-b/Abstract/2014/01000/Normative_reference_values_for_lower_limb_joint.3.aspx">children up to the age of eight</a>. </p>
<p>Health professionals will sometimes recommend children with in-toe walking wear a type of orthotic called gait plates. While gait plates may provide some cosmetic effect when worn, there is no evidence they will result in long-term change.</p>
<p>Parents should be cautious about claims these devices will fix in-toe walking. They need to consider if the expense is worth it for something that will naturally get better on its own. There is <a href="https://www.ncbi.nlm.nih.gov/pubmed/22328828">no good evidence</a> stretches or footwear will change this type of walking.</p>
<h2>Turning inwards or outwards at the hip</h2>
<p>Femoral torsion is where the upper leg bone (femur) or hip is turned in or outwards. Children may appear to walk with their feet inwards or outward. It also looks like their knees point inwards or outwards. </p>
<p>The femur goes through <a href="http://journals.lww.com/jpo-b/Abstract/2014/01000/Normative_reference_values_for_lower_limb_joint.3.aspx">many changes up to the age of 12</a> and an inward turn at the hip is more commonly seen in <a href="https://www.ncbi.nlm.nih.gov/pubmed/18383647">girls</a>. Rotational changes at the top of the leg are also a very normal part of growth.</p>
<p>Walking changes from the top of the leg and hip sometimes appear more common in children who frequently W-sit. This sitting position is with their bottom on the ground and legs folded outwards. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/147715/original/image-20161128-22732-qp6jmu.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/147715/original/image-20161128-22732-qp6jmu.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=627&fit=crop&dpr=1 600w, https://images.theconversation.com/files/147715/original/image-20161128-22732-qp6jmu.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=627&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/147715/original/image-20161128-22732-qp6jmu.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=627&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/147715/original/image-20161128-22732-qp6jmu.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=788&fit=crop&dpr=1 754w, https://images.theconversation.com/files/147715/original/image-20161128-22732-qp6jmu.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=788&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/147715/original/image-20161128-22732-qp6jmu.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=788&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">W-sitting isn’t necessarily harmful, but can affect a child’s walking.</span>
<span class="attribution"><span class="source">Author Provided</span></span>
</figcaption>
</figure>
<p>There is no research proving sitting like this is harmful, but therapists often observe hip muscle tightness in children who sit this way and it may affect the child’s walking. As harm is unknown, it might be best to get children to sit or play in other positions. </p>
<p>There are no shoes, orthotics, garments, taping or stretches that have evidence supporting them being used to change walking associated with these rotational changes. Parents should seek medical attention quickly if there is pain at the hip or pain extends into the groin while walking at any age.</p>
<p>Children walk in-toe and out-toe for many reasons. Parents should see a health professional if their child is tripping from their leg position when their child is school-aged, if one leg turns substantially more inwards or outwards than the other, seems longer or looks very different compared to the other. </p>
<p>For the majority of children, in-toe or out-toe walking is just part of growth.</p><img src="https://counter.theconversation.com/content/67297/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Cylie Williams consults in private practice and for an education company providing paediatric podiatry education. In the past, Cylie has received funding from the Australian Podiatry Education and Research Foundation for research into children's gait.</span></em></p><p class="fine-print"><em><span>Verity Pacey receives funding from The Menzies Foundation, Arthritis Australia, Osteogenesis Imperfecta Society of Australia, Rheumatology Health Professionals Association and The Ian Potter Foundation.</span></em></p>For the majority of children, in-toe or out-toe walking is just part of growth.Cylie Williams, Adjunct Post Doctoral Research Fellow, Monash UniversityVerity Pacey, Senior Physiotherapist, The Children's Hospital at Westmead, and Lecturer in Physiotherapy, Macquarie UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/665712016-12-19T19:05:17Z2016-12-19T19:05:17ZExplainer: how diabetic foot disease can lead to amputations and even death<figure><img src="https://images.theconversation.com/files/145957/original/image-20161115-30782-cu7mpu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Diabetes-Related Foot Disease is very common.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/jeremybrooks/2763992743/in/photolist-5dfbKi-8gLYWQ-8qDfmT-fb3oS-4PNsLg-5mVHr9-ewtmR-91rRJG-u3cUd-7SuQKP-5LQCXD-o5qnYy-bR5Jm8-81utrs-4DW65o-6Ykd8u-4YPfti-dySuXf-2zEjAC-dNQA1i-qNfgdw-pRxsEX-qvLdhG-dKmskj-9iDFLu-94hotQ-esJWno-bPPS7Z-fCgg2H-CELv4x-54Syfg-dNtDyQ-5TWQPd-baZ364-5pFC1w-4G21sc-8Jx3cS-5vU2iS-9cHzoz-6Le2z-bBYzuW-f1DMo-n5ar2-8zvJhi-7CQe6k-3yQxbw-kW6o8M-5Uuye5-owJDoU-2xabiL">Jeremy Brooks/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>People with diabetes are prone to foot disease, which can lead to amputations and even death. Australia has the second-highest rate of lower-limb amputations in the developed world – with the rate having <a href="https://www.mja.com.au/journal/2012/197/4/limb-lost-every-3-hours-can-australia-reduce-amputations-people-diabetes?0=ip_login_no_cache%3Dbc77bdf4e3f85d156cb4dd449c799816">risen by 30% over the past decade</a>.</p>
<p>This is because as rates of type 1 and 2 diabetes increase, so do the very common related problems of foot health – known as Diabetes-Related Foot Disease (DRFD). </p>
<p>Five-year survival rates for those with diabetic foot problems are <a href="https://www.researchgate.net/publication/23482085_Mortality_Rates_and_Diabetic_Foot_Ulcers_Is_it_Time_to_Communicate_Mortality_Risk_to_Patients_with_Diabetic_Foot_Ulceration">lower than for prostate, breast and colon cancer</a>, yet the severity of the problem isn’t widely recognised.</p>
<p>If you are one of the estimated <a href="http://www.aihw.gov.au/diabetes/">one million Australians</a> with diabetes, paying close attention to your foot health could save you from serious, sometimes devastating complications.</p>
<h2>How does diabetes cause foot disease?</h2>
<p>The <a href="http://jamanetwork.com/journals/jama/fullarticle/200119">most common type of foot disease</a> related to diabetes, affecting up to a quarter of diabetes sufferers, is foot ulcers. These are actually a big financial burden as well. Of the US$116 billion allocated for diabetes care in the United States in 2007, <a href="http://www.sciencedirect.com/science/article/pii/S0741521410013248">one-third was directed</a> to treat foot ulceration. Here’s why it happens.</p>
<p>Diabetic skin <a href="http://www.sciencedirect.com/science/article/pii/S0002944011001246">contains less of the structural protein collagen</a> than normal skin. This means it becomes fragile, stiff and more prone to breaking. So a diabetic is more likely to experience injury and poor wound healing.</p>
<p>Diabetes also <a href="https://www.nhlbi.nih.gov/health/educational/pad/materials/index.html">increases a person’s risk</a> of developing poor blood circulation by up to four times. Stiffer blood vessels restrict blood supply to tissues in the body. When circulation is poor, injuries such as cuts and blisters are less able to heal and more likely to become infected or turn into ulcers. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/145966/original/image-20161115-30749-1tbckih.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/145966/original/image-20161115-30749-1tbckih.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/145966/original/image-20161115-30749-1tbckih.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/145966/original/image-20161115-30749-1tbckih.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/145966/original/image-20161115-30749-1tbckih.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/145966/original/image-20161115-30749-1tbckih.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/145966/original/image-20161115-30749-1tbckih.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Australia has the second-highest rate of lower limb amputation in the developed world.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>Wounds related to diabetes most commonly happen on the extremities (feet and lower legs) because these areas are the first to lose feeling and blood supply. The forces of walking and pressure from footwear can also cause damage to the tissues in these areas.</p>
<p>Once a wound has occurred, abnormalities in diabetic cells also prevent healing in the usual way. Although a diabetic’s wound usually contains the cells needed for it to heal, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1857239/">these are often not present</a> in the right amounts or at the right time. </p>
<p>The longer the wound remains unhealed, the more susceptible it is to infection from opportunistic bacteria.</p>
<p>Those with diabetic foot disease often have reduced feeling, or complete loss of it, in their feet – known as peripheral neuropathy. This means they are less likely to notice trauma such as blisters from a rubbing shoe. </p>
<p>A minor injury, such as a small cut, can quickly develop into an ulcer. Peripheral neuropathy <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1464-5491.1994.tb00310.x/abstract">has been shown to contribute</a> to 90% of foot ulcers. </p>
<p>These are <a href="https://www.ncbi.nlm.nih.gov/pubmed/8501419">notoriously difficult to heal</a> and reoccur in up to 70% of cases. Experts consider those with a healed foot ulcer to be in a state of remission needing careful ongoing monitoring.</p>
<h2>How foot disease can be prevented</h2>
<p>Men are more at risk of developing diabetic foot disease than women. </p>
<p>Other <a href="http://www.consultant360.com/articles/risk-factors-diabetic-foot-ulcers-first-step-prevention">risk factors include</a> living with diabetes for more than ten years, being older, smoking and drinking alcohol, kidney disease and high blood pressure.</p>
<p>Although foot disease in diabetes is a severe problem, there are <a href="https://www.bakeridi.edu.au/Assets/Files/Foot_FullGuideline_23062011.pdf">simple and relatively accessible ways</a> to reduce its rate and severity.</p>
<p>The first basic preventive strategy is for every diabetic patient to request a comprehensive foot examination. </p>
<p>This is often carried out by a podiatrist but any suitably skilled health professional such as a GP or diabetes educator can do so. The health professional will examine the feet, looking at circulation, sensation and footwear. </p>
<p>Ideally, those at risk of ulcers should be managed by a foot protection program. This is a designated podiatrist-led service for preventing, treating and managing diabetic foot problems. It includes education about caring for feet, a podiatry review and appropriate footwear. Such programs <a href="http://www.futuremedicine.com/doi/abs/10.2217/dmt.13.32">can reduce the chance</a> of amputation by 85%. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/145965/original/image-20161115-30777-s5ypvk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/145965/original/image-20161115-30777-s5ypvk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/145965/original/image-20161115-30777-s5ypvk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/145965/original/image-20161115-30777-s5ypvk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/145965/original/image-20161115-30777-s5ypvk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/145965/original/image-20161115-30777-s5ypvk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1130&fit=crop&dpr=1 754w, https://images.theconversation.com/files/145965/original/image-20161115-30777-s5ypvk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1130&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/145965/original/image-20161115-30777-s5ypvk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1130&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Ulcers are the most common type of diabetic-related foot disease.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>Unfortunately, foot-screening rates in Australia are low. Only around 20% of those with diabetes get <a href="http://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0016/291220/Save-a-leg2.pdf">regular foot checks</a>. And foot-protection programs are in their infancy, while specialist footwear is often too expensive for the average person.</p>
<p>Personal technology devices are <a href="https://www.ncbi.nlm.nih.gov/pubmed/20682681">playing a role</a> in preventing and managing foot disease in diabetes. Smartphone technology and activity monitors, such as iPhones and Fitbits, can help monitor gait patterns and physical activity in those at risk of ulceration. This information can be integrated with specialist apps to modify lifestyle, activity and footwear.</p>
<p>Combining innovative, widely available technology with professional screening and management strategies can prevent the catastrophe foot ulceration represents.</p><img src="https://counter.theconversation.com/content/66571/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Frances Henshaw does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Diabetes is on the rise and one of its most common complications is Diabetes-Related Foot Disease (DFRD). DFRD is difficult to treat but simple preventive strategies do exist.Frances Henshaw, Lecturer in Podiatry, Western Sydney UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/429822015-07-08T09:52:19Z2015-07-08T09:52:19ZAre your beach feet ready?<figure><img src="https://images.theconversation.com/files/84738/original/image-20150611-11406-11t17x1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Best foot forward.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-143175415/stock-photo-beautiful-female-a-foot-and-a-heel-on-a-white-background.html?src=2XWLhfzNPE1sC29UnYpDmA-1-0">Pieds by Shutterstock</a></span></figcaption></figure><p>The summer sun sees us strip off. And from a podiatrist’s perspective, that’s means the arrival of new footwear, as people ditch boots and trainers for sandals and flip flops. For the past several months, our feet have been hidden away, and in some cases, neglected, but now, most of us want our feet looking and feeling good for summer. </p>
<p>So as an expert in feet, here are my top tips for things you can do to get your feet ready for the summer. </p>
<h2>General foot care</h2>
<p>When it comes to toe nails, cut straight across – avoid cutting down the sides of the nails as you run the risk of an ingrowing toe nail. </p>
<p>During the winter months our feet can become dry, cracked and form hard skin called callus. A useful approach to combat this is to soak your feet in warm water for about ten minutes and then use a pumice stone or foot file to lightly take the dry skin off. This should be followed by a moisturiser cream applied daily. For those who have particularly dry and callus feet, a cream with the ingredient urea (which can hydrate and regenerate the skin, soothe irritations and soften the top layer of the skin) can be very useful. </p>
<p>If your feet are very dry, you may wish to put on a pair of socks after the application of the cream to increase absorbency. And if you do suffer with callus that is not responding to self-care, or you have corns – concentrated hard areas of skin that occur on the joints of the toes or on the bottom of your forefoot – then you will need to see a registered podiatrist.</p>
<p>If your feet are dry, with a scaly-type of rash or the skin is itchy you may have Athlete’s foot which is a fungal infection. Likewise, if you have thickened and discoloured nails that crumble on cutting, it may also be due to a fungal infection known as onychomycosis. While it is tempting to cover them up with nail varnish don’t – this will only make the problem worse. Again a registered podiatrist can help and there are a number of over-the-counter fungal topical products that a pharmacist can advise you about. </p>
<h2>Summer footwear</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/86975/original/image-20150701-31882-14whutk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/86975/original/image-20150701-31882-14whutk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=405&fit=crop&dpr=1 600w, https://images.theconversation.com/files/86975/original/image-20150701-31882-14whutk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=405&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/86975/original/image-20150701-31882-14whutk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=405&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/86975/original/image-20150701-31882-14whutk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=509&fit=crop&dpr=1 754w, https://images.theconversation.com/files/86975/original/image-20150701-31882-14whutk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=509&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/86975/original/image-20150701-31882-14whutk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=509&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Flip-flopping footwear.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/easymakesmehappy/5638202204/in/photolist-9Aeg5Q-5dU9h8-5dYoj7-9AegkW-bVcpa1-daZiKy-2dVNHL-9kXrff-5dU9yn-6zXUXs-4tRiYV-4Ew9Ca-8C9FAU-2j22Pj-6ng116-9Abjvv-P2KLM-9Abjr2-P2frS-2uwEpG-4oiPWL-eHqHDo-4VESWy-5dU2RK-9Abj4Z-5dU2j8-55KKMZ-8vAfRk-FvV95-9Abh9t-73irWq-8iHycV-48s4XX-eRPkFi-7oXuau-axqNv9-7PAZQx-4EwaqK-g23jV-7CAbuT-bAhHuS-babBbr-6bpdtR-nDzmK6-nGZBg-aonKPK-5xLYZQ-7CE2o3-PvEYa-7EEiRH">Tara</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span>
</figcaption>
</figure>
<p>The less-is-more approach to footwear in the summer has many of us donning sandals and flip flops, the latter of which in particular offers minimal protection and support to the foot and lower limb. Changes to footwear styles and an increase in activity – summer walks in parks and along the beach, for example – can increase the chance of injury to the foot. In the case of flip flops, the separator between the first and second toes can cause all of the toes to claw (curl) during “toe-off” as we walk to keep the flip flop on, since there is little support across the top of the foot. This can increase the stress and forces within the forefoot area and for some individuals, the separator between the first and second toes can cause irritation of the skin resulting in blistering during the early stages of wear. </p>
<p>We advise that individuals stage the use of less supportive footwear such as flip flops and sandals with more supportive footwear – trainers, lace ups. </p>
<p>In addition, where possible, for those who wear sandals, it is advised that a style which incorporates a strap mechanism across the top of the foot be worn. By adopting a staged approach to summer footwear, it can allow the feet to adapt and minimise the risk of problems that could occur within your foot, ankle and lower limb – this can include forefoot pain, heel pain (tendinitis), fractures, strains and sprains. </p>
<p>It is important to note that if you have poor circulation, diabetes and/or a loss of sensation of your feet (neuropathy) you will need to be extra cautious. Remember, everyone needs to protect and care for their feet – looks are important, but pain-free walking in the summer sun is even more essential.</p><img src="https://counter.theconversation.com/content/42982/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah Curran does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>If you’re thinking about getting your thongs out – no, not your bikini – then here’s the best way to make sure your feet are at their best.Sarah Curran, Reader of Podiatry, Cardiff Metropolitan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/422032015-05-21T17:41:36Z2015-05-21T17:41:36ZCannes tries to bring women to heel – but high shoes are a menace to the body<figure><img src="https://images.theconversation.com/files/82557/original/image-20150521-989-urntfn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">High heel parkour.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-202758577/stock-photo-woman-wearing-black-leather-pants-and-red-high-heel-shoes-in-old-town.html?src=5qTF1AJjJ9dGK5IDx-VN-g-1-0">Heels by Shutterstock</a></span></figcaption></figure><p>Cannes festival organisers recently sparked controversy after a group of women, some of whom had medical conditions, was reportedly turned away from a gala screening <a href="http://www.theguardian.com/film/2015/may/19/cannes-backlash-high-heels-emily-blunt-flat-shoes">for failing to wear high-heeled shoes</a>. While it is unclear what the fashion police had the most problem with, the lack of heels or the idea of flat shoes with rhinestones, the incident does raise some important questions about wearing footwear that isn’t very good for you.</p>
<p>Wearing high shoes regularly and for long periods of time can change the way you walk and lead to long-term bone and joint problems. Not to mention the usual problems that come with corns <a href="http://www.patient.co.uk/health/bunions">and bunions</a> that come with toes rubbing or being pushed into particular positions (“hammertoe” anyone?). </p>
<h2>What happens when you wear heels</h2>
<p>The first thing that most women will notice when they put on a pair of high heeled shoes is that their body weight is shifted forward, away from the heel towards the front of the foot. This shift has a profound effect on the functioning of the foot, making it more rigid and less to able to absorb the shock associated with ground contact. The shift also increases the likelihood of pressure ulcers forming under the ball of the foot.</p>
<p>These ulcers can be very dangerous for people who suffer with diabetes as, if left untreated, can lead to serious foot complications, and in some cases foot amputation. One of the women turned away in Cannes was wearing flat shoes because <a href="http://www.telegraph.co.uk/film/cannes-festival/emily-blunt-cannes-heel-row/">part of her left foot had been amputated</a>. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/82561/original/image-20150521-1020-33lobi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/82561/original/image-20150521-1020-33lobi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/82561/original/image-20150521-1020-33lobi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/82561/original/image-20150521-1020-33lobi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/82561/original/image-20150521-1020-33lobi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/82561/original/image-20150521-1020-33lobi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/82561/original/image-20150521-1020-33lobi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Toes for balance.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/pulguita/2681824287/in/photolist-55Z3VM-F2c8D-F2cms-F2cd9-F2ckE-F2caA-F2bY2-F2c6L-F2cff-db5S8-8g1gy6-6tVqDJ-mgJyBJ-d5k9Th-mgJyXJ-hjNBDx-mgJzqY-4AGKEW-edDaA-qhhvN-qhhrq-fUPv32-Jf1Y2-8m5GMY-a8fH1d-8g1gok-5cCm2v-JdAKt-8g1gJ8-5zDzcC-8g4wkh-8g1fLP-8g1hcF-8g4w7s-8g4x19-8g1hnk-8g4x9W-5JaWSk-F2cdx-F2cpN-6sp6YL-5pK2kA-qhhyq-qhhtY-eA3cdK-cjuD9o-cjuA8Q-Ajd9W-dGf14b-hu1eqL">Paula Rey</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>When we walk we use our big toes for balance in order to stop us falling forwards. The big toe becomes even more important in high heel when there is an increase in the load over the forefoot. This means that anyone without a functioning big toe would put themselves at high risk of a fall if they tried to walk in high heels.</p>
<p>As well as increasing the likelihood of a fall or an ankle sprain, habitual wearing of high heels can lead to long term adaptations in the muscles and tendons around the ankle joint. For example, women who regularly wear high heels <a href="http://jeb.biologists.org/content/213/15/2582">can expect</a> shortened calf muscles, a stiffer Achilles tendon and reduced ankle flexibility. These changes will result in a less efficient walking pattern that then leads to problems when they change to flat shoes, especially if they participate in sports.</p>
<h2>Lower back issues</h2>
<p>Human walking is a fine balancing act in which we have to maintain our centre of gravity within relatively tight constraints to avoid falling and keep moving forward. So relatively small changes in the position of our foot can have consequences all the way up the body. Typical effects higher up include an increase in the <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3206568/">curvature of the lower back</a>, a change in the way the pelvis moves, or an increased backward lean. All these changes have the potential to over-strain the low back and possibly lead to back pain.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/82576/original/image-20150521-982-1ovpfov.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/82576/original/image-20150521-982-1ovpfov.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/82576/original/image-20150521-982-1ovpfov.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/82576/original/image-20150521-982-1ovpfov.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/82576/original/image-20150521-982-1ovpfov.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1006&fit=crop&dpr=1 754w, https://images.theconversation.com/files/82576/original/image-20150521-982-1ovpfov.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1006&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/82576/original/image-20150521-982-1ovpfov.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1006&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Bunion foot.</span>
</figcaption>
</figure>
<p>Many women will find themselves feeling tired after prolonged periods of wearing high heels shoes. This is partly because high heels put the body into an awkward position and, as a result, our muscles have to work harder to move us forward. </p>
<p>This has been proved scientifically <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0037390">using EMG-based studies</a> which have shown that the low back, knee, hip, calf and foot muscles all have to work harder with a high heeled shoe.</p>
<p>Is the answer to wear flat shoes? Well probably, but we still have to be careful. Many women’s flat shoes have a pointed toe box, the front part of the shoe, which is not really big enough to accommodate the foot. </p>
<p>The main effect of this is that the big toe is forced outwards and this can restrict the motion of the toes and lead to toe deformity and bunions. Not surprisingly, <a href="http://beapartoftheshift.com/?p=791">more than 90% of operations</a> performed to correct these problems are carried out on women. </p>
<p>So, even if you do decide to opt for flat shoes, make sure you consider how well the shoes fit you feet.</p><img src="https://counter.theconversation.com/content/42203/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Steve Preece does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>High heeled shoes may lift you up and look fabulous, but your body tells a different story.Steve Preece, Research Fellow, University of SalfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/105272012-11-14T03:29:30Z2012-11-14T03:29:30ZReflexology: panacea or placebo?<figure><img src="https://images.theconversation.com/files/17404/original/x4kwrz6y-1352351405.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">It's unclear whether reflexology provides any therapeutic benefits beyond those of a generic foot massage.</span> <span class="attribution"><span class="source">Paul Bence</span></span></figcaption></figure><p>Reflexology is a form of manual therapy based on the principle that specific locations on the feet, hands and ears have connections to the rest of the body. By applying pressure to these locations using various massage techniques, reflexology is thought to stimulate the body’s natural healing processes.</p>
<p>A very broad range of conditions are treated with reflexology, including headache, asthma, premenstrual syndrome, irritable bowel syndrome, dementia, incontinence, diabetes, low back pain and cancer-related pain. The <a href="http://www.reflexology.org.au/home2/index.php?option=com_content&view=article&id=20:reflexology-and-you&catid=2:modern-practice&Itemid=9">Reflexology Association of Australia</a> states that “all body systems benefit from reflexology”.</p>
<p>A <a href="http://www.ncbi.nlm.nih.gov/pubmed/17718647">population-based survey</a> of 1,067 Australians in 2005 found that 4% had received reflexology in the previous 12 months.</p>
<h2>History</h2>
<p>The history of reflexology has not been thoroughly documented, although practises resembling reflexology have been identified from ancient Egyptian, Greek, Chinese, Indian and Native American sources. </p>
<p>A <a href="http://upload.wikimedia.org/wikipedia/commons/d/d5/Akmanthor.jpg">wall painting in the tomb of Ankhmahor</a> (c 2,330BC) in Saqqara, Egypt is often cited as one of the earliest depictions of reflexology, although it is unclear whether the image merely represents massage as opposed to reflexology.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/17402/original/qfj9rqzs-1352351181.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/17402/original/qfj9rqzs-1352351181.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=316&fit=crop&dpr=1 600w, https://images.theconversation.com/files/17402/original/qfj9rqzs-1352351181.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=316&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/17402/original/qfj9rqzs-1352351181.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=316&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/17402/original/qfj9rqzs-1352351181.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=397&fit=crop&dpr=1 754w, https://images.theconversation.com/files/17402/original/qfj9rqzs-1352351181.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=397&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/17402/original/qfj9rqzs-1352351181.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=397&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Akmanthor.</span>
<span class="attribution"><span class="source">Wikimedia Commons</span></span>
</figcaption>
</figure>
<p>An early form of reflexology (zone therapy) was introduced to the United States in 1913 by <a href="http://www.reflexologyinstitute.com/reflex_fitzgerald.php">Dr William Fitzgerald</a>, an ear, nose and throat specialist. Fitzgerald proposed that there were ten vertical zones in the body. By stimulating the appropriate locations on the soles of the feet, bioelectrical energy flows could be altered, leading to pain relief in other body regions.</p>
<p>The modern practice of reflexology is primarily influenced by the work of Eunice Ingham, a nurse and physiotherapist whose 1938 text <a href="http://www.worldcat.org/oclc/9867508">Stories the Feet Can Tell</a> contained detailed maps of the “reflex” areas of the sole of the foot corresponding to the rest of the body, including internal organs.</p>
<p>Reflex areas do not correspond to either the nervous system or to acupuncture meridians, and published maps demonstrate <a href="http://www.ncbi.nlm.nih.gov/pubmed/22789788">several inconsistencies</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/17410/original/939kn28v-1352352322.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/17410/original/939kn28v-1352352322.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/17410/original/939kn28v-1352352322.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=364&fit=crop&dpr=1 600w, https://images.theconversation.com/files/17410/original/939kn28v-1352352322.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=364&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/17410/original/939kn28v-1352352322.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=364&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/17410/original/939kn28v-1352352322.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=457&fit=crop&dpr=1 754w, https://images.theconversation.com/files/17410/original/939kn28v-1352352322.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=457&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/17410/original/939kn28v-1352352322.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=457&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">There are many incosistencies between published maps.</span>
<span class="attribution"><span class="source">Stacy Simone</span></span>
</figcaption>
</figure>
<h2>Mechanism</h2>
<p>There is no clear consensus among reflexologists as to how the therapy “works”. Several mechanisms have been proposed, including the unblocking of energy fields, the removal of toxins, the breakdown of crystalline deposits in the lymphatic system, the release of endorphins, alteration of electromagnetic fields, and the increase of blood flow to internal organs.</p>
<p>Many of these mechanisms are inconsistent with mainstream physiological principles and are therefore unmeasurable with conventional scientific methods. </p>
<p><a href="http://www.ncbi.nlm.nih.gov/pubmed/23072265">Four trials</a> have demonstrated some evidence of a reduction in systolic blood pressure and heart rate in individuals undergoing reflexology. However, these studies did not adequately control for non-specific (placebo) effects, so it is not possible to delineate the benefit of stimulating reflex areas from the beneficial effects of simply lying down and receiving a relaxing foot massage.</p>
<h2>Reflexology to aid diagnosis</h2>
<p>Some reflexologists claim that the identification of tenderness at specific locations on the foot can assist in the diagnosis of medical conditions. Two studies have explored this by asking reflexologists to examine patients of whom they had no previous knowledge.</p>
<p>In both studies, the <a href="http://www.ncbi.nlm.nih.gov/pubmed/11068346">level of agreement between reflexologists was very low</a>, as was the level of agreement between the reflexologists’ diagnoses and the known medical history of the patients. There was also evidence of <a href="http://www.ncbi.nlm.nih.gov/pubmed/9528375">over-diagnosis</a> by the reflexologists. Therefore, the reflexology approach to diagnosis cannot be considered valid.</p>
<h2>Does reflexology work?</h2>
<p>The most recent and comprehensive <a href="http://www.ncbi.nlm.nih.gov/pubmed/21111551">systematic review</a> on the effectiveness of reflexology found 23 trials where reflexology had been compared to no treatment, usual care, or a placebo/sham treatment. The methodological quality of these trials was generally poor, with few studies adequately controlling for non-specific (placebo) effects or blinding the assessors documenting the outcome measurements. </p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/17408/original/gs2pfdhw-1352351911.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/17408/original/gs2pfdhw-1352351911.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/17408/original/gs2pfdhw-1352351911.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/17408/original/gs2pfdhw-1352351911.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/17408/original/gs2pfdhw-1352351911.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/17408/original/gs2pfdhw-1352351911.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/17408/original/gs2pfdhw-1352351911.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">There’s no consensus about how reflexology ‘works’ but some believe it removes toxins.</span>
<span class="attribution"><span class="source">countrygal</span></span>
</figcaption>
</figure>
<p>The review concluded that there is insufficient evidence to demonstrate that reflexology is an effective treatment for any medical condition.</p>
<p>It needs to be acknowledged, however, that conducting high quality trials of reflexology is inherently difficult. <a href="http://www.ncbi.nlm.nih.gov/pubmed/23072264">Possible solutions</a> to the problems of inconsistent reflexology maps and difficulties controlling for placebo effects have recently been proposed, but have not yet been implemented.</p>
<h2>Is reflexology safe?</h2>
<p>There appears to be very few adverse effects associated with reflexology treatment itself. However, reflexology, like many other complementary therapies, could potentially be life threatening if used in the place of orthodox medicine for treating serious conditions (such as <a href="http://www.ncbi.nlm.nih.gov/pubmed/8200209">patients with diabetes using alternative treatments</a> in preference to taking insulin).</p>
<h2>The verdict</h2>
<p>Reflexology is a popular form of manual therapy. The basic underlying premise of reflexology has no sound scientific basis, reflexology maps exhibit several inconsistencies, and there is no convincing evidence that reflexology assessment can identify underlying medical conditions. </p>
<p>Several low quality trials have been conducted, so it remains unclear as to whether reflexology confers any therapeutic benefits beyond those provided by generic foot massage.</p>
<p><strong><em>This is the seventh article in our series Panacea or Placebo. Click on the links below to read the other instalments:</em></strong></p>
<ul>
<li><p><a href="https://theconversation.com/western-herbal-medicine-panacea-or-placebo-7474">Western herbal medicine</a></p></li>
<li><p><a href="https://theconversation.com/aromatherapy-panacea-or-placebo-9270">Aromatherapy</a></p></li>
<li><p><a href="https://theconversation.com/chiropractic-therapy-placebo-or-panacea-8104">Chiropractic</a></p></li>
<li><p><a href="https://theconversation.com/colonic-therapy-panacea-or-placebo-9926">Colonic therapy</a></p></li>
<li><p><a href="https://theconversation.com/modern-acupuncture-panacea-or-placebo-8102">Modern acupuncture</a></p></li>
<li><p><a href="https://theconversation.com/myotherapy-panacea-or-placebo-9183">Myotherapy</a></p></li>
</ul><img src="https://counter.theconversation.com/content/10527/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Professor Hylton B Menz receives funding from the National Health and Medical Research Council of Australia.</span></em></p>Reflexology is a form of manual therapy based on the principle that specific locations on the feet, hands and ears have connections to the rest of the body. By applying pressure to these locations using…Hylton B Menz, Professor; NHMRC Senior Research Fellow , La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/21692011-08-23T20:41:33Z2011-08-23T20:41:33ZStand tall, ladies: harm from high heels can be minimised<figure><img src="https://images.theconversation.com/files/2166/original/3331250779_790d268813_b.jpg?ixlib=rb-1.1.0&rect=2%2C2%2C1024%2C812&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">These kinds of shoes typically appear next to articles warning of the dangers to health posed by high heels.</span> <span class="attribution"><span class="source">d b/Flickr</span></span></figcaption></figure><p>Women are often told how the very high-heeled shoes they wear are doing them harm.</p>
<p>But instead of trying to make them feel guilty about their footwear, we would be better off discussing how to help women minimise the negative effects of high heels on foot health.</p>
<h2>Same old, same old</h2>
<p>As a researcher with a clinical background in podiatry, I’m often asked by journalists to provide comment on the “dangers” of high-heeled shoes.</p>
<p>Most of the time, I refer these requests to colleagues or to my professional association.</p>
<p>My reason for doing so is not because I disagree with the premise that wearing high heels is detrimental.</p>
<p>Rather, I tend to avoid these invitations because the articles that result from such exchanges are invariably sensationalist, and from a public health perspective, largely ineffective.</p>
<p>If the goal is to effect behavioural change in women in the interests of their foot health, articles about the dangers of high-heeled shoes inevitably fail.</p>
<p>These articles usually follow a fairly predictable script:</p>
<ul>
<li><p>women are “warned” of the “dangers” or “risks” of wearing high heels by a well-intentioned health professional ;</p></li>
<li><p>the piece is accompanied by a celebrity reference – <a href="http://www.dailymail.co.uk/tvshowbiz/article-1231270/Bunions-Beckham-Years-killer-heels-left-Victoria-agony--need-urgent-op.html">Victoria Beckham’s bunions</a> being a popular choice; </p></li>
<li><p>a stock image of some extreme footwear (often red patent leather stilettos, the higher the better); and</p></li>
<li><p>a vox pop of an office worker who loves her Jimmy Choo’s and doesn’t want to stop wearing them even though they make her feet hurt. </p></li>
</ul>
<p>Reference to an escalating “epidemic” of ankle injuries resulting from high heels is occasionally added for extra impact, although I’m yet to find a convincing peer-reviewed study to support such a claim.</p>
<p>So what, if anything, do these articles achieve?</p>
<p>Very little, I would argue, other than filling space in a newspaper on a slow news day or providing some public relations exposure for researchers, podiatry organisations or orthopaedic surgeons.</p>
<p>Indeed, every time this story gets a run in the media, an opportunity is lost to educate the general public about the effects of high heels – information that could be used to make informed choices about a lifestyle issue that could (potentially) have detrimental consequences.</p>
<h2>Lack of evidence</h2>
<p>The fundamental problem is that we simply don’t have convincing data to base bold statements about the long-term effects of high-heeled footwear.</p>
<p>Instead, we have to rely largely on biological plausibility as our evidence base.</p>
<p>Research into the effects of high heels is almost exclusively <a href="http://en.wikipedia.org/wiki/Cross-sectional_study">cross-sectional</a> or <a href="http://en.wikipedia.org/wiki/Retrospective_cohort_study">retrospective</a>, meaning that we can only look at associations, not causes.</p>
<p>To adequately ascertain the effect wearing high heels has on the body, we would need to follow up research participants for a very long time – decades, in fact – which would be expensive, time-consuming, and ultimately impractical. </p>
<p>Researchers have instead examined the effects of high heels on <a href="http://www.ncbi.nlm.nih.gov/pubmed/7711763">posture</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed/20231788">muscle activity</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed/18253023">balance</a> and <a href="http://www.ncbi.nlm.nih.gov/pubmed/19912724">walking patterns</a>, and have investigated associations with <a href="http://www.ncbi.nlm.nih.gov/pubmed/19790125">foot pain</a> and common foot disorders, such as <a href="http://www.ncbi.nlm.nih.gov/pubmed/16110238">calluses</a> and <a href="http://www.ncbi.nlm.nih.gov/pubmed/19747997">bunions</a>.</p>
<p>These studies indicate that high heels do indeed change the alignment of the body, and alter force distribution through the foot in a manner that could, at least partly, explain the development of pain in the back, hips, knees, ankles and feet.</p>
<p>Women who regularly wear high heels have <a href="http://www.ncbi.nlm.nih.gov/pubmed/20639419">stiffer Achilles tendons</a> than women who don’t, and <a href="http://www.ncbi.nlm.nih.gov/pubmed/19747997">recent evidence</a> suggests that bunions are more common in women who previously wore high heels. But genetic predisposition is also likely to play a role.</p>
<p>Despite the inherent limitations in the available evidence, it seems plausible enough that wearing a shoe that lifts your heel off the ground and squeezes your toes into a very small space could make your feet hurt and increase your chances of developing problems in the future.</p>
<p>On balance, you’d be better off not doing this on a regular basis.</p>
<h2>Not just health</h2>
<p>Women wear high heels for a range of cultural, aesthetic and occupational reasons. So it’s probably futile for health professionals to advise them to completely stop wearing these shoes because of their potentially detrimental effects on musculoskeletal health.</p>
<p>Indeed, the late William Rossi, an expert on footwear best known for his 1976 book <a href="http://openlibrary.org/books/OL5204327M/The_sex_life_of_the_foot_and_shoe">The Sex Life of the Foot and Shoe</a>, referred to this as “an exercise in eternal futility”.</p>
<p>No number of alarmist newspaper reports is likely to have much of an effect on women’s shoe choices.</p>
<p>Instead, what is required is more accurate and detailed reporting of research into high-heeled shoes; an examination of the context in which women wear them and; the provision of pragmatic advice and treatment of any ensuing problems by health professionals.</p>
<p>In other words, what we need is a harm minimisation approach, recognising that while wearing high heels may not be ideal, regular podiatry treatment, the use of <a href="http://www.ncbi.nlm.nih.gov/pubmed/16390637">insoles</a> to cushion the ball of the foot, and <a href="http://www.ncbi.nlm.nih.gov/pubmed/17186300">stretches</a> to prevent calf muscle shortening may be of more use to women who choose (or are compelled) to wear them. </p>
<p>It certainly would do more good than lecturing them.</p><img src="https://counter.theconversation.com/content/2169/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Professor Hylton B Menz receives funding from the National Health and Medical Research Council of Australia.</span></em></p>Women are often told how the very high-heeled shoes they wear are doing them harm. But instead of trying to make them feel guilty about their footwear, we would be better off discussing how to help women…Hylton B Menz, Professor; NHMRC Senior Research Fellow , La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.