No Shoes, No Pain, No Acceptance

Southern Nazarene University No Shoes, No Pain, No Acceptance The Requirement of Shoes in Society Patrick Sanford Contemporary Social Issues: SOC 3013 Prof. Linda Wilcox 5 May 2013

Outline I. Introduction A. Thesis II. Research A. Requirement of Society B. Injury 1. Fungi and Bacteria 2. Blood and Lymph Flow 3. Forefoot Issues 4. Toe Issues 5. Arch Issues 6. Heel Issues 7. Running Injuries 8. Contact Dermatitis C. Maldevelopment 1. Posture 2. Balance 3. Gait 4. Arthritis 5. Habitually Barefoot Societies D. Psychological Harm E. Deprivation 1. Sensory Feedback

F. All Shoes 1. Tennis Shoes 2. Heels 3. Flip Flops 4. Minimalist III. Summary A. Summary of Harm Caused by Shoes B. Podiatrists Disagree C. How Shoes Protect IV. Conclusion A. More Research B. More Awareness C. More Acceptance

Abstract Everyone wants to live healthy and comfortably, but in many establishments throughout the country this is limited by the rules, procedures, the dress code enforced there as a result of society s demands. To live in the best environment as possible, even knowing when to wear shoes could affect the health of an individual. Research has been accumulated to show that going barefoot in safe environments is better for the spine, nervous system, cardiovascular system, and emotional well being, as well as the lower extremities. This paper will be analyzing several books, articles, and interviews to support this conclusion: requiring shoes directly affects one s ability to live in a way that promotes a healthy lifestyle. Every establishment such as a restaurant, business, or school that requires individuals on their premises to wear shoes is indirectly depriving those individuals of the benefits that could be gained by walking and being barefoot. An establishment that uses it s lawful power to have a policy or verbally demand any patron or person to wear shoes within their premises will cause on that person high likelihood of injury to the skeletal structure, deterioration of emotional well being, maldeveloped anatomy of the foot, and depriving them of the sensory enjoyment of the ground beneath them.

People like to kick off their shoes after a long day at work. The laces come undone, the foot comes out, sometimes with a pungent odor, and a sudden sense of relaxation floods over the body. Some may think to themselves, If only I didn t have to put on shoes in the first place. Why do people put on shoes? Mainly the answer is because society has required individuals to. Shoes are required to go to work, school, the gym, shopping, eating out, and generally everywhere. This requirement against individuals of society is harmful to the individuals because wearing shoes increases the likelihood of injury and maldevelopment, and may cause some psychological harm and the deprivation of sensation to the bottom of the soles. It is not hard to see that society requires shoe use in many locations. This can be seen in the No Shirt, No Shoes, No Service signs, proper footwear required signs, management or employees verbally enforcing shoe requirement, or policies written down in library member pamphlets or university handbooks. Most people believe a myriad of myths that encourage them to wear shoes as well. The National Federation of State High School Associations mandates shoes to be worn by high school runners (Howell 83). Even in the realm of podiatry, where feet are studied exclusively, going without shoes is not even considered an option (Buttgen). Society sees the wearing of shoes, except in certain instances, as normal. Even though normal, a behavior that the vast majority of people in a community do, it is not healthy. In Daniel Howell s book, the barefoot book: 50 Great Reasons to Kick Off Your Shoes, the professor of biomechanics discusses many issues shoes cause. In the very beginning he compares being forced to wear shoes is like asking someone to smoke cigarettes. He says, Okay, shoes are not as devastating as cigarettes, but for most of us daily shoe wearing will cause chronic foot problems. (5) Although he is correct in saying shoes are not as problematic as cigarettes, the wearing of shoes is still dangerous.

One of the most common ailments of the foot is foot fungi and bacteria. The skin of the body is the first mechanism humans have to protect against invading forces. Feet trapped in shoes, particularly closed shoes and socks have the skin altered by this closed, heated environment. The skin changes appearance, texture, and chemical composition; these changes makes the skin more susceptible to the growth of bacteria and fungi. In addition to these changes, the environment around the foot is dark, becomes warmer due to lack of ventilation, and moister due to sweat glands. This environment is ideal for the growth of most bacteria and fungi, including ones that affect the feet (Howell 40). When the smell from shoes is unpleasant and pungent, the source is usually caused by Staphylococcus (Staph) and Pseudomonas, growing bacteria. Both of these bacteria can cause an infection, especially if a puncture wound is present on the feet (Howell 14). Pseudomonas infection can be potentially fatal, but rarely occurs on barefoot persons (Howell 14, 41). The wearing of tight-laced shoes and elastic socks also restrict the flow of blood to the foot. All shoes restrict movement and flexing of the foot, which when barefoot stimulates blood circulation even in lower extremities (Howell 88). Blood flow is not the only effect of the restricted movement and flexing, interstitial fluids, more commonly known as lymph, also improves flow through the lymph nodes and vessels. The restriction of lymph reduces the ability to cleanse toxins, dead cells, and microbial invaders (Howell 88). When walking, the foot is designed to expand and flatten out. A barefoot walk will allow the forefoot to expand about 20 percent from a non-weight bearing foot. If shoes are worn, this expansion is prevented and squeezes the sides of the foot (Howell 58). During the push-off phase of a walk, the barefoot uses the toes to grip the ground and spring forward. Shoes prevent this biomechanical ability and compensate by having a toe spring designed in the footwear. The toe

spring raises the toes upward and allow the shoes to roll and push off from the toe spring. Most shoes have this design, even many sandals. This toe spring hyperextends the toes and the metatarsal-phalangeal joints. This hyperextension is not natural for the plantar fascia and also weakens the arch of the foot (Howell 52-53). Shoes also have the ability to cause problems with the toes. Hammer toe is caused by shoes with a toe box area that is too small (Howell 64). Ingrown toenails are also caused by narrow toe boxes or shoes with a low profile. This may penetrate the skin because the toenail curves downward (Howell 65). In conjunction with the bacteria present, this may also cause an infection. Another problem with toes is hallux valgus, which is where the great toe turns inward toward the other toes. Because shoes do not allow the toes to push off, the weight is shifted toward the middle of the foot. This shift in weight and the toe spring of the shoe rolls the great toe inward, causing hallux valgus (Howell 63). The arch of the foot acts as a shock absorber when the foot strikes the ground, and shifts into a locked rigid structure that allows the toes to spring forward on the push off. Many shoes have arch supports inside them, which most people believe helps with supporting the arch and comfort. Howell uses the analogy of the shock absorbers on a vehicle suspension system. They work fine by themselves, but if you put a brace that limits the amount of shock the absorber can take, then the shock is transferred through the brace to the rest of the vehicle. These arch supports act in a similar manner and does not allow the arch of the foot to perform as it is designed (54). The fact that shoes weaken the arches means that individuals are more inclined to believe they need arch supports, when in fact it is the shoes that have caused the problem in the first place.

The heel of a shoe causes problems as well. If the heel is elevated, then the ankle is extended past 90º. This extension weakens the arch, reduces the shock absorption of the foot, and reduces the spring capacities of the arch. The heel elevation also redistributes the weight of the body over the foot. [H]aving your heel constantly lifted above ground level shortens your Achilles tendon. (Howell 51) Raising the heel also strains the plantar fascia. All of these changes affect the body negatively, resulting in weak arches and leg muscles, arthritis, and lower back pain. Of course, the consequences are more prominent with the heel being raised even further (Howell 50-52). Walking with heels creates the need for the spine and pelvis to be supported not by posture, but by erector muscles. This need diminishes when the length of the heel is smaller, down to no heel, or barefoot. Different muscles are used when the length of the heel in the shoe changes (Adriana 2554-55). Shoes also affect the bottom of the foot. Many times the traction of your feet is better than the traction of the soles of shoes (Howell 113). Shoes also cause plantar fasciitis by elevated heels, arch supports, and toe springs which place stress on the plantar fascia, or the layers of muscle and intervening connective tissue on the bottom of the foot (Howell 36, 62). Running barefoot has become more popular in the recent past. In as short of time as six months, 79% of runners sustain some kind of running injury. Physical education believes that strengthening the foot by exercising barefoot will reduce the injuries sustained by runners (Hart). One lesser-known injury is contact dermatitis. This affliction is where the skin comes in contact with chemicals and materials that irritate the skin. Shoes contain all kinds of chemicals and allergens such as potassium dichromate, ethyl butyl thiourea, mercaptobenzthiazole, and p- tertiary butylphenol formaldehyde. Howell and Dr. Robert Adams believe that although this may

be a common problem, it is rarely diagnosed simply because it is unrecognized or the possibility is not considered (66-67). Although the previous injuries can be daunting, other problems such as maldevelopment can also occur. Shoes, particularly ones with an elevated heel, affect proper posture. An elevated heel shifts the body s center of gravity forward. To adjust for this shift, the body makes adjustments to the posture. The more elevated the heel, the more extreme the body makes the adjustments. The toes begin to curl, the arch is strained, the calf muscles are flexed, the knees are bent, the pelvis tilts, the spine curves and the buttocks protrudes, and the chest is lifted in the event of an unnatural heel elevation. This artificial posture, which society believes makes women sexier, is unhealthy and damaging especially with prolonged exposure (Howell 69-70). Issues with posture are prominent, but balance is also affected. As mentioned above, elevated heels shift the center of gravity of the body more towards the forefoot or toes. This shift immediately makes balance harder to maintain. The soles of the foot also provide feedback information so the body can adjust to the surface of the ground. Shoes take away from this feedback and also decrease the ability to maintain balance. Balance and posture are keys to several health issues. Many yogic and Eastern philosophies stress the importance of balance in the health of the body and spiritual equilibrium. Learning varied surfaces barefoot is a key to balance, as demonstrated by children in other countries who traverse an uneven playground barefoot, yet a non-exposed child has difficulty (Périssé). Shoes also affect the wearer s gait, or the pattern of how a person walks. Shoes increase the stride making it longer. This is because of the elevation of the shoe and the actual gait of the person is longer. The longer stride increased the shock of impact on the joints in the feet, ankles, legs and back (Howell 55-56). Because shoe soles are often hard and inflexible, the shoe often

contains a curved heel and toe spring. This changes the function of the gait from a step to a roll. Since the foot is held in place and rigid, the complex patterns of movement and body distribution are lost (Howell 60). The increased impact caused by shoes leads to the stress of joints. Multiple studies suggest that the major cause of knee arthritis is decades of shoe use. (Shakoor) The constriction of shoes do not allow the full range of motion for the foot and ankle joints or allow the complex bones in the foot to flex. This increases pressure on the bones of the forefoot and knees. Shoes are often responsible for lower back pain and cause knee arthritis (Howell 88-89). Studies show that older women have reduced arthritis by switching to minimalist shoes (Isabel). These shoes have less impact on the joints than traditional shoes. Developed world citizens live in environment that shoes are declared normative. The long-term effects of shoes create the need for podiatrists to practice in every major city. Societies with shoes commonly have issues with hallux valgus, hammertoe, ingrown toenails, and bunions. These issues are not present in societies where shoes are rarely worn (Howell 12). One study found that a staggering 80 percent of preschool-aged children had foot and toe deformities that were not seen in children who went habitually barefoot. (Howell 78) Studies have also shown that flat feet are much more likely to occur in developed societies (Howell 79). Although maldevelopment can occur at any time during the course of a person s life, it is most likely to occur in the young years of development. Children s feet are not fully developed until at least eight years of age. Children who wear shoes are far more likely to have foot problems as adults because shoes impair the development of the arches and weakens the soft structures of the foot. The cast of a shoe restricts the free movements of the foot which impacts

foot development significantly (Howell 77-78). Dr. Steve Bloor believes that people have weakened muscles and poor postural control due to over-reliance on footwear. (Buttgen) Not only is injury and maldevelopment at stake when shoes are worn, but the psychological mind can be affected as well. Recent studies indicate that exposure to certain harmless soil bacteria actually elevates our mood, reduces depression, and boosts the immune system. (Howell 15) Shoes not only give an ideal environment for bad bacteria to grow but also inhibit the wearer s exposure to bacteria that may help his mood and immune system. Many testimonies of people who have switched from wearing shoes to going barefoot include positive results in the physical, emotional, psychological and spiritual well being. Footwear limits the sensory feedback from the sole to the brain. It is suggested that sensory feedback from the foot is important in the maintenance of normal gait patterns. (Nurse) The sensory feedback is important to the gait. A reduction of sensory input changes the pressure distribution of walking (J de Koning). The feedback from a barefoot allows the foot to shift within parts of a second to avoid damage to the foot. The skin resists perforation and is key to human locomotion (Robbins). The mechanism that prevents the sensory feedback precedes a long stride and stronger heel strike. This increased impact is damaging to joints along the body. Natural strides are shorter and have less impact on the joints. These natural strides are present when walking or running barefoot (Howell 57). One may suggest that when required to wear shoes, he or she should wear a shoe that minimizes some of the ailments listed above. While this may be good advise, no shoe is exempt from the negative effects of the shoe. A popular suggestion is the sensible shoe: the tennis shoe. Tennis shoes are the notorious incubators of bacteria that are so harmful. The tight laces and construction of the shoe do not allow for ventilation of cool fresh air to the foot. This shoe

also constricts the blood and lymph flow. Tennis shoes are also the proponents of the rounded heel and toe spring discussed earlier. The problems with tennis shoes are meek in comparison with high heels. These shoes have many women taking them off voluntarily even after a short time wearing them. The elevated heel presents all of the problems associated with it, and pushes the body weight to the metatarsals and toes, which are usually scrunched together and cramped. These shoes may very well be the reason why 80% of podiatrist patients are female (Howell 68). Flip-flops, which are quite popular in Western society, also have issues. Flip-flops are generally quite slippery on wet floors. They can also be trapped when driving, and should be avoided in that situation. Flip-flops also present a unique tripping hazard (Howell 106, 113). One study showed wearing flip-flops increase peak plantar pressure, placing the foot at greater risk for pathologic abnormalities. (Carl) Other minimalist shoes are available. From moccasins, Vibram fivefingers, Nike Free, Nike Studio Wrap, Vivo Barefoot, and many others, minimalist shoes abound. Although many have less damaging effects than traditional shoes, all have a heel, even if just a few millimeters. Most are closed in, creating the warm environment perfect for bacteria. In the use of these types of shoes, Howell says, Minimalist shoes are the least damaging to the feet and body, but in terms of foot health, I don t advocate footwear of any kind except where the feet are exposed to extremely harsh conditions like bitter cold or dangerous chemicals. I would rather see social attitudes about barefooting change. (111-12) The only footwear that may actually have no effect on gait or physiological factors is barefoot sandals. These are actually foot jewelry that usually wrap around the ankle and attach to one of

the toes. While called sandals, these jewelry pieces are not effective if an establishment is requiring shoes to be worn. Shoes can cause chronic foot problems over time with frequent use. Closed in shoes breed bacteria and fungi that are unwanted. Shoes and tight socks restrict blood and lymph flow. Most shoes restrict the forefoot from expanding normally. Toe springs hyperextends the toes and metatarsal-phalangeal joints and create hallux valgus. Small toe box areas cause hammer toes and ingrown toenails. Arch supports, and in some sense the sole of a shoe, weakens the arch, transfers more impact shock to the joints, and restricts the arch from springing into the next step. The heel of a shoe extends the ankle, weakens the arch, transfers more shock to the joints, reduces the arch to spring forward, redistributes body weight closer to the toes, and strains the plantar fascia. Toxins in shoe construction can also cause contact dermatitis. Shoes prevent correct posture, inhibit balance, alter gait, and leads to osteoarthritis. These shoes prevent the foot from flexing naturally and can cause maldevelopment, especially in younger children. Absence or reduced sensory feedback from the sole affects gait and increased shock impact. In addition to these injuries, shoes also negatively affect the mood of the wearer. Although this research shows some affects shoes may cause, podiatrists disagree on whether shoes are the cause of most of these problems. Some podiatrists are questionable about the benefits of barefoot locomotion, and others are vehemently opposed to such an idea (Shavelson). Some podiatrists say that genetics are the main source of the issues presented above (Traczyk). Some say that over- or under-pronation and foot structure are the causes (Hall, Maxwell). Other podiatrists, such as Dr. Rossi, say, there is no such thing as a sensible shoe because shoes, by their very nature, alter foot form and function. (Howell 5-6) Or podiatrists are slowly realizing that their products and methods are for the rare occasion and actually the

removal of shoes helps alleviates or eliminates problems of patients. One podiatrist who has made this change is Dr. Bloor, who after 25 years in podiatry now believes that the normal foot is bare, and encourages his patients to go barefoot more often (Buttgen). Unfortunately for society, podiatrists earn a significant portion or their profits from prescribing and selling orthotics, shoe inserts that alleviate foot problems. This presents a conflict of interest in the practice of podiatry and the best interest of the patients. With the argument that shoes are harmful to the body, one should also be aware of situations in which shoes should be worn. Howell has mentioned two such instances in which shoes should be worn, extreme cold and chemical presence (112). Shoes should be worn in other cases where the risk of injury or damage is greater than the benefits of being barefoot. These situations are few and far between, but they do occur on occasion. In this area, research suggests shoes being harmful to the body. Although this is the case, more research would help solidify the facts further. Although more research is needed, the research that has been done needs to be more present in the minds of professionals and the public. Podiatry Management has expressed this view in their objective view of barefoot running. They said that running barefoot would not increase the likelihood of injuries, but were still skeptical about the benefits proposed by barefoot runners (Jenkins). However, Bloor says, There is more than enough scientific research to back up our barefoot position and very little if any to back up the shod position as being healthy! (Buttgen) In reality, it is not the podiatrists that are the source of the problem. Society itself requires the habitual use of shoes, to the public s detriment. Without the constant barrage of commands stating, Shoes required, the public might consider barefoot an option. The pressure of society

is hurting its members and needs to be lifted. Being aware that going barefoot is healthy will benefit those who choose to employ that option.

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