This is an article of mine—co-authored with Dr. Ray McClanahan—that was originally published in the August 2012 Edition of the Dynamic Chiropractic publication Practice Insights. The article was initially intended for chiropractors, but it has been adapted here for practitioners and non-practitioners alike.
The need for natural and conservative alternatives to conventional foot and toe treatments has never been greater. According to the American Academy of Orthopedic Surgeons, approximately 43.1 million Americans have foot problems, and the cost of foot surgery to correct problems associated with improper footwear—bunions, hammertoes, corns and calluses, among others—is about $2 billion per year. The cost rises to $3.5 billion when you factor in lost work time for surgery and recovery. Many of these surgeries could be avoided if there was a better understanding of what constitutes normal, healthy foot anatomy and the actions required to preserve foot form and function.
Natural foot care is a new approach to treating foot and lower extremity ailments that draws on the accumulated wisdom of podiatric visionaries, observations of unshod cultures, and a growing body of evidence-based resources. At the core of the natural foot care approach is the belief that your foot is inherently strong, stable, and adaptive, and that by restoring proper foot anatomy and function, you can realize lifelong foot health. Natural solutions for foot and toe problems are safe and elegantly simple, and, in many cases, they address the underlying cause of common foot and lower limb conditions.
Philosophical and Historical Underpinning
The principle philosophical approach underlying natural foot care is that you were born with perfect feet and that your feet require no additional support, augmentation, or embellishment to improve their function. You can maintain the same foot shape as an infant throughout your lifespan with the proper care and attention, which in turn may protect you from some of the most common foot and toe ailments. Non-congenital foot and toe deformities are common among shod, or shoe-wearing, people, and many of these deformities—and the disorders associated with them—are caused by the prolonged use of unhealthy footwear.
Studies conducted decades ago on the feet of unshod populations showed that there were marked differences in the structure, appearance, and health of these feet compared to the feet of shod populations. One such study, published in 1949 in the Journal of the National Association of Chiropodists, examined the feet of people in India and China who had never worn shoes. The authors of this study reported that the incidence of foot problems in unshod populations, including hallux valgus, hallux rigidus, arthritis, and fungal infection, was significantly lower than in shoe-wearing populations. Examples of normal, healthy foot anatomy can still be seen today in certain regions of the world, such as parts of Africa, Asia, and South and Central America, in which no or little conventional footwear is worn.
Things to Look For in Feet and Footwear
To gain a better understanding of the most common signs and symptoms of foot and toe problems that may benefit from a more natural treatment approach, it’s important to first review the characteristics of normal, healthy foot anatomy. A human foot in its most natural state is widest at the ends of the toes (not at the ball of the foot), possesses significant natural toe splay, and shows no evidence of bent or crooked toes. A healthy human foot also possesses strong, sturdy arches (arches can be low, medium, or high and still be healthy), excellent manual dexterity and range of motion, and smooth, pink toenails.
Many non-traumatic foot problems may be treated by restoring proper foot anatomy and function and selecting footwear that accommodates natural toe splay. Foot pain or problems that may respond to this conservative treatment approach include bunions, hallux limitus and rigidus, hammertoes, clawtoes, neuromas, ingrown toenails, and plantar fasciosis. Other conditions that may be treated or prevented using natural methods (such as shoe therapy and toe realignment), include shin splints, runner's knee, and knee osteoarthritis. A 2006 study published in the journal Arthritis and Rheumatism states that shoes (at least conventional shoes) may unfavorably boost loads on the lower extremity joints, including the knees, which in turn may contribute to increased prevalence and progression of osteoarthritis in our society.
Most conventional shoes, according to sports podiatrist Dr. Ray McClanahan, possess at least four design elements that may contribute to foot and toe deformities and other problems over time, including tapering toe boxes, heel elevation, toe spring, and rigid, inflexible soles. Other problematic design elements often built into conventional footwear include arch support, pronation control, and faulty last design. Taken together, these design features place your foot in an unnatural position and immobilize it for prolonged periods. A healthy shoe should allow your foot to function like a bare foot inside your shoe, allow your toes to splay the way nature intended, and enable natural arch support. A healthy shoe should respect the natural design of your foot instead of supporting the idea that your foot is inherently flawed and worthy of remodeling.
Natural Foot Care Strategies
For short-term foot pain relief, consider using all relevant tools at your disposal. Chiropractic manipulative therapy, soft tissue massage, instrument-assisted soft tissue mobilization, therapeutic taping techniques, and physical therapy modalities such as cold laser, microcurrent, and ultrasound may all be helpful in treating acute foot pain. The following points discuss strategies to help restore foot health and anatomy, provide long-term relief for foot problems, and prevent future foot, toe, and lower extremity ailments:
Healthy Footwear: Consider choosing shoes that are completely flat from heel to toe, have wide toe boxes (i.e., toe boxes that are widest at the ends of the toes, not at the ball of the foot), possess little or no toe spring, and have flexible soles that can easily be bent or twisted (Note: These features can be hard to find in shoes, including athletic shoes; the men's and women's footwear offerings on the Natural Footgear site all conform to our strict criteria for what constitutes truly foot-health-positive footwear). Accordingly, consider avoiding shoes that possess heel elevation, tapering toe boxes, toe ramps, rigid soles, and arch support or other motion control features. True arch support involves positioning both ends of your foot arch—your heel and forefoot—level with each other and flat on the ground, not propped in the middle. An arch becomes stronger when large forces are placed upon it, as the increased weight causes the arch's components to mesh more effectively.
Toe Spacers: Consider using a toe spacing device to realign your toes to their normal anatomical position; that is: with toes properly splayed, the individual phalanges should be aligned with their corresponding metatarsal bones, and the toes should be resting flat on the ground. Realigning the big toe to its normal anatomical position—in line with its corresponding metatarsal bone and the inside or medial edge of the foot—can help prevent overpronation, as the big toe actually has a supinatory effect on the foot when it is placed in this position. Start with 30 minutes of use the first day and increase your wear time in increments of 30 minutes to 1 hour per day. Select a toe spacing appliance, such as Correct Toes, that can be comfortably used in footwear during weight-bearing activity (many toe-spacing appliances are designed to be used only while at rest). Here are some additional reasons why you might consider using Correct Toes over other toe-spacing products on the market.
Metatarsal Pads: Consider placing metatarsal pads inside your shoes or using Strutz foot pads (mobile metatarsal pads). Metatarsal pads, which should be placed just behind the ball of your foot, help spread your transverse foot arch, prevent tightness in your toe extensor muscles and tendons, and encourage the return of your forefoot fat pad to a position that supports your metatarsal heads. Allow a few days for your feet to adjust to the pads. Here is some more info about how to successfully place metatarsal pads in your shoes.
Toe Socks: Consider using toe socks instead of conventional socks. Toe socks allow your toes to move freely, and they help keep your feet dry and cool inside your shoe. Many conventional socks pinch the toes together, further contributing to the toe deformities caused by tapering toe boxes. Toe socks can, in many cases, be used in combination with toe spacing devices such as Correct Toes and appropriate men’s and women’s footwear to achieve optimal foot health.
Exercises & Stretches: Consider performing relevant foot exercises or stretches, including the Toe Extensor Stretch, can be extremely helpful in rehabilitating your feet and toes. To stretch your toe extensor muscles and tendons, curl your toes under, place the tops of your toes on the floor and gently press the front of your ankle forward (from a seated position). Many people have an imbalance between their toe flexor and extensor muscles and tendons that can be normalized with this stretch. Other helpful foot rehabilitation techniques include the Big Toe Stretch and the Hammertoe Stretch, as well as the Hacky Sack Grab and Short Foot exercises.
Pain Cream: Consider applying therapeutic cream (e.g., Dr. Swaim's Pain Relief Max, Icy Hot, Tiger Balm, etc.) to your painful area at the beginning of the day or before activity and cold (e.g., ice pack, ice water soak, bag of frozen peas, etc.) for 6 to 10 minutes at the end of your day or after activity.
Many people with foot pain or problems will enjoy at least some degree of immediate relief using the above strategies. Most people will experience full or significant relief after several weeks or months of adopting this approach. Compliance with this protocol is absolutely necessary to achieve optimal natural foot health gains. Of course, you should always consult your physician before beginning any health care regimen, to determine what strategies are most appropriate for you and your unique health considerations.
The Shoe Liner Test
To help ensure that you purchase the healthiest possible footwear, consider performing the shoe liner test. To perform the shoe liner test, remove the liner from your shoe of interest and stand on it, placing all your weight on that foot. You should buy the shoe only if your entire foot (with toes in their correct anatomical position) fits within the margins of the liner. If any part of your toes, the sides of your foot, or your heel hangs over the liner, the shoe is too small or narrow to support natural foot form, function, and health.
Natural foot health techniques—shoe therapy, toe repositioning, simple stretching exercises—respect and encourage your body's own natural healing mechanisms and can have a profound effect on your musculoskeletal health and quality of life. These strategies can be used for many different types of foot problems and in people of all ages, and they represent a safe, cost-effective, and a helpful first line of approach for many foot and toe problems.
- American Academy of Orthopedic Surgeons
- Rossi WA. Footwear: the primary cause of foot disorders. Podiatry Management. February 2001.
- Hoffman P. Conclusions drawn from a comparative study of the feet of barefooted and shoe-wearing peoples. The American Journal of Orthopedic Surgery. 1905 Oct; 3(2): 105-136.
- Sim-Fook L, Hodgson AR. A comparison of foot forms among the non-shoe and shoe-wearing Chinese population. The Journal of Bone & Joint Surgery. 1958 Oct; 40: 1058-1062.
- Kalcev B. The hallux position in natives of Madagascar. East African Medical Journal. 1963 Feb; 40: 47-54.
- Shulman SB. Survey in China and India of feet that have never worn shoes. The Journal of the National Association of Chiropodists. 1949; 49: 26-30.
- Shakoor N, Block JA. Walking barefoot decreases loading on the lower extremity joints in knee osteoarthritis. Arthritis & Rheumatism. 2006 Sep; 54(9): 2923-2927.
- McClanahan, Ray. Personal interview. 26 May 2012.