Classic Study #1: A Comparison of Barefooted & Shoe-Wearing Peoples

This is the first installment in what will be an ongoing series of articles examining classic research studies in the field of natural foot form and function. Many of the articles that will be reviewed here were published in reputable journals that still exist today. Many of these studies, which range in size and design, were published over 40, 50, 60, or, in this case, 100 years ago. The studies are old, true, but they’re valuable because they offer a unique perspective and common sense observations that most contemporary physicians could still use to their benefit in treating foot ailments. In fact, after reading these articles, it’s hard to believe how far we’ve strayed from what we once knew about foot form, function, and health with near absolute certainty.

Disclaimer: Please note that the language and nomenclature used in some of these studies, especially as it pertains to the various ethnic groups examined, has been changed in places to reflect more contemporary ways of describing groups or individuals. Social mores and attitudes have changed considerably over the years since these articles were published, and though these terms were commonly used at the time of publication, they are no longer used or accepted in our society.

The first study we’ll look at was conducted by a gentleman named Philip Hoffman, and it was published in the October 1905 edition of The American Journal of Orthopedic Surgery. Hoffman’s study, called “Conclusions Drawn From a Comparative Study of the Feet of Barefooted and Shoe-Wearing Peoples,” drew upon observations he made of the feet of unshod individuals; specifically, he examined the feet of barefooted individuals from the Philippines and Central Africa who were attending the Louisiana Purchase Exhibition—also known as the St. Louis World’s Fair—in 1904.

Hoffman, based on his research comparing shod and unshod groups, notes the following:

The shape of the foot and its range of voluntary and passive motion are practically the same in barefooted and shoe-wearing [people] up to the time of the use of footwear that compresses and splints the foot, usually about the end of the first year, after which, in shoe-wearers, there is progressive narrowing of the anterior portion of the foot and diminution in the range of motion of its phalangeal, tarsal, and ankle joints.

He adds that

In most adult shoe-wearers the toes, beyond giving additional length to the foot, are practically functionless, while in barefooted people they serve a variety of functions, as in climbing and grasping. This difference in function is not due to a congenital difference in structure, but is dependent upon daily use and development of such functions in the bare foot and their inhibition in the shoe-wearer. The same development of toe function could undoubtedly be attained by individuals of shoe-wearing [societies].

Mr. Hoffman, in several places throughout the article, chastises the shoe industry for its lack of attention to and respect for true foot shape (What would he think if he saw the shoes most people are wearing today?), and he even appears to be a little hot under the collar in this eloquent 1905-style rant:

The lasts over which the footwear of civilization is shaped are rarely modeled in the spirit of truth that would make them conform to the contour of a normal foot. The whim of society and the manufacturers' enterprise regulate their shape. Society, apparently, agrees that the human foot as formed by nature is coarse, vulgar and unsightly, and that its width, especially at the toes, is entirely too great […] Here beauty is less than skin deep, or at most lies no deeper than the calfskin product of the cobbler's art. The manufacturer through ignorance and self interest fits the desires of his patrons rather than their feet, and places upon the market footwear that more or less crowds the front of the foot.

Oh, snap! Turn-of-the-century zinger! Well put, Mr. Hoffman. Well put. One explanation for shoe manufacturers’ lack of urgency or desire to create foot-shaped shoes, suggests Hoffman, is the fact that seemingly not all foot and toe deformations cause pain, at least not right away.

If foot [i.e., toe] compression always led to immediate and severe discomfort, it would not, perhaps, be quite so common [i.e., creating more foot-shaped shoes would be a higher priority for shoe manufacturers]. Nevertheless, painful or painless, when long continued, it must result in irreparable damage.

Hoffman also debunks a common myth of the day concerning arch shape and foot function:

Observations on the longitudinal arch of the foot led to the conclusion, contrary to common opinion and teaching, that its height and shape are of little or no value in estimating the usefulness of the foot, and that there is no one type as the normal, but that normal feet present high, medium and low arches.

Listed below is a summary of Hoffman’s findings:

• The relative lengths of the foot and its component parts are practically the same in barefooted and shoe-wearing groups.
• The form, functions, and range of voluntary and passive motion of the foot are the same in both groups up to the time of shoe-wearing, after which progressive characteristic deformation and inhibition of function ensue.
• The height and shape of the longitudinal arch have no bearing on the strength or usefulness of the foot. Weakness of the arch is rarely, if ever, accompanied by breaking or lowering, and flat foot as a pathological entity hardly exists.
• There is no relationship or coincidence between the height of the arch and the character of the gait.

Join us again next time as we examine a 1931 study conducted in the Belgian Congo (now Democratic Republic of the Congo).