This is an article of mine—co-authored with Correct Toes inventor 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 still a relatively 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 toe alignment and foot 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 numerous common foot and lower limb conditions.
Philosophical & Historical Underpinning
The principle philosophical approach underlying natural foot care is that you were born with perfect feet and that your feet, in their healthiest and most robust form, require no additional support, augmentation, or embellishment to improve their function. You can maintain the same foot shape as an infant (which is typified in the image above) throughout your lifespan with the proper care and attention, which in turn may protect you from some of the most prevalent 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 & 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, noninvasive 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 toe alignment and foot 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 toe separation and the introduction of healthy-foot-shaped footwear 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 the 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 inclusions place your foot in an unnatural position and immobilize it for prolonged periods. A truly healthy shoe, on the other hand, 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 foot-healthy shoe should, therefore, respect the natural design of your foot instead of supporting the idea that your foot is inherently flawed and worthy of remodeling.
Top 10 Natural Foot Health Tools & 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, rest, and physical therapy modalities such as cold laser, microcurrent, and ultrasound may all be helpful in getting you out of acute pain. To build foot strength and resiliency, rehabilitate feet that have been harmed by conventional footwear, and prevent future foot, toe, and lower extremity ailments, you might consider adopting the tools and strategies listed here:
Let’s take a closer look at the various footgear and approaches mentioned above to learn how they support your feet—the hardworking foundation of your entire musculoskeletal system.
1. Foot-Healthy Footwear
Consider choosing shoes that are completely flat from heel to toe (aka “zero drop” footwear), have wide toe boxes (i.e., toe boxes that are widest at the ends of your toes, not just wide at the ball of your foot), possess little or no toe spring, and have flexible soles that can easily be bent, folded, or twisted. 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 main foot arch—that is, your heel and forefoot—level with each other and flat on the ground, not propped in the middle. Indeed, an arch becomes stronger when large forces are placed upon it, as the increased weight causes the arch's components to mesh more effectively. In terms of selecting foot-healthy footwear, this article from our site discusses how to shop for shoes and is a helpful resource for anyone interested in finding footwear that permits the foot to function naturally inside the shoe. Also, the men's and women's footwear we feature on the Natural Footgear site all conforms to our strict criteria for what constitutes truly foot-health-positive footwear.
Note: For those who have bunions, hammertoes, or other types of crooked toes, a tool such as the FootFitter Shoe Stretcher can be helpful in creating a bit more space around the problem area and preventing rubbing on the affected toe or toes.
Consider using a toe spacing device to realign your toes to their normal anatomical position; that is: With toes properly splayed, individual phalanges aligned with their corresponding metatarsal bones, and toes 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 separating appliance, such as Correct Toes, that can be comfortably used in footwear during weight-bearing activity (most other toe spacing devices are designed to be used only while at rest). Here are some of the top reasons to use Correct Toes toe spacers, and here are some thoughts on why you might consider using Correct Toes over other toe spacing products on the market.
Consider placing Pedag metatarsal pads inside your shoes or using Strutz foot pads to improve foot comfort and restore optimal foot function. The former has an adhesive backing and is adhered to the insole or footbed of your shoe; the latter is, essentially, a type of “mobile” metatarsal pad that you can wear on your bare feet, over a pair of toe socks, and within almost any type of footwear. Metatarsal pads, which should be placed just behind the ball of your foot, help spread your transverse foot arch (creating more space for the nerves and blood vessels that serve your toes), prevent tightness in your toe extensor muscles and tendons, and encourage the return of your forefoot fat pad to a position that supports and cradles your metatarsal heads. For Pedag metatarsal pads, make sure you’ve got the positioning of the pad dialed in before committing to a permanent placement, and then allow several days for your foot to adjust to the pad. Here is some more specific info about how to successfully place metatarsal pads inside your shoes, and here is some additional info about the various benefits associated with both types of metatarsal pad mentioned in this section. This article serves as a Strutz foot pad instruction guide.
Consider using Injinji toe socks instead of “regular” or “conventional” socks to experience a more comfortable fit and to free your toes from the burden of too-tight sock seams. Thanks to their individual toe sleeves, toe socks allow your toes to move about freely, unencumbered by the oppressive forces imposed upon them by other, lesser sock varieties. Indeed, the toe area of many conventional socks pinches the toes together, further abetting the passive toe deformities that are often initiated through prolonged conventional footwear use. Also important is the fact that toe socks help keep your foot dry and cool inside your shoe, contributing to a healthier foot environment and a reduced likelihood of problems such as blisters and fungal nail infection. Toe socks alone can be quite helpful in thwarting common toe ailments, but they can also be used in combination with toe spacing devices such as Correct Toes and appropriate men’s and women’s footwear for synergistic foot health benefits.
Consider adopting Naboso proprioceptive insoles to help wake up your feet and improve foot strength and balance. Naboso insoles incorporate a textured, small nerve proprioceptive material that's designed to improve posture, enhance movement, and prevent injuries. These innovative insoles stimulate the mechanoreceptors in your feet, which helps activate your postural muscles, helps control impact forces on your body, and allows you to tap into the power of your nervous system. Naboso insoles can be used for a variety of purposes, including neurological rehabilitation, athletic performance, and general wellness. Flexible, comfortable, and completely flat, Naboso proprioceptive insoles can be customized to fit almost any foot or footwear shape; simply cut them to size and replace your existing shoe insoles with your new Naboso insoles. Naboso insoles work best when worn against bare feet, but they can also be effectively deployed in combination with a lightweight toe sock (for those who want a bit less stimulation).
Consider using various massage and other foot care tools as part of your home- or work-based foot care routine. Tending to your feet in this way puts the health locus of control squarely back in your domain, and while there is sometimes no substitute for the skilled hands of a professional bodyworker, you can achieve a lot, of your own volition, when it comes to enhancing the musculoskeletal health and well-being of your feet. Chief among the goals associated with home-based bodywork is myofascial release—the process of breaking up scar tissue or adhesions to eliminate pain or discomfort, restore optimal tissue tone and function, and address trigger points in various locations throughout your foot and lower body. Of all the self-myofascial release tools out there, our favorite is the Naboso Neuro Ball, which also happens to incorporate hundreds of raised domes for enhanced sensory stimulation. Use the Neuro Ball to help relieve plantar fascia tension and post-exercise foot soreness as well as to relax tired foot muscles after long periods of standing. Or use the smaller “micro round” contained within for more targeted soft tissue work.
Where appropriate, consider incorporating natural foot care products—the likes of which are produced by companies such as Dr. Swaim’s—into your overall foot care approach. Dr. Swaim’s produces a nice line of medicinal products, all of which incorporate healthy ingredients that you can feel confident using. Our favorite Dr. Swaim’s products include the following: Anti-Fungal Nail Balm Kit, CalluSTOP, Medicated Body & Foot Powder, Medicated Foot Cream, and Pain Relief Cream (the latter of which also comes in roll-on form). Each of these foot care products serves a different purpose and can help address certain ongoing foot issues, or, in the case of Dr. Swaim’s Medicated Body & Foot Powder, help prevent problems from arising by creating a healthier environment inside your shoe (while eliminating foot and shoe odor). For more acute and painful conditions, you might consider applying Dr. Swaim’s Pain Relief Cream to your painful area twice daily (or as needed) to reduce discomfort and improve your quality of life. Of course, always consult with a foot care provider to determine what products may be best suited to you and your unique situation.
Consider performing relevant foot exercises, including—and perhaps especially—the Toe Extensor Stretch, as this stretch can be extremely helpful in rehabilitating your feet and toes. To stretch your toe extensor muscles and tendons from a seated position, curl your toes under, place the tops of your toes on the floor (at your side or slightly behind you), and gently press the front of your ankle forward. You can work one side at a time or work both sides simultaneously. 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 and the Foot Arch Strengthening Exercise. For the Hacky Sack Grab and Foot Arch Strengthening exercises (and for home-based foot care in general), we really like using the Naboso Neuro Ball, which is discussed in more detail in the “Massage Tools” section above. Lastly, this video demonstrates several exercises you can perform to help reverse a bunion or simply realign a big toe that has deviated toward the other toes—a very common occurrence among most people who have worn conventional footwear for years or decades.
9. Barefoot Time
Adding some barefoot time to your foot health regimen can be extremely helpful in building a strong and resilient foot and ensuring optimal foot function over the long-term. Indeed, spending at least some time barefoot, even if only around the house, can help condition the soles of your feet and strengthen your foot and toe muscles, accelerating the foot adaptations that occur with Correct Toes use and minimalist shoe wearing in a safe and constructive manner. If appropriate, you may also consider walking outdoors in your bare feet, weather permitting, starting with as little as one block or a few hundred yards/meters. Consider walking barefoot on surfaces that offer good visibility, such as a running track or the hard-packed sand at a beach, so that you don’t inadvertently step on any debris (grass can hide sharp objects and is not, somewhat counterintuitively, the best surface upon which to walk barefoot).
Other helpful resources from our site concerning barefoot walking include the following:
A number of excellent books on this topic have been published and some of them are mentioned in the first article linked to above.
10. Education & Learning
Of the various tools and tips mentioned in this post, perhaps the most potent of all is education. Feet and footwear are the source of a tremendous amount of misinformation in our society, and being informed can help you cut through the misconceptions and marketing ploys to understand (and benefit from) the most accurate and actionable information possible. On our side, to help you with this, we’ve created a number of free email courses and digital guides that focus on relevant topics of interest for those with existing foot conditions or those who wish to learn more about a natural approach to foot and toe health. We have also published many articles on our Educational Articles, Shoe & Footgear Reviews, and Popular Q&A blogs to help expand your knowledge base, and we have a page on our site devoted exclusively to relevant foot health research and applicable online/print publications. In the information age in which we live, you have the power to determine your own foot health destiny.
The Shoe Liner Test: An Important Consideration
As an addendum to point No. 1 above (about foot-healthy footwear), and to help ensure you buy the healthiest and most accommodating shoes for your feet, consider performing the Shoe Liner Test, where it’s possible to do so, before purchasing. To perform the Shoe Liner Test, remove the liner or insole 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 your toes in their correct anatomical position, which will often require the assistance of Correct Toes to achieve) fits within the margins of the liner (or is very close to doing so). If any part of your toes, the sides of your foot, or your heel noticeably hangs over the liner, the shoe is too small or too narrow to support natural foot form, function, and health.
A Journey Toward Optimal Foot Health
Natural foot care techniques—shoe therapy, toe spacing, simple stretching and strengthening exercises, etc.—respect and encourage your body's own natural healing mechanisms and can have a profound effect on your musculoskeletal health and quality of life. The strategies mentioned in this post can be used for many different types of foot problems and in people of all ages, and they represent a safe, cost-effective, and helpful first line of approach for many foot and toe problems. A natural approach toward optimal foot and toe health should be viewed as a journey, an expedition and adventure that will involve plenty of helpful discoveries along the way, but that will also take some time to complete.
Most people with foot pain or problems will enjoy at least some degree of immediate relief using the above strategies. And many people will experience full or significant relief after several weeks or months of adopting this approach. Compliance with this protocol is, of course, necessary to achieve optimal natural foot health gains. As always, you should consult your foot care provider before beginning any foot care regimen to determine what strategies are most appropriate for you and your unique considerations. If you have any questions about the tools and tips discussed in this article, please do reach out to us through our site’s contact form. We look forward to hearing from you!
Dr. Robyn Hughes is a naturopathic physician, or ND, with a special interest in natural foot health and sports medicine. After completing medical school at the National College of Natural Medicine in Portland, Oregon, Dr. Robyn trained extensively with renowned sports podiatrist and natural foot care specialist, Dr. Ray McClanahan. Dr. Robyn is a co-founder of Natural Footgear, a founding member of the Natural Foot Health Institute, a freelance health writer, and a regular speaker at foot care teaching events. Dr. Robyn lives in Asheville, NC, where she’s an avid road cyclist, trail runner, and yoga student.
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