THE BLOG

Featuring fresh takes and real-time analysis from HuffPost's signature lineup of contributors

Glenn D. Braunstein, M.D. Headshot

The Shoe Fits, But Does It Help or Hurt Your Health?

Posted: Updated:

From running barefoot to shoes with shape-up or fit descriptions in their names, there's no shortage of bountiful health claims cropping up these days about our feet and what covers them -- or doesn't. We've come a long way from our hunter-gatherer days when humans wore nothing on their feet. Shoes, originally made to protect us from the environment, now are marketed as the next quick fix for myriad health issues -- from weight loss to muscle tone. But what type of footwear is helpful for our feet and joints, and what is simply hype, or even risky, for overall joint health? If you're a runner like me, or a fashionista nonpareil, look in your closet to see the evidence on just how much time and energy we devote -- not always productively -- to our feet and shoes.

Because we're on our feet every day, we put stress not only on our arches and toes, but on our knees and hips, too. Conditions ranging from bunions (where the big toe angles toward the smaller toes) to plantar fasciitis (where a long band of tissue that supports the longitudinal arch and connects the heel bone to the toes becomes strained and inflamed) can be painful and difficult. And it's because of conditions like these that we need to pay attention to our feet and footwear and not just what's stylish or trendy.

Women especially are all too familiar with the stabbing discomfort that can develop as the result of shoes fitting poorly, even if they look hot and just seem to beckon from the pages of a fashion magazine. A female foot, which tends to have a narrower heel in relationship to the forefoot, has a different structure and biomechanics than a male's foot. A female foot also tends to have smaller Achilles tendons and be narrower in shape overall. Osteoarthritis of the knee, a common joint disorder caused by 'wear and tear' on the knee, is twice as common in women as in men. More than 10 million Americans suffer from knee osteoarthritis, and the risk for disability from osteoarthritis of the knee is as great as that from cardiovascular disease.

One study of 20 healthy women compared barefoot walking with walking in high-heels. Researchers looked at stress on the leg joints and found that women applied an average of 23 percent more force on their their knees when walking in heels than if barefoot. Forces on the knee caused by heels may create degenerative joint changes. Other studies have shown a connection between high heels and leg and back pain; the footwear can aggravate already painful bunions. The message of these studies is clear: those heels may come with the unexpected price of foot, leg and back pain, and possibly osteoarthritis.

Too Good to be True?

While heels have been around for so long that consumers have gotten ample chance to know their downsides, attention is focusing now on one of the latest fanciful footwear crazes: toning shoes, which reached an estimated $1 billion in sales last year. The idea behind toners seems simple in theory. They're designed differently, with rounded bottoms so as, supposedly, to mimic that walk on the beach; they claim they make your muscles work harder to balance your body, and, in doing so, cause you to burn more calories and tone your muscles. Advocates say that when you step on toners' unstable soles, it forces your body to use muscles in your feet, legs and butt that you normally would not, leading, again in theory, to weight loss.

But don't swap your monthly gym fee for a new pair just yet.

Two recent studies give resounding thumbs down to fitness claims associated with this kind of footwear. A study by a Wisconsin university, with the American Council on Exercise, compared four different types of shoes at three different workloads on a dozen of physically active women around the same age. The study measured participants' heart rate, calorie burn and oxygen consumption during exercises. It found no evidence that toners provided users with a more intense workout than regular walking shoes.

Another published study compared a brand toner with a neutral running shoe on muscle activity of three large extrinsic muscles. Researchers also asked subjects to try both shoes on level and inclined ground. The study concluded there was no effect on larger extrinsic muscles with the toner versus regular running shoes, though it said further testing would be needed to see if the name-brand shoe affected smaller extrinsic muscles.

Do You Have More to Gain ... or Risk?

As happens with heels, reports also show that toners may be harmful, causing more injuries than regular running shoes. Consumer Reports said in May that since March, when the U.S. Consumer Product Safety Commission started gathering information on the shoes, there were 36 injury reports -- more than for any other type of product in its database. Reported injuries included tendinitis and broken bones, needing surgery, and many individuals also experienced hip, leg and foot pain.

And though this type of shoe may help relieve aches among those with heel pain (they alleviate pressure from the heel), the force from walking still must go somewhere, and often times, these shoes may put stress on the legs and back. Because of the inherent instability in toners, this shoe is not a good option for those who struggle with ailments such as back pain, balance or for those with neuropathy. They wouldn't seem a wise choice, either, for seniors who could increase their risk of falling, resulting in other serious injuries.

In August, Consumer Reports notes in its magazine that many manufacturers offer toners, and it quotes a spokesman for a footwear trade group who says the shoes are often misused and who calls them exercise products, adding that exercise comes with risks.

Back to Barefoot Basics

Even as some enthusiasts are trying toners, other trendy types are tossing their footwear entirely, arguing that maybe going sans shoes is the best option. A study by the International Journal of Sports Medicine noted that Kenyans, who often travel farther shoeless and who have demonstrated their distance-running prowess, have a low body mass index, low body fat and slim limbs. Researchers found that Kenya's top runners have short contact time with the ground, faster cadence and greater leg stiffness, which they believed was due to a different landing. Instead of their feet hitting the ground in a heel-strike pattern, barefoot runners -- who run on their forefoot -- used less energy, had less impact force and less demand on their quads. They do, however, place more strain on their calf muscles.

The researches said barefoot running actually could be better for your body because shoeless dashes led to less high vertical displacement and less stress on the knee. Aside from the obvious concern of building up sufficient calluses and other natural protections, or planting an unprotected foot on a sharp object, running barefoot does not come without pains. Running barefoot puts greater strain on the Achilles tendon, and if you don't progress into this style of running gradually, this can make your body's muscles and tendons more prone to injury.

In the athletic fan press, tens of thousands of words have been devoted to barefoot running, or a parallel footwear trend -- suddenly chic "minimalist" gear that looks like high-tech slippers; untold ink and electrons have been spilled on the choices among standard and pricey running shoes and orthotics whose vast manufactured array might dizzy NASA scientists.

But the bottom line is simple: outfits like the U.S. military, which has millions of reasons to know how best to care for service personnel's feet and footwear, have found that whether it's Air Force or Marine trainees or performers in marching bands, a comfortable, well-fitting shoe matters more than elaborate theories; indeed, the fitness of the folk who climb into those soles may be key, not what they wear. At the end of the day, it's more about taking care of your feet, joints and body and less about the promises of the newest fad shoe.

So, start by following the common sense care regimens, so critical, for example, that legendary basketball coach John Wooden took time to drill some into his championship players: keep your feet clean, dry and well-maintained with particular attention to properly trimmed nails; treat those blisters, skin breaks, calluses, corns, drying, chafing or inflammation immediately and properly.

Guys, a little hygiene goes a long way, and even the most tolerant love interest won't be keen if your feet stink, possibly due to a fungal infection you picked up at the gym. (Read my earlier post on athlete's foot and other gym-acquired bugs.) Gals, if you rely on a salon for a pedicure as a key part of your foot care, you may want to follow health precautions outlined by California consumer officials. (Also, read one of my previous posts on prudent pampering.) If you're unaccustomed to going barefoot or with spare foot protection, be wary in summer and protect yourself from infections, burns, sunburn and other injuries in the season of flip-flops, sandals and naked skin on sand, streets or sidewalks. Your feet, ankles and toes can provide important indicators to your overall health; so if you notice discoloration, bruising, swelling, temperature changes or pain in your limbs, talk with your doctor as you may have circulatory or other health issues. Those with diabetes -- whether diagnosed or developing -- need, of course, to pay special heed to the condition of their feet to avoid dire issues that can result, in worst cases, with amputation.

For those afflicted with bunions, hammer toes, deformities, arthritis, chronic pain or with serious or complicated injuries, say as occupational hazards of professions such as dance, it's worth consulting expert orthopedists. Podiatrists, of course, also provide a sound foot health resource, including their public suggestions on what to look for to make good choices in shoes and athletic footwear. These sensible recommendations should help you avoid needless pains in both your feet and purse or wallet because, as with all things in life, if claims for a product or service sound too good to be true, they probably are.