Barefoot Shoes and Foot Health: What the Evidence Actually Shows

Your feet are the only part of you that touches the ground, and most of us keep them in an uneven, squashy box for up to sixteen hours a day. Here is what happens when you stop, and how to make the change without hurting yourself.

Each foot contains 26 bones, 33 joints and more than 30 muscles. It is built to flex, splay, spring and grip, and it is packed with sensory nerve endings that tell your brain where you are in space. Then we put it in a shoe that is narrower than the foot itself, lifts the heel, holds the arch up and stops the sole bending. It should not be a surprise that feet get weak and stiff.

What a conventional shoe does to your foot

Most shoes share four features, and each one takes work away from your foot:

•      A narrow, tapered toe box that squeezes the toes together, when toes are actually designed to spread apart as you take weight.

•      A raised heel. Even a modest heel on your shoes shifts your weight forward and shortens the calf and Achilles over time.

•      Built-in arch support that holds and supports the arch up, can cause the muscles of the foot to work less, therefore losing strength over time and causing more arch issues.

•      A stiff, thick sole that blocks the foot from bending and dulls the sensory information coming up from the ground.

A barefoot or minimal shoe reverses all four: a wide toe box, no heel-to-toe drop, no arch support, and a thin flexible sole. The idea is not that the shoe does something clever. It is that the shoe gets out of the way and lets the foot work.

Does it actually strengthen your feet?

This is one of the areas where the marketing has run ahead of the research, so it is worth being specific about what has been shown.

In a randomised trial, runners who simply walked in minimalist shoes for eight weeks increased foot muscle size and strength as much as a group doing prescribed foot strengthening exercises. Both improved; a control group did not.¹ A separate study using MRI followed runners through a six-month transition and found significant increases in both foot and lower leg muscle volume, with bigger gains in those who wore the shoes more.²

The most recent systematic review pooled 28 trials and around 1,400 participants. It found that minimalist footwear and foot exercises do increase foot strength, but rated the certainty of the evidence as low to very low, mainly because the individual studies are small and carry a high risk of bias.³

So: the direction of the evidence is genuinely positive, and the mechanism makes sense. It is not yet strong enough to promise that barefoot shoes will fix a particular problem, and anyone who tells you otherwise is overselling.

Start by being barefoot at home

The cheapest version of all this costs nothing. Take your shoes off indoors. Walk on grass, sand or uneven ground when you get the chance. Let your feet feel different textures and temperatures, because that sensory input is half the point.

Barefoot time also gives your toes room to move, which matters if you have spent decades in shoes that press the big toe inwards. Simple things help: spreading your toes deliberately, picking up a towel with them, or balancing on one leg while you brush your teeth.

Feet and the rest of the body: the osteopathic view

Osteopathy takes a whole-body view, and feet are a good example of why that is useful rather than mystical.

Your feet are your base of support. They are also one of the richest sources of sensory information your balance system has. When a foot is stiff, weak or painful, two things tend to follow. You change how you move, often without noticing, and the load that used to be shared gets redistributed somewhere else. That might show up as a sore knee, a nagging hip, or a low back that never quite settles.

The honest version is that this works in both directions and is not deterministic. Not every knee problem starts in the foot, and plenty of people with flat feet have no symptoms at all. But if you have been getting treatment on your knee for months without lasting change, it is worth someone looking at what the foot and ankle are doing underneath it (as well as the hip above). That is the practical reason osteopaths assess the whole chain rather than only the painful part.

How to transition without injuring yourself

This is the part people skip, and it is the part that matters most. When your foot stops being supported, the bones and soft tissues take load they are not conditioned for.

In one trial, recreational runners were moved to minimalist shoes over ten weeks. MRI scans afterwards showed increased bone marrow oedema, an early sign of bone stress, in 10 of the 19 runners who transitioned, compared with far fewer in the control group. One participant developed a frank stress fracture.⁴ The authors’ conclusion was not that minimalist shoes are dangerous, but that the change has to be made slowly.

A sensible approach:

•      Start with barefoot time at home before you buy anything.

•      Wear the new shoes for short periods, an hour or so a day, and build gradually over months rather than weeks.

•      Use them for walking well before you use them for running.

•      Expect your calves and the soles of your feet to feel worked. That is normal.

•      Sharp, localised or pinpoint pain in a bone is not normal. Stop and get it looked at.

Who should be cautious

Barefoot walking is not for everyone. If you have diabetes, peripheral neuropathy or reduced circulation in your feet, going barefoot carries a real risk of unnoticed injury, and you should follow your treating team’s footwear advice rather than anything you read here. The same caution applies if you have a rigid foot deformity, are recovering from a stress fracture, or have been prescribed orthotics for a specific diagnosed reason.

If you are unsure which camp you fall into, ask before you change anything.

How osteopathy can help with foot health

Feet respond well to hands-on treatment, partly because so much foot trouble comes down to stiff joints and overloaded soft tissue rather than anything structural.

At Grassroots Healthcare we commonly see:

•      Plantar heel pain (often called plantar fasciitis), the sharp pain under the heel that is usually worse on the first few steps in the morning.

•      Achilles and calf problems, which often flare when footwear or activity changes suddenly.

•      Forefoot pain from load being concentrated under the ball of the foot.

•      Stiff ankles after an old sprain that never fully recovered.

•      People mid shoe-transition who have taken on too much too fast.

Treatment usually combines hands-on work to free up the joints of the foot and ankle, soft tissue work through the calf and sole, and a specific loading programme to build strength in the foot and lower leg. We will also talk about your footwear, your activity, and how quickly you are progressing, because that is usually where the problem started.

We take the same approach with the rest of the body. If desk work is leaving you with a sore neck, or pain is disturbing your sleep, we've written about both.

Where to buy barefoot shoes in Australia

Fit matters more than brand, and the main thing you are looking for is a toe box genuinely wide enough for your toes to spread. Australian-made and imported options vary a lot in shape, so trying them is worthwhile.

We usually point people towards Sole Mechanics, an Australian retailer specialising in foot-health footwear. They carry most of the well-known barefoot and minimal brands, offer a free fitting service at their store in Melbourne, or a free online foot assessment if you aren’t near the store.  They also ship Australia-wide, which is handy if you are not near a stockist.

If you use the code GRHC15 at checkout, you will receive 15% discount, except when they have their regular sales throughout the year, where you may snag an even bigger discount.

(A note on transparency: we earn a 10% commission when you use this code. We're happy to recommend Sole Mechanics regardless. They know footwear, they're great to deal with, and their range is wide enough that most feet find something that fits). 

If you would rather try on a physical pair of barefoot shoes to make it feels right, there are plenty of other stockists around the Gold Coast and Brisbane that stock various barefoot shoes, such as Wild Earth, Wildfire Sports, or The Running Shop. A quick google search will point you in the right direction.

I myself have 6 different pairs of barefoot shoes, in particular the Vivo Barefoot brand. They vary from dress shoes, to hiking boots, to trail running shoes, to EXTREMEMLY comfortable slides that have become my main go to casual footwear these days, especially in the clinic (when I’m not actually going barefoot).

Where to start

Take your shoes off at home this week. That is free, low-risk, and the best possible test of whether your feet enjoy the change. If you are considering barefoot shoes and are unsure whether your feet are ready, or you are already sore, come and have them assessed first.

Foot, heel or ankle pain? Our osteopaths at Grassroots Healthcare in Canungra can help. Book an assessment online or call 0422 071 200.

References

1. Ridge ST, Olsen MT, Bruening DA, et al. Walking in minimalist shoes is effective for strengthening foot muscles. Med Sci Sports Exerc. 2019;51(1):104–113. https://doi.org/10.1249/MSS.0000000000001751

2. Chen TL, Sze LKY, Davis IS, Cheung RTH. Effects of training in minimalist shoes on the intrinsic and extrinsic foot muscle volume. Clin Biomech (Bristol). 2016;36:8–13. https://doi.org/10.1016/j.clinbiomech.2016.05.010

3. Peters-Dickie JL, Detrembleur C, Guallar-Bouloc M, et al. The effects of foot core exercises and minimalist footwear on foot muscle sizes, foot strength, and biomechanics: a systematic review and meta-analysis. Clin Biomech (Bristol). 2024;122:106417. https://doi.org/10.1016/j.clinbiomech.2024.106417

4. Ridge ST, Johnson AW, Mitchell UH, et al. Foot bone marrow edema after a 10-wk transition to minimalist running shoes. Med Sci Sports Exerc. 2013;45(7):1363–1368. https://doi.org/10.1249/MSS.0b013e3182874769

This article is for general information and does not replace individual clinical assessment. If you have diabetes, neuropathy or circulatory problems affecting your feet, follow your treating team’s footwear advice. Citations retrieved via PubMed.