What is a Healthy Shoe?

Before I get into what I consider a healthy shoe, understand that I am basically a gangster in the medical world.  An alarmingly low percentage of medical professionals agree with me when it comes to shoe recommendations and spending time barefoot but I don't take that too personally.  My mission is to keep it real, to better understand the universal laws that govern life, and to find what works.  This is why I have come to love my barefoot time so much and I am a complete hard ass about good shoes when I need to where them.

After 45-years of shoe companies financing research in an attempt to prove that their shoes prevent injury and improve performance, they have yet to demonstrate any compelling data to support that claim.  Sigh.  This is certainly a topic for a much longer blog series which I would consider doing except that I get chest pains just thinking about it.  Xero shoes CEO, Steven Sashen, did a great job of unstupidifying this mess on the Boulderist Podcast, Episode 003.  Give it a listen and you'll be glad you did.  Steven is way funnier than I.

One last disclaimer before we get started.  Everything I'm saying in this article about healthy shoes meets two important criteria.  First, everything I am saying is supported by scientific evidence.  Second, I have lived the results of eschewing really crappy foot-weakening, Quasimodo-deforming footwear and have been able to rehabilitate back to healthy movement.  This is where I get all my gangster powers.

What is a healthy shoe?

Healthy shoes are shaped like your feet and offer adequate protection for the terrain.

Our toes are meant to be the widest part of the foot (look at a baby's foot for reference). Nearly all running and lifestyle shoes narrow our toe base and cause deformation of the toes in the name of fashion. It should seem like a common-sense rule of thumb that your feet should never deform their natural shape to fit inside a shoe.

“Adequate protection” means that if you are traveling on harsh/rocky terrain, you'll want a thicker sole than if traveling on a smooth road, groomed trail, or grassy area. The rule of thumb here is to use the least amount of sole you need to get the job done, according to what your feet can handle.

Healthy shoes are void of cushioning or arch support technology.

Arch support was designed to fix a problem that wouldn't exist without bad shoes. As we narrow our toes and base of support, we effectively obliterate the function of our arches to load and spring back as they are designed to do. Although the sole of the shoe should be appropriate for the terrain, research demonstrates that cushioning actually causes people to land with more force when running or walking. Landing more forcefully places undue stress on your knees, hips, and spine during activity. Though cushioning might provide the feet with more comfort, it actually worsens movement quality and perpetuates bad habits.

But your joints will.

Healthy shoes are zero-drop and extremely flexible.

Wearing a heel in any shoe will cause postural modifications up the entire kinetic chain. A big, cushy heel also encourages harder landings and over-striding, which are associated with running injuries. The stiffness of most running shoes is one result of the faulty belief that we should run with a heel-to-toe gait pattern. Studies conducted in cultures lacking modern footwear demonstrate more natural running mechanics, which generally involves a midfoot to forefoot strike, a soft, quiet landing, and a springy return of energy. Children do not naturally run heel-to-toe before the introduction of heavily cushioned shoes. It's simply not natural or efficient. A cushioned heel in a running shoe is another answer to a problem we never had.

Why do I hype about flexibility? Our feet, much like our hands, are extremely mobile and flexible, providing us with a plethora of movement opportunities that actually help to protect our joints further up the body. Ski boots are a great illustration of the risk, because everything knows that once you cast the foot and ankle (by trapping them in boots), the knee is much more susceptible to a twisting injury. In the same way, making footwear stiff casts many joints of the foot and will place more stress on the ankle, knee, and hip over time.

An example of an extremely flexible road shoe.

A healthy shoe also doesn't claim to do the work for you.

I always find it silly when a shoe company claims that its shoes can do something for you.  By default, whatever a shoe does for you is something your body is no longer doing.  We turn then to our trusty use it or lose it principle for a quick reference in common sense.  Oh yeah, that's right, not using stuff is bad, I should probably let my body do some work unless I want it to deteriorate.  These marketing messages can bring about self-fulfilling and debilitating downward spiral—it is exactly that for many aging athletes.

In the 1990s, the standard of care for back injuries was often to use a back brace for additional support (oh yeah, and bedrest).  Eventually, research data showed that this treatment paradigm actually made people much worse and increased disability.  Providing unnecessary support to peoples' back and core muscles simply caused the wearers to grow weaker and less resilient over time.

It’s the same with shoes.  Following the warped shoe company logic, I might as well give everyone who has a sprained ankle crutches for life.  Instead, we know innately and science confirms that our bodies can adapt over time with the proper cycle of stress and rest.  Oddly, when it comes to footwear, we lose our minds and become fearful of utilizing the very training principles we use for every other athletic endeavor.

Can I interest you in a catheter and bed pan as well?

Since most people in our society wear shoes that do not fit these qualities, their bodies are not ready to do hard work without support/cushion/etc.  Their joints have become stiff, tendons weak, bone density decreased, and just as badly, many can no longer feel or understand the signals their feet are sending to their brain.  If you were to wear a mitten for a decade and never use your fingers independently your brain would eventually remap the hand (aka neuroplasticity, use it or lose it), and you would have lost your fine motor control of the hand (not to mention, it would be very stiff and tight).

When we finally free our feet from the coffins of bad shoes, we have to be careful about transitioning.  Our feet are vulnerable and our brains might not know what to do with all this new information.  In my next post I will offer some guidance and recommendations as well as resources for you to improve your foot health and prepare your body for a lifetime of better movement instead of needing that damn walker.