The Plight of the Modern Foot: Conditions that Plague Us—and How to Avoid Them

Inline_Foot_ProblemsFor all the focus on hearts and arteries, brain tissue and muscle mass, we tend to neglect one critical part of the body with dramatic influence over how we fare in later decades. It’s little surprise really. Feet don’t exactly garner much attention, let alone media time. Yet, the stakes are big.

For example, research shows that foot conditions like hallux vagus (HV, a common forefoot deformity in older people commonly referred to as “bunions”) was directly associated with marked decreases in quality of life. Foot pain, reduced foot function, lowered social capacity, and even degraded general health. That sort of thing.

But that’s just one foot condition, right? Yes…and no. The picture of averages looks rather bleak.

A clinical assessment of 166 Hong Kong hospital outpatients over the age of 65 found that 70% of those patients had some sort of foot condition. In the U.S., things aren’t much better. While surveys have shown extensive variability in reports of foot problems (anywhere between 30% and 95%), other research points to more dramatic prevalence of what I’d consider significant problems. Large-scale, random epidemiological studies aren’t available without confounding factors that muddy the waters. Still, one extensive European study found that 78% of people over 65 suffered from kind of diagnosed foot issue. Even at the most conservative of estimates, that means a minimum of one third of all Americans over 65 will have some form of debilitating foot disorder. And the worst part? Many of the studies discovered that only a small percentage of these people actually report or complain about their foot problems. Apparently, for them it’s just a fact of life.

But most of us here choose differently for ourselves. We prefer to challenge that fatalist “come what may” approach to aging. Feet shouldn’t be an exception. In fact, given the statistics, they might well be a smart priority.

Common Foot Conditions to Avoid

The human foot is an anatomical masterpiece. Each one is made up of 42 muscles, 26 bones, 33 joints, and over 50 ligaments and tendons. That’s more than a little impressive, but it also means that a lot that can go wrong…especially given their workload every day.


Gout targets the feet and particularly the big toe, causing intense pain and a whole lot of swelling. Unfortunately, many health care providers seem to take great pleasure in informing the Primal, paleo, or general whole food eater that their chances of gout have just skyrocketed on account of all those purines. Purines from organ meats, seafood and various other quintessentially Primal go-to’s.

I’ve talked about gout at length before, so there’s no need to delve back into it. Suffice to say that these kinds of “rich man’s” foods do elevate purines and therefore uric acid in the blood, but they’re also generally high in anti-inflammatory fatty acids. Research shows that systemic inflammation is a key catalyst for gout attacks, meaning high-quality Primal-friendly meats can actually reduce your risk of gout by lowering this causative inflammation. Hah!

I’d personally be more worried about fructose. In elevated doses from the likes of high fructose corn syrup and table sugar, fructose has been shown to promote excess uric acid production and prevent it’s excretion in urine. Alcoholic and smoking binges will have much the same effect.

Athlete’s Foot

As you’re probably well aware, athlete’s foot is the work of our good friend, fungus. Ideal conditions for this mildly repulsive affliction are the same as those for most fungi—warm, dark, moist environments. The same environment that you’re creating on your feet every time you slip on socks and shoes for the day… Look for signs of athlete’s foot between the toes or on the soles of the feet, indicated by inflamed skin or a white, scaly rash with a red undertone. Delicious.

And while most of us would file athlete’s foot under minor inconvenience, there’s sometimes more worth considering. The cause of athlete’s foot can morph from a fungal-derived condition at the early stages to a bacterial overgrowth-derived condition as the skin slowly but surely becomes more “macerated.” Athlete’s foot also has a strong association with cellulitis. Marathon runners have been identified as one of the most at-risk groups for developing athlete’s foot. (File it under obvious on account of having their feet shoved into hot, sweaty shoes for hours at a time.) Barefoot running, anyone?


If your second, third, or fourth toe is crossed, bent in the middle of the toe joint, or just pointing at an odd angle, you may have a hammertoe. Hammertoes are the tip of the poor foot-health iceberg, and can pave the way for various other foot conditions. The number one cause of hammertoe? Ill-fitting shoes. This might seem straightforward, but, again, the picture gets more complicated than shoe design.

While adopting a Primal diet greatly diminishes your diabetes risk, it’s useful to know that people suffering from diabetes have a much higher likelihood of developing foot problems like hammertoe. In fact, of the 16 million or so Americans with diabetes, around a quarter of them will develop foot problems related to this disease. Pro-inflammatory cytokines, appear to play a role in the development of diabetic foot disorders like hammertoe. Diabetic neuropathy lowers one’s sensitivity to pain, meaning they’re more likely to develop foot-stressing gaits and wear ill-fitting shoes that can then lead to the development of hammertoe. Neurological conditions like Parkinson’s and Cerebral Palsy or any other health problem that distorts the gait can put you more at risk.

Bunions (Hallux vagus)

Got a weird-looking joint on your big toe that forces it to turn into your smaller toes? You’ve probably got a bunion. Research has time and again identified shoes as the leading cause of bunions. As one study observed, “hallux vagus (the condition I mentioned earlier) occurs almost exclusively in shoe-wearing societies.” (Grok is nodding here….)

The more constrained the shoe, like heels or pointed dress shoes, the higher the risk. Safety footwear has also been identified as a common harbinger of bunions.

Women and anyone who is flat-footed might take special notice.

Corns and calluses

An oddly visual yin and yang of the hardened skin world. Corns look slightly cone-shaped and point inwards, while calluses cover a larger area and are more convex in nature. If you’ve got hard areas of skin forming where certain foot pressure points are rubbing on your shoes, you’ve probably got a corn or callus forming.

Corns and calluses can be the result of stresses imposed by ill-fitting footwear, foot deformity (and the subsequent mechanical abnormalities), as well as high activity levels. Essentially, corns and calluses are your skin’s attempt to protect itself from excessive friction. And I think you know where that friction is coming from.

Plantar Fasciitis and Heel Spurs

Plantar fasciitis occurs when the connective tissue between the ball of your foot and the heel becomes inflamed. Coming from experience, it feels like a perpetual bruise on the bottom of your foot. Heel spurs are bony growths at the heel base that often develop after you’ve had plantar fasciitis.

I’ve actually had plantar fasciitis before, and I can confirm that it’s no fun at all. My theory is that it developed by repeated jumping and high-impact exercises performed on a hard surface with no shoes. It wasn’t the lack of shoes that was the problem, it was the hard surface – repeated slamming of the feet (and perhaps not enough landing on the balls of my feet) on that surface was bound to result in bruising, and hence plantar fasciitis, eventually. This didn’t go away until I ditched my nearly every shoe I owned and spent more time on grass and sand than hard surfaces.

Using Primal Approaches to Promote Foot Health

As much impact (oh, the puns…) as foot health can have on mobility and quality of life, it’s really rooted in the basics of Primal well-being. The more your feet can emulate those of Grok, the more robust they’ll likely end up being. As always, we modify for the necessities of our immediate environments. Wood chopping barefoot? Heavy weightlifting barefoot? Strolling the urban jungle barefoot? I’d be inclined to opt for the “shoed” option in those scenarios.

I’ve written at length about bare footing and minimalist shoes. In the past, I’ve highlighted research showing that societies that have largely forgone the whole shoe craze were completely free of all the modern foot conditions I discussed in the previous section. I’ve reflected on the ways shoes have become a part of our psyche, and why switching to a shoeless way of life can ensure continuing foot health into the future.

So what are you to do when faced with a compulsory shoe scenario? This is where our conventional practitioners’ advice may finally be of some use. Unsurprisingly, research shows that folks who switch to wider, higher, “box-toed” shoes reduce their risk. Research also indicates that those who wear constrained shoes like heels or pointed dress shoes are at the greatest risk of developing foot problems. The take-away from this is self explanatory, really – give your feet room to move within their compulsory housing. Avoid shoes that taper in towards the end, that have a low ceiling, and that don’t allow your toes some lateral and vertical wiggle room. Free range toes, as it were.

LIkewise, it’s important to keep feet both dry and supple. This might seem like a bit of a conundrum, but they don’t have to be mutually exclusive. As soon as you get home from work, ditch both the shoes and the socks. If you have access to sunshine, whether through an open window or (preferably) on a sun drenched lawn, get those feet in it!

The benefit of this will be two-fold: first, research has shown that light therapy, whereby concentrated UV irradiation is used to treat fungal infections of the skin and nails, is an effective form of treatment. That sunshine is essentially providing your own light therapy, albeit at lower concentrations than in the lab. Second, you’re re-activating the small muscles of your feet that have essentially been in hibernation since you donned your shoes that morning.

Once you’ve immersed your feet in some healing sunshine, or perhaps just thrust them out in the general direction of a fireplace or heater, you’ve essentially fulfilled the “dry” requirement. Next, lock in the moisture by applying a natural hydrating product like coconut or avocado oil. Both have the added benefit of being anti-fungal and antibacterial, killing two pathogenic birds with one stone. Moisturizing your feet in this way should help to prevent the development of hardened skin layers, which as we know can lead to nasties like bunions, corns and calluses.

And why not give your feet a little care and attention? Therapeutic massage can soften clenched muscles in the feet, reduce inflammation, and remove adhesions between muscles and fascia tissue. All of which means the likelihood of developing muscular or bone-related disorders of the foot are further reduced. Consider it justification for frequent indulgence. It’s just possible that massage therapy may also alleviate the symptoms of diabetic neuropathy, which can contribute to foot problems down the line. Post-oil application, use your knuckles and thumbs to knead the sole, arch and toe joints as you would a lump of (Primal) bread-dough. Mmmmm, dough.

On a side note, I know most people these days rip up any remaining carpet in their house and install hardwood floors, tiles, or even polished concrete. It may look sleek, but our feet weren’t designed to spend their days pounding perfectly flat, unforgiving surfaces. From an evolutionary perspective, this is a relatively recent development. Even post-Agricultural Revolution, most people would have lived in houses with either dirt floors or dirt floors covered in straw. I like the cleanliness of hard floors, but I keep plenty of rugs in the living areas and gel mats in the kitchen and workout room. If you have a standing workstation, consider it for there, too.

Beyond these simple daily steps, there are plenty of other pro-foot changes you can make:

  • Gut dysbiosis has often been linked to a greater risk of toenail fungus and athlete’s foot. Ditch the antibiotics, up the probiotics, and ease up (big time) on the sugar intake.
  • Up the anti-inflammatory ante. As I discussed earlier, foods that are high in omega-3s and low in omega-6s can help to reduce your risk of gout, but they can also reduce your risk of developing the likes of plantar fasciitis and any number of other arthritis-derived foot conditions.
  • Stretch those feet! Studies have shown that stretching is one of the most effective forms of both prevention and treatment for many muscular and tissue-based foot conditions.
  • Ample low level, low impact activity (e.g. biking, walking, swimming) can keep foot muscles and tendons in good shape, too.
  • If you’re suffering from recurrent fungal foot attacks, consider investing in a strong topical anti-microbial like tea tree oil. And apparently marigold therapy shows some promise for natural treatment of bunions, warts, and even plantar fasciitis. It’s not a sure thing, but it might be worth considering.

Thanks for reading, everybody. Have you dealt with any of the above issues? Have you found any particular Primal-friendly steps to be effective? Share your solutions (or questions) in the comment section. Take care.


About the Author

Mark Sisson is the founder of Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint, which was credited with turbocharging the growth of the primal/paleo movement back in 2009. After spending three decades researching and educating folks on why food is the key component to achieving and maintaining optimal wellness, Mark launched Primal Kitchen, a real-food company that creates Primal/paleo, keto, and Whole30-friendly kitchen staples.

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66 thoughts on “The Plight of the Modern Foot: Conditions that Plague Us—and How to Avoid Them”

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  1. Has anyone came across any substantial fix to flat fleet and collapsed arches? Seems that there are various arguments for this condition: its genetics, once its collapsed there’s no fixing it, you need arch supports etc… Podiatrists will default to arch support, any research in the ancestral health community will say go barefoot and it’ll correct itself. Not sure of what to believe. Are there any effective corrective exercises like toe crunches that will develop the natural arch? I’ve experienced a variety of musculoskeletal pain and misalignment due to flat feet ie. knee pain, IT band/lateral quad tightness, ankle pain etc. Is the collapsed arch a symptom or cause? Any resources?

    1. Yes. Go barefoot very gradually (see my lengthy post below). You probably have knee pain due to the heels on your shoes (even sneakers and men’s dress shoes have a half inch heel or more), not your flat feet. They cause misalignment in you patellar tracking. I’m not a Dr. this was just my experience.

    2. You could try tai chi, some people think the regular standing pose in tai chi can help lift the arches. (Stand with feet about shoulder width apart, toes forward or maybe even slightly in, but knees slightly out, over the feet rather than under the hips, this should lift the arches a little.)

    3. I had completely flat feet and the physios told me I needed to wear orthotics, I wore them for years and my feet were ruined. After gradually going barefoot and focusing on walking form, my flat feet are reversed and I have really good strong arches. The main point for me though is not just go ‘go barefoot’, but you really need to research into and study proper walking form, then you need to focus on it and refine it daily. It took me about 6 months before I was happy with my walking form, as muscular imbalances affect it hugely so it’s not easy to just suddenly start waking properly.

      1. You’re right. I watched and read many “how to walk barefoot” videos and tutorials, haha…who would have ever thought we’d need to learn how to walk again?!

      2. Can you folks who are suggesting that those of us with flat feet “go barefoot” explain what that means exactly? I never wear shoes at home, but wearing shoes at work, at the gym, etc. is mandatory for me.

        1. Besides taking off shoes as much as possible, there are minimalist shoes that feels almost barefoot. Ditch your regular shoes and gradually transition into minimalist shoes.

    4. I went primal 7 years ago and that included going barefoot and wearing nothing but vibram 5 fingers shoes ever since. I was size 12 when I reached adulthood but in my mid to late thirties I had to start getting size 13. Had no idea why. Just figured my feet were getting bigger. BTW I am 61 now and was 54 when I switched to barefoot and minimalist shoes. After about a year of this I noticed my arches were obviously higher and just figured that was a benefit of my feet getting in better shape with the new lifestyle. I also noticed that my toe shoes were getting loose and figured they were getting old and stretched out. But when I went to get new shoes the size I was accustomed to (European 47’s) were also big and sloppy and I had to go down a size! It struck me that perhaps the re-arching of my feet brought me back to size 12. Fortunately the hoarding of old shoes allowed me to test my idea. Sure enough the 13’s were loose and long and some 12’s I had were comfortable and even roomy at the toes! I’m no podiatrist nor I have I ever seen one, but that’s my story and I’m sticking to it 🙂

    5. I’ve never suffered from collapsed arches (fortunately, it sounds unpleasant), but three years of yoga has given me super strong arches and they seem to be more lifted than before. Balancing on one leg, standing on the toes, all the different standing poses in which the feet are at different positions, and all of this on bare feet… you can really feel all the little muscles working. I would think that it should be possible to train your arches back to health with a something like that. Maybe a good yoga teacher can help? Good luck!

      1. If someone has fully fallen arches they need remedial massage/physical work before attempting yoga

    6. I’ve heard flat feet are due to maternal nutrition being inadequate quality. I feel guilty as my twin boys both have terribly flat feet!

  2. This article hits home. I suffered from plantar fasciitis all last summer and could not camp, boat, hike, etc. The orthotics the Podiatrist prescribed nearly crippled me and I ditched them after a month. They just support the dysfunction, but made my feet feel so weak it felt like they were made of glass and might break.

    I started transitioning to barefoot by walking barefoot around my kitchen a few times twice a day, then on the deck, then the sidewalk. It has taken about 9 months but I wear minimal shoes exclusively now ( no running yet, just walking). (Zero drop from heel to toe, no toe spring, no arch support).

    Mark is right that we didn’t evolve on hard surfaces primarily, however it is best to learn proper barefoot form on hard concrete, or wood floors. Trust me, you will not heel strike more than once on concrete. Grass and sand require much more musculature that you won’t have yet. The PF is gone, I still have a bit of stiffness on the first morning steps. Then I’m good all day. It is a major overhaul of the lower leg mechanisms, plan on at least a year to safely transition. If you are overweight be even more careful.

    My knee pain of 12 years disappeared. Since I no longer have my heel jacked up, even by half an inch, and toes squished into a point, my foot doesn’t tip over (pronate), and it allows proper tracking of the patella in the femur groove.

    1. Amy, that is exactly my experience and I’m barefoot as much as possible, always at home and in my socks a lot at work. I have a standing desk and a lot of exercise toys on the floor to stand on. And I love in my Vivobarefoot moccasins. Give running a try. It’ll seem insanely slow at first, but you’ll find that your turnover rate increases significantly. I don’t get the next morning soreness anymore, but I do feel the muscle fatigue, which I take as a sign that I’m on the right path!

      1. Thanks Brad, did you get calf pain or numbness ever, during your transition to barefoot? My right calf (same as the PF foot) started going numb at night when I rested weight on it, it started coincident with the PF and continues on and off. I was told (by a running shoe store owner) that was typical for a calf injury, and PF was really just a calf injury referring pain to the heel. I’m only 9 months into the transition. Hoping that will go away too.

    2. As a chiropractor with an emphasis on kinesiology and whole body health I have had a tremendous amount of success fixing PF and I wanted to point out a few things I have learned from my experience. Firstly, focusing only on the plantar aponeurosis attachment to the heel, where the pain is, is not typically effective long term. I find that most people I check with PF have:
      1. Weakness of the calf muscle due to a S1 nerve root impingement in the low back which diminishes the calf muscle’s ability support the heel through the Achilles tendon.
      2. A subtle displacement of the heel that needs to be mobilized. This can cause weakness in some of the foot muscles, .
      3. Weakness and fascial restriction of the tibialis posterior, a muscle directly involved in supporting the arch of the foot.
      4. Faulty shoes. I agree with Mark about being barefoot or wearing shoes that allow the foot to move naturally. I am not a fan of orthoses long term as a solution/band aid.
      5. Other imbalances that are unique to the individual.
      By correcting these imbalances most are able to return to their activities within a few months. Hope this helps.

  3. Also, a big YES on gout being from sugar and corn syrup, not meat. One summer I went camping and had, (over the whole long weekend) two ice creams, a big strawberry malt, and several s’mores every night. When I got up on Monday my knees were so stiff and inflamed I could hardly bend them. (Have given up sugar since, life is so much better. )

    1. I think the causes of gout can vary quite a bit. My dad had gout and never ate sweets. His trigger was pickles. He loved them but had to avoid them like the plague.

      A few pointers to anyone wanting better feet… As Pete Egoscue, a well-known physiologist, once said, “High heels are a good-looking bad idea.” Save them for special occasions if at all possible. Skip the pointy toes as well. Your feet aren’t pointed; neither should your shoes be. High heels and pointed toes probably cause more foot and back problems than anything else. Don’t lend your shoes to other people unless you want a case of athlete’s foot or warts. Go barefoot as often as you can; otherwise (or additionally), invest in a pair of Birkenstocks or something similar. For walking, try Nikes, New Balance, or the like–something with good support and a wide toe box. Cheap shoes can be expensive in the long run because there’s no such thing as “breaking in” a pair of shoes. If they don’t fit right in the store they never will. Trim toenails straight across to avoid developing ingrown toenails, and either skip or limit professional pedicures. The pointed instruments used can cause injuries.

      1. I just started working with Pete Egoscue’s book a week ago, so I cannot talk about results yet, but it makes so much sense. We have lost the natural stacking of our joints, and need to re-align our bodies.I suspect people might see it as too simple to be true, similar to “food as medicine”. My daughter – very athletic in yoga and acro-yoga – says it consistently keeps her functioning without pain. She had horrific SI joint hypermobility as a teen athlete. Gone!

  4. I developed plantar fasciitis a couple of years ago. I’m convinced it was from runnning in high heeled, overly supportive running shoes. A podiatrist automatically prescribed arch supports. I only wanted to go that route as a last resort. Instead I started walking, and then running, barefoot. Believe it when you are told to transition slowly. I do it regularly now and I believe that I have healed myself. My feet, achilles, and calves are stronger than ever in my life. I only run barefoot on the treadmill (its just too easy to step on something that hurts outside) and in the winter it is a perfect partner to Primal Endurance and the MAF principles. Outside, I’m now a full fledged Altra guy. I’m a firm believer and will do it forever now. Peter Larson’s book, Tread LIghtly, is a great resource.

  5. you didn’t mention fat pad atrophy. its a terribly debilitating condition that i have been dealing with for years. i believe it was either caused or exacerbated by doing high impact activity such as dancing, running and just walking on concrete with minimalist footwear. i am in pain upon ambulation and weight bearing, but i maintain fitness by biking, and continuing to be active even though it can be very painful. i am only 27 years old btw

    1. Can you get gel padding for under your heel and the ball of your feet? I would think they could do this for you…

  6. Had foot surgery about 8 months ago for an old karate injury, I’ve developed plantar fasciitis and pain and numbness in my foot, I’ve had to back off on some activities, it’s definitely frustrating. Will keep rehabbing and pushing forward … what else can you do. 🙂

  7. I will never give up my cute shoes, most of which are pretty high wedges since I’m 5′ 1″. But I’m always barefoot at home, and any other time it is possible. I’ve been fortunate to be free of the foot problems listed. Very interested in learning about reflexology. Curious if anyone in this community has info?

  8. My feet have always been flat and pronated but I never perceived it as a problem, had some orthotics prescribed but they were torture and were discarded immediately.

    After 20 years of jamming my feet in foot straps while windsurfing I developed huge bone spurs behind both big toes and now have very little range of motion. This got very painful and worrisome, I was considering surgery where they just remove the whole joint leaving the big toes flopping. But I noticed that the longer I went barefoot the better they felt, after a year of 80% bare foot Arizona living they rarely hurt me anymore. In the prior climate I always had pain for months when transitioning from shoe season to barefoot season or vice versa. I can’t do burpees nor windsurf in foot straps but at least for now I can walk and bike. If anybody’s had that surgery I would be interested in hearing how it worked out for you.

    1. I would advise seeing another podiatrist if your pain returns. There are several other ways to fix an arthritic big toe joint.

  9. I have had a bunion on my right foot for at least 10 years. I never wore high heels or confining shoes. I am told that bunions are also genetic. (Mine from my grandmother.) I don’t intend to have surgery so would love an alternative to it.

    1. “Correct Toes” is a silicone toe spacer product, worn in your shoes (they must be wide enough) that claims to straighten bunions. Dr. Ray McClanahan is the Podiatrist who invented them. I’ve read good things. Good luck. When your feet ain’t happy ain’t nuthin’ happy!!

      1. My podiatrist told me I needed surgery for debilitating mortons neuroma. Then, I found Correct Toes and Lems Shoes. I wore those exclusively for almost a year and transitioned to Vibram toe shoes (when it’s not raining). I am now pain free! Only time it hurts is if I try to wear my old toe squeezing shoes.

  10. This topic is something that I really need some help with. I’m relatively new to the primal conversation, but I am so excited that topics include all areas of health, including our feet. I have very wide feet, high arches have several foot problems. I’m petite, and when I was in my twenties and teaching high school students, I wore low heels every day, despise foot pain, and now that I am in my thirties, I am now paying for that mistake. Bunion on one foot, and I have a haglunds deformity on the other foot. I had to do physical therapy for three months last summer. Shoe shopping is impossible, almost all shoes I wear hurt me, and it seems like the next stop is surgery (like my mother). Thankfully, as a stay at home mom, I am barefoot at home for much of the day, only putting on shoes when I run errands or take kids out. I avoid shoes as much as I can, because they hurt. Even then, I only wear Birkenstocks in the summer and wide boots in the winter. My days of cute shoes are long, long gone. And as for long walks, hikes, running, I just can’t do it. It hurts too much.

    I have recently been experimenting with stretching my toes regularly and that seems to be helping reduce pain. I’d love to find a foot stretching and strengthening routine for optimal foot health! I need foot yoga! Is that a thing? Would it work??

    Thanks for addressing this important health topic!

    1. Try “writing” the alphabet with your feet while sitting down. Do each foot separately. It strengthens the feet as well as the ankles and also works the leg muscles.

    2. Katy Bowman’s book “Whole Body Barefoot” has exercises, also William Prowse’s “Strong Healthy Feet”. And has buttery soft leather moccasin-like shoes that feel like barefoot (they are actually cute, too!). You should find them comfortable, and they have videos on proper sizing and a great return policy. Good luck.

      1. Thank you for your suggestions. I learned so much from the post and the comments on this post. I’ve been scurrying around the internet looking up the shoes and websites everyone has mentioned and I finally feel a glimmer of hope that maybe I won’t always be in pain! Thank you all so much. If anyone has any other recommendations for natural, minimal shoes, send them my way, please!

  11. I developed a mystery inflammation/tendonitis pain in my left foot last year at a time of stress. Apart from the fact that the stress was a factor, I wanted to try and find out what else I could do as I was becoming less and less mobile.

    I went to the GP / Doc and he sent me away saying “wear gel insoles”.

    I then privately went to a podiatrist who was helpful in identifying that the left foot was overpronating and this had caused irritation to the tendons running over the inside of the heel bone. She recommended stretches for my hip flexors, quads and calves to reduce the tightness going down through my legs.

    She also gave me orthotics. Being a Primal gal I was skeptical but gave them a try because I wanted to fix the problem. (She also told me to wear sturdy shoes but that was a bridge too far for me as I wear very minimal shoes.)

    The orthotics helped to mechanically prevent the overpronation which gave me some short term relief. I do not believe that they fix the problem, as the foot is never called on to support itself when you have them. But they were a help temporarily to reduce the inflammation and get me out walking more.

    The REAL fix for me (and this is an ongoing situation) is to stretch stretch stretch those muscles every day. I get a massage when i can afford it, my OH does my feet sometimes for me. I also use a roller (a paint roller!) to help release tight points on my legs by leaning on it and rolling it on the sore point.

    The other thing that really helps is non-repetitive movement. Walking on rough terrain (minimal shoes) and dancing (at home in bare feet) are great. You do have to work up to it gently and listen to the feedback your body is giving you.

    2 lessons learned:

    1) You have to make lots of small changes but keep them up. Especially when you start getting better, it’s tempting to stop because it feels fixed.

    2) Trust your instinct. I believe that using orthotics causes a dependency and that my foot can be helped to support itself. Don’t forget most people the specialists see never bother with their exercises. The podiatrist nearly cried when she saw the improvement because it was so rare that anyone did what she recommended.

  12. I am a district nurse specialising in wound care (I can smell if someone has athlete’s foot before they take their shoes off). I almost never see normal looking feet among the elderly – when I do, the feet are male. Elderly women almost always have shoe-shaped feet.

    Hammer toes are only a tiny part of the horror that is diabetic neuropathy. The mechanism of diabetic foot ulcers (in a nutshell, for anyone who is interested) is reduced sensation in peripheral areas, because of high blood sugars which have basically been caramelising nerves for years. This is usually feet but can also be in the hands (and other extremities). So you see diabetics who walk all day with a stone in their shoe, or a shoehorn (true story), or just poorly fitting shoes, and they get blisters and wounds. Diabetics at this stage almost all have extensive ischemia, so there is reduced blood flow in their extremities, which is a poor condition for wound healing. And the diabetes impacts their immune response so they are at a high risk of infection, including bone infections. So it’s an unholy trifecta of neuropathy-ischemia-infection. Amputations aside, the process has a huge impact on quality of life, mobility, independence, and has enormous personal and societal costs.

    Personally I have problems with heel pain in my left foot, which has gotten much better after I’ve started working on it using some of Katy Bowman’s techniques. Absolutely recommend to everyone, but especially people with foot pain.

  13. I grew up in Sweden where it is considered rude to wear shoes indoors ( unless someone is throwing a fancy party ). I never had any foot problems ( always barefoot as a child running around grandma’s farm , often stepping in unwanted “uneven ground” ( thanks to the cows that were roaming free ). The work environment was also very lax about what people wore in the office ( I just wore sandals ). until then I don’t think I had ever seen a nail fungal infection.
    Then I moved to the UK – everyone is suited and booted. Uncomfortable tight hard leather shoes all day long and the weird fact that people wear shoes at home. I just never got it.Shoes are a big no no in my household and all guests take them off upon arrival, even if I’m having dinner 🙂
    Looking around the gym in the changing room I see green toe nails everywhere here.
    I’ve not gone as far as doing sprints in my 5-toe Vibrams but anything else in the gym including MAF sessions is always wearing Vibrams.
    Now that it’s getting warmer I will start training and walking barefoot in a nearby huge park and give uphill sprints on grassy hills a go.

    1. Mine went away when I switched to minimalist shoes from SoftStar or LEMS. Ski boots and narrow dressy pointed flats caused it. Morton’s neuroma is characterized by a nerve being pinched by those metatarsal bones. Give your toes spreading room and it should go away. Good luck.

    2. Here’s what I did to fix mine (based on instructions from my ND) – You’ll need to do 3 things, all together: Get Correct Toes and wear them daily, buy Original Croc’s so that you can wear the Correct Toes (very few shoes will fit the Correct Toes), and wear Dr. Jill’s Ball-of-foot Pads placed on the arch of the foot, not the pad of the foot. I’ll break it down a bit more with instructions:

      Wear “Correct Toes” inside your shoes. They’re toe spacers that spread the toes so that it relieves the pinching pressure on your nerves. They’re flat on top and bottom so you can walk in them. Look up the website Northwest Foot and Ankle to purchase them. The only shoes these will fit in are original Crocs and LEMS. I bought both, but because of the pain when walking I could only wear the Crocs. Crocs are cushier and I wasn’t ready for a minimalist shoe like LEMS. But get the Correct Toes first and then try them in Crocs Originals to see which size will fit because they really expand your toe box and I needed a size larger shoe. Start out wearing them a couple hours a day, then work up to full days. I did this for a full 5 months and then I was able to cut back on wearing Correct Toes.

      Also get Dr. Jill’s Ball-of-Foot cushions 1/8” thick, on Amazon. Wear these on the arch of your foot, not on the ball of the foot as is shown in the picture. So place them just behind the ball of the foot. They come in ¼” thickness and that was way too thick for me, so start with 1/8” thickness. I still wear these daily. These will help take pressure off the ball of the foot which is essential for you right now. They are reusable, just rinse them each night.

      When I had pain, it was so bad that I could barely walk. Now, I’m pretty good but I’m still cautious about over-doing it. I had to switch to using the bicycle and elliptical for exercising, to avoid putting pressure on my feet. Hiking/running/walking was out. Also, I bought Katy Bowman’s foot health book. I’ve tried to change my posture a bit because I noticed that I was leaning forward slightly when I stand and walk which puts more pressure on the ball of the foot. All of this helped, but the biggest help was the Correct Toes, Crocs, and Dr. Jill’s Foot Pads. Good luck!

  14. Gout is the most painful and debilitating form of metabolic arthritis. Imagine trying to sleep with what feels like a truck parked on your ankle.

  15. I got major plantar fasciitis when I run sprints one day at the beach (by the water, where the sand is harder). It came on and off during a couple of years. My problem (hindsight is 20/20) is that I never let it recover fully. I am 100% cured, I can do zumba classes barefoot. The therapy that worked best for me was to stretch the foot on a stairwell step (let the talon hang). Do it every day two or three times a day. And follow the Primal Law “don’t do stupid things” and “use your brain”

    1. What did “not letting it recover fully” look like? You continued to run? Or walk long distances”

      1. It means stop doing sprints, stop doing zumba, stop doing the weekly walks to and from work (5km each way), stop trying to better my mile time. I did not do any of these things and the PF stayed 🙁
        In short: change the activities 🙂

  16. 25 years ago I had my first gout attack. It took two weeks to finally find a medication that resolved that. I was then put on allopurinol. I took that for 20 years. In 2011 I switched to my ancestrally approriate diet (primal) l and resolved 12 health issues (T2 diabetes, high blood pressure, plantar fasciitis, gout, weight etc.). I stopped/started allorpurinol several times over the next 5 months but eventually stopped it. My uric acid level is actually higher now (still within normal range) than it was when I was taking allorpurinol, but I have had no symptoms for over 5 years. I also had plantar fasciitis in both heels (worse in right) and a heel spur (right). All those issues resolved with a corrected diet. I now walk a few miles a day on a treadmill barefoot. My arches are in great shape (at age 56). You can read my story on the ‘About’ page of

  17. WOW! Now this post is very close to my heart! I was starting to develop a hammertoe and also bunions on both feet. I tried wearing toe spacers to bed every night for a few months but not much was improving. Then, I found and tried VIBRAM FIVE FINGERS at about the same time I discovered Katy Bowman and read all her blogs (KatySays), doing her foot ‘exercises’ and started going barefoot outside….I even garden barefoot! I actually did get callouses on the bottom…but that was a good thing. (I also stepped on a bee…whoops, yikes…it hurt like $&@???)
    It has been about 2 years now and I can say that I really love my feet and that they are so much stronger! I have much better ‘toe separation’ now. I only wear toe shoes (and toe socks) except in the Canadian winters when I wear Manitoba Mukluks( no heel, large toe box and I can feel the bumps and bits thru the Vibram soles.) Last fall I hiked the Canadian Rockies in my Vibrams! I bicycled and hiked through Europe for 2 months and only took 3pairs of Vibrams( they are so light and easy to pack!)
    I will never go back to ‘regular’ shoes!!!!
    I am also much more aware when I walk, of the environment, my gait, etc.
    PS If you simply can’t wear toe shoes, Katy suggests any FLAT shoe with no heel and minimal sole will do the trick to assist in aligning your posture.
    I am presently installing a ‘cobblestone mat’ in my kitchen so my feet will be getting a workout when I’m cooking!
    Also of note…my knee, hip and lower back problems have all been resolved since this change to minimal footwear. Just know that you have to be willing to work at this adaptation…there is no magic bullet!

  18. April first falls on a Saturday this year, but I’m still ready for Mark’s post, just in case. Because I’ve researched Mark’s claims so much and know that they pan out, I tend to lower my skepticism. So it was that just now I caught myself–the joke’s on me–simply accepting the axe advice, not waiting for the “not!” later in the sentence. Well I’ll put my axe away after balancing it on my big toe and after running barefoot down main street, but in a year I’ll probably remember the following as if Mark actually recommended it. Call it a pre-April fools-on-me. Mark said: “Wood chopping barefoot? Heavy weightlifting barefoot? Strolling the urban jungle barefoot?” [and I thought, sure, okay]

  19. I have high arches and very high insteps, along with very wide feet (6E is often too narrow). I just bought what I hope will be my last pair of production shoes. After this, I plan to go the custom shoe route. The maker I have in mind started out doing orthotics so I’m hopeful their shoes can address all of my emerging foot problems.

    On another note, I use lanolin on my feet and it works wonders.

  20. Tea tree oil has been a lifesaver, helping treat both athlete’s foot and fungal nail infections.
    One little trick I’ve used to relieve daily foot strain is to give myself quick foot massages during bathroom breaks. Nothing crazy, just separating the toes and squeezing the whole foot a bit helps get the blood flowing again. Definitely remember to wash your hands afterwards!
    Lastly, I’ve started bringing a change of socks to slip into around the middle of the day (usually post – massage), to help keep my feet dry.

  21. I’ve dealt with toe fungus and athlete’s foot for the last 20 years and a month ago, on a hot tip, mixed up some coconut oil and oregano oil (about 25 drops of oregano oil in 2 tbsp of coconut oil) and started applying it to my toes after showers. The athlete’s foot is gone, for now, and the skin is all healed up. I don’t know if the fungus will stay gone when I discontinue the use of the mixture, but here’s hoping.

  22. Great post. I have suffered from years of Chronic Exertional Compartment Syndrome (despite not being a runner) and am getting ready for a second round of surgery surgery (I had bilateral fasciotomies in 2014). I used to have severe plantar fascitis due to being unable to walk ‘normally’ and before the CECS dx, I tried 6 different pairs of very expensive orthodics-its heartening to hear that they also didn’t work for some other people and in fact made things worse!

  23. Great read! Two years ago I opted for a career change that took me from a desk job, to the construction site. I’m always amazed at how many people are wearing the cheapest steel toe boots they could find, and that they’re usually so old and neglected that they’re practically falling apart. It’s no surprise that safety footwear is linked to foot problems.

    Jaws hit the ground when people find out how much I paid for mine, but I’m a firm believer that you get what you pay for. Hand made in Vancouver BC (It’s a bonus that I get to support the Canadian economy), from high quality materials, and they measure your foot for the perfect fit. I prefer go barefoot whenever possible. Camping, hiking, fishing are all barefoot (to my girlfriend’s dismay), weather permitting. Shoes and socks even come off the moment i get home. I simply hate wearing shoes, and always have. But my feet can stay in these work boots all day, and not get tired. Plus, if they’re like the other shoes I’ve bought from this company, they’ll far outlast anything that comes from a factory, which saves me money in the long-run.

  24. When men stop thinking high heels and other forms of more feminine footwear, such as pointed flats, to be sexy, that’s when I can stop wearing them. A fellow Paleo friend had urged me to start wearing Correct Toes, which I was going to do, and then I realized it would likely eventually make my feet too wide to fit most of my favorite shoes. I do wear shoes as little as possible, so I’m hoping that helps.

      1. No, of course not. Everyone is different. Hell, some men find obese women sexy. But I’m just going off what seems to be the general consensus right now.

    1. Reverse your thinking: some people will find you sexy in any or no shoes, the guys that are waiting for your footwear to impress them are not worth your time! I have Morton’s Neuroma post-surgical nerve damage that restricts my shoe choices (barefoot can be more painful, but I do on natural ground) but I’ll be darned if I’m going to suffer for someone elses pleasure 😉 Good luck ?

    2. Lol I’m walking around in vivobarefoot shoes, happily married. Men never had any problem with my footwear choices. Guys care about these thing much less than you would think…Of course it’s your choice if you don’t want to have healthy feet because of some imaginery problems, but don’t blame it on guys. And there are very pretty barefoot shoes too.

  25. If it’s gotten to the point of debilitation there’s so much more going on than the foot. Lower extremity dysfunction gives you a hint on where the source is (lumbar spine)

  26. When you have had severe Raynaud’s (autoimmune), going without socks is not an option in colder climates… and you have to be extra careful when going out to shovel snow on a cold day to wear warming insoles. Even so, chillblains (red and swollen toes due to poor circulation) is a danger – once activated in the cold, doesn’t go away until spring. Blue toes are no fun.

  27. I’ve struggled with hard, callused, and peeling feet my whole life. I’ve tried the coconut oil and barefoot treatments before on numerous occasions but to no avail. Additionally, my right leg from knee to heel is 12mm shorter than my left (a recent discovery) and I wear a lift in my right shoe, so long term barefoot walking throws me out of alignment.

    Does anyone have any recommendations as far as how to get back to a more barefoot lifestyle? I do minimalist shoes, but I miss not wearing them at all. Is anyone aware of any research on length imbalance correction?


  28. I had awful plantar fasciitis a few years ago. What worked for me was 2 things. First, I went to the chiropractor, who explained that a small imbalance at the top of the chain, in my neck, could have a much larger impact at the bottom of the chain (my feet). The adjustment took most of the pain away instantly. The other thing that helped was switching to Altra shoes. They are zero drop with massive amounts of toe room, but cushioned to account for the unforgiving industrial surfaces I had to stand on all day.

  29. I study ballet and almost laughed out loud when the article asked if my shoes are too narrow, restrictive, or abrasive. On the other hand, my feet, while heavily callused, are very strong and flexible, and when I’m not dancing they are usually naked and free. Great article, thanks.

  30. Orthofeet’s Ortho-Cushion ® System is engineered with advanced orthotic insoles and Ergonomic Soles, which provide anatomical support to the foot along with unsurpassed cushioning. The orthotic insoles help alleviate strain on the plantar fascia and the Ergonomic Soles reduce impacts on your heel, enhancing comfort and helping relieve pain associated with plantar fasciitis.

  31. What about Morton’s neuroma? Is there specifics for helping with this pain?