Issues Regarding Safety

Despite the common belief that shoes are required in stores or restaurants, this is just a myth that can be confirmed by talking to the Ohio Department of Health or the Fairfield County Department of Health. Yes, some McDonald's do have a sign on their door that says, “No Bare Feet By Order of the Department of Health,” but these signs are simply not true. Generally, I have no problem at all going barefoot in all sort of stores and at all sorts of other places.

Concerns about the safety of barefooted partrons are misplaced and based on yet another myth that somehow feet are fragile objects that are particularly susceptible to injury. I have personal experience that bears directly on this subject. In the past three years I have hiked barefoot over 600 miles (over the past 10 years it's probably close to 2,000 miles, but I only officially started keeping track three years ago). I regularly shop at stores many times during a typical week. I regularly walk through store parking lots (yes, many with broken glass) and on city streets. Every year I do the nine-mile “Walk to Work with Joe Day” walk down High Street, sponsored by Joe Blundo of the Columbus Dispatch.

Have I ever injured a foot? Yes, a few times, when bushwacking off-trail in the woods. The injury was handled with a simple bandage. But I have never injured my feet while in a store and I have never injured my feet while walking on a city street. All injuries have been in extreme hiking conditions, and all those injuries have been minor. In fact, I usually have more cuts and scrapes on my hands from working around the house and garden than I ever have on my feet (actually, I usually have injuries in neither location).

I know what constitute hazards to bare feet and I know how to look out for them. In that regard the Fairfield County Library and libraries in general are absolutely pristine. In going to the vairous libraries barefooted for more than ten years, I have never seen anything that could remotely be considered a hazard to a barefooted person. Thus, banning bare feet at a library for safety has no basis in fact, and is in reality merely an arbitrary and capricious choice.

There are numerous scientific studies that demonstrate the dangers of various other choices of footwear; focusing merely on bare feet as a footwear choice that needs to be prohibited is quite arbitrary. It is well-established that shoes visit a number of ills on the human body: athlete's foot, hallux valgus, knee problems, corns and bunions, ankle sprains. I'd like to detail some of those to illustrate how having libraries focus on bare feet and rely on myth is poor policy and poor rulemaking.

The damage that shoes do to feet is well-documented. In 1905, a study1  was published that discovered that peoples who regularly went barefooted did not suffer from flat feet. While many had low arches, the study concluded that

The height and shape of the longitudinal arch have no bearing on the strength or usefulness of the foot. Weakness of the arch is rarely, if ever, accompanied by breaking or lowering, and flat foot as a pathological entity hardly exists.

We need only look at the many arch-support products of today to realize how shoes, particularly those with hard soles, weaken the foot. If libraries are determined to get into the footwear evaluation business (which is what they are doing by banning bare feet), then they are being remiss by not banning such shoes, too.

In 1949, another study2  examined other populations, in India and China, that had never worn shoes. What is most remarkable about the study is that, in its sample of over 5,000 people, not a single instance of ingrown toenails, hallux valgus, corns, or bursitis at the first or fifth metatarso phalangeal articulations was found. Hallux valgus is the inward-bending of the big toe caused by wearing shoes with pointed toes; a quick look at many women's feet show what high heels do to them. In my case, I have a slight hallux valgus which formed before I stopped wearing shoes. I also had associated bursitis in that toe, which only went away once I stopped wearing shoes. When I did occasionally wear shoes, even for as little as two hours, the bursitis returned. Libraries with a singular footwear rule have focused on one particular small risk and totally ignored the long-term damage that other sorts of footwear do to feet. A more even-handed evaluation would not be so limited in its scope. There are additional papers3  that also highlight this damage to feet caused by shoe-wearing that a library rule does not address.

More recent scholarship4  was initiated by the observation that the technological development of running shoes, with fancy arches and generous padding, did nothing to reduce the injury rate of runners. That study concluded that feet that are not in shoes are able to flex and thereby protect the feet from the sorts of injuries that shod runners get. In addition, this particular study noted that sensory feedback from the sole of the bare foot is important in protecting the feet. Another study5  stressed the importance of such sensory feedback from the sole in alerting the body to the foot being overloaded. Further research6  also noted how the foot is protected by the innate flexibility of the bones, ligaments, and tendons of the foot, allowing the sole to deform around dangerous objects. As the authors put it in the abstract:

These data provide insight into how, when barefoot, the plantar surface resists perforation yet provides protection to local bony structures. These data further support the notion that plantar sensory feedback plays a central role in safe and effective locomotion.

Those who buy into the myths of the necessity of shoes also bring up the issues of athlete's foot and plantar warts. Neither concern has a valid scientific basis. Athlete's foot is a disease of shoe-wearing populations. As a review article7  put it,

Tinea pedis is the most common fungal infection worldwide, affecting 30% to 70% of the population. It is a disease of civilized humans, having evolved in the late nineteenth and early twentieth centuries, that predominantly affects adults, with reportedly an equal male to female incidence.

This only makes sense. Athlete's foot is a fungus; fungi prefer warm, dark, moist environments — like the inside of a shoe. The athlete's foot spores get spread in warm, moist environments such as locker rooms, but really need the inside of a shoe to develop. Without the proper environment, the athlete's foot organism just cannot take hold. A true concern by libraries for foot health would be demonstrated by a ban on the closed footwear that promotes athlete's foot. The situation with plantar warts is a bit different, in that warts are spread by a virus. However, even then, two studies strongly suggest that again it is the wet environment that allows them to make a successful attack. The first study8  found a much greater incidence of plantar warts in those who used communal shower stalls than in those who merely used a communal (and drier) locker room. The second study9  found something similar, saying in its abstract:

Excessively sweating feet rather than barefoot gymnastics in school, and perhaps the wearing of rubber boots or nylon stockings appear to facilitate the infection. The use of a public swimming pool may be a possible cause, but could not be proven. It seems that an intact, thickened, dry callus layer provides some protection whereas a softened, moistened and macerated callus layer promotes the spread of plantar warts.

Additionally, both studies found higher rates of plantar warts than seen in the barefoot populations of the Shulman study. In addition to diseases like athlete's foot, there are additional maladies that affect shoe-wearers almost exclusively; one example is pitted keratolysis,10  which thrives on the wetness of sweaty feet kept in athletic shoes. Again, libraries are being arbitrary by relying on myths in their choice of which footwear to regulate.

Footwear is also strongly associated with ankle sprains. Lateral stability, which prevents inversion of the ankle, has been shown11  to be best under barefoot conditions. This is not surprising, since the addition of a heel lengthens the moment arm for the torque that is applied to the ankle whenever the foot is on an uneven surface. Of course, higher heels mean even higher torques, with a corresponding higher likelihood of a sprain. A review article12  also notes how the enhanced proprioception of bare feet decreases the possibility of such ankle sprains. My own experience strongly supports this research on ankle sprains. Before I started hiking barefoot, I would regularly have a sprained ankle, despite wearing high-top hiking boots. Since I started hiking barefooted, though, I have never sprained my ankle. When hiking I can feel what I am stepping on, so I know how loose or slippery it is, and if it is on an angle. I can feel if my foot is landing on the trail at an odd angle, and immediately make a correction. And, if my foot does get turned a small amount, there is not the moment arm of a heel driving my ankle to turn over even more, resulting in a sprain. Finally, I note that, while the floors in a building like a library are generally well-maintained and even, even door jambs can have some unevenness that could lead to ankle sprains. Bare feet would be safer on those surfaces.

Regarding ankle sprains, the height on high-heels makes them particularly dangerous. But high-heels are an assault on the body beyond just the possibility of sprains. One review article13  that was evaluating the risk of falls in older people noted that, not surprisingly, the higher the heel, the poorer the balance. Another study14  showed that wearing high-heels increases muscular fatigue (it's work to balance on those things), which leads to an increased rate of accidental injury. Finally, other scientific work15  has shown that high-heels are much more damaging to the body as a whole: for instance, wearing heels increases the torque on the knees by up to 30%, and possibly contributes in that fashion to knee osteoarthritis. Many of the injuries inside buildings related to high-heels are due to the heel getting caught in some irregularity, such as the edge of a carpet, or a grate of some sort. Again, it is arbitrary that libraries make a rule about bare feet on “safety” grounds but do not make a rule about heel height or narrowness.

Folks also conjure up fanciful scenarios in which a barefooted person steps on something like a screw. I call it fanciful because it is so horribly unrealistic, and because, even if it somehow happened, such an event would also be an equal, or greater, danger to your shod patrons. First, in all likelihood, the screw would land on its side, not on its base with the point facing up. If it landed on its side and I not only missed seeing it but also stepped on it, so what? I've done it before, sometimes on purpose to prove the point. As noted in the paper by Robbins, the foot deforms around the shape of the screw without any injury being inflicted. However, suppose that it did land with the point facing up. There are numerous studies in the scientific literature of feet being punctured as such screws or nails go right through the relatively soft soles of sneakers. Worse yet, as the Kerrigan study16  points out, when it was a sneakered foot that was punctured, there was a greatly increased risk of a bone infection (osteomylitis) from the Pseudomonas aeruginosa that resides only in the warm, moist environment inside a shoe (none of the barefooted punctures acquired this infection). One would be better off going barefoot. Finally, adding my own experience from hiking over varied terrain, I find that the instant feedback of having a sharp object touch the sole of my bare foot often allows me to quickly compensate and relieve the pressure before I have put my full weight on that foot, thereby preventing any puncture. If a person steps on such a screw or nail wearing a sneaker or flip-flop, the first they would feel that sharp point would be only after it had already penetrated the sole of the shoe and after the person's full weight is on the foot. In that situation, the screw or nail would be much more likely to be driven fully into the foot unless the person were wearing a hard sole. Thus, for this scenario, bare feet are a safer alternative than sneakers or flip-flops. Yet, I don't see any “safety-related” rule banning sneakers or flip-flops and requiring hard soles. Banning only bare feet is just an arbitrary and capricious choice made by various libraries.

Choice of footwear is a highly personal choice. Women who wear high heels are usually well-aware of the effects of such footwear on their feet: hallux valgus, corns, sprains; but they make the personal choice that their sense of fashion outweighs those other considerations. Other people wear other footwear as part of their personal choices, and libraries do not step in to negate that choice. Libraries are only doing so for my personal footwear choice, which I can justify with the numerous scientific studies I have presented here. There really is no scientific safety reason for your footwear rule that singles out my particular footwear choice, but not other footwear choices. It is unreasonable to perpetuate a myth by relying on signs on the sides of fast food restaurants.




Footnotes:

1. "Conclusions Drawn from a Comparative Study of the Feet of Barefooted and Shoe-wearing Peoples", by Phil. Hoffman, M.D. The American Journal of Orthopedic Surgery, Vol. 3, No. 2, pp. 105-136 (October, 1905). A copy of this paper is available at <http://www.ohiobarefoothikers.org/osf/hoffman1905.pdf>. All citations are on-line at <http://www.ohiobarefoothikers.org/osf>. [Back]

2. "Survey in China and India of Feet That Have Never Worn Shoes", by Samuel B. Shulman, Pod.D. The Journal of the National Association of Chiropodists, Vol. 49, pp. 26-30 (1949). A copy of this paper is available at <http://www.ohiobarefoothikers.org/osf/shulman1949.pdf>. [Back]

3. "Footgear - Its History, Uses and Abuses", by Steele M. Stewart, M.D. Clinical Orthopaedics and Related Research, Vol. 88, pp. 119-130 (October, 1972). A copy of this paper is available at <http://www.ohiobarefoothikers.org/osf/stewart1972.pdf>. [Back]

4. "Running-related injury prevention through barefoot adaptations", by Steven E. Robbins and Adel M. Hanna. Medicine and Science in Sports and Exercise, Vol. 19, No. 2, pp. 148-156 (April, 1987). A copy of this paper is available at <http://www.ohiobarefoothikers.org/osf/robbins1987.pdf>. [Back]

5. "Overload protection: avoidance response to heavy plantar surface loading", by Steven E. Robbins, Adel M. Hanna, and Gerard J. Gouw. Medicine and Science in Sports and Exercise, Vol. 20, No. 1, pp. 85-92 (February, 1988). A copy of this paper is available at <http://www.ohiobarefoothikers.org/osf/robbins1988.pdf>. [Back]

6. "Running-related injury prevention through innate impact-moderating behavior", by Steven E. Robbins, Gerard J. Gouw, and Adel M. Hanna. Medicine and Science in Sports and Exercise, Vol. 21, No. 2, pp. 130-139 (April, 1989). A copy of this paper is available at <http://www.ohiobarefoothikers.org/osf/robbins1989.pdf>. [Back]

7. "Dermatophytosis of the Feet", by Gayle D. Masri-Fridling, MD. Dermatologic Clinics, Vol. 14, No. 1, pp. 33-40 (January, 1996) (citing "Cutaneous infections: Dermatophytosis and dermatomycosis," by J. W. Rippon. Medical Mycology, pp. 218-223 (Philadelphia, W. B. Saunders, 1988)). A copy of this paper is available at <http://www.ohiobarefoothikers.org/osf/masri1996.pdf>. [Back]

8. "Communal showers and the risk of plantar warts," by L. W. Johnson. The Journal of Family Practice, Vol. 40, No. 2, pp. 136-138 (February, 1995). A copy of this paper is available at <http://www.ohiobarefoothikers.org/osf/johnson1995.pdf>. [Back]

9. "Untersuchung über mögliche kausale Faktoren bei epidemischer Häufung von Plantarwarzen" ("Possible causative factors in epidemic incidence of plantar warts"), by U. Benz and F. Gilliet. Schweizerische medizinische Wochenschrift, Vol. 106, No. 20, pp. 666-671 (May 15, 1976). A copy of this paper is available at <http://www.ohiobarefoothikers.org/osf/benz1976.pdf>. [Back]

10. "Pitted Keratolysis: A Common Infection of Active Feet," by Michael L. Ramsey, MD. The Physician and Sportsmedicine, Vol. 24, No. 10, pp. 51-57 (October, 1996). A copy of this paper is available at <http://www.ohiobarefoothikers.org/osf/ramsey1996.pdf>. [Back]

11. "Lateral stability in sideward cutting movements," by Alex Stacoff, Jurg Steger, Edgar Stussi, and Christoph Reinschmidt. Medicine and Science in Sports and Exercise, Vol. 28, No. 3, pp. 350-358 (March, 1996). A copy of this paper is available at <http://www.ohiobarefoothikers.org/osf/stacoff1996.pdf>. [Back]

12. "Factors associated with Ankle Injuries - Preventative Measures," by Steven Robbins and Edward Waked. Sports Medicine, Vol. 25, No. 1, pp. 63-72 (January, 1998). A copy of this paper is available at <http://www.ohiobarefoothikers.org/osf/robbins1998.pdf>. [Back]

13. "Footwear and Postural Stability in Older People," by Hylton B. Menz and Stephen R. Lord. Sports Medicine, Vol. 89, No. 7, pp. 346-357 (July, 1999). This paper also noted some situations in which, due to loss of plantar sensitivity in the aged, bare feet were not recommended. A copy of this paper is available at <http://www.ohiobarefoothikers.org/osf/menz1999.pdf>. [Back]

14. "Analysis of muscular fatigue and foot stability during high-heeled gait," by Amit Gefen, M. Megido-Ravid, Y. Itzchak, and M. Arcan. Gait and Posture, Vol. 15, No. 1, pp. 56-63 (February, 2002). A copy of this paper is available at <http://www.ohiobarefoothikers.org/osf/gefen2002.pdf>. [Back]

15. "Women's shoes and knee osteoarthritis," by D. Casey Kerrigan, Jennifer L. Lelas, Mark E. Karvosky. The Lancet, Vol. 357, No. 9262, pp. 1097-1098 (April 7, 2001). A copy of this paper is available at <http://www.ohiobarefoothikers.org/osf/kerrigan2001.pdf>. [Back]

16. "Soft tissue and bone infections from puncture wounds in children", by Terese J. Laughlin, David G. Armstrong, Joseph Caporusso and Lawrence A. Lavery. The Western Journal of Medicine, Vol. 166, No. 2, pp. 126-128 (February, 1997). A copy of this paper is available at <http://www.ohiobarefoothikers.org/osf/laughlin1997.pdf>. [Back]