Building a Firm Foundation With Our Feet

Proper foot posture can help manage joint pain, mitigate osteoarthritis, and prevent bunions.

Jacob Lund/Shutterstock

Whether we’re trying to maximize our daily steps or are avid runners, we spend a lot of time on our feet. Generally, we understand how overall posture is important for our back, knees, and shoulders, but its role for our feet is often neglected.

When we optimize our foot posture—both at rest and in movement—we can improve well-being and help prevent and manage potentially debilitating conditions like plantar fasciitis, osteoarthritis, bunions, and chronic joint pain.

Austin Keith, a professional foot health coach based in Arkansas, helps his clients with an alternative approach to podiatry, earning him the nickname, “Barefoot Will.”

“[For] the modern human, the mechanics of the feet are very altered compared to what you see in primitive culture,” Mr. Keith said. “There’s been an introduction of modern footwear that is not necessarily aligned with the natural biomechanics of the feet.”

Mr. Keith got his start in foot health as a physical therapist assistant working with college athletes.

“That’s where I got my introduction to basically how the athletic rehab world looked. And it didn’t look good in my opinion,” Mr. Keith told The Epoch Times.

“A ton of kids were just really blown out. Their ACLs [anterior cruciate ligament of the knee], their ankles, a lot of shoulder injuries as well,” he said. “These athletes were super strong, especially in the weight room, but some of their mechanics were just incredibly sloppy, and I didn’t really understand why they were getting so injured.”

Not long after, Mr. Keith made the switch to “barefoot” shoes. Soon, he noticed that he developed more strength and better mobility, even beyond his feet.

“I started to do a lot of research within those first couple of years and started to apply it to my patients within the clinic and started seeing pretty significant results out of … their form, their biomechanics … when they were jumping and running.”

The Weakest Link in the Kinetic Chain

Mr. Keith draws on a concept known as the “kinetic chain,” a physical rehabilitation concept borrowed from engineering. In this framework, limbs and joints are seen as interconnected chains that affect each other as they move.

When there’s an imbalance in the feet, it can translate to problems at other points in this kinetic chain. This, Mr. Keith explains, can cause common problems like flat feet, plantar fasciitis, bunions, and neuromas. These conditions get worse because the “chain” can facilitate negative feedback loops.

For example, flat feet occur when the medial longitudinal arch—the primary arch, which bridges the inner side of the heel and the ball of the foot—over-flattens for reasons including abnormal bone structure, relaxation of muscle ligaments, injuries, or poor foot posture.

When walking, just before our heel makes contact with the ground, weight is transferred to the outer edge of the foot and our arch is rounded, in a motion called “supination.” As we bear weight on the now-landed foot, it then rolls inward and the arch flattens in a process called “pronation.” From there, our foot “takes off” and the cycle continues.

Mr. Keith explained that the medial arch is supposed to act as “the shock absorber for your body,” acting as a flexible spring, pairing with our Achilles tendon for support.

“It compresses when you make the impact, stores energy, and when it’s time to release energy, there is propulsion created out of the same mechanism of the arch.”

But, this intricate design falters when our foot health isn’t optimal. We can suffer from excessive pronation when the arches collapse in motion, characterized by touching the ground—or, on the other hand, we can be afflicted with excessive supination, when the feet fail to roll inward and the arch remains high.

In a 2018 study published in Clinical Biomechanics examining novice runners, researchers found that excessive supination was linked to a nearly 77 times higher incidence of injury than a neutral foot posture. Excessive pronation was connected to a 20 times elevated risk of injury.

Taking flat feet as an example, Mr. Keith explains that up the kinetic chain, they can make the hips over-rotate inwardly, tilt the pelvis forward, and cause the knees to cave in, putting more strain and wear on the joints. All this rotation and pulling can lead to a feedback loop that can in turn make foot posture even worse.

A 2023 study published in Arthritis Care & Research showed that flat feet were correlated with midfoot osteoarthritis in adults aged 50 or older.

“Once the process of negative adaptation begins to occur, the body does not like being out of whack, if you will. So it’s going to figure out a way to compensate or to get back into whack, the best way possible. But if you never actually address—and this is the key word here—the root cause of the problem—then yeah, you will definitely see this continue to occur,” Mr. Keith said.

Strong Shoes, Weak Feet

The boilerplate solution advocated by mainstream orthopedics and podiatry to address foot conditions usually comes in the form of shoes and therapeutic insoles designed to support and cushion the foot.

Mr. Keith disagrees with this common prescription, arguing that these products do not reflect the natural human foot nor its natural mechanics. Instead, he advocates for both using shoes that give the feet room to return to their natural shape, as well as exercises that strengthen the foot. As such, he likens modern footwear to a crutch.

“Most people have been wearing a ‘cast’ underneath their arch for decades, so no wonder these feet are weak, no wonder these feet are flat. We have to provide an opportunity for the arch to redevelop without this artificial support,” he said.

To facilitate this, he recommends shoes with a wide “toe box” that allows the toes, especially the big toe, to spread out. He also recommends non-constricting socks, as many end up binding the toes.

In a study published in Arthritis Care & Research in 2021, researchers found that incidence of bunions was associated with “wearing shoes with a very narrow toe-box shape,” among other factors.

Further, Mr. Keith emphasized the importance of having “zero drop” in our shoes. Most shoes elevate the heel. This pushes the toes even further into typically narrow toe boxes, exacerbating the cramped condition.

This is especially important for the older population, he said, pointing to how falls can be catastrophic events as we age. He underscored how high-heeled shoes, employed in many types of footwear, raise one’s center of gravity.

“A big contributor to a lack of balance … is the thickness of the sole of their shoe. Basic physics and mechanics will tell us the object that is higher off of the ground is more susceptible to imbalance.”

Another common feature of modern shoes is the toe spring, an upward curvature of the sole at the front of the shoe, designed to help the forefoot roll forward and propel when walking or running. However, there is evidence that, in attempting to aid biomechanics, they can actually contribute to weakening of the foot muscles, increasing susceptibility to issues like plantar fasciitis, according to a 2020 study published in Scientific Reports.

Also, many shoes have very thick soles. This further impedes balance by obstructing the feet’s ability to adapt to changing terrain, explaining that there are more than 200,000 sensory receptors and 8,000 nerve endings in the feet that “provide communication about your environment to your brain.” Mr. Keith said.

“If we push a thick rubber and foam sole beneath the foot, we lose that communication with the ground and therefore we lose our balance.”

Treading New Ground

When identifying “barefoot-friendly” shoes, Mr. Keith looks for a wide toe box, zero drop, a thin and flexible sole, no artificial arch support, and lightweight construction—all to get as close to barefoot as possible.

Mr. Keith advises barefoot dabblers to gradually transition to these shoes. Years of depending on artificial support in normal shoes weakens the muscles we need to walk naturally. But use of minimalist shoes may be able to strengthen them. A review published in the International Journal of Sports Medicine this year found “significant increases” in foot strength and volume after using such shoes.

On exercise, one of Mr. Keith’s starting recommendations is to simply start walking barefoot on natural surfaces to strengthen the feet, develop proprioception, and ground ourselves electrically to the earth.

A 2006 study published in Arthritis & Rheumatism found that walking barefoot, as opposed to wearing “comfortable walking shoes,” decreased joint load on the hips and knees in those with osteoarthritis (OA) by as much as nearly 12 percent. As the authors note, excessive joint loading is associated with both the onset and progression of OA.

Also, he recommended focusing on developing the muscle-mind connection between the feet, knees, and hips. Starting small with simple exercises like calf raises, working up to bigger, compound movements like squats.

In one study published in 2019 in Gait & Posture, “short-foot” exercises, designed to strengthen the medial arch muscles, were found to improve both static posture and gait biomechanics, which may help prevent or treat injuries associated with flat feet.

In a 2023 review published in the British Journal of Sports Medicine, researchers found preliminary evidence that minimalist footwear can reduce joint load while running, which could be particularly beneficial for those with patellofemoral pain (a type of chronic knee pain) or osteoarthritis.

Additionally, Mr. Keith said toe spacers can help create and maintain toe separation—which he specifically drew attention to as being “restorative”—giving the toes freedom to learn to operate independently.