How many of you, reading this right now, can relate to the subsequent scenario. You wake up and swing your legs out of bed, either keeping the socks you already had on during sleep or putting on slippers, only until you put on that day’s outfit. An outfit that more than likely requires socks and shoes, or at the very least, shoes alone (work flats, heels, sandals). You then head out for the day, walking, sitting, standing for an average of 10-12 hours only to come home to remain in at least your socks until you get into bed. Just think about it for a second, how much time out of the waking hours of your day (hopefully 16 hours, allowing for 8 hours of sleep) do you spend barefoot? If you’re anything like the average person (including children, unfortunately), the answer is probably under an hour at most.
While everyone is spending much more time, on average, working from home, I’d like to take the opportunity to remind everyone of something often overlooked in the days of penny loafers, high heels, and work flats. Sure, most of us are fortunate enough to be equipped with decent iterations of the five basic senses- sight, smell, taste, hearing, and touch. But I’d like to focus on touch, and how two of the most underrated contributors of input from the outside world into the survival and comfort of your existence are in fact, your feet. We spend almost every minute of every day, wearing at least some amount of covering on our feet (socks). On top of that, we strap on our bulky, movement restricting, “fashionable” clodhoppers and further distort the quality and latency (speed of upload) of the proprioceptive input entering our body. To compare that to another sense, it would be the vision equivalent of waking up every day and wrapping some vintage lace curtains around your face before heading to work. Good luck driving or walking to work, jotting down notes at a meeting, or even making it to the bathroom!
Another parallel to putting on shoes and socks is wearing gloves. Imagine the sacrifice in dexterity and accuracy of your fine motor skills you make when you’re wearing something like winter gloves. How difficult it becomes to even tie your shoe or apply the right amount of pressure to grip your keys when fumbling around your purse or pockets. That sacrifice is one that we make daily in regards to our feet, for the obvious benefit of not stepping on a rock, nail, or other hazard in the metaphorical minefield of the western world. I’d like to take a moment to point out the primary risk that many people face, especially as we age, when our feet spend all that cumulative time wrapped inside the straight-jacket known as the modern shoe.
Decreased Balance and Fall Risk
There are two types of skin of the human body, hairy and glabrous (non-hairy). For the sake of keeping this post succinct, I want to highlight the relative importance to balance that glabrous skin plays. The only regions of the human body containing glabrous skin are the palms of the hands, lips, nipples, portions of the genitals, and most importantly (at least in regards to our current topic) the soles of the feet. This type of skin contains exponentially more mechanoreceptors (types of nerve endings responsible for detecting mechanical stimuli) than hairy skin, per square inch. These nerve endings detect everything from vibration to skin stretch, light touch to deep touch, and are critical for our sense of proprioception (body’s sense of position in space). It is the sense of proprioception and our glabrous skin’s contribution to it, that will be the emphasis of this post.
Just like when we wear gloves, and fine motor skills rapidly deteriorate, when we put on socks and shoes, a similar phenomenon occurs to what our feet can do. When the quality of input received through the nerve endings in our feet is compromised, one could reasonably predict that the subsequent output might be flawed as well. Sometimes those flaws manifest themselves in small, manageable ways, but in other instances, those flaws can set off a cascade of faulty reactions (or lack thereof) to surface or directional changes resulting in losing balance and potentially falling. A common term when evaluating one’s risk for falling is “sway” or “sway pattern”. In short, the more your body’s center of pressure deviates, or sways, from the starting point, the more vulnerable you are to a fall. If one is unable to detect that relative change in position in time for an accurate positional correction, then a fall is likely. According to a 2017 study in the British Geriatric Society’s publication, Age and Ageing, “compared with the first quintile, the odds of falling were increased by 75–90% among participants in the fifth quintile of COP sway length”. Their definitions for the first and fifth quintile were 161-249 mm and greater than 400 mm, respectively.
The primary method that I use to determine the magnitude of one’s sway is a piece of technology called the “P-Walk” Plantar Pressure Plate, from BTS Bioengineering. I implement this in a variety of ways for my clientele, but using it to demonstrate sway patterns in different conditions (more specifically, barefoot, or in shoes) has proven to be an enlightening experience for not only the client, but for myself as well. Over some time now, I have been compiling data to illustrate just how much shoes and socks can disrupt our sense of proprioception.
The Results Are In
Below I have pictured an example of one client’s test results. Each test was conducted for ten seconds, with eyes closed, and the Plantar Pressure Plate was able to measure 172 points within that time frame (17.2 measurements per second). If you focus your attention on the portion labeled “Body Barycenter”, you will see that this client’s total center-of-pressure deviation, or sway area, is represented as 247.86 (mm²). This test was conducted with shoes and socks on.
After conducting one round with shoes and socks on, I asked the client to remove both and perform another round in the barefoot condition, still with eyes closed. The results are below, and the relative improvement in this person’s balance in this specific condition is staggering. In the barefoot condition, this person’s sway area went from 247.86 (mm²) to 27.24 (mm²), for an improvement of 89 percent!
Using the same protocol, I conducted the same experiment for a total of 16 clients, with an age ranging between 21-80. The amount of improvement ranged from 92 percent to 14 percent, with a strong correlation to age (better improvements with increased age). Below I have graphed the group averages of total sway area in shoes (left) versus barefoot (right).
What to Make of the Data
Given, this “study” probably won’t stand up to the research standards in many well respected academic publications, but taken for face value, we can reasonably conclude that balance improved in the barefoot condition for this cohort. Having discussed the importance of ensuring accurate proprioceptive input through the mechanoreceptors in the glabrous skin of the soles of the feet, and actually seeing the relative improvements from one condition to another, hopefully those reading this will be convinced of spending a bit more time walking around without shoes and socks.
At the very least, spend more time at home barefoot, where you can control the likelihood of encountering environmental hazards (i.e. dog toys). At the other end of the spectrum, you could even consider working out barefoot, and applying that newly discovered improvement in your proprioceptive input to something more athletic. Just be sure that wherever you decide to spend more time barefoot, be cognizant of your surroundings and the types of surfaces you’re on. A good starting point for those looking to stimulate their feet on a surface designed to enhance motor control is the Naboso Training Mat by Dr. Emily Splichal, a Podiatrist and pioneer in barefoot training and research (I receive no commission for endorsement, just FYI).
Everyone can benefit from spending a bit more time without the restriction and sensory distortion of shoes and socks. From infants and toddlers developing arches and learning about the world through touch, to baby-boomers trying to enhance their balance and decrease their fall risk, we can all get a bit more out of life by simply getting out of our shoes on occasion.
Prevention over treatment,
Sam