These Shoes Are Killing Me! | Freakonomics Radio | Episode 296

The human foot is an evolutionary masterpiece, far more functional than we give it credit for. So why do we encase it in “a coffin” (as one foot scholar calls it) that stymies so much of its ability — and may create more problems than it solves? This episode was originally published May 19, 2021. For a full transcript, resources, and more, visit: https://freak.ws/3Zonfqu Photo credit: Audrey Bernstein FOLLOW FREAKONOMICS RADIO: YouTube: https://freak.ws/3yIl6dl Apple Podcasts: https://freak.ws/3yAvQh0 Spotify: https://freak.ws/3TsdCmV ABOUT FREAKONOMICS RADIO: Discover the hidden side of everything with host Stephen J. Dubner, co-author of the Freakonomics books. Each week, Dubner speaks with Nobel laureates and provocateurs, intellectuals and entrepreneurs, and various other underachievers to uncover things you always thought you knew (but didn’t) and things you never thought you wanted to know (but do) — from the economics of sleep to the future of education, from markets for marriage to the surprising utility of wolves. ABOUT THE FREAKONOMICS RADIO NETWORK: Freakonomics began as a book, which led to a blog, a documentary film, more books, a pair of pants, and in 2010, a podcast called Freakonomics Radio. Hosted by Stephen J. Dubner, it’s one of the most popular podcasts in the world, with a reputation for storytelling that is both rigorous and entertaining. Its archive of more than 500 episodes is available, for free, on any podcast app, and the show airs weekly on NPR stations. Freakonomics Radio is now the flagship show of the Freakonomics Radio Network, which includes the podcasts No Stupid Questions, People I (Mostly) Admire, and The Economics of Everyday Things. FREAKONOMICS RADIO NETWORK PODCASTS: Freakonomics Radio: https://freakonomics.com/series/freakonomics-radio/ No Stupid Questions: https://freakonomics.com/series/nsq/ People I (Mostly) Admire: https://freakonomics.com/series/people-i-mostly-admire/ The Economics of Everyday Things: https://freakonomics.com/series/everyday-things/ Special series: https://freakonomics.com/topics/ CONNECT WITH US: [email protected] https://twitter.com/freakonomics https://www.instagram.com/freakonomics/ https://www.facebook.com/freakonomics/ https://www.tiktok.com/@freakonomicsradio https://www.linkedin.com/company/freakonomics-media Subscribe to our newsletter: http://eepurl.com/bKm0cf

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:04Stephen J. Dubner?

  The COVID-19 shutdown has produced a variety of strange and surprising side effects. One of them has been the health of our feet. Doctors have reported an increase in all sorts of foot maladies, in part because so many of us have been spending so much time barefoot. The implication is that our feet would be better off if they were still in shoes every day. But is that necessarily true? After all, we aren't born with shoes, at least I wasn't, maybe you were. If the question is, what do you do with a human foot? Are we sure the best answer is put it in a shoe? That's a question we ask in

• 0:46Stephen J. Dubner?

  the following episode. We dug it out of our archive. It was first published in 2017. It is called "These Shoes Are Killing Me." Hope you enjoy.

• 1:00Stephen J. Dubner?

  What are you wearing right now, shoe-wise?

• 1:02Speaker 01

  I'm wearing a pair of Vivier flats.

• 1:07Stephen J. Dubner?

  How many NBA players regularly get pedicures? 90% of them. What kind of animals have you put in shoes? We put sheep in shoes, actually. Have you ever had people come to you who want their foot surgically altered so that they will fit the fashionable shoes they want to wear better? Once a week.

• 1:29Stephen J. Dubner?

  There is a theory I've been kicking around. Not really a theory, more like an idea. Eh, barely an idea. Let's call it an observation. The observation is this: Very often, when we see something that needs improvement, that needs correction, we respond with an overcorrection. You see this all the time with nutritional trends. You see it in politics and government, in a lot of the rules and regulations we draw up. You see it in human behaviors, large and small. Our sages have warned us against this, as one old saying goes, "Do not use a cannon to kill a mosquito." And yet, many of us are guilty of this all the time. So, rather than simply correct in measured increments,

• 2:13Stephen J. Dubner?

  we overcorrect. That's my observation, at least. You don't have to agree. But I'm telling you this because I believe one overcorrection we've made has become so normalized that we've lost sight of just how extreme it is.

• 2:28Speaker 02

  You know, we do have that attitude because we think, you know, it's natural to think the world around us is normal, right? We think it's normal to sit in chairs and we think it's normal to eat breakfast cereal that comes out of a box and we think it's normal to drive around in these little metal contraptions and take elevators and, you know, get on the internet. All of these things we think are completely, absolutely normal. And, and from an evolutionary perspective, they're not. And one of those categories is, is shoes.

• 2:55Stephen J. Dubner?

  That's right. Shoes. Today on Freakonomics Radio, the social and economic history of footwear, the history of walking and running, and what our modern shoe fetish may be costing us.

• 3:08Speaker 01

  I think that if you just added a few foot exercises to your daily routine, you might be playing cards before you know it. Yeah.

• 3:28Speaker 03

  This is Freakonomics Radio, the podcast that explores the hidden side of everything. Here's your host, Stephen Dubner.

• 3:46Stephen J. Dubner?

  Not long ago, I was buying a case for my new smartphone. It was a rubbery, protective case that also extends the phone's battery life. And I thought, what does it say about my smartphone that right out of the box, it needs this fairly substantial piece of add-on gear? Then, for some reason, walking out of the store, I had the same thought about shoes and feet. Do shoes represent some kind of evolutionary failure? Why does nature's most advanced biped need to supplement its own feet with such substantial add-on gear?

• 4:20Speaker 02

  You know, people have been wearing shoes probably for thousands and thousands of years, but the kind of fancy, modern shoes that we wear today are really quite unusual and haven't been around for very long.

• 4:29Stephen J. Dubner?

  That's Dan Lieberman.

• 4:30Speaker 02

  I'm a professor of human evolutionary biology at Harvard, and it's sort of my job to look around the world and think about, and how we use our bodies, and think about what's sort of normal and what's abnormal. And that's not to say that everything that's abnormal from an evolutionary perspective is bad. I mean, I think a lot of great abnormal things that we do are terrific, like antibiotics and refrigerators and, you know, sterile surgery.

• 4:52Stephen J. Dubner?

  So where do shoes fit in? Probably helps to start at the beginning, or at least a really long time ago.

• 4:59Speaker 02

  So, you know, when you walk around and see people, most of the day, you see people just walking, right?

• 5:03Stephen J. Dubner?

  Right. Human ancestors are thought to have begun walking upright, at least some of the time, about 6 million years ago.

• 5:10Speaker 02

  But it turns out that running played a really important role in our evolutionary history.

• 5:14Stephen J. Dubner?

  Running was important because why?

• 5:16Speaker 02

  Because you can't really be a hunter without being a runner.

• 5:18Stephen J. Dubner?

  This was long before any sophisticated weapons.

• 5:21Speaker 02

  For millions of years, the most lethal technology available to our ancestors was a sharpened wooden stick or a club.

• 5:28Stephen J. Dubner?

  So how did this hunting happen?

• 5:29Speaker 02

  We have abundant evidence that what people did was run animals in the heat to a state of hypothermia.

• 5:35Stephen J. Dubner?

  At which point, the animal would lie down and could be clubbed to death.

• 5:39Speaker 02

  It's called persistence hunting. The hypothesis really is that all these features, which range from having a spring in our feet, short toes, to having a big butt, Achilles tendon, for example, all these are novel features that humans have, that enabled our ancestors to become long-distance runners who could then chase animals down into a state of heat stroke.

• 6:01Stephen J. Dubner?

  And all that running was not done in Nikes or Onitsuka Tigers.

• 6:06Speaker 04

  Remember that this new technology in footwear has only been around for about five or six decades, and yet we've been running for 2 million years in either bare feet or shoes that are extremely minimal.

• 6:18Stephen J. Dubner?

  That's Irene Davis.

• 6:19Speaker 04

  I am a professor in physical medicine and rehabilitation at Harvard Medical School. I'm also the director of the Spalding National Running Center.

• 6:29Stephen J. Dubner?

  Her view of feet and modern footwear?

• 6:32Speaker 04

  I think that we have lulled ourselves into thinking that our feet need cushioning and support to survive and to withstand the loads of walking and running. So it's very hard for people to make this paradigm shift back. To really the way that we were running for the majority of our evolutionary history.

• 6:52Stephen J. Dubner?

  Anthropologists estimate that humans began to wear rudimentary shoes somewhere between 26,000 and 40,000 years ago. So let's ask two questions, one small, one large. Why did we first embrace shoes? And what have they come to represent?

• 7:08Speaker 01

  See, you're getting ahead of yourself. I mean, you're rushing to, or maybe you haven't yet, define shoe.

• 7:14Stephen J. Dubner?

  That is Elizabeth Semelhak.

• 7:17Speaker 01

  And I'm the senior curator at the Bata Shoe Museum.

• 7:19Stephen J. Dubner?

  Which is in Toronto. She's also the museum's director. All right, then, how do we define shoe?

• 7:26Speaker 01

  So shoe is, you know, it's a term, obviously, that we bandy about to mean all kinds of things. But more technically, it is something that has a sole. And then it has an upper or parts that cover the entire foot. And so a boot would be a shoe then that had a shaft. So the upper's continued, you know, up to the knee, perhaps. A sandal might just have an upper and a thong to secure it to the foot.

• 7:56Stephen J. Dubner?

  What about the barefoot running shoes that are kind of like a rubberish sock for the shoe with toes?

• 8:03Speaker 01

  Yeah, what about them?

• 8:06Stephen J. Dubner?

  You don't, you don't sound very excited by them. Are they a shoe? Are they a shoe? And do you have some of them at Bata Museum?

• 8:13Speaker 01

  We actually don't have a pair, and we should have a pair. I think that they are an interesting invention. I still find them very disconcerting when I see them out on the street.

• 8:26Stephen J. Dubner?

  Really? Because why?

• 8:27Speaker 01

  I do. You know, I think it's, with the exception of maybe summer sandals, the foot is usually encased, right? We don't really see it that often. And so I think to see each toe enveloped in its own little...

• 8:45Speaker 01

  Toe casing, I don't know. It's still.

• 8:48Stephen J. Dubner?

  It's not your thing. It offends your sensibilities somehow.

• 8:51Speaker 01

  It doesn't offend them. I just am still struck by it every time I see them.

• 8:55Stephen J. Dubner?

  I see. So that's interesting, though, because I'll be honest with you. I'm challenging, in my mind at least, the central premise of the shoe and that encasing. Because, and I mean, I'm not a total idiot. I understand that when it's cold or wet or, you know, the ground is rough or sharp or whatever, that obviously you want to protect the bottom of your feet. But I also wonder, you know, at what cost we've encased our feet for lo these many millennia? And we've now, you know, created many, many, many, many different forms that have all different kinds of political and economic and social signals. And that's fascinating. But I am curious if you ever step back and wonder about the, you know, the necessity of this encasing strategy.

• 9:41Speaker 01

  Yeah, I do, actually. And, you know, when I think about Chinese foot binding, which resulted in women's feet being around three inches in size, and it seems like such a profound body modification. But the fact of the matter is, is that all of us who have grown up wearing footwear have bound our feet to some extent. And if we were able to meet our non-shod selves in a different dimension and look at what our feet would be like naturally, they would be much larger, much more splayed, rougher. In some ways, the foot would become the shoe needed, right? To make it through daily life, because the body has the ability to build up calluses at the bottom of the foot.

• 10:29Stephen J. Dubner?

  That said, Elizabeth Semelhak appreciates what the shoe has helped us accomplish.

• 10:34Speaker 01

  Shoes have been central to things like being an astronaut and living in the Arctic and venturing across a hot desert. Like, I do think that there are many places where the human spirit for adventure was probably helped by a pair of boots. I think it's probably hard to summit Mount Everest not wearing footwear. And so I think that its protective quality has helped humans expand their territory. But I also think that it has been central to their expansion of class division. I think the true function of footwear is more about establishing who you are,

• 11:19Speaker 01

  what your gender is, what your status is. And so it functions as a communicative social tool while at the same time, some shoes make it comfortable to walk around in, but not all.

• 11:30Stephen J. Dubner?

  When and why did women start wearing shoes that, to me at least, looked to be, painfully small and constraining?

• 11:41Speaker 01

  So if you look at paintings from the early 17th century, like a painting of a bunch of Dutch people drinking, it'll be women and men, and their feet are all very clearly visible. And there's really no size difference between men's and women's shoes. But if you fast forward through that century, all of a sudden, the women's feet are tiny in representation, and men's are much, much larger. Some of it has to do with shifts in ideas about gender. Enlightenment thinking was attempting to establish that men and women were different. And so some of that finds expression in fashion. And

• 12:23Speaker 01

  so by the end of the 17th century, there's this much larger thing happening within culture that's suggesting that men are rational and that their clothing should sort of not betray any excess interest in the fancy things in life. Women are seen as naturally irrational and frivolous, and the high heel sort of fits into that perfectly.

• 12:46Stephen J. Dubner?

  The shoe, like just about everything we humans wear and use and do, is a hybrid of function and form. It's plainly useful, but part of its use lies in its ability to signal something about the person wearing it. Consider the humble sneaker, or I should say, the sneaker that I had presumed was humble. In 2013, Semmelhak put together a museum exhibit on sneakers.

• 13:15Speaker 01

  A lot of people think of sneakers as being really casual, some of them, the majority of them being inexpensive. But what my research showed was that sneakers actually started out as objects of luxury. The early sneakers, tennis shoes, were expensive and they reflected privilege because in the middle of the 19th century, before the 40-hour workweek, only the wealthy had the time to play. Only the wealthy could afford multiple pairs of shoes, to have specific shoes to play in. And then rubber itself was expensive and the cost of sneakers was quite high.

• 13:51Stephen J. Dubner?

  So how did the sneaker cross over into an everyday thing?

• 13:55Speaker 01

  In the 1930s, one of the things that becomes sort of a pan-cultural obsession is the physical fitness of each country's citizenry. World War I had sort of proven to the world that there were not enough fit men to fight a war. And so as World War II was brewing, eugenics and ideas about racial superiority obviously led to fascist concepts. And countries around the world began to sort of insist that their citizens exercise, one, to prove physical superiority or ethnic, racial superiority, but also to get ready for the next war. And so in many ways, it was this moment of fascism that democratized the sneaker.

• 14:39Stephen J. Dubner?

  Speaking with a shoe historian like Elizabeth Semelhak, you get the sense that every kind of shoe imaginable has a similarly winding history, like the sneakers, a similar blend of form and function, and, this is what I'm most interested in, a similar tally of benefits and costs.

• 14:59Speaker 02

  Sure.

• 15:00Stephen J. Dubner?

  The evolutionary biologist Dan Lieberman.

• 15:03Speaker 02

  Just so you know, my perspective is I'm not, despite what people sometimes say about me, I view shoes probably much like an economist. There are costs and benefits to them, and I don't see them as being all good or all bad. I'm wearing them right now, for example.

• 15:16Stephen J. Dubner?

  Why is Lieberman so insistent that he is not anti-shoe? Because he kind of has that reputation. Because in addition to studying the evolutionary history of distance running, he is a distance runner who often doesn't wear shoes.

• 15:33Speaker 02

  Sometimes I wear sandals. Sometimes I'll wear sort of minimal shoes. Sometimes I'll wear trail shoes and sometimes I'll go barefoot. And often at the end of my run, I'll take my shoes off and run the last mile or so barefoot.

• 15:46Stephen J. Dubner?

  So describe what it's like to run barefoot, even just a mile.

• 15:51Speaker 02

  You know, it's funny. Most people are kind of afraid of the concept of barefoot running and that haven't tried it. But actually, it's a delightful experience. If you have, by some estimates, the fourth most innervated part of the body is the sole of the foot. You get lots of information about the world from the sole of your foot. And taking your shoes off can be, as we all know, an intensely pleasurable experience. I think the reason people are afraid of barefoot running is they think it will hurt. But what almost everybody discovers when they take their shoes off and start running is that you stop running in the same way. So most people, when they're wearing shoes, land on their heel. And you have all this cushioning in the heel that kind of makes it comfortable. Almost everybody, when they take their shoes off and start running on a hard surface,

• 16:36Speaker 02

  gets off their heel and starts to land on the ball of the foot. That's called a forefoot strike. And when you run that way, there's no collision. And actually, it doesn't hurt. So barefoot runners don't mind how hard the surface is. What they care about is how smooth the surface is. So running on a smooth, concrete asphalt road is like running on butter. The things that really hurt are gravel, knobbly things, things with a lot of texture, until you have calluses.

• 17:03Stephen J. Dubner?

  There have been some world-class barefoot runners, even in recent history. There used to be a handful of barefoot placekickers in the NFL. Some of the best soccer players in the world grew up playing barefoot. And then, of course, there was baseball's Shoeless Joe Jackson, who reportedly played in his socks one day because a new pair of spikes had given him blisters. Dan Lieberman, meanwhile, might best be called a fan of barefootedness rather than an outright advocate.

• 17:30Stephen J. Dubner?

  He's also spent a lot of time thinking about the benefits and costs of shoes.

• 17:35Speaker 02

  Well, I'm, you know, I mean, that, like, I wear shoes most of the time, and I'm not so sure that shoes cause that many problems. I think it's a little bit more complicated than that. I think, you know, just putting on a shoe is not like smoking a cigarette. It doesn't, you know, cause you to become unhealthy. Instead, I think it masks other problems that can lead to poor health.

• 17:54Stephen J. Dubner?

  He knows this how?

• 17:55Speaker 02

  Believe me, I've looked at thousands of barefoot people's feet and thousands of shod people's feet. And I've seen a lot of horrific feet. I buy a lot of those wipes, you know, those disinfectant wipes in my lab. And I will tell you that I'll take a barefoot person's foot over a shod person's foot any day.

• 18:12Stephen J. Dubner?

  So what has the shoe done to our feet? Coming up on Freakonomics Radio, we get into the details.

• 18:19Speaker 05

  On the short term, the problem is the overuse in, you know, in your knees and your hips.

• 18:23Speaker 04

  You know, feet get sweaty. They get stinky. But that's because we keep them in shoes.

• 18:28Speaker 05

  The long-term effect is it shortens the Achilles tendon. It shortens the muscles in the back of the calf.

• 18:33Speaker 04

  I wonder what our hands would smell like if we kept them in some kind of, you know, device that didn't let them breathe.

• 18:41Speaker 05

  There isn't anybody who wears a six-inch heel into my office who doesn't know that it isn't detrimental to their health.

• 18:47Speaker 04

  Yeah, I think the foot is an amazing structure that is highly underappreciated.

• 18:54Stephen J. Dubner?

  It's coming up, right after this break.

• 19:09Stephen J. Dubner?

  Our ancestors went barefoot for many, many years and happened to be great distance runners. The earliest shoes, made of animal skins or plant matter, were necessarily minimalist. But many modern shoes, whether formal or casual, whether made of natural materials or entirely man-made, are far more constructed. They've often got hard soles and substantial heels, heavy padding and cushioning from fore to aft. They've got what's called a toe box, which strangely enough, is often not shaped like our toes, which are wider than the rest of the foot. But the toe box is narrower. All this has led critics to conclude that many shoes are, at the very least,

• 19:51Stephen J. Dubner?

  a most unnatural appendage and, worse, are perhaps quite bad for our health. Peter Griffin from Family Guy is not a fan of the shoe.

• 20:01Speaker 06

  Peter, would you mind putting on some shoes? Oh, you mean foot prisons? Yes, I would.

• 20:05Stephen J. Dubner?

  Or, as the late podiatrist William Rossi once wrote, "Natural gait is biomechanically impossible for any shoe-wearing person."

• 20:15Speaker 04

  Yeah, I think the foot is an amazing structure that is highly underappreciated.

• 20:20Stephen J. Dubner?

  Irene Davis, again, from Harvard Medical School. Her PhD, by the way, is in biomechanics.

• 20:26Speaker 04

  The foot has 26 bones. It has 33 articulations or joints, each with six degrees of freedom of movement. We have four layers of arch muscles, and that complexity is purposeful because the foot has to function as our base of support, a mobile adapter to uneven terrain. It has to be spring-like at times. It has to be rigid at times. And when you take that foot and encase it in these very rigid shoes, which I'll call coffins, the foot then loses its ability to function in the way that it was adapted. And I see this in the clinic all the time. I see feet that have become extremely deconditioned.

• 21:09Stephen J. Dubner?

  Davis's Harvard clinic is not to be confused with a Harvard lab run by Dan Lieberman.

• 21:14Speaker 02

  We try to understand how, for example, the foot works and then test hypotheses about how feet function and how variations in foot anatomy affect function, hence performance.

• 21:24Stephen J. Dubner?

  But it is interesting, even heartening, you might say, that Harvard has at least two entirely separate research facilities devoted to exploring, as Davis called it, "the highly underappreciated foot."

• 21:35Speaker 02

  So we will bring into the lab people who have never worn a shoe in their lives and people who wear shoes all the time.

• 21:42Speaker 04

  So there was a recent study by a group in Brazil, and I'd spent some time with them.

• 21:47Speaker 02

  And we've looked at how they run and how they walk, how strong their feet are.

• 21:51Speaker 04

  And they actually randomized these women who had knee osteoarthritis into one or two groups.

• 21:57Speaker 02

  And we tried to collect some data on injury from them, and, for example, their knees. We've been x-raying people's knees.

• 22:03Speaker 04

  One group stayed in a pair of cushioned shoes and the other group were given this five dollar in US dollar pair of shoes that were highly flexible. And what they found is, number one, their mechanics were more normal in the minimal shoe.

• 22:18Speaker 02

  And what we find is that in those barefoot populations, we find almost no incidence, for example, of people who have flat feet. They just don't exist.

• 22:27Speaker 04

  But more importantly, to these patients, they had significant reduction in their pain medication and significant improvement in their functional outcomes. And that's just with a pair of minimal shoes.

• 22:40Speaker 02

  We look at incidence of musculoskeletal diseases and the evidence appears to be that they have really considerably lower rates of diseases like arthritis. So, doesn't mean that these people don't have problems, of course they do, but they have fewer problems, it seems, in their feet and their knees and possibly also their hips.

• 22:57Speaker 04

  It's interesting because in the beginning, I really didn't think footwear mattered. And as time went on and my thinking evolved, I started to understand how much footwear impacts our mechanics.

• 23:12Speaker 02

  Foot health can affect what's often called the kinetic chain.

• 23:15Speaker 04

  If you take someone who has run barefoot all their life and you put them in a pair of shoes, they're very likely, when they're running without shoes, to land on the ball of their foot because it hurts to land on your heel. But if you put them in a pair of cushioned shoes, they will very likely transition to landing on their heel. And so that actually creates a cascade of events that happen up the lower extremity and up to the hip.

• 23:42Speaker 02

  When you have foot problems, that often causes knee problems, which cause hip problems. And we have, for example, an epidemic of osteoarthritis today. And one contributing factor to arthritis might be the kinds of shoes that we wear. That's a hypothesis, I don't have any data on that.

• 23:58Speaker 04

  So, I'm going to suggest that when we put a pair of shoes on that has cushioning like that, it actually creates a mismatch between the way we adapted to run, which is on the ball of our foot, and the way that we run today. That mismatch results in mechanics that we have shown to be related to injury.

• 24:17Speaker 02

  So there are a variety of diseases we call mismatch diseases caused by our bodies being poorly or inadequately adapted to novel environments. And they lead to problems that range from, you know, flat feet all the way up to, you know, really serious problems like, like certain kinds of cancers and, and heart disease and diabetes. And when we treat the symptoms of those problems, those mismatch diseases, rather than the causes, we allow the diseases to remain prevalent, sometimes become even more severe. So it's a vicious cycle that we have create by using sort of cultural methods to not treat the symptoms of mismatch diseases.

• 24:52Speaker 04

  And then we've got shoe companies who are very much invested in the cushioning and the support and all of the technology that they put into shoes.

• 25:02Speaker 02

  What's happened is the shoes create a problem and then they create other aspects of the shoe that then solve the problem and then tell you that that shoe is better. You know, Mother Nature was a pretty good engineer.

• 25:12Stephen J. Dubner?

  So do all the shortcomings of the shoe mean that we should consider it, to some degree, a stupid invention?

• 25:21Speaker 04

  I think that shoes in general, the earliest shoes, were not stupid inventions at all. They were there to protect the bottom of our foot, perhaps when it was cold out or we had to go over rough terrain. So just to protect our foot, very much like most of the other clothing we wear. What I think is stupid is that we have then started to add all of this technology to the shoe. We're adding cushioning when our muscles can do that cushioning. We're adding motion control when our, when we can control our feet with the muscles that we have and all of the movements that we have. And by doing that, we're actually setting our feet back.

• 25:59Speaker 02

  I think the basic foot that we all inherited is probably a pretty good foot. And to me, the null hypothesis is that, that kind of natural, barefoot or minimal shoe is probably healthier than a more conventional shoe unless you can prove otherwise.

• 26:19Speaker 05

  People do things that aren't necessarily the best thing for them. What it is, is what looks good with what they're wearing at the time. So getting over the fashion aspect of it is a very difficult thing for a lot of people.

• 26:31Stephen J. Dubner?

  That is Howard Osterman.

• 26:33Speaker 05

  And I'm a podiatrist in the Washington DC area.

• 26:35Stephen J. Dubner?

  And you happen to treat a couple of sports teams, I understand?

• 26:38Speaker 05

  Correct. I do the Washington Wizards and the Washington Mystics.

• 26:41Stephen J. Dubner?

  When Osterman says that getting over the fashion aspect of shoes is hard for people, you may have thought he was referring to women's high heels or men's dress shoes with their narrow toe boxes. He wasn't. He was talking about his basketball patients.

• 26:55Speaker 05

  You would think that they would wear, you know, for their period of time that they're in the NBA or the WNBA, the most appropriate shoe that they can wear. Bottom line is, they want something that is from a company that they want to wear it from and a style that they want to wear.

• 27:11Stephen J. Dubner?

  I would think that in the NBA, foot health is hugely important and that there's a lot of things that can go wrong.

• 27:19Speaker 05

  Sure. And the players are interesting in that they really have one piece of equipment that they have to buy, and that's their shoes. And they really don't care what their foot structure and shoe company go with. They really will just, for the most part, take what is going to pay them the most for that or what they can get for free.

• 27:36Stephen J. Dubner?

  You're kidding. Really? They really do that? I always thought that if you sign a deal, then you basically have whoever it is, Nike, Adidas, Puma, custom make you for your foot at that level. Is that, that's not happening?

• 27:47Speaker 05

  You know what? The stars have that. But most of the time, I would say we have probably two or three players that that's for us, and there's 15 players on the team. So a lot of times, you want to know what is my main job working with these basketball teams or with these sports, is that I basically strip the insides of their shoes and rebuild them with a custom insert.

• 28:07Stephen J. Dubner?

  How many NBA players regularly get pedicures?

• 28:12Speaker 05

  90% of them.

• 28:18Stephen J. Dubner?

  So I'm curious, from your perspective, from the footside view, whether the shoe, on balance, whether there are more benefits or more costs?

• 28:27Speaker 05

  I think there's more benefits. Look, we've paved our environment. We work in areas that have hard floors and we do extensive walking. Most of us carry a little extra weight than we theoretically should. You know, our core strength is not what it was 50 years ago when manual labor was more of an issue. So what happens is the shoes can be used for structural stability. They can be used for cushion and shock absorption. They can be used for protection against the elements.

• 28:55Stephen J. Dubner?

  What share would you say of the problems that a podiatrist addresses are actually caused by shoes?

• 29:02Speaker 05

  I wouldn't necessarily say caused by shoes. I'd say exacerbated by shoes.

• 29:06Stephen J. Dubner?

  What does it say, I guess, about evolution that we need this fairly complicated piece of add-on gear to walk properly, when in fact we evolved as a walking animal?

• 29:16Speaker 05

  I mean, shoes tend to be a fashion statement. There isn't anybody who wears a 6-inch heel into my office who doesn't know that it isn't detrimental to their health. When you're in that higher heel, and anything really over an inch and a half, throws your body forward enough that it puts a lot of stress on the front of the knees. So the four muscles, the quadriceps that come in the front of the knee, that attach just beyond the knee, in the front of the shin, they have to fire constantly to give you some stability. Also, you will arch your back to try to keep you from leaning forward. So that combination puts stress on the knees and the low back. So the short-term effect is overuse, where the muscles are just not capable of handling it. The long-term is, it affects the entire mechanics of how a foot works.

• 30:02Stephen J. Dubner?

  Have you ever had people come to you who want their foot surgically altered so that they will fit the fashionable shoes they want to wear better?

• 30:10Speaker 05

  Once a week.

• 30:11Stephen J. Dubner?

  You're kidding.

• 30:13Speaker 05

  Most of them are just asking because when you tell them what's really involved, they really don't want to have it done, you know, because once you start, you know, changing joints and realigning toes, then you really are throwing the foot into a whole different functional capacity.

• 30:26Stephen J. Dubner?

  So it sounds like the shoe causes more changes to our physiology than any other piece of clothing, certainly, right?

• 30:34Speaker 05

  Oh, absolutely. One of the things about these thick sole, rubber-based shoes with their good stability is we were born, both the palms of our hands and the soles of our feet are born with nerve sensors that do what we call proprioception. So when your foot hits the ground, it has to register at your brain a certain position, a certain sensation. The problem is when you get these big, thick, clodhopper shoes, what ends up happening is you lose that. So there's a lot of sensitivity that's lost by going to these more supportive shoes, which is really why the minimalist shoe industry came about.

• 31:11Stephen J. Dubner?

  And you're generally in favor of them, I gather, yes?

• 31:14Speaker 05

  Absolutely. The problem is, again, we tend to carry too much weight and we don't have the mechanics that allow those lesser supportive shoes to not create things like heel spurs and plantar fasciitis.

• 31:25Stephen J. Dubner?

  But is part of the problem, when you say we don't have the mechanics, is that we don't have the mechanics because we've trained ourselves out of having the mechanics by wearing shoes?

• 31:34Speaker 05

  That's a portion of it. I think our population is living longer, so there's more wear and tear on the joints. So there's exercises you can do also to build the musculature. You know, when we send people to physical therapy, they'll have them either picking up a towel, trying to grip a towel, or picking up marbles, trying to do that.

• 31:50Stephen J. Dubner?

  Should everybody do those kind of exercises on a regular, maybe even prophylactic basis?

• 31:56Speaker 05

  Absolutely.

• 31:57Stephen J. Dubner?

  But are you doing marble exercises?

• 31:59Speaker 05

  On occasion.

• 32:00Stephen J. Dubner?

  What's that mean, on occasion? Come on.

• 32:02Speaker 05

  On occasion.

• 32:04Stephen J. Dubner?

  How many times in the last month have you picked up marbles with your toes?

• 32:06Speaker 05

  That would be a zero. That would be.

• 32:10Stephen J. Dubner?

  All right, so here's the question. On the scale of, let's call it stupid stuff, right, with 10 being a really bad idea or stupidly executed, and one being absolutely awesome and perfectly done, where do you rank the median shoe?

• 32:26Speaker 05

  I would tell you that most of the shoes now are a three or a two. They've gotten much, much better.

• 32:31Stephen J. Dubner?

  Hmm, really? So we should be grateful.

• 32:34Speaker 05

  Well, I think most of the shoe companies, they have really caught the idea that people are wearing different styles. So many of these companies that really have taken to better materials and make better shoes.

• 32:46Stephen J. Dubner?

  So what would you say that people should look for generally in a shoe, keeping in mind, we wear shoes for many different uses and many different occasions?

• 32:56Speaker 05

  You want something that has a rubber sole that actually provides some cushion and shock absorption. It needs to have some level of flexibility in the forefoot, so that allows the toes to bend at the level where they bend. A lot of the issues that we see are shoes that either bend midfoot, or don't bend at all, which force the foot to work outside of the general mechanics of the way a foot should work.

• 33:20Stephen J. Dubner?

  Have you ever looked at videos or maybe seen live, people who play music, let's say with their feet, people who are missing hands or arms, they learn to play piano or guitar with their feet?

• 33:30Speaker 05

  Absolutely.

• 33:31Stephen J. Dubner?

  So is that something that you think any of us could be able to do if we habitually used our feet more and obviously had them out of shoes more?

• 33:40Speaker 05

  The musculature in the feet are very similar to the musculature in the hands. Look at any child who was born without arms, and you see what they can do with their feet. Like you said, play music, things like that. So the dexterity, the neurotransmitters that your brain puts out should just as easily be able to do the toes as they can the hands.

• 33:59Stephen J. Dubner?

  So doesn't it just seem like there's this huge wasted resource that we're all born with these appendages that have capabilities that we're not using? Doesn't that seem like a shame to you?

• 34:09Speaker 05

  Of course. But it's a societal issue as much as anything. We went from quadrupeds to bipeds, and it changed the whole mechanics of what we needed.

• 34:17Stephen J. Dubner?

  But that said, even though you have that position, you're not even picking up marbles with your feet. Do you use your feet for anything beyond what I might use my feet for?

• 34:26Speaker 05

  I'll take my shoes off when I'm home, things like that. We'll wear sandals in the summer, or whatever it ends up being.

• 34:31Stephen J. Dubner?

  But you're not like playing cards with your feet, or playing piano with your feet?

• 34:35Speaker 05

  No, not at all.

• 34:38Stephen J. Dubner?

  All right, let me ask you a flip question. Let's say that we had evolved through physiology and culture and so on to, for some reason, always be wearing heavy gloves on our hands, kind of the equivalent of shoes. But let's say no shoes on our feet. How atrophied do you believe our hands would be as a result of that?

• 34:58Speaker 05

  I think it would be remarkably similar.

• 35:04Stephen J. Dubner?

  Irene Davis agrees that we could be doing more with our feet.

• 35:07Speaker 04

  The feet actually are very similar in a lot of ways to the anatomy of the hand in terms of muscles, in terms of nerve supply, in terms of blood supply. Obviously, the toes aren't as long as the fingers, so you don't have the same kind of dexterity. But I do think that you have the ability to make them more hand-like.

• 35:26Stephen J. Dubner?

  She also thinks we should all spend more time barefoot.

• 35:30Speaker 04

  As much as possible. And if you're in an office where people don't have to see you because there's this cultural thing about being barefoot or taking your shoes off, the minute I get into work, I take my shoes off. I treat patients with my shoes off. Take your shoes off at home when you're walking around the house. Spend some time outside walking barefoot. So, yes, I think as much as possible.

• 35:53Stephen J. Dubner?

  That cultural thing about being barefoot, it runs deep, at least in many cultures. Why else would it be illegal to go into a store or a restaurant barefoot or drive a car? Actually, it's not. There are no federal or state laws against driving barefoot, although if you crash while driving barefoot, you may be blamed more harshly than if you were wearing shoes. As for restaurants and stores, they can legally make their own rules about their customers as long as they're applied equally to everybody. Davis believes this kind of restriction is less about hygiene than pure social stigma.

• 36:30Speaker 04

  I have thought about that a lot. And I don't understand it because hands go many more places than feet do. And actually, feet are likely cleaner from a bacterial standpoint than hands are. I just think it goes back to culture. I think it's something that has evolved in our culture, that we should cover our feet. And your feet get sweaty. They get stinky. But that's because we keep them in shoes. I wonder what our hands would smell like and would our hands get sweaty if we kept them in some kind of device that didn't let them breathe.

• 37:07Stephen J. Dubner?

  Irene Davis has a dream. She wants this to be what she calls the decade of the foot. I've decided to do my small part. I've been spending a lot more time barefoot. I've even been walking around Manhattan barefoot. Well, in my socks, actually, because I'm a bit of a coward. I've walked about 10 miles by now on the streets. It's amazing how much more you notice uphills and downhills and how many different sidewalk surfaces there are. And your leg muscles definitely feel different. I've also played some golf barefoot, super fun. And as Dr. Howard Osterman prescribed, I've been picking up marbles with my toes nearly every day. And you know what? He's right. My

• 37:47Stephen J. Dubner?

  foot dexterity has increased so much and so fast. Here, check this out.

• 38:00Stephen J. Dubner?

  Not bad, huh? All right, that's not really me. It's my friend Bayada Moon, a composer and pianist, playing with her hands. But I have learned to turn up the volume with my toes.

• 38:21Stephen J. Dubner?

  That's it for our show this time. We'll be back next week with a brand new episode of Freakonomics Radio. Until then, take care of yourself and, if you can, someone else, too. Freakonomics Radio is produced by Stitcher and Renbud Radio. We can be reached at [email protected]. The Freakonomics Radio network also includes No Stupid Questions, People I Mostly Admire, and Sudhir Breaks the Internet. This episode was produced by Shelley Lewis. Our staff also includes Alison Kreglo, Greg Rippon, Mark McCluskey, Joel Meyer, Tricia Bobita, Zach Lepinski, Mary De Duke, Jasmine Klinger, Emma Terrell, Lyric Bowditch, and Jacob Clemente. Our theme song is Mr. Fortune by The Hitchhikers. All the other music was

• 39:05Stephen J. Dubner?

  composed by Luis Guerra. You can get the entire archive of Freakonomics Radio on any podcast app. If you would like to read a transcript or check out the show notes, which have links to all the underlying research, visit Freakonomics.com. As always, thanks for listening.

• 39:23Speaker 02

  Just so you know, I'm not an anti-shoe absolutist. Although, you know, I gather there are people who are. Oh, my gosh. And you know many of them, I assume, yes? Sadly, and I'm sure they'll email me again after this.

• 39:40Speaker 03

  The Freakonomics Radio Network.

• 39:46Speaker 03

  Stitcher.