Several months ago, Dr. McClanahan, a podiatrist in Oregon had offered up his Correct Toes product for me to try.  In addition to using the product, I decided to make a full-time switch to completely minimalist shoes at work as well.  That meant bucking the trend of wearing dressy shoes in a very conservative region for medical attire. Though my zero drop timberland black and brown dress shoes were definitely not your typical "classy" dress shoe, they were also only "close enough" to minimalist standards of footwear. Nonetheless, I was ready to go more natural with shoegear at work.
     For at-work shoes, I decided to go with solid black Crocs most days and occasionally wear brown Stems, both of which meet the criteria of allowing and promoting natural foot health. (See the links section for the criteria of choosing a shoe.)  I have been wearing the correct toes approximately 60-80% of the time (including sleeping, running, working), and using a shoe with my 3 specifications 100% of the time. This was very liberating for me, because I was able to "go minimal" at work as well as play, and finally wear shoes corresponding to natural foot function at all times. The crocs and stems were also the only shoes I had that I was physically able to fit in with the correct toes.
    I have to say, I was very skeptical of the correct toes.  There are other "bracing" products on the market, such as yoga toes and flextastic.  Patients seem not to have success with them, but those same patients also continue to wear terrible shoes.  Yoga toes and flextastic are meant to be worn just at the end of the day and never in shoes, but the main feature of the correct toes is that you are supposed to wear them at all times, so I was quite interested to see what they could do.
    The first xray above shows my foot in late August of this year; on that day I was taking an xray to familiarize myself with the system at my new job.  At that point, I had been wearing minimal shoes running for years, but I still had casual shoes that did not meet specifications, and my dress shoes were still relatively narrow in the toebox, but much better than the high-heeled, tapered toebox shoes ("classy") I had used in the past in our podiatry school clinics.  My foot may have felt pretty healthy at the time of the xray, but look at the bunion deformity and look how my toes fit the shape of a modern shoe, similar to the picture in the header of this website.
    Recently, when I remembered I had taken an xray of my foot a few months ago before using the correct toes, I decided to take another to see if there was any measurable progress.  So, after almost 4 months of using minimal shoes 100% of the time, and using the Correct Toes product 75% of the time, this is what the foot looks like now:   

    This is really an astounding change for 4 months!  The bunion deformity is decreased and the toes are more rectus (straight) and appear to have freed themselves from the influence of a modern, tapered-toebox shoe.  Even the metatarsus adductus angle (metatarsal bones pointing inward) seems lessened, though I haven't  confirmed this by drawing out the angles. I don't know if my eyes are playing tricks, but my arch seems less cavus as well.
    Because of the combined influence of the correct toes and the switch to wearing minimal shoes full-time, I can't say what contributed more to the positive changes.  I can say, though, that I have been wearing minimal casual and running shoes for 2+years, and the bunion and cavus deformities still looked pretty significant 4 months ago.  The correct toes seemed to have helped me strengthen my intrinsics with the toes in a corrected position.  
    Here's a comparison:  when I do short sprint workouts (200 meter or less) I wear one of two pairs of shoes.  One is my traditional cross country racing waffle, which I have run in for years.  Those shoes are very minimal (zero heel drop, minimal to no cushioning) but have a significantly tapered toebox.  The other is my vibram five fingers.  After a hard sprint workout in the VFFs, I can feel a good post-workout soreness in the foot intrinsics, which I have never felt in any other shoe.  Like the correct toes, the VFFs hold the toes themselves in a more natural, rectus position (they way they probably would've developed without the influence of modern shoes).  Holding the toes in this position may better allow for the proper development of those intrinsic foot/toe muscles (versus doing exercises, using minimal shoes without that bracing).  So far, the correct toes seem to be an invaluble tool for regaining natural foot health and function in people who have helped deform their feet with modern shoegear. I'll continue to keep a critical eye on them and report back in the future!

Check the correct toes out for yourself on Dr. McClanahan's website:

Unless you are the "iceman," Wim Hof, who is known for his feats of tolerating cold in his skivvies, you are unlikely to be doing much barefooting in winter.  To keep your feet strong in thick wintry boots over the winter months, I've garnered some suggestions.  
    1.  Make your winter boots into minimalist boots!  (see previous blog entry).   I am actually in the process of doing this, and will report back regularly on their status over the winter months.
    2.  Keep your shoes off in the house in winter.  Walking around barefoot can maintain that muscular strength you've developed  over the summer. We podiatrists see a rash of plantar fasciitis in  the spring/summer because people take their weak, atrophied feet out of their thick, supportive boots and put them in flip flops with no transition.  To prevent this, keep the feet strong.
3.  Pick shoes based on my shoe selection rules 1. Zero drop (heel shouldn't be higher than the forefoot), 2.  No toe spring (shouldn't be an upward curve at the front of the shoe), and 3. Wide toebox! (again, the hardest qualification to find in most shoes. The ones that do this well are: basic crocs, altras, stems, vivobarefoot, and a handful of other shoe brands).   Vivobarefoot makes a good waterproof winter boot, and you can find moccasins and mukluks that fit all specifications, but they aren't waterproof.

4. Yoga.  Keep up your yoga all winter to strengthen your feet.  The downward dog pose helps keep your calf/achilles  flexibility and poses like warrior 3 really strengthen the instrinsics of your feet and muscles of the lower leg as well as being excellent for improving ankle proprioception.
5. Functional fitness indoors.  Keep hitting the gym with your five fingers or other flat bottomed shoes.  Besides being good for the foot alone, they put your entire body in better alignment for lifts, especially if you are doing crossfit (see previous blog post on this).  Better yet, if you have your own home gym, exercise barefoot (or see if its acceptable in your public gym--its much more sanitary than bare  hands on all the machines!).  Laird Hamilton is among many who do this.  (Check out his youtube workout session for good functional fitness exercises: http://www.youtube.com/watch?v=s3sMjz6dtX0&feature=related). 
6. Keep doing all the "transition to barefoot/minimalist exercises" I've mentioned in previous posts:  hip flexor; calf/achilles; bottom and top of foot stretches, and eccentric calf; toe-push; towel pickup; heel walking; and one-legged stand strengthening exercises.
7.  Exercise the feet in the boots.  If you have to be in big clunky boots outside for work all winter, first make sure you pick boots with enough room in the toebox, and that have zero drop heel:forefoot ratio, and with a thin sole as possible.  No matter what, do toe curls, and big toe push exercises in the shoe several times throuought the day--it'll help keep those toes warm too!

Over the last decade, the world of health and  wellness has had a "primal reawakening."  Answers to many health questions are already part of our genetic structure; what was once routine for us hundreds and thousands of years ago, has been clouded by modern changes.  
    These recent throwbacks began with our obsession with food and weight.  Books such as the Primal Blueprint suggested following a primal diet, which allowed many to become healthy and fit.  By avoiding a high grain-based and sugary-fatty foods that are so easy to quickly obtain, many people have been able to transform their lives by copying our ancestors. Just a decade or two ago, we thought 40 and 50 year old people were old; over the hill in many ways and unable to regain any sense of youth or fitness.  We are now impressed at 50 and 60+ somethings that are strong and fit.  These are not new revelations; in ancient Greece, Spartans were warriors for life and it would not be odd to see old men in battle.  Many modern afflictions can be fully reversed with lifestyle changes. 
    I have been recently reading Dr. Karp's Happiest Baby on the Block book, which suggests its own primal wisdom.  It centers around colicky crying and why it doesn't exist in many "uncivilized" cultures.  Many answers lie in this ancient simplicity we once considered backward.  
    This simplicity and minimalist movement has come to feet and footwear.  Anthropological evidence points to foot problems only developing with the advent of shoes and modern lifestyle.  Like dieticians, podiatrists have evolved to fix conditions that humans have created through a discord with nature. 
    Hopefully we will continue to realize these benefits of past lifestyles and do our best to weave them into our daily routine.   We can find peace of mind and body in this simplicity we abandoned for 'bigger, faster and better.'  How have you changed your life by reverting to an ancient, primal or more simplistic approach? 

As I see it, there's only one true argument against being barefoot, and that's: what do you do in the winter?!  Well, we can look back at our ancestors, who used animal skins--moccasins and mukluks, but they were not waterproof.  In our modern world, we don't have lovely powder everywhere; we have relatively warm roads and sidewalks and de-icing salt, that make that beautiful hue of brown and gray snow and slush.  A serious winter needs serious waterproofing.  
    Vivobarefoot has some winter boots that are waterproof, and so do several other minimalist companies.  Unfortunately, like the title of my post in a previous blogsite, "minimalist is maximalist in price." Most of these boots are $200 minimum.  Now, if you already own a pair of thick-soled and thick-heeled boots like I do, you can create your own minimal winter, waterproof boots.  Please check out this blogsite, and, take a crack at changing your boots into minimalist winterwear:

One of my favorite quotes comes from one of America's brilliant minds; Thomas Edison said in 1903: "The doctor of the future will give no medicine, but will instruct his patient in the care of the human frame, in diet and in the cause and prevention of disease."
    Medicine has certainly turned in this direction.  The more we know about a disease process, the more we adjust treatments accordingly.  When we know what causes a disease, we can avoid acquiring it.  In the newest realm of medicine, even stem cell research has this potential to prevent or reverse genetic disease.  
    Much of our basic health has to do with diet and exercise.  We know adjusting preventable causes of disease can garner amazing results.  Most of the time these lifestyle adjustments don't just repair physical well being, but mental and spiritual health as well. 
    Just a few decades ago, doctors warned against exercise; "you'll have a heart attack!" We now know that this sentiment is outdated; it is akin to discouraging someone from going to school because they may fail. The benefits outweigh the risks, and those benefits can help people love and enjoy life.  
    My specialty of podiatry is now at the beginning of a revolution to bring preventative medicine to our feet. Helping the foot to function as it was intended, without the influence of modern shoes and orthotics, can be lifechanging!  Like you would consult a doctor before beginning an exercise regimen, you want to visit myself before you begin discarding orthotics, using minimal running or casual/dress shoegear or going barefoot!

I don't believe they are at all.  Before a diabetic starts using minimalist shoes and going barefoot, they should be evaluated by a podiatrist.  Even before that, the magic cures of diabetes should be implemented:  diet change and exercise.  
    The biggest potential complication to a diabetic going minimalist is the presence of neuropathy.  If there is neuropathy (loss of sensation), steps can be taken to slow or reverse it before barefoot activity is undertaken. It is NOT recommended if you are completely neuropathic.
    If you are a diabetic and looking for alternative, natural, holistic, or complementary means of fighting diabetes, please visit this link on the national center for complementary and alternative medicine's website for helpful suggesions: http://nccam.nih.gov/health/diabetes/CAM-and-diabetes.htm
My favorite two alternative treatments that I suggest to diabetics are as follows:
1.  For early neuropathy, Alpha lipoic acid (ALA) 600mg daily, works wonderfully.  Thought to aid in nerve function, studies in Europe has shown its effectiveness for improving neuropathy symptoms and pain, especially in diabetic neuropathy.
2.  Green tea has been shown to have beneficial effects on blood glucose level.  There are conflicting studies out there about its true effects, but green tea is not a bad item in your diet no matter what, especially if it helps change your lifestyle.  Replacing that soda or other sugary drink with tea (with a little sugar, honey or artificial sweetener) is better for a diabetic whether or not it has potential blood glucose stabilizing effects!