Video and Transcript: Back to Barefeet

Hi, everyone! [I’m] Dr. Orit Hickman from Pain Science Physical Therapy. 

And, I wanted to put together a short video to address how to get comfortable with walking or being barefoot again. I see a lot of patients who develop foot sensitivity over the years. And, I wanted to address a little bit about why that happens and then how we tend to treat it here in the clinical setting. 

So, typically, foot sensitivity will occur maybe because you’ve developed some nerve irritation under the foot. Maybe you’ve been given a diagnosis for plantar fasciitis. There’s a lot of different reasons why people will experience foot pain. 

But, foot sensitivity is when maybe the foot pain has really gone away for whatever reason. Maybe it’s been treated. But, after the fact, what you’ve done is you’ve been told, “Hey! You need to be in orthotics. Hey! You need to be in supportive shoes.” And, as a good patient, you are now in shoes all the time. So, I have patients who pretty much never take their shoes off, and, if they do, they then are putting slippers on. So, their feet really never contact the ground. In extreme situations, I’ve had patients who actually wear shower shoes, so they never go barefoot, not even in the bathtub or the shower.

The reality is-is being barefoot is incredibly important. You’re-You have a lot of muscles under your feet, and they help to control your toes. And, they’re really important for balance. But, when you’re wearing shoes all of the time, those muscles don’t get the same kind of workout because the shoe is providing a lot of support. 

So, going barefoot has a good number of benefits, not to mention that the skin on the bottom of your feet are sensitive, and they’re meant to feel things. But, also, we don't want them to be too sensitive. And, that’s something that can happen is if you’ve been protecting your feet for a long period of time, your feet can actually become hyper-sensitive. And, they’ll become hyper-sensitive to loading, so pressure, or they become hyper-sensitive to stretch, when you go to-you know-roll over your toes [and] stretch out your foot. They can become sensitive to vibration. So, there’s a lot of different sensations that your feet are supposed to tell you about, but we don’t want them to be hyper-sensitive. They should be able to tolerate a good amount of loading, a good amount of stretch, [and] a good amount of vibration and forces through the foot. 

So, if you find that you’re one of those people who wears shoes all the time and then gets home and puts shoes on in the house so that you’re never barefoot or you try to avoid walking barefoot or you don’t like to have your feet on hard surfaces and you walk on carpeting, then this video is for you. 

So, the very first thing that I’ll ask a patient to do is to spend time with their feet out of their shoes. Just doing that in and of itself might be pretty scary for you, so-you know-keep your socks on. Let’s start really easy. And then, just spend time with your feet resting on the ground and get comfortable with your feet being on the floor. Find a surface that you feel is threatening, but not too threatening. So, maybe it’s not your hardwood floor or your tile floor. Maybe it’s somewhere in the house where you have some carpeting. But, it’s probably going to be a location where you still don’t feel comfortable walking barefoot. 

So, then, after you feel life you can tolerate with your feet being in socks on the ground, you would transition to taking socks off. And so, that’s actually what I’m going to do right now. So, forewarning: bare feet coming through. And, [it’s the] same idea. You spend time with your feet just resting on the ground. So, this activity that I’m highlighting right now is called Graded Exposure. We’re just slowly introducing sensory information to an area that your brain is saying, “This is really dangerous. We need to protect this area.” So, it’s not something that’s comfortable. 

So, we start with socks. Then, we move to no socks. Then, we move to standing. Ok? And, if this is one foot, then you take the pressure off of that foot, and you bring the pressure back onto that foot. If it’s both feet, then maybe you go to sit back down again after a few seconds. The idea here is to introduce the sensory information and do this at a very graded manner. So, with any of these activities, you might start as little as one to five seconds and work up to 20, 30 seconds at a time and then, eventually, one minute, two minute, three minutes. This can take a long time. So, patients are often saying, “Well, I want to be done with this yesterday.” And, I’m like, “Well, this could take weeks, months, for you to get through this process.” And, the longer that you’ve been protecting your feet, the longer that process-you know that then we kind of have to think about how long that process is going to take. If you’ve been protecting your feet for 20 years, you’re not suddenly going to get to barefoot overnight. So, patience is really important.

So, [it goes] socks on, socks off, sitting, then standing, and loading. So, again, if it’s one foot, then you are loading the weight onto that one foot and taking the weight off. Loading the weight on. Loading the weight off. And then, you work to bring your weight forward off the foot as if you’re taking a step, and then you’re taking a step back. Taking a step off that foot and back again. And, [you’re] shifting and practicing doing this on one side and then the other. And, again, maybe you’re doing this for a couple of steps just to start.

I have some patients who had to start with three or four steps forward, three to four steps backwards, and that was it. And then, socks and shoes came right back on again. Everybody is different. 

So, Graded Exposure is a process. It takes time. And, the key here is bumping that pressure, bumping that stress up just a little bit every time you feel a little bit more comfortable to do so. 

Be patient with yourself. Allow yourself to take the time. If you’re not sure how to do this and you feel like maybe you started it and it’s really flared things up, well, then get with a physical therapy who’s familiar with treating the nervous system and retraining that system to be able to tolerate things better. You can also leave a note in the chat for me, and I’m happy to answer any questions.

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