Foot Defects and Minimalist Shoes - Mgr Hanna Krześniak

Foot deformities can be divided into congenital ones – visible in a newborn from birth, such as clubfoot – and more common ones that appear after verticalization, such as flatfoot. However, saying that someone has "flat feet" does not automatically imply a set treatment. It can represent a range of different medical conditions of varying severity. If we suspect that we have a foot deformity, it is worth consulting a specialist who can properly examine and diagnose the condition. The success of therapy and daily comfort depends on determining the cause of the disorder, deformity, or pain.

Can you walk in minimalist shoes with a foot deformity?

There is no simple answer to this question, as it depends on the type of deformity, its cause, and the symptoms present. Each case should be evaluated individually, and appropriate treatment—whether conservative or surgical—should be decided. In the case of conservative treatment, an individual orthotic insole can be placed in a minimalist shoe if a thin sole, lack of cushioning, and heel are not an issue for the patient. Due to the length of this article, less common deformities will not be discussed in detail. The focus is on the most common issues, whose causes can be corrected.

What causes deformities?

Some deformities result from weakened muscle strength and are characterized by worsening of the condition during dynamic movements—such as walking or running. This may be linked to the type of shoes worn in the past. If the shoe’s cushioning, hard sole, and heel have loosened the foot’s ligament and muscle structures over many years, abnormal joint positioning in the entire lower limb may be noticeable during a barefoot examination. This situation can be addressed in two ways: with well-fitted orthotic insoles, improved shoe cushioning (which is often replaced), and external technologies that properly position the foot and absorb shocks. The second solution requires more time and attention from the patient and involves strengthening or even restoring the foot’s natural shock-absorbing mechanisms, making the foot—rather than external aids—responsible for shock absorption, shock attenuation, and proper lower limb alignment. Wearing minimalist shoes supports the process of strengthening the feet, but it is not suitable for all patients and must be introduced gradually.

What foot problems make it difficult to walk in minimalist shoes?

There are no clear or radical contraindications regarding the use of minimalist shoes. However, there are groups of people for whom it would be impossible or problematic to wear such shoes in their current condition. Existing inflammatory conditions (e.g., Achilles tendon, plantar fascia) or post-surgical states could be a contraindication for wearing minimalist shoes, as the foot is forced to work more intensely in them. Also, people with metatarsalgia, understood as pain in the forefoot of various origins, or those with peripheral hypersensitivity who feel uncomfortable walking barefoot, may experience difficulties. Additionally, people with atrophy of the fat pad may, especially during the initial adaptation phase, experience discomfort.

Flatfoot-Deformity (Pes Planovalgus)

This is one of the most commonly diagnosed and encountered foot deformities, and it is also associated with features such as Morton’s foot and joint hypermobility.

Flatfoot-deformity is a physiological variant of the foot in young children. Babies are born with flat feet, and on the medial side of the foot, a fatty pad is visible. Only the initiation of independent walking and loading of the lower limbs influences the formation of the longitudinal arch of the foot and the correction of hindfoot alignment. In preschool children, feet and knees enter a period of physiological valgus (although some cases may deviate from the norm and may require treatment). By the age of 7, feet and knees should align in an intermediate position; if not, it is worth taking the child to an orthopedic doctor or physiotherapist for assessment.

Flatfoot-deformity is a syndrome consisting of improper alignment of two components: valgus alignment of the hindfoot (heel) and the forefoot positioned in abduction and supination relative to the hindfoot. This is different from flat feet, which are characterized by a normal heel alignment, with the only visible sign being a lack of a longitudinal arch.

Types of Flatfoot-Deformity

Classification based on the type of deformity and its cause distinguishes:

Flexible flatfoot – most often caused by dysfunction of the posterior tibial muscle.
Rigid flatfoot, which may be caused by:
- Talocalcaneal or calcaneonavicular synostosis,
- Congenital flatfoot,
- Neurogenic flatfoot.

In the case of flexible deformities, strengthening the muscles of the so-called foot stirrup (e.g., posterior tibial, long fibular) helps to mitigate the valgus alignment of the foot. Walking in minimalist shoes can be a good stimulus for encouraging the foot to work. First, however, the skill of consciously correcting the foot’s position is necessary, because in the case of significant deformities, suddenly switching to shoes without foot stabilization may lead to overloads and pain.

Bunion (Hallux Valgus)

The occurrence of a bunion is primarily caused by genetics and can also coexist with Morton’s foot and the previously described flatfoot-deformity. The type of footwear can contribute to either worsening or alleviating an existing tendency. Wearing high-heeled shoes with pointed toes that squeeze the toes and cause the big toe to deviate can exacerbate an existing deformity.

Walking in minimalist shoes offers several benefits in supporting the big toe in its proper alignment:

A wide toe box allows the big toe to align correctly without valgus deformation.
The ability to abduct the big toe engages the abductor muscle of the big toe and the short foot muscles, which positively affects the transverse arch.
Proper function of the big toe enables the activation of the foot’s shock-absorbing mechanisms.
A flat sole (zero drop) improves the distribution of forces acting on the foot and relieves pressure from the forefoot.

Transitioning to Minimalist Shoes with Foot Deformities

The foot deformities described above are associated with weakened or shortened muscles that cannot maintain the correct foot alignment. In the case of a correctable deformity (e.g., flexible flatfoot), proper exercises and manual therapy can restore proper biomechanics. Success depends on the degree of deformation, age, consistency of exercises, and accurate diagnosis. If we were to try to make a sudden transition from “traditional” cushioned shoes to minimalist shoes, this could carry the risk of injury and pain. The body needs time and proper adaptation to new tasks. The foot needs to strengthen the muscles but also stretch and loosen those that have been shortened up to this point.

Tomaszewski R., Czasławska B., Stopa płasko-koślawa dziecięca, Pediatr Med Rodz 2020, 16 (4), p. 368–372
Kołodziejski P., Bryłka K., Marzec P., Bażant K., Czarnocki Ł., Are historical concepts for treating hallux valgus still relevant today? Ancient medicine and veterinary science, Environment and Humans, 2013, p. 200-201.
The author of the text is physiotherapist Mgr Hanna Krześniak.