Growing Up Barefoot: How Going Shoeless in Childhood Shapes Foot and Arch Development

Table of Contents

• Key Points
• Why This Research Matters
• How the Study Was Conducted
• Key Findings: Barefoot vs. Shod Feet
• Understanding the Results
• What This Means for Patients and Parents
• Study Limitations
• Recommendations for Families
• Frequently Asked Questions
• Source Information

Key Points

• In 810 children aged 6–18, habitually barefoot living was linked to higher arches, more pliable feet, and straighter big toes compared to regular shoe wear.
• Differences between barefoot and shod children appeared across all age groups, with the most dramatic dynamic arch differences found in children ages 10–14.
• Barefoot children had higher static arches in every age group and a significantly lower hallux angle (straighter big toe) overall.
• This cross-sectional study cannot prove causation; the barefoot group was mostly South African and shod group German, so cultural factors may contribute.
• The authors suggest regular barefoot time, flexible shoes with a wide toe box, and physical activity may support healthy foot development in childhood.

Why This Research Matters

Human beings walked barefoot for millions of years of evolution. Only in the last few centuries have people in industrialized countries regularly worn shoes for everyday walking and running. Today, an ongoing debate exists in the medical community about whether early and permanent footwear use helps or harms children's feet — yet until now, surprisingly little research has examined how habitual barefoot living affects foot development during the growing years.

The development of the human foot is crucial for motor learning in children and adolescents. The foot provides the basic requirements for bipedal locomotion (walking on two legs) and stable standing. Understanding how footwear influences this development matters because foot problems in adulthood — such as flat feet (pes planus) and bunions (hallux valgus) — may have their roots in childhood.

Previous research has offered clues but has been limited in important ways. Studies have shown that people who have been barefoot almost all their lives appear to have wider feet, fewer foot and toe deformities, higher foot arches, and lower hallux angles (meaning straighter big toes) compared to habitually shod individuals. Shod feet also show reduced pliability (flexibility). However, the term "habitually barefoot" has been used inconsistently across studies, and most data came from adult populations, which cannot easily be applied to children and youth.

Several factors are known to influence foot characteristics in children:

• Body weight: Higher body weight is associated with a reduced arch height
• Physical activity: More active children tend to have increased arch heights
• Ethnicity: Foot shape varies across ethnic groups
• Age: The arch height of shod children increases especially in the first years of life, becoming relatively stable after around age 7

This raised the central question of the study: does the influence of footwear use change while feet are still growing? To answer this, researchers needed a large group of habitually barefoot and shod children and adolescents from different age groups. This study was designed to fill that gap.

How the Study Was Conducted

Study Design and Setting

The researchers conducted a cross-sectional observational study (a study that examines a population at a single point in time) in South Africa and Germany between March 2015 and June 2016. The study followed the STROBE guidelines for reporting observational studies and received ethical approval from the university ethics committee (protocol number HS1153/2014) and the medical association (protocol number PV4971). The research was carried out in accordance with the Helsinki Declaration guidelines, and written informed parental consent and the child's assent were obtained before participation.

Why compare these two countries? The answer lies in cultural differences around footwear. In Germany, children are obligated to wear footwear at school. In South Africa, it is common for children to attend school barefoot. This natural contrast provided the ideal setting to compare the long-term effects of barefoot versus shod living.

Data collection took place in 22 primary and secondary schools across rural and urban areas in the Western Cape (South Africa) and Northern Germany. Schools were randomly selected per stratum after approval from responsible school authorities. The response rate was 22% in Germany and 55% in South Africa. Children who agreed to participate were tested at school during their regular physical education lessons.

Who Was Included

Children and adolescents aged 6 to 18 years were eligible if they were healthy and physically active for at least 120 cumulative minutes per week (as reported by parents or legal guardians). Exclusion criteria included current injuries, as well as orthopedic, neurological, or neuromuscular abnormalities likely to affect walking. For even recruitment, researchers aimed to include at least ten female and ten male participants per class level and group.

Of the initial 1,017 children tested, a total of 810 children (50.1% females, 49.9% males) were included in the analysis. The average age was 11.99 ± 3.33 years. The participants' average body height was 153.99 ± 17.91 cm, average weight was 48.10 ± 17.90 kg, and average BMI was 19.55 ± 3.94.

How "Habitual Barefootness" Was Defined

Because no standardized definition existed in the literature, the researchers developed a three-point Likert scale to classify children. Children were asked whether they were barefoot most of the time (2 points), half of the time (1 point), or none of the time (0 points) in three settings:

1. During school
2. During sports
3. In and around the house

Participants were classified as habitually barefoot if they scored at least 3 out of a maximum 6 points — equivalent to being barefoot at least half of the time at school or sports in addition to being barefoot at home. The rate of habitually barefoot children in South Africa was 90.9%. In Germany, all children were habitually shod.

What Was Measured

Before testing began, the research teams held joint training sessions in Germany over several days to ensure identical use of equipment and data collection. Part of the German team also attended the first weeks of testing in South Africa.

The testing protocol included anthropometric measurements (date of birth, height, weight, foot size) plus static and dynamic foot measurements. The main foot mechanical measures were:

• Seated and standing foot length (heel-to-toe length, HTL)
• Foot width (FW)
• Dorsum height (DH) — measured at 50% of HTL
• Dynamic arch index (dAI) — measured via pressure platform
• Hallux angle (HA) — the angle of the big toe

From this data, researchers calculated two additional values. The static arch height index (sAHI) is the ratio of dorsum height to heel-to-toe length. The pliability ratio (PR), calculated according to Kadambande et al., compares foot measurements at 50% of body weight versus 10% of body weight to determine how much the foot flexes and adapts under load.

Both feet were measured during sitting and standing positions using two specially constructed calipers that were tested for validity. The reliability of the static foot measurement was shown to be good to excellent for children (intraday reliability: 0.88–0.90; inter-rater reliability: 0.80–0.85).

For dynamic measurements, footprints were obtained using a capacitance-based pressure platform (Emed n50, Novel GmbH, Munich, Germany) embedded in the middle of a 3-meter portable wooden walkway. Using a two-step approach, the mean plantar pressure of three valid walking trials was used for each foot. Participants walked at a comfortable, self-selected speed, and only trials in which the foot was fully placed on the pressure plate were used. The software calculated the dynamic arch index according to Cavanagh and Rodgers, and the hallux angle according to Donatelli and Wolf. A small dynamic arch index corresponds to a high arch, while a high hallux angle corresponds to a valgus-deviated (angled outward) big toe. The reliability of dynamic plantar pressure assessment in children has been shown to be excellent (ICC = 0.92) and is preferable over static plantar pressure assessments.

Sample Size and Statistical Methods

For sample size calculations, researchers used published values of the dynamic arch index (mean: 0.19, SD: 0.07) from a large cohort. Twenty percent of the average (0.038) was considered the minimal important difference. With a significance level of 0.05 and a power of 0.8, they calculated a minimum of 16 participants per age group and country.

To address potential bias, the researchers included BMI, ethnicity, and physical activity as confounding variables. Physical activity was measured using the validated Physical Activity Questionnaire for Children and Adolescents (PAQ-C and PAQ-A). All outcome parameters were analyzed in separate mixed-effects linear regression models, adjusting for the clustered structure of repeated measurements (both feet, seated and standing). The predictors "habitually barefoot" and age (in three developmental stages) were modeled, along with their two-way interaction. Statistical significance was set at p < 0.05, with Bonferroni corrections applied for the six main hypotheses (adjusted alpha = 0.008). All analyses were performed using STATA 14.

Key Findings: Barefoot vs. Shod Feet

The study divided participants into three age groups: 6 to <10 years, 10 to <14 years, and 14 to 18 years. Significant differences between habitually barefoot and habitually shod children were found across multiple measures.

Participant Breakdown by Age Group

The shod group (N = 425) and barefoot group (N = 385) were distributed as follows:

• 6 to <10 years: 101 shod (53.3% female), 123 barefoot (49.2% female)
• 10 to <14 years: 155 shod (45.0% female), 154 barefoot (45.7% female)
• 14 to 18 years: 169 shod (58.2% female), 108 barefoot (48.3% female)

Effects of Confounders

The researchers first examined how other factors influenced foot measurements. For the static arch height index, significant effects were found for:

• Which foot was measured (side, p < 0.001)
• Sex (p < 0.001)
• BMI (p = 0.002)

For the pliability ratio, only sex had a significant effect (p = 0.031). Notably, there was no statistically significant effect of ethnicity or physical activity on static foot outcomes.

For dynamic foot outcomes, the picture was different:

• Dynamic arch index was significantly affected by BMI (p < 0.001), side (p < 0.001), and ethnicity (p < 0.001)
• Hallux angle was significantly affected by side (p < 0.001), sex (p < 0.001), and ethnicity (p < 0.001)

Main Differences Between Barefoot and Shod Children

When comparing habitually barefoot to habitually shod participants, age-independent globally significant differences were found for three key measures:

• Static arch height index (p < 0.001) — barefoot children had higher arches
• Pliability ratio (p < 0.001) — barefoot children had more pliable (flexible) feet
• Hallux angle (p = 0.001) — barefoot children had straighter big toes

These results held even after adjusting for sex, ethnicity, BMI, physical activity, and other confounders.

Age-Specific Comparisons

The study also examined differences within each age group, revealing a more nuanced picture:

Foot length: In the 6 to <10 years age group, shod children had significantly longer feet than barefoot children (difference of −0.58 cm, p = 0.006). The same was true in the 14 to 18 years group (difference of −0.63 cm, p < 0.001). In the 10 to <14 years group, no significant difference was found (p = 0.802).

Foot width: In the 6 to <10 years group, shod children had significantly wider feet (difference of −0.20 cm, p = 0.010). No significant differences were found in the older two age groups.

Static arch height index: Barefoot children had significantly higher static arches in all three age groups (p < 0.001 for each group). The estimated difference was approximately −0.02 to −0.03 in the index value.

Pliability ratio: Barefoot children had significantly more pliable feet in all age groups (6 to <10 years: p < 0.001; 10 to <14 years: p = 0.025; 14 to 18 years: p = 0.014).

Hallux angle: Barefoot children had more favorable (lower) hallux angles across all ages, with the difference reaching statistical significance in the 10 to <14 years group (difference of −1.22 degrees, p = 0.039). The overall main effect was significant at p = 0.001.

Dynamic arch index: This measure showed a different pattern. A significant interaction between barefoot status and age group was detected (p = 0.004 for the interaction), meaning the effect of barefoot living on the dynamic arch changed with age. In the 10 to <14 years group, habitually shod children had significantly flatter arches (higher dynamic arch index) than barefoot children (difference of 0.03, p < 0.001). However, no significant differences were found in the 6 to <10 years (p = 0.822) or 14 to 18 years (p = 0.696) groups.

Understanding the Results

Why Are Barefoot Children's Arches Higher?

The finding of an increased static arch height index in children and adolescents growing up barefoot aligns with earlier reports of lower rates of flat feet in habitually barefoot children. Interestingly, only one previous study compared statically measured arch characteristics between habitually barefoot and shod adults, and it found no statistically significant difference. The researchers note that this discrepancy could stem from differences in assessment methods (navicular height and drop versus sitting and standing static arch height), the smaller sample size in the adult study (255 versus 810 participants), or the different populations studied (over 18 years versus 18 years and under).

The fact that the researchers adjusted for confounders such as sex, ethnicity, BMI, and physical activity strengthens the conclusion that habitual footwear use itself influences arch development in children.

However, the dynamic arch index results were less consistent — only the middle age group (10 to <14 years) showed a significant difference. Why might this be? The researchers point to two main theories frequently discussed in the medical literature regarding reduced foot arch height:

• The bone and ligament theory: Arch height is determined by the strength and structure of bones and ligaments
• The muscle strength theory: Arch height is maintained by the strength of muscles in the foot and lower leg

What Happens Inside the Foot?

Evidence exists for altered biomechanics that depend on footwear. A recent study by Kelly and colleagues investigated the activation of intrinsic foot muscles when running either barefoot or shod. They found an altered activation pattern for two key muscles — the flexor digitorum brevis and the abductor hallucis — that was directly dependent on footwear use. These intrinsic muscles work alongside the tibialis posterior and flexor hallucis longus muscles to support the foot arch.

Another study found poor extensor muscle activity during the heel-contact phase in children with flexible flat feet. The possibility of altered muscle tone could also contribute to the lifting of the medial longitudinal arch. In accordance with the "bone and ligaments" theory, a long-term altered muscle activation pattern could eventually lead to adaptation of the bones and ligaments of the foot. This mechanism may explain the differences observed between children habituated to barefoot versus shod walking.

The Mystery of the 10–14 Age Group

The researchers were candid about the fact that dynamic arch index differences appeared only in the 10 to <14 years group, and this finding is not yet fully understood. There is a known plasticity (adaptability) of the arch during childhood development, and puberty appears to impact this process. However, no longitudinal studies exist that track the effect of footwear on foot development through this specific phase.

The researchers speculate that fat distribution and ligamentous strength transform over time during puberty, and hormonal changes (such as growth hormones and testosterone) influence bone and muscle growth during this phase. It is plausible that the years between 10 and 14 are particularly important for foot arch development — but this idea requires prospective investigation.

Another possible explanation lies in the difference between static and dynamic arch measurements. In a pilot study, the researchers found high reliability for both measurements but a low correlation between them. The dynamic arch index represents the area of the middle third of the footprint as measured by a pressure platform, and it can be influenced by skin thickness and plantar fat distribution. This would be consistent with the different confounding factors that influenced the two measures — the dynamic arch index was affected by side, African ethnicity, and BMI, while the static arch height index was affected by side and sex only.

What This Means for Patients and Parents

This study provides strong evidence that footwear habits during childhood significantly shape foot structure and function. For parents, several practical takeaways emerge:

• Foot arch development matters: Children who spent significant time barefoot developed higher foot arches. Since flat feet are associated with various foot problems in adulthood, allowing children regular barefoot time may help support healthy arch development.
• Big toe alignment: Barefoot children had straighter big toes (lower hallux angles), which may reduce the risk of developing bunions (hallux valgus) later in life. Hallux valgus is a common and painful deformity in shod populations.
• Foot flexibility: Barefoot children had more pliable feet, suggesting better adaptability of the foot to different surfaces and loads. Reduced pliability in shod feet may contribute to stiffness and injury risk.
• The 10–14 age window: The finding that dynamic arch differences peaked in the 10–14 age group suggests that early adolescence may be a particularly sensitive period for foot development.

It is important to note what this study does not say. It does not prove that shoes are "bad" or that all children must be barefoot at all times. Rather, it suggests that habitual, long-term footwear use changes the natural development of the foot, and that regular barefoot time during childhood may have protective effects.

The study also highlights that modern footwear habits are relatively new in human history — for millions of years, barefoot locomotion was the norm. The long-term health consequences of shod living are only now becoming clearer through research like this.

Study Limitations

The researchers acknowledged several important limitations that affect how the findings should be interpreted:

• Cross-sectional design: Because this study examined children at a single point in time, it cannot prove cause and effect. The researchers cannot definitively say that barefoot living caused the differences observed; it could be that children with naturally higher arches or other foot characteristics were more comfortable going barefoot.
• No longitudinal data: The researchers noted that there are no longitudinal studies investigating the effect of footwear on foot development during puberty. Long-term prospective studies are needed to confirm these findings.
• "Habitually barefoot" definition: The researchers developed their own three-point scale to classify barefoot status, acknowledging the heterogeneous use of this term in previous literature. Different classification methods could yield different results.
• Geographic clustering: The barefoot group was almost entirely from South Africa, while the shod group was almost entirely German. Although ethnicity was included as a confounder, the geographic and cultural differences between groups cannot be fully separated from the barefoot/shod comparison.
• Static vs. dynamic measurements: The low correlation between static and dynamic arch measurements means that these approaches capture different aspects of foot structure and function. Findings from one method may not translate to the other.
• Underlying mechanisms unknown: The study did not measure muscle strength, bony structure, or ligamentous properties directly. The explanations for the differences observed remain theoretical.
• Sample size nuances: While the overall sample of 810 was large, the minimum calculated sample size was 16 participants per age group and country, and some subgroup analyses had relatively small numbers.

Recommendations for Families

Based on this research and the broader body of evidence, here are practical steps parents and caregivers may consider:

1. Allow regular barefoot time. Encourage children to spend time barefoot at home, in safe outdoor areas, and during supervised activities. The study suggests that being barefoot at least half of the time at school or sports — in addition to being barefoot at home — is associated with measurable differences in foot development.
2. Choose footwear wisely. When shoes are needed, opt for flexible, wide-toe-box shoes that allow natural foot movement rather than rigid, narrow, or highly cushioned designs that restrict the foot.
3. Pay attention to the pre-teen years. The 10 to <14 age group showed the most pronounced differences in dynamic arch index, suggesting that early adolescence may be a crucial window for foot development.
4. Watch for warning signs. If you notice your child complaining of foot pain, frequent tripping, or visible foot deformities, consult a pediatrician or podiatrist. Early intervention matters.
5. Balance safety with natural movement. The goal is not to eliminate shoes entirely — protection from injury, cold, and unsafe surfaces is important. The goal is to avoid habitual, constant footwear use that restricts natural foot development.
6. Consider physical activity. The study confirmed that children who are more physically active show increased arch heights. Regular physical activity supports foot health regardless of footwear choices.

For adults reading this study, the findings about childhood foot development carry an important message: the foundations of foot health — arch structure, toe alignment, and flexibility — are laid during the growing years. While this does not mean adults cannot improve foot strength and flexibility through targeted exercises, it underscores how early lifestyle factors shape lifelong foot health.

Frequently Asked Questions

What did this study find about children who grow up barefoot?

In a study of 810 children and adolescents aged 6 to 18 in South Africa and Germany, those habitually barefoot had higher foot arches, more pliable feet, and straighter big toes than children who regularly wore shoes. These differences were seen across all age groups.

How was being 'habitually barefoot' defined for this study?

Researchers classified children as habitually barefoot if they scored at least 3 out of 6 points on a scale based on time barefoot at school, during sports, and at home. For example, being barefoot at least half the time at school or sports while also being barefoot at home met the cutoff.

Does going barefoot prevent flat feet or bunions in children?

The study found barefoot children had higher arches and straighter big toes (lower hallux angles), which may lower the risk of flat feet and bunions later in life. However, because this was a cross-sectional study, it cannot prove that barefoot living causes these benefits.

Should I let my child walk barefoot more often?

Based on this research, allowing regular barefoot time appears beneficial for foot development. The study suggests being barefoot at least half the time at school or sports, plus at home, is linked to higher arches and more flexible feet. Safety and protection still matter, so shoes remain necessary in risky environments.

What are the main limitations of this barefoot study?

This was an observational study, so it cannot prove cause and effect. The barefoot group came almost entirely from South Africa and the shod group from Germany, so geographic and cultural factors may play a role. The authors also note no long-term studies have yet tracked footwear effects through puberty.

Does this study mean that wearing shoes is bad for children?

No. The study does not prove shoes are bad or that children must be barefoot at all times. It suggests that constant, habitual footwear use changes natural foot development. Choosing flexible, wide toe-box shoes when needed, while allowing regular barefoot time, may better support healthy arch and toe alignment.

When should I seek a second opinion about my child's flat feet or toe alignment if they grew up barefoot or always in shoes?

Consider a second opinion if a child has foot pain, frequent tripping, or visible foot deformities, or if doctors disagree on whether treatment is needed. Research on 810 children shows that growing up habitually barefoot is associated with higher foot arches, straighter big toes, and more pliable feet than regular shoe use, with the 10–14 age range appearing especially influential. However, these findings do not prove cause and effect, and each child's situation differs. A specialist can review individual risk factors and help parents decide. Diagnostic Detectives Network provides independent expert second opinions.

Source Information

This patient-friendly article is based on peer-reviewed research published in Scientific Reports (Nature Publishing Group).

Original Article Title: Hollander-2017-Growing-up (habitually) barefoot

Authors: Karsten Hollander, Johanna Elsabe de Villiers, Susanne Sehner, Karl Wegscheider, Klaus-Michael Braumann, Ranel Venter, and Astrid Zech

Publication: Scientific Reports, Volume 7, Article number 8079 (2017), DOI: 10.1038/s41598-017-07868-4

Affiliations: Department of Sports and Exercise Medicine, University of Hamburg, Germany; Department of Sport Science, Stellenbosch University, South Africa; Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Germany; Department of Sport Science, Friedrich Schiller University Jena, Germany.

This patient-friendly article is based on peer-reviewed research. It is intended for educational purposes and does not constitute medical advice. Parents with concerns about their child's foot development should consult a qualified healthcare professional.