Q: I read with great interest your recent review of Muscle Imbalances Revealed, and in particular, your comments on Mike Robertson’s presentation that touched on factors related to excessive pronation. I have this excessive foot pronation, plus a spondylolisthesis, a history of ankle sprains, double-jointed elbows and knees, and hips that move around like John Travolta’s in Saturday Night Fever. Basically I should have given up my career and gone into the Cirque de Soleil.

What I want to know is that specifically with my feet if wearing a supportive shoe with orthotics is such a bad thing. Everyone is on this barefoot kick, but it just doesn’t work for me. If I go barefoot my hips move out of correct position and my ankles and calves ache. In fact, when I was a child, my dad had to massage my calves and arches at night because I’d be in tears from the pain of being flat-footed. Once I got my first orthotics at age 7, I was so much more comfortable. I feel that orthotics and a nice flat shoe for me helps me use my feet correctly and allows me to stay away from internal rotation of the tibia and femur, and reduces pelvic tilt, etc.

Or, I could be mistaken? What do you think, and have you heard anyone else talk about this? Other hypermobile people and I have talked about this and we all seem to feel the same: barefoot is not the way to go for us.

A: Extensive barefoot stuff is definitely not for everyone, and if you were having issues that significant at such a young age, you’re probably just someone with a structurally different foot type. There are definitely scenarios where orthotics are indicated, and the fact that you’ve gotten so much symptomatic relief from them tells me that they’re a good thing in your case.

That said, you might still benefit from just a bit of barefoot training – like deadlifting barefoot and doing some bowler squats and the like. Basically, just use it for situations where foot positioning doesn’t change. Then, you don’t have to mess around with how it affects the gait cycle. I think you’ll get some of the benefits of strengthening the small muscles of the feet and improving proprioception (in light of your history of ankle sprains) without all the unfavorable compensations further up. And in folks who don’t have your hypermobility, improving dorsiflexion ROM would be an added benefit.

I wouldn’t say that it’s specific to hypermobile individuals, though. A lot of them probably have issues with barefoot training because they lack the strength and underlying stability required at the lower leg and hip to take the ground reaction force stress off the feet. Remember that mobility and stability are always working at odds with one another; if you’ve got too much of one, you have to train the other one to pick up the slack. My hunch is that most of these people don’t have structural pronation; they have excessive functional pronation because the anti-pronators – specifically the hip external rotators – aren’t strong enough to decelerate that pronation. Check out the valgus (poor) positioning on the left here:

Of course, in the general population, we see it for this reason, as well as the fact that most people walk around in terrible cinder blocks footwear that completely “tunes out” the joints and muscles of the feet.

A lot of the folks that try barefoot training and wind up in pain get that way because they’re idiots and jump right in full-tilt. You can’t go from wearing cross-trainers to wearing thin pieces of cloth/rubber overnight. And, as Nick Tumminello wisely pointed out recently, while our ancestors were barefoot all the time, they weren’t barefoot on CONCRETE for loads of mileage. And, they weren’t as overweight as today’s society is, with such low relative strength. As always, people get hurt because they are stupid and not because a specific training modality is bad.

Typically, in a broad sense, I recommend that people do their 1-leg (pistol) squats, all deadlifting variations, and box squats without sneakers.

As long as they aren’t really overweight – or presenting with a history of foot problems – we’ll also have them do their warm-ups without sneakers.

Everything else (including more quad dominant squatting variations) are done with footwear. I’m a big fan of the New Balance Minimus; you can read my full review at the following link: The New Balance Minimus: The Best Minimalist Training Shoe on the Market.