Foot Anatomy 101 (“Normal” vs “Natural”)

When most scholars speak about the foot, they start by explaining the different anatomical parts and how they connect and work together. They will describe how there are 26 bones connected by 33 joints and held together by over 100 muscles, tendons and ligaments. 

This is part 2 of a series titled “Foot Pain (How To Fix ‘Plantar Fasciitis’ and Other Common Foot Problems)”  

Part 1: Introduction 

Part 2: Foot Anatomy 101 (Normal Vs Natural)  

Part 3: How Shoes Change Your Foot

Part 4: What Causes Plantar Fasciitis?

Part 5: How To Screen Your Foot Pain

Part 6: Foot Pain – The Rebuilding Process

Part 7: Foot Pain – Should You Wear Orthotics?

Part 8: Foot Pain – What About Steroid Shots? – Coming Soon…

To say the foot is a sophisticated and complex structure would be an understatement. During our day the foot must be flexible enough to navigate over uneven surfaces, mobile enough to absorb forces when landing from a jump, and strong enough to provide a stable foundation when squatting, deadlifting, or running. 

While there is nothing wrong with learning about the foot in this traditional textbook manner, I want to take a different approach. This starts by understanding the difference between “normal” and “natural.” 

The Merriam-Webster dictionary defines “natural” as the ideal form and function stemming from nature and untouched by the influences of civilization and society. The word “normal” describes what we believe to be usual or common. Something can be “normal” but not necessarily “natural.” For example, it is very normal for children (especially in America) to eat cereal every morning for breakfast. However, a box of Cap’n Crunch is not natural (if you can find a cereal tree, please let me know…). 

So how does “normal” and “natural” relate to our feet and the injury/pain that can develop there? 

It all starts by understanding how your foot looked when you were just a baby. You see, when you were born your toes were the widest part of the entire foot. Don’t believe me? Go ask your mother or father if they still have your foot imprints that were made at the hospital soon after you were born. 

When you look at a baby’s foot, each toe can be separated from the others. They are not crowded or pinched together. Also, the first and fifth toes are in direct alignment with the corresponding metatarsal bones of the foot. This “natural” shape would continue throughout our lives were it not for the types of shoes we wear.

In fact, there is actually a ton of research dating back to the early 1900’s that support this transformation. If you actually look in the right places you can easily find many scientific accounts describing the enormous differences in foot shape and function between those who grew up wearing shoes and those who didn’t.^1-15 Many of us in industrialized countries wear shoes that unknowingly transform our foot and progressively alter it into an unnatural shape.

Unfortunately, many of us (including many in the medical field) are fundamentally unaware of this problem. Because doctors and other rehabilitation professionals rarely ever see a “natural” foot they can only base their recommendations through their comparison of one “normal” (already shoe-adapted) foot with another. 

Next week we’ll go over the three features of modern shoes that change your feet. 

Until next time,

References: 

1. Sim-Fook L, Hodgson AR. A comparison of foot forms among the non-shoe and shoe-wearing Chinese population. J Bone Joint Surg Am. 1958 Oct;40-A(5):1058-62.
2. Hoffmann P. Conclusions drawn from a comparative study of the feet of barefooted and shoe-wearing peoples. The American Journal of Orthopedic Surgery. 1905;s2-3(2):105-136. 
3. James CS. Footprints and feet of natives of the Solomon Islands. The Lancet. 1939;234:1390-1394.
4. Shine IB. Incidence of hallux valgus in partially shoe-wearing community. Br Med J. 1965;1(5451):1648-50. 
5. Shulman SB. Survey in China and India of feet that have never worn shoes. The Journal of the National Association of Chiropodists. 1949;49:26-30. 
6. Mafart B. Hallux valgus in a historical French population: paleopathological study of 605 first metatarsal bones. Joint Bone Spine. 2007 Mar;74(2):166-70.
7. Mays SA. Paleopathological study of hallux valgus. Am J Phys Anthropol. 2005 Feb;126(2):139-49.
8. Swallow A. The history of shoes. Baillieres Clin Rheumatol. 1987 Aug;1(2):413-29. 
9. D’AoÛt, K., Pataky, T. C., Clercq, D. D., Aerts, P. 2009. The effects of habitual footwear use: foot shape and function in native barefoot walkers. Footwear Science, 1(2):81–94.
10. Sachithanandam V, Joseph B. The influence of footwear on the prevalence of flat foot. A survey of 1846 skeletally mature persons. J Bone Joint Surg Br. 1995 Mar;77(2):254-7.
11. BARNETT CH. The normal orientation of the human hallux and the effect of footwear. J Anat. 1962;96(Pt 4):489-494.
12. Kato T, Watanabe S. The etiology of hallux valgus in Japan. Clin Orthop Relat Res. 1981 Jun;(157):78-81.
13. Hollander K, de Villiers JE, Sehner S, Wegscheider K, Braumann KM, Venter R, Zech A. Growing-up (habitually) barefoot influences the development of foot and arch morphology in children and adolescents. Sci Rep. 2017 Aug 14;7(1):8079.
14. Thomas B, Singh YL, Mullerpatan RP. Comparison of foot structure between urban and rural Indian school children. Physiother – J Indian Assoc Physiother. 2019;13:38-42. 
15. Dittmar JM, Mitchell PD, Cessford C, Inskip SA, Robb JE. Fancy shoes and painful feet: hallux valgus and fracture risk in medieval Cambridge, England. International Journal of Paleopathology. 2021. https://doi.org/10.1016/j.ijpp.2021.04.012

Special thanks to Dr. Ray McClanahan from whom much of this information was first learned.