EvidenceHealthFootwear / Barefoot

Barefoot walking versus shod walking for persistent plantar heel pain

Study type:: single-blind randomised controlled trial, n = 52 adults with persistent plantar heel pain
Added:: 2026-09-04
Status:: published

Strength of evidence

Moderate

Source

Reinstein M, Weisman A, Masharawi Y. Barefoot walking is beneficial for individuals with persistent plantar heel pain: a single-blind randomised controlled trial. Ann Phys Rehabil Med. 2024;67(2):101786.

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In a single-blind randomised controlled trial, 52 adults with persistent plantar heel pain were assigned to 4 weeks of treadmill walking either barefoot or in conventional shoes; all participants additionally received therapeutic ultrasound. Both groups improved in pain, physical function and quality of life, but the barefoot group showed greater improvements in physical function, role limitations due to physical health, pain, pressure pain thresholds and pain tolerance. Outcomes were direct clinical measures, but the design was single-blind, the main endpoint was self-reported, the follow-up lasted only one month, and the additional ultrasound treatment in both groups weakens the isolation of the barefoot effect. Under WorthDay Evidence Criteria this supports moderate-quality evidence that barefoot walking can help foot pain, but the comparison is barefoot-plus-ultrasound versus shod-plus-ultrasound, not barefoot alone versus nothing.

Key findings

Design: single-blind randomised controlled trial, n = 52 adults with persistent plantar heel pain.
Groups: Barefoot walking group (BWG): 4 weeks of treadmill walking with bare feet. Shod walking group (SWG): 4 weeks of treadmill walking in conventional shoes.
Co-intervention: ALL participants received therapeutic ultrasound.
Measurements: baseline, after 4 weeks of treatment, and at 1-month follow-up.
Endpoints: Primary: SF-36 functional questionnaire score. Secondary: self-reported and clinically assessed pain provocation, pressure pain thresholds, pain tolerance, treadmill walking time and speed, and a daily walking diary.
Results: Barefoot group improved significantly in all SF-36 items except emotional well-being. Shod group improved only in the pain and health change items. Barefoot group improved more than shod group in physical function and role limitations due to physical health.
Both groups had significant pain reduction; improvement was greater in the barefoot group (effect size 0.89).
Only the barefoot group showed significant improvements in pressure pain thresholds (effect size 0.70) and pain tolerance (effect size 0.67).
Both groups significantly increased treadmill walking time and speed and self-reported outdoor walking time.
All clinical pain tests were significantly less positive in the barefoot group at all time points.

Background

Persistent plantar heel pain (PPHP), often labelled plantar fasciopathy, is a common and stubborn foot problem. Protected, heavily cushioned footwear is frequently recommended, but there is little experimental data on whether actively walking barefoot - letting the foot work without support - changes pain and function. This trial directly tested a barefoot walking programme against walking in conventional shoes in people with persistent heel pain.

Methods

Design: single-blind randomised controlled trial.
Participants: 52 adults with persistent plantar heel pain.
Randomisation: into two groups: 1. Barefoot walking group: 4 weeks of treadmill walking with bare feet. 2. Shod walking group: 4 weeks of treadmill walking in conventional shoes.
Co-intervention: all participants received therapeutic ultrasound in addition to the walking programme.
Measurements: baseline, after the 4-week programme, and at 1-month follow-up.
Endpoints: Primary: SF-36 functional questionnaire (quality of life and function). Secondary: self-reported and clinically assessed pain provocation, pressure pain thresholds, pain tolerance, treadmill performance (time, speed), and a daily walking diary.

Results

The barefoot group improved significantly in all SF-36 items except emotional well-being.
The shod group improved only in pain and health change items.
Greater improvements in the barefoot group were found for: physical function, role limitations due to physical health.
Both groups reduced pain significantly, but the improvement was greater in the barefoot group (effect size 0.89).
Only the barefoot group significantly improved: pressure pain thresholds (effect size 0.70), pain tolerance (effect size 0.67).
Both groups increased treadmill walking time and speed and outdoor walking time; the increases were generally larger in the barefoot group.
All clinical pain provocation tests were significantly less positive in the barefoot group at every time point.

Interpretation

From a conventional sports-medicine perspective, the study suggests that a structured walking programme improves persistent heel pain, and that performing it barefoot may give additional benefit for pain, function and pain tolerance compared with walking shod.
From the WorthDay perspective, the honest reading is:
This is an experimental study with direct clinical endpoints (pain, function, quality of life), not just laboratory surrogates.
Both groups received therapeutic ultrasound, so the trial cannot separate "barefoot alone" from "barefoot plus ultrasound". The clean comparison is barefoot-plus-ultrasound versus shod-plus-ultrasound.
The trial is single-blind, not double-blind, the main outcome is self-reported, the sample is small (n = 52), and follow-up lasts only one month.
There is no untreated control group, so the absolute effect of the walking programmes themselves (versus doing nothing) cannot be quantified here.
Under WorthDay Evidence Criteria, S0061 earns moderate-quality evidence: the hypothesis is tested experimentally with direct, relevant endpoints, but the study does not meet all criteria for high quality.

Limitations

Single-blind design; no double blinding.
All participants received therapeutic ultrasound, so barefoot walking was not tested in isolation; there is no null control group.
Primary outcome is a self-reported questionnaire (SF-36); pain measures partly rely on subjective reports.
Small sample size and one-month follow-up; long-term durability unknown.
The intervention was treadmill walking in a clinic-style setting, not free-living barefoot activity; transfer to everyday barefoot walking is plausible but not directly demonstrated.
No comparison with commonly used treatments such as stretching programmes, orthotics or injection therapy; the study answers "barefoot versus shod walking", not "barefoot versus best current care".

WorthDay perspective

S0061 is one of the few genuinely barefoot RCTs with clinical, patient-relevant endpoints. It supports the hypothesis that a structured barefoot walking programme can reduce heel pain and improve function and pain tolerance, at least within a 4-week to 1-month window.
Because both arms received ultrasound and structured walking, the best-supported claim is: barefoot plus additional treatment beat shod walking plus the same treatment on several direct measures, not that barefoot alone cures heel pain.
For WorthDay users, this study justifies a careful, gradual self-experiment with barefoot walking for foot discomfort - introduced step by step, with attention to pain signals - alongside movement, recovery and routine. It is a moderate-confidence arrow in the quiver, not a magic bullet.
This entry fits the Health category and the Footwear / Barefoot tag, and can later be linked to S0047 (foot muscles and arch structure) for the broader barefoot picture.

Permalink: https://www.worth-day.com/science-compass/s0061-barefoot-walking-versus-shod-walking-for-persistent-plantar

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