Category Archives: Studies

Survey In China And India Of Feet That Have Never Worn Shoes – A Summary

There have been a few studies carried out on barefoot populations. An interesting and large study carried out by Samuel B. Shulman, Pod.D., entitled SURVEY IN CHINA AND INDIA OF FEET THAT HAVE NEVER WORN SHOES surveyed a total of 5,128 persons. The study spanned 10 months, 8 of which were in and around Kunming, China and the last two months in and around Calcutta, India. These people had never worn shoes, except for an occasion flat sandal with no support. Socks were not worn.

Participants In the Survey

The only people who excluded from the survey were people with “obvious generalized disease or deformity”. This means people born with leprosy, for example, were not included in the survey. However, some conditions, such as Polydactylism, a condition in which a person has more than five finger per hand or foot, and Macrodactylism, a condition in which a person has abnormally large toes or fingers, were included in the survey.

The participants in the study ranged from 4 to 87 years old. Most of the individuals were male, but no significant differences were found between male and female.

Number of Persons Examined—China 3906—India 1222—Total 5128

Condition China India Total % of Total
Weakfoot 91 29 120 2.34%
Congenital Pes Planus (flatfoot from birth) 44 12 56 1.09%
Eczemas of All Types 41 11 52 1.01%
Epidermophytosis (athlete’s foot, ringworm) 30 9 39 .75%
Arthritic Complaints 21 6 27 .53%
Polydactylism (many toes) 16 5 21 .41%
Tylomata (a callous condition) and
depressed anterior metatarsal arches
13 5 18 .35%
Sebaceous Cyst 14 4 18 .35%
Tibiale Externum (enlarged scaphoid) 3 4 17 .33%
Verruca (plantar wart) 11 4 15 .29%
Varicosities (swollen or twisted veins) 11 3 14 .27%
Pigmented Nevi (moles) 10 3 13 .25%
Flattened Foot 6 4 10 .19%
Congenital Overlapping Toes 6 3 9 .18%
Fibroma (solid raised growth bumps) 5 2 7 .14%
Lacerations and Abrasions 3 2 5 .10%
Mycetoma (disease induced by fungi) 0 4 4 .08%
Onychauxis (size increase of the nails) 3 1 4 .08%
Burns 2 0 2 .04%
Onychogryphosis (abnormal toe growth and curvature) 1 1 2 .04%
Macrodactylism (excessive size of toes)  2 0 2 .04%
HalluxRigidus (disorder of joint by the big toe) 1 1 2 .04%
Os Vesalianum (accessory bones) 1 1 2 .04%
Sprained Ankle 0 1 1 .02%
Lipoma (tumor) 0 1 1 .02%
Ulcer 1 0 1 .02%
Total 346 116 462 9.01%

Some foot conditions were not found at all:

Condition China India Total % of Total
Heloma (callosity or corn) 0 0 0 0%
Onychocryptosis (ingrown toe nails) 0 0 0 0%
Hyperidrosis (excessive sweating) 0 0 0 0%
Bromidrosis (offensive sweat) 0 0 0 0%
Hallux Valgus (displacement of the great inwards) 0 0 0 0%
Hallux Varus (displacement of the great toe outwards) 0 0 0 0%

Data Summarized

These numbers are quite significant when compared to cultures that habitually wear shoes. For instance, a 2012 study estimated the prevalence of hallux valgus to be 23% to 35%:

No deformity of the forefoot occurs more frequently than hallux valgus. A recent review estimates the global prevalence of hallux valgus at up to 23% in 18- to 65-year-olds and 35% in those over 65, although of course it is difficult to draw a line between normal and pathological positioning of the great toe

Conditions such as athlete’s foot, plantar warts, and flat feet are also significantly higher in shoe wearing cultures.

Notable findings

  • Individuals had “remarkable ranges of motion” with the abduction of the great toe.
  • Arches were “quite a bit lower” than what is considered normal in the United States, but had normal function.
  • Not a single person who had weakfoot complained of pain of any kind.
  • Individuals were allowed to let their toenails grow long
  • 1/7th of the Chinese and and 1/3rd of the Indians currently had or previously had hookworm.

There is also a mention of 180 rickshaw coolies, who had “feet were more perfect than the others”. These rickshaw pullers would spend long hours on hard surfaces such as cobblestone. There were many complaints of much pain and swelling in the beginning of work, but after a week, the pain passed and never returned.


These numbers are quite significant, and does show the negative effects shoes can have on foot health. The conclusion from the study says it best:

People who have never worn shoes acquire very few foot defects, most of which are painless and non-debilitating. The range of their foot motions are remarkably great, allowing for full foot activity. Shoes are not necessary for healthy feet and are the cause of most foot troubles. Children should not be encouraged to walk prematurely and should not wear any footgear until absolutely necessary. Footgear is the greatest enemy of the human foot.