Footwear: How the Past Affects Patients Today

Footwear: How the Past Affects Patients Today

April 11, 2019

Author: Kevin B. Rosenbloom, C.Ped, Sports Biomechanist


Modern shoes are altering the natural morphology and biomechanics of the foot (D’AoÛt et al. 2009). As a result, healthcare professionals often answer patients’ questions regarding modern shoe recommendations.

From the footwear of grass and domesticated animal hides of the past, to the modern shoes of foam, synthetic leathers and rubbers of today, footwear has certainly evolved. A brief look into the history of footwear will not only reveal how modern shoes are changing foot behavior but provide more enticing facts about shoes to share with patients.

The Oldest Footwear

Several Copper to Bronze Age shoes have been found in Denmark (Hald 1972), Israel (Schick 1998) and all over Ireland (Lucas 1956). Iceman Ötzi’s snow shoes and shoelaces, found on the border of Austria and Italy, have been dated back to 5,300 years ago (Bonani et al. 1994). In the Americas, a variety of sandals, moccasins and slip-ons that were found in a cave in Missouri, USA predate any found in the old world. The fiber and/or leather sandals found there could possibly be up to 8,300 years old (Kuttruff et al. 1998).

Figure 1Right shoe of the Ötzi (construction drawing), translated from German.

Photo credit: Malhotra and Fansa, Experimentelle Archäologie, 1998. Licensed under CC BY-SA 2.5


Both Ötzi and the Missouri cave find differ from most other prehistoric European shoes because they were made without a vamp and consist of one soft piece of leather (Pinhasi et al. 2010). When the prehistoric shoes found in Ireland were compared to those found in a recent excavation in Armenia, it was observed that both possess similar manufacturing technology, despite being crafted more than 2,600 miles apart. The well-preserved and complete Armenian shoe had leather and grass samples dated to originating approximately 5,600 years ago (Pinhasi et al. 2010). However, Pinhasi’s team suggest that given their simplicity of design, both shoes were manufactured independently of one another (2010).


Figure 2Leather shoe from Areni-1, Armenia.

Photo credit: Pinhasi et al. PLOS One 2010. Licensed under CC BY-SA 4.0


Anatomical evidence for footwear goes further into the past

Because the leather and other materials from prehistoric footwear do not fossilize well, finding preserved archaic shoes is limited to modern sediments. Paleoanthropological excavations into deep and older rock are essentially nonexistent. As a result, scientists have been forced to find anatomical evidence that would suggest footwear usage. Building the ground work in this area is Erik Trinkaus. Trinkaus’ findings noted that the 40,000 year old proximal pedal phalanges for the individual found in Tianyuan cave near Beijing, China demonstrate morphological changes contributed to footwear (Trinkaus & Shang 2007).

Did other hominids wear footwear?

The approximate date in Trinkaus’ research directly connects the era of footwear with another hominid species, Homo neandethalensis (King 1864). The most known of the classic Neanderthals is said to have lived from about 70,000 to 35,000 years ago (Stinger & Andrews 2012). Currently, there is no direct evidence that Neanderthals possessed shoes; however, it is assumed that they too would of had unsophisticated shoes to protect them from cold winters (Wales 2012).

Figure 3. Homo neanderthalensis adult male.

Photo credit: Mahuli96, Wikipedia 2018. Licensed under CC BY-SA 4.0


How has footwear changed foot biomechanics?

According to a 2005 study, the robusticity of the pedal phalanges has been reduced in populations that used little to no footwear (Trinkaus 2005). The Tianyuan individual also displayed middle phalange gracility (Trinkaus & Shang 2007). With early footwear it is shown that as foot mobility and flexibility decrease, the frequency of foot deformities can increase (Sim-Fook & Hodgson 1958, Zipfel & Berger 2007, D’AoÛt et al. 2009, Shu et al. 2015).

Prehensile strength and forefoot mobility in an unshod group of people was compared to the common deformities and restricted nature of shod feet (Sim-Fook & Hodgson 1958). Various morphological differences between habitually shod and unshod runners was observed, i.e. hallux valgus (Shu et al. 2015). More severe pathological variation in the metatarsals was found in those exposed to habitual footwear and modern substrates compared to pre-pastoral groups (Zipfel & Berger 2007).

Figure 4. 2D foot print image of habitually shod (left) and unshod (right) runners.

Photo credit: Shu et al., PLOS One, 2015. Licensed under CC BY-SA 4.0


Final Thoughts

Researchers at Kevin Orthopedic agree that the development of footwear was a remarkable success of human innovation, but it also appears to be a detriment to foot health and performance. This article represents another step forward in the research of advanced biomechanical solutions. However, it does leave one with several questions about current footwear, modern substrates and the practice of foot biomechanics. These questions will be explored and discussed in upcoming articles, collectively available through this laboratory.




References & Works Cited

Bonani, G., Ivy, S. D., Hajdas, I., Niklaus, T. R., Suter, M. 1994. “Ams14C Age Determinations of Tissue, Bone and Grass Samples from the Ötztal Ice Man,” Radiocarbon 36; 2: 247-250.

D’AoÛt, K., Pataky, T.C., De Clercq, D., P. Aerts, P. 2009. “The effects of habitual footwear use: foot shape and function in native barefoot walkers,” Footwear Science 1; 2: 81-94.

Goubitz, O., Driel-Murray, C., Groenman-Van, W. W. 2001. “Stepping through time: Archaeological footwear from prehistoric times until 1800,” Zwolle, Netherlands: Stichting Promotie Archeologie.

Hald, M. 1972. “Primitive shoes: an archaeological-ethnological study based upon shoe finds from the Jutland Peninsula,” Copenhagen: The National Museum of Denmark: Gyldendal.

King, W. 1864. “The reputed fossil man of the Neanderthal,”  Quarterly Journal of Science 1: 88-97.

Kuttruff, J.T., DeHart, S.G., O’Brien, M.J., 1998. “7500 Years of prehistoric footwear from Arnold Research Cave, Missouri,” Science, 281: 72–75.

Lucas, A. T. 1956. “Footwear in Ireland,” County Louth Archaeological Journal 13:309-394.

Pinhasi, R., Gasparian, B., Areshian, G., Zardaryan, D., Smith, A., Bar-Oz, G. Higham, T. 2010. “First Direct Evidence of Chalcolithic Footwear from the Near Eastern Highlands,” PLOS One 5(6): e10984.

Schick, T. 1998. “The Cave of the Warrior: A Fourth Millennium Burial in the Judean Desert,” IAA Reports 5: 54-58.

Shu, Y., Mei, Q., Fernandez, J., Li, Z., Feng, N., Gu, Y. 2015. “Foot Morphological Difference between Habitually Shod and Unshod Runners,” PLOS One 10(7): e0131385.

Sim-Fook, L., Hodgson, A. R.. 1958. “A Comparison of Foot Forms Among the Non-Shoe and Shoe-Wearing Chinese Population,” Journal of Bone and Joint Surgery 40-A; 5: 1058-1062.

Stringer, C., Andrews, Peter. 2012. “The Complete World of Human Evolution,” 2nd Ed. Thames & Hudson, London, UK. 154-157.

Trinkaus, E. 2005. “Anatomical evidence for the antiquity of human footwear use,” Journal of Archaeological Science 32: 1515-1526.

Trinkaus, E., Shang, H. 2007. “Anatomical evidence for the antiquity of human footwear: Tianyuan and Sunghir,” Journal of Archaeological Science 35; 7: 1928-1933.

Wales, N. 2012. “Modeling Neanderthal clothing using ethnographic analogues,” Journal of Human Evolution 63(6): 781-795.

Zipfel, B., Berger, L. R. 2007. “Shod versus unshod: The emergence of forefoot pathology in modern humans?” The Foot 17: 205-213.



Kevin B. Rosenbloom, C.Ped, Sports Biomechanist

Kevin B. Rosenbloom, founder and president of Kevin Orthopedic, is a renowned certified pedorthist and sports biomechanist practicing in Santa Monica, CA. With his continuing research on the historical development of foot and ankle pathologies, comparative evolution of lower extremities and the modern environmental impacts on ambulation, he provides advanced biomechanical solutions for his patients and clients.

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