Can Toe Spread Sandals Enhance Foot Function? EBFA Research

Over the past several months EBFA has been busy conducting several research studies related to barefoot science, footwear and function.   One such study looked specifically at the benefit of toe spread sandals on overall foot function in subjects with mild to moderate bunion pain.

Why Toe Spread? 

Flip-flopsMost of our favorite footwear favors an unnatural foot shape causing excess pressure to the forefoot and digits.   Overtime pressure from shoes can lead to the formation of bunions, hammertoes, metatarsalgia and neuroma pain.

Although we are in a season of flip flops and espadrilles these shoes are not without their risks as well.    Your traditional flip flops are notorious for foot pain specifically to the heels and digits.

In traditional flip flops the single thin strap between the big toe and second toe can lead to toe gripping and a change in gait. Toesox-Five-Toe-SandalsThe continuous gripping of the digits to hold onto the flip flop can lead to an intrinsic / extrinsic muscle imbalance in the foot which ultimately leads to  hammertoes.

In a toe spread sandal such as that created by ToeSox a small strap is placed between each of the five digits allowing a more secure foot placement as well as a splinting effect for intrinsic muscles of the digits.   Subject perception is that of much more comfort and improved function when wearing a toe spread sandal.

To closer evaluate the benefit of toe spread sandals EBFA conducted a pilot research study to determine if radiographic changes could be observed in the foot after 3 months of toe spread sandal use.

Toe Spread Research Study

Eight subjects (7 women, 1 man) with mild to moderate bunion pain were recruited to wear toe spread sandals (ToeSox) for 2 hours every day for a total of 3 months.  Prior to the intervention all subjects’ feet were X-rayed in an AP view, weight bearing position and were evaluated for intermetatarsal angle, hallux abduction angle and sesamoid position.    In addition all subjects completed a Foot Function Index Survey.  Subjects were X-rayed after 2 months and 3 months of toe spread sandal use with 4 of the subjects being followed for 6 month follow up.

At the end of the 3 months all subjects reported much less foot pain and improved function.   This improvement in foot function was also noted by improvements in all subjects’ Foot Function Index score with scores improving between 4% and 16%.   No radiographic changes were noted at 3 months, however the 6 month follow ups are still pending.

Interpretation & Application of Study

Despite the lack of radiographic changes in subjects wearing toe spread sandals, the improvement in function and perception of foot pain was significantly improved after 3 months of use.   Many subjects stated they felt much better in the sandals and are going to continue to wear them despite the study being over.

Maintaining intrinsic / extrinsic balance is a key component to overall foot function and healthy movement.   For those people seeking footwear that is low profile and easy to slip on but still provides support and appropriate foot function toe spread sandals (ToeSox) offer a good option.

To learn more about ToeSox and their sandals please visit 


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