Biology, history surround ‘foot etiquette’ and hookworms

After reading letters  like Kriss Sands’ on being barred from the Mountain State Fair for going barefoot [“Why I Won’t Be Attending Mountain State Fair This year,” Sept. 10, Xpress] and also seeing people disregarding the “No Shoes, No Service” public health codes in Asheville stores and restaurants, I feel people need a little biology and history lesson on the very good reasoning behind such laws and “foot etiquette.” Let’s start with one word: hookworm.

Hookworm larvae and other intestinal parasites burrow through soles of unshodden feet from contaminated soil. Once in a person, the individual can spread it through their saliva  and excrement (aided through hand to hand transactions, etc.). Hookworm and intestinal  parasites can cause low immune system and malnourishment and even lead to death (as it often does in many poor countries today where shoes are a luxury).

We were once a much poorer nation, too (think the Great Depression). Many people, especially children, didn’t have shoes. Yes, stomach parasites, illness and death were a problem in the U.S. then, and so, you guessed it, we passed and encouraged health ordinances so people did not contract and spread worms in public places (like a “state fair,”  let’s say). We have far less infection today due to ordinances like this, but worms still surely exist in the U.S.

Kriss Sands may or may not have worms, but chances of contracting them are far greater going around barefoot in public, and in turn we all would have greater chances of contracting and spreading them if we all chose this “lifestyle.”

This sort of “pro-barefoot” rant would be Portlandia laughable if it wasn’t so ignorant of facts and dismissive of the health of others. If Kriss does now have a few spare pairs of shoes lying around, there are currently people in a long list of countries that would be too happy to have them.

Chalk this one up to “USA — We’ve come so far we’re regressing.”

G.J. Cage

Asheville

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32 thoughts on “Biology, history surround ‘foot etiquette’ and hookworms

  1. First: There is no “health code” that requires shoes. Serious experts who write health codes do not consider bare feet to be a health problem. Barefoot advocates have letters from Health Departments in all 50 US states.

    Second: The historic problem with human hook worms was from a time when indoor plumbing was rare or non-existent in many places. Human feces were often dumped in streets, gardens, and yards. Hook worms were only one health issue involved. Health codes now prohibit open disposal of human feces. Proper hygiene and waste disposal is the way to prevent diseases according to health codes.

    Third: Shoes cause many health problems of their own. Twisted bent damaged toes. Bunions. Gout. Inflammations. And, crippling shock damage to knees, hips, and backs. Our species evolved with bare feet walking on mother earth.

    In conclusion. There is no significant health problem from going barefoot and no health code requiring shoes, but shoes cause health problems so bare feet are the healthy normal choice.

    • Matt

      From the last article; Shoes or not I will just say I never evolved ! I never crawled out of the mud or lived swinging through the trees. I was created by God the Father! I was born barefooted but I choose to wear shoes. If you don’t like shoes that’s ok with me too .

  2. J. Johnson

    According to the CDC website, infection by filariform hookworms occurs through skin contact with soils contaminated with human feces containing hookworm eggs. The best way to prevent the spread of hookworms is to prohibit outdoor defecation or the spreading of human feces as fertilizer (“night soil”). Barefooting does not spread hookworms, but unsanitary hygiene does. Therefore, the best way for fair organizers to prevent the spread of hookworms is provide effective sewage disposal systems to protect the health of all fairgoers, shod or not. While once common in the humid Southeast, hookworm has virtually been eliminated through the use of modern indoor plumbing and proper septic systems.

  3. Hookworm can be spread through salavia? Not a problem. I haven’t spit on anyone since I was three.

    No shoes health codes? Just compare the signs that classroom claim this to the signs that ban smoking indoors in a restaurant and see if you can spot the difference.

    Kris’s rent being laughable and ignorant of the facts? Your rant is the same to me.

  4. Kellie

    “Once in a person, the individual can spread it through their saliva and excrement (aided through hand to hand transactions, etc.).” According to your own words it is picked up from contaminated soil. It looks like the CDC agrees with that statement. There is nothing on the CDC page regarding being able to transmit it through saliva or hand to hand contact. I would be really worried if there were people at the fair picking up poo and then shaking hands with one another. Eww.

    That being said, hookworm is more treatable than a cold, and is harder to spread than a cold. I’m more worried about cold and flu season than getting any kind of disease from the bottom of someone’s foot. It is very unlikely that being barefoot would cause a hookworm epidemic.

    Back when we were a “Poorer Nation,” and hookworm was more prevalent we did not have the treatments we have now. We were also a more agricultural nation, and sanitation from our farm animals as well as human waist wasn’t as well contained. That was how hookworm was spread.

    Cleanliness is still key and washing your hands or feet continues to be the best way to stop the spread of diseases and parasites.

  5. Dr. Porcupine

    My, my… where to begin. I know, let’s start with some factual information rather than speculation. According to the CDC: “Hookworm eggs are passed in the feces of an infected person. If the infected person defecates outside (near bushes, in a garden, or field) of if the feces of an infected person are used as fertilizer, eggs are deposited on soil. They can then mature and hatch, releasing larvae (immature worms). The larvae mature into a form that can penetrate the skin of humans. Hookworm infection is mainly acquired by walking barefoot on contaminated soil. One kind of hookworm can also be transmitted through the ingestion of larvae.”

    If you objectively consider this information, you will immediately see how G.J. Gage’s position doesn’t hold much weight. First, how many people do you think actually defecate outside? Yes, I’m certain it happens, but seriously, does anyone think it happens frequently? Second, among those who do this, how many actually have the hookworm larvae in their body? Third, call me crazy, but all people generally avoid stepping in feces. In your lifetime, how many times have you actually stepped in feces of any type? I have spent a lot of time outdoors in my life and I would guess maybe a dozen, and I seriously doubt any of it was human. Now, for someone who does have the hookworm infection to spread it to another person, that would mean that the individual would have to have enough infected feces on their body to transmit it to another person who in turn doesn’t realize they have infected feces on them, and then get that contaminated feces into their body’s intestinal tract via the mouth. How often do you think that happens? And how do you prevent that from ever happening? It’s called washing your hands. The issue is not about someone’s lack of shoes, it’s about the other person not utilizing proper hand-washing, which is also the reason that most other infectious diseases like the flu and the common cold are transmitted from person to person.

    To take this a step further, the CDC also says hookworm is most commonly found in warm and humid regions where feces is frequently used as fertilizer and hygiene is poor (e.g a lack of clean water for bathing and hand-washing). Now, if you are using feces as fertilizer, it is highly plausible that you are growing food, which you will work with using your hands. So you dig a hole, move some dirt, pick some produce, and whether you are wearing shoes or not, you are going to get potentially contaminated soil on your clothing and hands, especially under the fingernails. You don’t wash that produce or your hands well enough? Guess what, you can catch hookworm.

    How does the CDC recommend preventing transmission of hookworm? Here is their advice: “The best way to avoid hookworm infection is not to walk barefoot in areas where hookworm is common and where there may be human fecal contamination of the soil. Also, avoid other skin contact with such soil and avoid ingesting it. Infection can also be prevented by not defecating outdoors and by effective sewage disposal systems.”

    So we avoid areas where hookworm is common AND where you are likely to come into contact with fecal matter, don’t touch that dirt with any part of your skin, don’t eat the contaminated dirt, and use the toilet instead of the ground. Pardon me for pointing out the obvious, but when exactly was there a massive breakout of hookworm anywhere in the United States since the early 20th Century? I’ll make this easy for you; hookworm infections in the developed world are so rare that the World Health Organization doesn’t even have data on it. Cases of hookworm are prevalent in third-world/periphery countries where poverty is widespread and there is a substantial lack of clean water and medical care, not the United States.

    If you are concerned with personal ettiequte and the spread of disease, then worry about people who don’t wash their hands frequently, especially after using the toilet. Worry about people not keeping their vaccinations up-to-date. Worry about people who choose to expose their classmates, co-workers, and others they encounter because they don’t stay home when they are sick and contagious. If the writer of the original letter is genuinely so concerned about the health and well-being of people in other countries, I would challenge her/him to take action toward helping these countries develop resources so clean water and basic medical care is readily available or coordinate a campaign to collect and deliver donated shoes, but for pete’s sake, stop stereotyping and scapegoating people who choose to live differently than you do. If you actually did some honest research on how your lifestyle choices as a person in a developed first-world country negatively impact people in the “long list of countries” I presume you are referring to, I am pretty sure you wouldn’t give Mr. Sands’ choice to go shoeless a second thought.

  6. Kriss

    This letter (which is in response to my letter of 2 weeks ago) is so devoid of facts that it would be laughable if it weren’t so sad. So sad that in this day and age of enlightenment and easily obtained information, the writer’s only knowledge and concept of this issue is to only repeat urban myths he or she has probably heard someone else repeat.

    There are NO health codes or ordinances that require customers to wear shoes in any business, restaurant, grocery store, or other public place. Neither in North Carolina, nor in any other state in the United States. That is a fact, and if someone doubts it, just call your local health department and ask them. But it is, unfortunately, a myth believed by many.

    Hookworm infection is a total non-issue in the U.S. and other developed countries. Hookworm infection can only occur in places where human beings, that are infected with hookworms themselves, have left their infected feces out in the open on the ground, and the larvae from that infected human feces is still alive and viable. First, human beings in this country are highly unlikely to have been infected with hookworms in the first place, and even if they were, they are highly unlikely to be defecating directly on the ground and leaving it there where someone else might be spending enough time barefoot for the larvae to attach itself to the skin. So hookworms pose no threat whatsoever to someone going barefoot at the fair or any other place around here.

  7. quila

    Wow! If this worm can spread through hand to hand contact, why isn’t wearing gloves regulated by law? I think you should do some further research.

  8. J. Johnson

    If shoes be required for public safety because the fairgrounds are so unsanitary as to be contaminated with human feces containing live hookworms, I would rather not attend. If the fair is not safe enough for barefeet then it’s not safe enough for my family.

  9. maharet

    You are a complete ignoramus. You have no idea what the heck you’re talking about. Instead of just spouting nonsense from a place of fear and uncertainty you should have fact checked before you send in a letter bashing people’s lifestyle and opinions.

    • bryan

      I actually loled when I read the OP. I won’t detail the facts that have been iterated in previous posts about hookworm, but I’ll take a stab at your history lesson comment.

      Purpose of learning history: Learning history is about understanding the past to avoid mistakes that have already happened and is also to understand how we got where we are today. As far as understanding the past, understanding is connecting the dots. Connecting the dots here can be understood as correlation vs causation. While you may be correct that at that time in US history there was a higher rate of infection, you missed the point. Those times were CORRELATED with high infection, but the CAUSE wasn’t people walking around barefoot, it was the sanitation of the time, mostly indoor plumbing not being a thing. You mention that because of this time of infections that the US passed some health ordinances, please cite your source. You as the arguer are duty bound to provide the background information relevant to your arguments, not us.

  10. G.J.Cage seems to be an educated person and writes very well. It’s really surprising to me to read such nonsense and myths coming from such a person! Usually when someone is guilty of posting outdated information that ignores the current state of scientific research their basic ignorance is readily detectable, but not in this case. Thankfully others with REAL knowledge of the subject have steered readers here straight.

  11. Dan

    Ignorance like Mr. Cage is showing, is common in our society, in regarding to those of us who chose to live barefoot for whatever reasons.
    I have been walking barefoot everywhere, and every so often, you get an ignorant person like Mr. Cage who would come and say to you “You know it is unhealthy to walk barefoot”, and my answer is (if I even choose to answer) “No it is not, check your facts”.
    Society is obsessed with what is called the norm these days, and the norm is – unless you are at home, on the sea shore, in the park, or in the pool – you must wear shoes to protect your feet !!! Our feet are doing fine, and need no protection (other then in the extreme, like freezing weather), Man has been barefoot for thousands of years, and out feet are meant to be barefoot – not shod.
    Why is this so hard to understand?

  12. Kriss

    Most of the comments so far have mainly addressed hookworm infections and the misinformation stated or implied in Mr./Ms. Cage’s letter. All these responses have been well stated and accurate. But I want to elaborate on something I’d mentioned in a comment earlier, in which I stated there are NO health codes or ordinances that require customers to wear shoes in any business.

    Mr./Ms. Cage referred to “the ‘No Shoes, No Service’ public health codes.” Such signs on some businesses began in the United States in the late 1960s or early 1970s as a response to the hippie movement, and more particularly in response to Vietnam War protesting hippies and the more radical yippies.

    Their views were considered very un-American by many who supported the government and its policies, but since our constitution guarantees free speech, it was difficult to stop what was going on. One way that evolved was to attack their mode of dress, which was as unconventional as their views. Bare feet or no shirts in public places, though not necessarily commonplace before that period, were nonetheless never an issue of health or cleanliness or any reason to ban anyone from entering a business. However, as it became apparent that the hated hippies quite often went barefoot, and perhaps shirtless as well on occasion, this unconventional manner of dress gave many conservative thinking business owners an easy way to identify, isolate, and ostracize what many felt was a dangerous political movement.

    The idea of banning these undesirables based on their attire caught on, and at some point somebody came up with a cleverly worded sign using the word “NO” in large letters to cover two instances of unconventional attire that would result in not being served. It’s interesting that “shoes,” “shirt,” and “service” all begin with the same letter, and placing the same word in front of each results in a succinct and cleverly alliterative discriminatory dress code. They probably would rather have used “no entry” or “no admittance” instead of “no service,” but that just wouldn’t have rolled off the tongue quite as well.

    So, in other words, those signs and those attitudes started out as political statements, not dress codes based on any reason that may be claimed today, such as health, laws, liability, etc. People of today’s generation have no clue as to how or why they got started. They just assume that’s the way it’s always been and always should be, without even giving it a second thought – and that’s a shame.

    There were no major Vietnam War issues or hippie protestors in other parts of the world – at least nothing like the political upheaval in the U.S. So other parts of the world never started posting signs; so other parts of the world never got brainwashed into believing that bare feet are a bad thing that need to be banned. That’s how the signs and the negative attitude got started in the U.S.

    But contrary to Mr./Ms. Cage’s reference to the signs as “public health codes,” they are not that and have never been based on nor reflected any public health code, because there have never been any health codes that require customers or patrons to wear shoes. Why would there be? Bare feet do not touch anything except the floor of a business or other public facility, just like shoes do, and therefore are no greater health hazard than shoes could be. Health departments all across the country have the knowledge and expertise to know that bare feet are no threat to the health of anyone inside any kind of business – food service or otherwise – and that is why there have never been any such requirements related to what a customer wears or doesn’t wear on his or her feet.

  13. Great Bandini

    Fact – people do in fact deficate outside. Homeless and transient people are prevalent in Asheville and do frequent certain areas of Asheville (parks etc) and do sometimes have worms.
    Further FACT – dogs can transmit hookworm to humans! Naturally -most dogs defecate outside and I have seen people walking barefoot at/inside the Carrier Park Dog Park! (EW!)

    FACT – Hookworm can infest soil for up to two years , even throughout the winter etc..

    C.J. Cage was basically right in bringing up the fact that there are health considerations for oneself and the greater public health in going shoeless. Shoes have mitigated worms here (and our great plumbing as others have noted).

    B

    • Kriss

      “Fact – people do in fact deficate outside. Homeless and transient people are prevalent in Asheville and do frequent certain areas of Asheville (parks etc) and do sometimes have worms.”

      Yes, people do defecate outside sometimes. But if you’d actually done some research on this (or read some my other comments), you’d know that human feces must be infected with the hookworm larvae from an already infected person before it could potentially spread hookworm infection. As to homeless people having “worms,” there are many types of human parasitic worms, but I’m assuming you mean hookworms, since that’s what this is about. But I doubt very much that homeless people have hookworm infections any more than the population at large, the chances of which nowadays in the United States are miniscule, if not virtually zero.

      “Further FACT – dogs can transmit hookworm to humans! Naturally -most dogs defecate outside and I have seen people walking barefoot at/inside the Carrier Park Dog Park! (EW!)”

      If you mean dogs can transmit the type of hookworm that infects the intestines of humans, no, that is not a fact. Hookworms from animal feces are not the same type of hookworms that can be contracted from infected human feces, the type we generally think of when we talk about “hookworms.” As to humans actually getting infected with this type of animal hookworm, this is what the CDC has to say:
      “When people walk or sit on beach sand or soil where infected dogs or cats have defecated, the dog or cat hookworm larva can penetrate the skin of the foot or body and migrate in the top layers of the skin. This migration causes severe itchiness and raised red lines can form as part of the reaction to the larva in the skin. The larva will die in the skin after several weeks without developing any further, and the itchiness and red lines will go away…”

      That skin condition caused by dog or cat hookworm infection is called cutaneous larva migrans. If you care to do more research, more on that topic can be found here: http://www.cdc.gov/parasites/zoonotichookworm/gen_info/faqs.html

      Also, in an article from the Cornell University College of Veterinary Medicine, http://bakerinstitute.vet.cornell.edu/animalhealth/page.php?id=1097 , they talk about this type of infection that can be contracted from infected canine feces:
      “Lesions appear as red lines under the skin and sometimes break open at the skin’s surface. The condition causes no harm beyond severe itching, and usually disappears within several weeks as the larvae die.”

      I’m sure the vast majority of people who take their dogs to the Carrier Park Dog Park or any other dog park take good care of their pets and any medical conditions they may have. In any case, in the rare event that someone did get this type of infection from infected dog feces, the resulting temporary minor skin condition is really nothing much to worry about.

      “FACT – Hookworm can infest soil for up to two years , even throughout the winter etc..”

      No, that is not a fact. You may be thinking of how long a hookworm infection can remain in someone’s body. In this CDC article, http://www.cdc.gov/dpdx/hookworm/ , they state:
      “Most adult worms are eliminated [from the small intestine, where they reside] in 1 to 2 years, but the longevity may reach several years.”

      In the same article, they state: “These infective larvae [filariform (third-stage) that are in the feces and/or the soil] can survive 3 to 4 weeks in favorable environmental conditions.”

      “C.J. Cage was basically right in bringing up the fact that there are health considerations for oneself and the greater public health in going shoeless.”

      No, C.J. Cage was just as misinformed about these matters as you seem to be.

      • Great Bandini

        Not sure why you can’t admit that shoes have helped greatly to mitigate worms (and other health problems) in this country and it’s probably not a good idea to have a totally barefoot society. Advancements like shoes (and plumbing) are big reason why you can go barefoot here without much worry. I’m guessing it irks people when you are actually preaching from the soapbox of advancement. People posting here saying “hookworm is hard to get and easy to cure” are actually in turn championing the health advancements of this country as that was not always the case. You and others seem to be saying “I’m o.k. cause there are so few of me.” If MANY people went barefoot – good plumbing or not – hookworm and other health problems’ chances of making a comeback are undeniably greater- that is just infectious disease science.? Yes, bad shoe design can cause posture problems etc. , but the benefits ( lower infant and mother mortality for one) of shoes no doubt have outweighed the cons.

        Shoes are definitely considered a health advancement as anyone working in developing countries will attest. Villages are commonly de-wormed by healthworkers and THEN given shoes as it is cheaper and more feasible than installing modern plumbing. No, shoelessness of course does not cause worms- but having shoes is the prime DETERENT to getting them – as the CDC sight that many people quote here states. The world is not perfect- feces, even in the best of worlds makes it to the ground (porta-potties do spill when being taken away/emptied at a state fair). Most of us know (through being informed or through the echoes of cultural lessons) that the factor we can control in all this is to wear shoes. We error on the side of caution – don’t think we are stupid for that.

        Having myself worked with homeless people (and traveled in third world countries) I am informed and aware that homeless people have a host of diseases not common in the general public because they lack healthcare, clothing, shoes and frequent places where people defecate outside. Worms are indeed more prevalent among this population (as is T.B. and other diseases not common elsewhere). We frequently gave out shoes to homeless people as the shoeless were far more prone to serious infections from/through lesions, cuts and rashes (like the one you can get from dog hookworm) on their feet. They are also at a far greater risk to pneumonia and illness from heat loss through the feet. Your “doubt” about the prevalence of worms in the homeless sounds like wishful thinking (as does your hope that people de-worm their dogs – I know for a fact that there are many dogs in Asheville that never see a vet- and no most of us don’t even care for a rash). Hookworm likewise does exist in the general public and is not at “zero”. I have indeed known someone who had it.

        You and others are actually saying “I’m o.k. because there are so few of me now.” If MANY people went barefoot – good plumbing or not – hookworms chances of making a comeback are undeniably greater- that is just infectious disease science. Yes, bad shoe design can cause posture problems etc. , but the benefits ( lower infant and mother mortality for one) of shoes no doubt have outweighed the cons.

        There may not be health codes on any books anywhere (?) and people may be misinformed about that but if there is a cultural “taking pause” toward public shoelessness it comes through many years of hard earned health lessons and reasonable science. If you are not willing to see that you are missing a big piece of the puzzle in your frustration.

        Best,
        Bandini

        • Sandy

          Knee, hip, back, and ankle problems are serious health issues in developed countries, related to a life time of wearing shoes. One of the leading causes of death in seniors in the United States is falling – which is the result of poor balance and weakened ankles – again resulting from a lifetime of wearing shoes. These are problems that do not occur in populations that are habitually shoeless.
          There’s also the fact that people with foot pain and knee pain are less likely to walk or be active, and physical inactivity is a major factor in heart disease.
          It is not merely bad shoe design. It is that any shoe restricts the more than 70 muscles in each foot from exercising,and those muscles atrophy. Think of putting your hand in a splint 10 hours a day, every day. Now try to open a jar. Why do people need physical therapy after an arm or a leg is in a splint ? But we restrict the motion of a significant part of our body – our feet – day after day and think there will not be a consequence on the ability of the foot muscles to work properly.
          There’s also the fact that people just walk differently barefoot than shod. They take shorter steps. They are less likely to Iand on their heels. They are more likely to be aware of where they are stepping.
          I personally had continual knee and ankle pain, could not walk a block, was on the path to a knee replacement a year and a half ago when I decided to give walking barefoot a try. I now walk almost everywhere barefoot, and my knees no longer hurt. I can walk two miles comfortably. I’ve climbed a mountain in Vermont barefoot. I carry a note from my orthopedist that I am walking barefoot for medical reasons. Frankly, given the remote possibility of puncture or hookworms versus the fact that with shoes, even “good” shoes, I was in constant pain, was on the path to knee replacement, and my ankles were so weak I couldn’t walk across a parking lot, I prefer the benefits of walking barefoot against a remote possibility that i could pick up hookworms.

          • Dan

            I agree with sandy 150%. over a year ago, after suffering from back pain for a long time, and doctors wanted to operate, or have me live on pain killers, I figured I have nothing to lose, and chose the barefoot life style. My back does not hurt me any longer, I never injured my feet by walking barefoot, and I am happy and healthy.
            I myself wrote to the New York health department, and have a letter from them, stating the fact that there are no codes, or laws regarding entering any business with bare feet.
            I think Mr. Cage needs to check his facts, before talking about things he know nothing about (or so it looks).
            I invite anyone interested to log into my website http://www.barefootny.com and check out all the info regarding the barefoot subject, and the society that just hates bare feet.
            Hookworms are a subject from the past, unless you live in a farm, and work in the fields barefoot. As a barefooted guy I found out that I watch where I go, and what I step on more then I did when shod.
            Worried about hookworms – start wearing gloves too, you get it much faster then with your bare feet.

          • Kriss

            Great post, Dan. But I just want to clarify, someone living on a farm and working in the fields barefoot is not going to get hookworm simply due to working in the dirt barefoot. It takes infected human feces to have recently contaminated the soil to make such circumstances even a remote possibility. And that’s highly, highly unlikely in this country, or any developed country in the world. It actually feels great to be barefoot in freshly plowed dirt, as I’ve done it many times.

        • Kriss

          Bandini, the premise of your whole argument seems to be that shoes are the greatest invention known to mankind, the miracle cure for practically anything (prevents pneumonia? lowers infant mortality?), and anyone who would choose to do without him would have to be really stupid. You also attribute shoes to the virtual elimination of hookworm infections in the United States and other developed nations of the world. The fact is that it is modern sewage systems that have practically eliminated any risk of hookworm infection, not the wearing of shoes.

          “…but having shoes is the prime DETERENT to getting them – as the CDC sight that many people quote here states.”

          That’s not what the CDC actually says. What it does say related to wearing shoes is this:
          “People living in areas with warm and moist climates and where sanitation and hygiene are poor are at risk for hookworm infection if they walk barefoot or in other ways allow their skin to have direct contact with contaminated soil. Soil is contaminated by an infected person defecating outside or when human feces (‘night soil’) are used as fertilizer.”

          The point here that any exposed skin – not just bare feet – that has a direct contact with soil contaminated with infected human feces is at risk. So, if there is human feces lying around that is in fact contaminated with live hookworm larvae, or soil containing it – hardly likely in the U.S. and other developed countries, “where sanitation and hygiene are [not] poor” – then yes, a barefoot person spending a lot of time in such places would be at risk. If that person were wearing shoes at the time, they would most likely be at less risk.

          But your argument seems to be that anyone barefoot anywhere is at a very strong risk for hookworm infection all the time. It’s just not so. You could use almost the same reasoning to tell people they should never go outside without wearing a hat, because some people have developed skin cancer on their face or head area due to sun exposure that might have been prevented by always wearing a hat. But what are the chances? Slim. But I would guess that the chance of getting skin cancer (certainly potentially a much more deadly disease than a hookworm infection) on the face or head due to not ever wearing a hat is enormously greater than the chance of ever getting hookworm from going barefoot in the U.S., yet no one seems to ever make a big issue out of someone’s choice not to wear a hat as they do about a choice to not wear shoes.

          Neither I nor anyone else is saying that shoes don’t have some place and use in today’s world. As someone else mentioned, their only practical use is as tools, not much different from gloves. People don’t wear gloves every waking hour; they only wear them when needed to protect from severe weather or other conditions that would cause actual physical injury to the hands. Also no one is denying that there is risk in the world. Just living life involves risk. It should be each individual’s right to decide for himself/herself what risks, if any, are worth taking and which are not.

          I’d say if you love shoes so much, by all means please wear them. But implying that others who’ve made an informed decision to not wear them don’t really know what they are doing or are “missing a big piece of the puzzle” only reflects your own arrogance and refusal to accept others’ personal decisions that may different from your own.

  14. mg massey

    don’t have a dog in this fight bt I do have a question.. AS a Tsalagi (Cherokee) I pray morning and night barefoot on my property.. I ponder the risk ,but figure if I avoided animal feces and made sure I didn’t step in it.. I was okay,.. Have loved going barefoot since a child .Love the feel of grass and the earth beneath my feet. However I also see the risks.. Wild Turkeys roam my yard.. and I make certain.. they have not been roaming when I do this.. Come winter I’ll probably alter my behavior. Balance and common sense and making sure you don’t go barefoot around large groups of people I think is common sense. Not to mention not stepping in any thing left behind by other living beings seems wise.
    Yes I love barefoot but I wouldn’t go barefoot anywhere that I didn’t have some knowledge of what could be out there. COmmon sense is about as common as ethics in Washington DC.

  15. Kriss

    MG, I’m not exactly sure what your fears of walking barefoot where there might be animal feces are based on. Unless it’s a matter of personal squeamishness, I’m not aware of any harm that could come to your feet or your body if you stepped in it. If you live out in the country and are walking outside on the ground, you’re probably stepping in animal feces anyway sometimes without even realizing it. It’s just part of nature and the natural order of things for it to be on the ground from a variety of wild animals that roam around, and no harm comes from it. I live basically in the woods on the side of a mountain, where lots of animals roam around all the time – including wild turkeys as you mentioned, also deer, possums, raccoons, rabbits, squirrels, and an occasional bear. Not only that, I have chickens and step barefoot in chicken poop almost every day. Not on purpose, as I try to avoid it, but sometimes it’s unavoidable especially when I need to go into the chicken house or pen to do some maintenance. It’s just no big deal and easily washed off before going back into the house. I really don’t think you have anything to worry about as you go barefoot on your property. Or anywhere else, for that matter. I’ve been doing this for many years, and my feet have never been stronger or healthier.

  16. Steve Rogers

    If I lived in an impoverished area where there was no sanitation systems in place, then I might consider wearing shoes more. Wikipedia has a lot of good info on this topic:
    “A majority of these infected individuals live in poverty-stricken areas with poor sanitation. Hookworm infection is most concentrated among the world’s poorest who live on less than $2 a day”

    Sometimes increased bacteria and parasites can actually help us too:

    “a study in Gambia found that eradication of worms in some villages led to increased skin reactions to allergies among children.”

    “Moderate hookworm infections have been demonstrated to have beneficial effects on hosts suffering from diseases linked to overactive immune systems. This is possibly explained by the hygiene hypothesis.[45] Research at the University of Nottingham conducted in Ethiopia observed a small subset of people with hookworm infections were half as likely to experience asthma[55] or hay fever.[56] Potential benefits have also been hypothesized in cases of multiple sclerosis,[57] Crohn’s Disease[58] and diabetes.[59]”

    I have no reservations about walking almost anywhere in the US or any other developed country.
    Common sense is not very common. True. People often do what is “normal” and never question why. I had foot trouble and started to question why and it lead me to walking barefoot most of the time and my feet are thanking me for it.
    “These feet were made for walking”
    Finally, walking barefoot just adds another dimension to the world. It’s great to feel the world with my unmuffled feet. So many textures, temperatures and sensory input to be experienced. I wear shoe when I have to, like in extreme temps and to keep my job. Shoes as tools, just like gloves are tools only necessary for certains jobs and conditions.

    • Kriss

      Also interesting, Steve, from the same Wikipedia article:
      “These health education programs often stress important preventative techniques such as: washing your hands before eating, and staying away from water/areas contaminated by human faeces. These programs may also stress that shoes must be worn, however these come with their own health risks and may not be effective.[19]”

  17. Jeff Dill

    This is real simple. Does Kriss being barefoot affect your health in your shoes? No? Then who cares what your opinion of his safety to himself is? He’s a grown – ass man and can take care of himself.

    • Kriss

      Good point, Jeff. The thing is, if someone prefers to wear shoes, for whatever reasons, that does not somehow bestow upon him or her some kind of superior knowledge and authority to condemn others who may choose otherwise. Many of us, such as I, who have chosen a barefoot lifestyle, do not do it blindly. We have diligently researched any and all aspects of not wearing shoes – including legal, medical, health, physiological, social, historical, as well safety and potential risks – and have made the informed decision that being barefoot is the best way to live. We’re not telling others they should ditch their shoes and start going barefoot (though we do believe if they did, they’d have much healthier feet and have a healthier and better functioning body generally), so we don’t feel shoe-wearers should be telling us we should not go barefoot. It should really be none of anyone’s concern what others choose to wear or not wear on their feet, as being barefoot is perfectly legal everywhere (in spite of some popular myths to the contrary) and does absolutely no harm to anyone.

  18. I don’t want to start a personal attack so I won’t mention names but another poster claims shoes helped reduce worms. How exactly do they accomplish this? I was under the impression they were intestinal parasites that came from ingesting the eggs of the creatures. Or am I wrong in thinking this? Even if shoes were able to help in this reguard, other parts of the body are uncovered like legs, arms, hands. Wouldn’t the worms get flung up on to these body parts by normal activity? You also claim shoes are a health improvement. Maybe so but not a recent one. There are examples of various types of shoes dating back several thousand years. Coming into contact might be gross but not harmful. I have dogs that do their business in a fenced in backyard where I am frequently barefoot. The poop that I see I avoid. I’ve also missed seeing poop and stepped in i it but no parasites, diseases or anything unpleasant other than a dirty foot. As far as letting culture dictate my health decisions, it used to be culturally acceptable to smoke as well but we all know how bad that is as well. May I suggest barefoot is something your unused to but might be comfortable with if you have it a chance?

    • Kriss

      Bill, it’s not a personal attack to disagree with someone or point out errors in their thinking. As to intestinal parasites in general, true, many cannot infect someone unless they are ingested. But I think the main topic here has been specifically hookworms, which are the type of parasite that can enter the body directly through the skin. The issue is, how prevalent are they and what’s the risk to barefooters? The answer is, not prevalent at all in this country and not any significant risk whatsoever to barefooters. Also, as a rule, stepping barefoot in any kind of animal feces is not going to do you any harm.

      Good point about smokers being the cultural norm at one time. I’ve never smoked, and can remember 30 or 40 years ago, as a non-smoker, feeling kind of out of the mainstream. Kind of the way I feel now as a barefooter.

  19. own2feet

    Sadly, the letter by G.J. Cage reflects a common assumption that going barefoot is somehow “bad.” Other commenters have pointed out the factual inaccuracies in Cage’s letter, so I won’t reiterate them here. I’ll just say that people who enjoy walking barefoot are enjoying a simple, down-to-earth pleasure that in no way harms others. As Kriss pointed out in one of his comments, the “no shoes, no shirt, no service” mindset began as a way to block “hippies’ from entering businesses. It is a cultural artifact from another era with its basis in discriminatory attitudes, and it’s long past time to abandon such misguided policies. I personally enjoy going barefoot and would go barefoot to the fair if I could, but since the fair directors would rather act in a heavy-handed manner than allow freedom of choice, attending the fair would be akin to endorsing their irrational fears and prejudices. I have better things to do with my time than tacitly support those who would deny freedoms to their fellow Americans.

  20. Smart dust

    Hook worm can be caught from showers that dont drain, drinking tap water, eating vegetables that were fertilized with feces. You can wear crocks and those worms can still find your foot. The US healthcare system is currently referring all hookworm patients to mental counseling. The drugs dont work if the worms have spread beyond the GI tract. Other parasites will help spread the worm such as scabies. The infected should not be referred to mental institutions but should be treated with compassion and placed into isolation. It is highly contagious when airborne on other vectors.

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