The Hidden Dangers of Narrow Toe Boxes in Shoes: A Foot Health Perspective

Foot health is important. Similar to oral health, heart health, gut health, and all other “healths,” we can do things to maintain peak performance –but we don’t always do them. Or we ignore glaringly obvious issues that negatively impact how our feet are made to work. While I’m no health doctor, I do know a lot about foot health. 

Here’s the thing — if you want to move efficiently and effectively, you must focus on top-performing feet. Sadly, mainstream shoe brands actively sabotage that quest with narrow toe boxes and ill-fitting shoes.

So, let’s unpack what foot health even means, starting with why narrow toe boxes are detrimental to foot health and why we’re literally paying big bucks to mutilate our feet. 

Who is this post for?

  • Younger individuals who wonder why our shoes don’t match the shape of our feet. 
  • Older individuals who suffer from conditions such as Hallux Valgus (bunions), Hammer Toe, or Morton’s Neuroma.
  • Individuals who are conscious about foot health and longevity.

Which Altra Shoe is for you?

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Understanding Foot Anatomy

Before jumping into shoe design and proper fit, we must look at our feet and how they work. 

Compared to much of the body, the foot is a complex, intricate structure composed of bones, muscles, tendons, and ligaments. With 26 bones, 33 joints, and over 100 muscles, tendons, and ligaments, it’s an amazing structure. 

This complex structure allows for a wide range of movements that are adapting to the load put upon them and the surface underfoot. 

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So why are we wrapping our feet up and reducing flexibility, movement, and sensory input?

For over 1000’s years, humans have been covering the feet to protect the exposed skin from sharp objects and hot/cold surfaces. It makes sense. 

What’s relevant to us is that even though these designs have changed marginally throughout those 1000’s of years, we’ve only recently started seeing the prominence of higher heels, highly cushioned soles, pointed toe boxes, and overall more restrictive shoes. 

This begs the question, are modern shoes really designed for the human foot?

The Importance of Proper Shoe Fit

A proper shoe fit is not just about comfort but health and longevity. 

Many studies have shown that ill-fitting shoes can cause many issues ranging from blisters all the way to bunions (Hallux Valgus). 

One study found that certain footwear characteristics, such as high heels and narrow toe boxes, were associated with foot pain and deformities in older women, including hallux valgus.

But you may not identify as an older woman –so there’s nothing to worry about, right?  Wrong.

Further into the study, they found that wearing shoes with a very narrow toe box during your 20s and 30s may significantly increase the likelihood of developing hallux valgus later in life. 

So it’s not just what you do late in life; it’s your early life, too! Studies show the effects can start as soon as you’re wearing footwear (however, more studies are required on this topic to make this conclusive.)

What if you could build a more sustainable running experience by making simple tweaks that result in faster times and bigger distances…

Why Do Shoes Have Narrow Toe Boxes?

One area of particular concern is the shape of a shoe’s toe box.

Looking at many modern athletic and fashion shoes, you’ll see that the toe box narrows to a point. 

Although this may seem “normal” to you, it makes little sense when analyzing the shape of a human foot. 

Most human feet are shaped like a wedge, longer at the big toe and shorter towards the little toes. While some have a longer second toe (Morton’s toe), the shape is still relatively wedge and certainly not pointed. 

Fan feet

So why are shoes not anatomically shaped like a human foot? 

There are several theories on why shoes may be shaped in such a way, and the likelihood is that all are true to a certain extent. 

  • Early Fashion: In medieval Europe, around the 12th century, the pointed shoe was popularized. These shoes were worn by the upper class and wealthier members of society as a symbol of their status. The more extreme the shoe’s shape, the more it signified the wearer’s social standing, as the shoes were impractical for those who needed to work or walk extensively throughout the day​​.
  • Horse Riding Functionality: Pointed-toed shoes were created for practical horse-riding purposes. The pointed toe made it easier to fit the shoe into stirrups, providing more stability for riders. This design catered to the functional needs of equestrians before becoming a fashion statement in other contexts​​.
  • Prevent foot movement in athletics shoes: Athletics shoes are designed with a high heel drop (higher at the heel and lower in the forefoot), which can cause the foot to slip forward and bump the toes up against the front of the shoe. Laces hold the foot back to an extent, but restricting the width at the toe box was more effective, so we started to see pointed toe boxes. 

None of the above points address foot health issues or solve a movement problem.

Health Implications of Wearing Tight Shoes

Hallux Valgus (Bunions)

hallux valgus

Hallux valgus, also known as a bunion, is a condition where the big toe angles inwards towards the other toes, making it difficult to walk and potentially causing foot pain. If your big toe is not aligned on a straight line from your heel through the forefoot, you suffer from Hallux Valgus to some extent. 

A study by Montiel et al. showed a strong correlation between bunions and the use of individuals wearing shoes with constrictive toe boxes. 

This alone should make you stop and think about all your footwear. If it doesn’t, please keep reading.

Can your big toe splay, or is it squashed into the rest of your toes? Squashed toes devoid of natural splay movement is potentially setting you up for issues in later life.  

Hammer Toe

hammer toe

Hammer Toe is a condition where the second to little toe curls downward when the foot is in a relaxed position and is caused by a tightening of the muscles and tendons that control the motion of the toes. 

Studies have linked narrow toe boxes, especially high heels, to hammer toes and theorized that the constriction of such footwear over long periods of time fixes the position of the toes permanently. 

Whereas the studies are less hard-hitting than those related to Hallux Valgus, they may prompt you to rethink the use of those dress shoes for work or the persistent use of ill-fitting narrow Nikes. 

Morton’s Neuroma

mortons neuroma

Morton’s neuroma is a painful condition that affects the ball of the foot between the third and fourth toes. It occurs due to the thickening of the tissue around one of the nerves that leads to the toes and results in symptoms such as a sharp, burning pain or numbness in the forefoot and toes.

The same Hammer Toe study also found that Morton’s Neuroma was present in those who frequently wore high heels, leading us to believe ill-fitting shoes can cause such issues.

Considering all the issues with constrictive footwear, it seems immensely important to choose footwear that fits correctly, i.e. fits our natural footshape —which commonly means a wider toe box! 

Choosing the Right Shoe

How do we avoid these feet ailments and maintain healthy foot function into our older years? 

Simple: find shoes that fit well and allow our toes to splay naturally. 

However, be aware that our feet are shaped differently from one another, so one person’s wide toe box may be different from another. But some common brands and models fit the bill for everyone, you just need to “shop” around until you find the right one for your feet. 

altra lone peak 8 hero


Altra is a brand that popularized the “anatomical foot shape.” Simply put, that means the shoe is shaped like a foot! 

Their toe boxes are wide, and they create various models to suit different foot types. 

Altra is also the one brand on this list with substantial cushioning. I usually  like to promote low-to-the-ground barefoot-style shoes (that’s a whole other blog post topic!); but Altra options can be great for faster-paced workouts, rocky trails, and recovery runs. Meaning, Altras have their place in my books.

If you’d like to learn more about the many Altra models, head to the Altra review page to read all about them! 

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Altra Lone Peak 8

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Altra Lone Peak 8

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Altra Superior 6

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Altra Escalante 3

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Altra Lone Peak 7

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Altra Torin 7

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Altra Outroad 2

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Altra Rivera 3

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Altra Torin 6

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Altra Outroad

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Altra Timp 4

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Altra Superior 5

xero shoes aqua x sport hero

Xero Shoes

Xero Shoes is one of the US market’s biggest minimal/barefoot brands. 

As a minimal/barefoot brand, their shoes are thin and low to the ground which is great for long-term foot health. Just be sure to work into minimal shoes slowly. If you need help, I’ve written a perfect barefoot plan to follow to get you running in minimal shoes in “safe 6 months”.

Many in the barefoot scene scold Xero Shoes for their narrower toe boxes, but that’s only when compared to other brands I’ll mention later. 

Personally, I found Xero Shoes to be more than wide enough. And they also fit my deeper, wider midfoot too! 

They have LOTS of models, so head over to the Xero Shoes review page to learn more!

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Prio Neo

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Forza Runner

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Scrambler Low

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Lems Primal 2 hero


Lems are perfect for those looking for casual, very wide toe box options!

If you have a wide toe splay, meaning your toes fan out when under load, Lems can be a great option, and when you look at their shoes from above, it’s obvious to see why. 

Another plus point for Lems Shoes is the flexible materials used in the uppers, which allow the foot to flex and perform exactly how they were designed! 

You’ll find a range of minimal to cushioned Lems shoes, and for now, I have reviewed the Lems Primal 2, which is the only real viable running option in their lineup. 

Vivobarefoot primus lite knit hero


The last brand on this list is a barefoot powerhouse coming to you from the UK. 

Commonly noted as the stylish option for barefoot lovers, they sell a huge range of performance, fashion, hiking, and casual options. So you’re sure to find a perfect choice. 

It’s worth noting that all Vivobarefoot shoes are minimal, but again, that minimal nature also nurtures foot health and longevity, so it’s worth checking out barefoot options for long-term foot health. 

**Again, don’t jump into the deep end of minimal/barefoot shoes if you’re coming from Hoka-like stack heights! Easy does it, and you can follow my barefoot plan to get you running in minimal shoes in “safe 6 months”.

To learn more about the athletic offering from Vivobareoot, head over to the Vivo review page, where you’ll find some of my favorites! 

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Vivobarefoot Primus Trail Knit FG

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Vivobarefoot Primus Lite Knit

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Vivobarefoot Primus Lite III

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Vivobarefoot Primus Trail


If you’re suffering from any foot conditions mentioned in this post or others that may not have been mentioned, it’s important to seek professional help! But I don’t think it stops there. 

You can advocate for your own foot health.

The first step is to find shoes that fit your feet correctly and a pair that are shaped with a wide enough toe box to allow your toes to splay! 

Whether that’s cushioned options from Altra or minimal shoes such as Xero Shoes or Vivobarefoot, there are so many options out there! 

And if you’re ever in doubt, feel free to reach out to me on Instagram or via email, and I’ll do my best to put you on the right path! 


Nick is a UESCA-certified ultramarathon coach and avid barefoot runner, having over 5 years of experience in barefoot training and has competed in multiple ultra marathons wearing barefoot shoes. Starting his journey in the running industry over 10 years ago in New Zealand, Nick evolved from a running shoe salesperson to a passionate advocate for the transformative power of barefoot running. He believes in its potential to enhance running experiences for all and combines his unique insights from both personal achievements and professional coaching to guide and inspire the running community."

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  1. Hi Nick,
    It´s amazing you find week after week interesting topics. Great post, highly recommended for EVERYONE to read!
    Best wishes from Austria

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