What Diseases Can You Get From Walking Around Barefoot?

Walking barefoot exposes your feet to a surprisingly long list of infections and diseases, from parasitic worms that burrow through the skin to bacteria that enter through tiny cuts you may not even notice. The specific risks depend heavily on where you are, what the ground is like, and your own health. Some of these conditions are mostly a nuisance, while others can become serious or even life-threatening if left untreated.

Hookworm and Other Soil-Transmitted Parasites

Hookworm is probably the most well-known disease associated with bare feet, and for good reason. The parasites live as larvae in warm, moist soil contaminated with human feces, and they actively penetrate intact skin on contact. You do not need a cut or scrape for them to get in. A study of hookworm risk in China found that people who frequently farmed barefoot faced roughly four times the risk of infection compared to those who did not, making barefoot soil contact the single most significant risk factor identified in their analysis.¹ This tracks with the basic biology: infective-stage larvae sit in the soil waiting for skin to touch them.²

Once inside, hookworm larvae travel through the bloodstream to the lungs and eventually settle in the small intestine, where they feed on blood. Light infections may cause no symptoms at all. Heavier infections lead to iron-deficiency anemia, fatigue, abdominal pain, and in children, stunted growth and cognitive delays. Hookworm remains one of the most common parasitic infections on Earth, concentrated in tropical and subtropical regions with poor sanitation.

A related parasite, Strongyloides stercoralis, follows a similar playbook. It lives in contaminated soil and penetrates the skin of people who walk barefoot, garden without gloves, or otherwise have direct soil contact.³ Studies in rural communities in Northeast Thailand have confirmed that barefoot walking is a clear risk factor for strongyloides infection, alongside living in homes with earthen floors and proximity to water sources.⁴ What makes strongyloides particularly dangerous is its ability to reinfect the same host indefinitely through a cycle called autoinfection, which means the parasite can persist for decades. In people with weakened immune systems, this can escalate into a disseminated, potentially fatal illness.

Cutaneous Larva Migrans

If you have ever seen photos of a strange, snaking red rash on someone’s foot, you were probably looking at cutaneous larva migrans, sometimes called “creeping eruption.” This is caused not by human hookworms but by hookworms from dogs and cats, most commonly species like Ancylostoma braziliense. The eggs end up in soil or sand via animal feces, hatch into larvae, and then burrow into the skin of anyone who walks barefoot through the contaminated area.⁵

The larvae cannot complete their life cycle in a human host, so they wander aimlessly through the outer layers of skin, leaving behind an intensely itchy, winding trail that advances a few centimeters a day. Beaches in tropical and subtropical areas are classic hotspots, especially where dogs roam freely. The condition resolves on its own eventually because the larvae die off, but treatment with antiparasitic medication clears it much faster and spares you weeks of misery. Travelers who walk barefoot on beaches in Central America, Southeast Asia, the Caribbean, and parts of Africa and South America are the most commonly affected group.

Sand Flea Disease

Tungiasis, or sand flea disease, is caused by a female sand flea (Tunga penetrans) that physically burrows into the skin, almost always on the feet. Unlike hookworm larvae, which are microscopic, the sand flea is a visible insect that embeds itself into the skin’s surface and swells as it produces eggs, triggering a painful inflammatory reaction.⁶ The result is a hard, white-to-yellowish nodule with a dark central dot, usually found on the toes, soles, or around the toenails.

In endemic areas of sub-Saharan Africa, Central America, and South America, tungiasis affects millions of people, with children and elderly individuals hit hardest. Secondary bacterial infections are the real danger, because the embedded flea creates a portal for bacteria. Repeated infestations can deform the feet and toenails over time. Wearing closed shoes is the single most effective prevention, and a meta-analysis of multiple diseases confirmed that footwear use was associated with significantly lower odds of tungiasis.⁷

Athlete’s Foot and Other Fungal Infections

You do not need to travel to the tropics for bare feet to cause problems. Athlete’s foot (tinea pedis) is one of the most common infections picked up in gyms, public showers, locker rooms, and pool decks in any climate. The dermatophyte fungi that cause it thrive in warm, damp environments and can survive on floors and surfaces long enough to spread from person to person. Studies of swimming pool facilities in Japan found that dermatophytes could be isolated directly from pool floors, and that both athletes and non-athletes using the pool faced a significant risk of fungal skin infection.⁸

Research at public pools in Bologna, Italy found athlete’s foot in about a third of swimmers surveyed, with environmental sampling confirming that contaminated surfaces were a clear source of transmission.⁹ The infection causes itching, peeling, redness, and cracking skin between the toes or on the soles, and while it is rarely dangerous, it can become chronic and hard to shake. Wearing sandals or flip-flops in shared wet areas is a simple fix.

Plantar Warts

Plantar warts are caused by certain strains of human papillomavirus (HPV) that enter the skin through tiny breaks on the soles of the feet. Like athlete’s foot, they spread most readily in communal wet environments. A study of competitive swimmers in Greece found that those who walked barefoot on pool decks had roughly 50% higher odds of developing plantar warts compared to those who did not.¹⁰ Sharing equipment like swim fins further compounded the risk.

Plantar warts are not dangerous, but they grow on weight-bearing areas of the foot and can be quite painful. They are also famously stubborn to treat, sometimes persisting for months or years. Prevention overlaps with athlete’s foot: keep your feet covered in locker rooms and pool areas, dry them thoroughly, and avoid sharing towels or shoes.

Puncture Wounds, Tetanus, and Bacterial Infections

One of the most straightforward risks of walking barefoot is stepping on something sharp. Nails, glass, thorns, and shells can all drive bacteria deep into the foot, where they are hard for the immune system to reach. The infection risk from a puncture wound depends partly on what was on the object and partly on the depth and location of the wound.

Tetanus is the classic feared complication. Interestingly, one recent study found that Clostridium tetani, the bacterium responsible, was more frequently found on rusted metal and concrete surfaces than in soil itself, suggesting that soil-contaminated wounds may carry a lower tetanus risk than commonly assumed.¹¹ That said, tetanus remains a real danger wherever vaccination coverage is incomplete. A multicenter study of tetanus in children in Turkey identified penetrating foot injury as the single most common risk factor.¹²

Beyond tetanus, puncture wounds to the foot commonly introduce Staphylococcus aureus, the leading cause of soft tissue infections in these injuries.¹³ There is also a well-documented link between nail punctures through rubber-soled shoes and Pseudomonas aeruginosa bone infections. A ten-year evaluation of children with Pseudomonas bone and joint infections after nail puncture wounds found that the vast majority were wearing sneakers at the time, with only two cases occurring in barefoot children.¹⁴ The warm, moist environment inside rubber-soled shoes appears to cultivate Pseudomonas, and when a nail drives through the shoe and into the foot, it inoculates the bacteria deep into the tissue. So in this narrow scenario, bare feet actually seem safer than certain types of footwear.

Mycetoma

Mycetoma, historically known as Madura foot, is a chronic infection caused by certain fungi or bacteria that enter the body through minor skin trauma, typically in people who walk barefoot through terrain with thorns or sharp vegetation. The foot is the most commonly affected site. Patients often have no memory of a specific injury; the entry wound is usually too small to notice.¹⁵ Over months or years, the infection produces swelling, draining sinuses, and progressive tissue destruction that can reach bone. Mycetoma is concentrated in a “mycetoma belt” stretching across the Sahel region of Africa, parts of Central and South America, and the Indian subcontinent. Treatment is difficult and prolonged, often requiring surgery as well as months of medication.

Podoconiosis, a Non-Infectious Threat

Not every disease caused by bare feet involves a pathogen. Podoconiosis is a non-infectious condition that causes progressive swelling and elephantiasis-like changes in the lower legs and feet. It results from long-term barefoot contact with certain types of volcanic red clay soil, particularly at high altitudes with heavy seasonal rainfall. Worldwide, an estimated four million people live with podoconiosis, which causes significant disability and painful inflammatory episodes.¹⁶

The condition is most common among subsistence farmers in Ethiopia, Cameroon, and parts of India and Central America who spend their working lives barefoot in affected soil. Tiny mineral particles from the soil are thought to penetrate the skin and trigger a chronic immune response in the lymphatic system. Unlike the parasitic causes of elephantiasis, podoconiosis is entirely preventable with consistent shoe-wearing from a young age, making it one of the most directly shoe-preventable diseases known.

Who Faces the Highest Risk

Geography matters enormously. The parasitic diseases described above are concentrated in tropical and subtropical regions, particularly in areas with poor sanitation where soil is routinely contaminated with human or animal waste. But the assumption that temperate climates are safe is not entirely reliable. Research in Bolivia found high rates of strongyloides infection in a temperate, high-altitude region, including among patients who had never visited tropical lowlands, demonstrating that the parasite can be transmitted at elevations above 2,500 meters in places previously considered too cold for it.¹⁷

People with diabetes face a distinct category of barefoot risk. Diabetic neuropathy can dull sensation in the feet, meaning cuts, punctures, and burns may go unnoticed. A study of diabetic patients admitted for foot ulcers found that 84% of those who had been injured by sharp objects were barefoot at the time, and the overall risk of foot ulcers was roughly double for barefoot diabetics compared to those wearing some form of footwear.¹⁸ For people with diabetes, the issue is not just infection risk but the cascade from minor wound to non-healing ulcer to potential amputation. Medical guidelines universally recommend that diabetic patients avoid walking barefoot.

Immune-suppressed individuals also face amplified risks. The autoinfection cycle of strongyloides, mentioned earlier, can spiral out of control in people on immunosuppressive drugs or those with conditions like HIV. What would be a manageable parasitic infection in a healthy person can become a lethal disseminated disease.

Coastal and Freshwater Hazards

Walking barefoot is not limited to dry land, and water introduces its own set of risks. Beach sand can harbor animal hookworm larvae (the cause of cutaneous larva migrans), while wading barefoot in freshwater or floodwater is a known risk factor for leptospirosis, a bacterial infection spread through water contaminated with animal urine. A systematic review of diseases linked to footwear habits found that wearing shoes was associated with roughly 40% lower odds of leptospirosis.⁷

Saltwater beach environments carry additional concerns. Vibrio vulnificus, a bacterium found in warm coastal waters, can cause severe wound infections if it enters through abrasions on the feet or legs. Research on children playing at recreational beaches found that over half already had existing skin abrasions before they even started playing, and about 8% acquired new ones during their time at the beach, with sea water play being the most common context for new injuries.¹⁹ For healthy people, Vibrio wound infections are uncommon and usually mild, but they can be rapidly life-threatening in people with liver disease or compromised immune systems.

How Much Do Shoes Actually Help

The intuitive answer is “a lot,” and for the most part the evidence agrees, but the picture is slightly more complicated than just telling everyone to wear shoes. A large systematic review and meta-analysis that pooled data across multiple neglected tropical diseases found that footwear use was associated with significantly lower odds of hookworm (about half the risk), strongyloidiasis, tungiasis, cutaneous larva migrans, leptospirosis, and Buruli ulcer.⁷ Those are meaningful reductions across a broad range of diseases.

However, real-world shoe distribution programs have produced mixed results. A trial on Pemba Island, Zanzibar, that gave shoes to schoolchildren found no significant difference in hookworm rates between schools that received shoes and those that did not, in part because shoe-wearing increased across all the schools during the study period. Among children who were actually wearing shoes at the end of the study, hookworm risk was about 30% lower, suggesting shoes do help when consistently worn.²⁰ A separate study found that combining footwear distribution with public health messaging about why shoes matter led to sustained reductions in hookworm and strongyloides infection intensity, while distributing plain shoes without that messaging did not produce lasting change.²¹

The takeaway from these intervention studies is that shoes work, but only if people actually wear them consistently. Owning shoes is not the same as wearing them in the contexts that matter, like walking through agricultural fields, using latrines, or moving through areas with damp soil. For infections acquired in communal wet areas, like athlete’s foot and plantar warts, the same principle applies: flip-flops in the locker room only protect you if you actually put them on.

The Pseudomonas Paradox and When Shoes Make Things Worse

The Pseudomonas data from puncture wounds is worth sitting with for a moment, because it cuts against the simple “shoes protect you” narrative. In the ten-year study of children with Pseudomonas bone and joint infections after nail punctures, 70 out of 77 cases involved children wearing tennis shoes, while only two cases occurred in barefoot children.¹⁴ The likely explanation is that Pseudomonas colonizes the warm, moist inner sole of sneakers. When a nail punches through, it carries the bacteria from the shoe lining directly into the bone. A barefoot person stepping on the same nail might still get a staph infection, but the specific risk of Pseudomonas osteochondritis appears to be largely a shoe-related phenomenon.

This does not mean shoes are bad. It means the risk calculus is more specific than “covered feet good, bare feet bad.” Shoes protect against soil-transmitted parasites, sand fleas, fungal contamination, and many puncture injuries. But poorly maintained, chronically damp footwear introduces its own microbial ecosystem. Keeping shoes clean and dry, rotating pairs, and treating foot injuries promptly regardless of shoe status all matter more than the binary question of whether your feet were covered.

1
PLOS Neglected Tropical Diseases. Spatial distribution patterns and risk factors of hookworm disease in China: A study based on successive national surveillance
2
PubMed Central. Incidence and Risk Factors of Hookworm Infection in a Rural Community of Central Thailand
3
The Journal for Nurse Practitioners. Strongyloidiasis
4
PubMed. Geospatial distribution and risk factors of Strongyloides stercoralis in rural communities of Northeast Thailand
5
PubMed Central. Creeping eruptions: cutaneous larva migrans
6
PubMed Central. Treatment of tungiasis with a two-component dimeticone: a comparison between moistening the whole foot and directly targeting the embedded sand fleas
7
PLoS Neglected Tropical Diseases. Association between Footwear Use and Neglected Tropical Diseases: A Systematic Review and Meta-Analysis
8
PubMed. Tinea pedis outbreak in swimming pools in Japan
9
Public Health. Risk of infection associated with microbiological quality of public swimming pools in Bologna, Italy
10
PubMed Central. Prevalence of Plantar Warts, Genital Warts, and Herpetic Infections in Greek Competitive Swimmers
11
PubMed Central. An Assessment of the Presence of Clostridium tetani in the Soil and on Other Surfaces
12
PubMed. Tetanus in Children: Clinical Insights and Management From a Multicenter Study in Turkey
13
PubMed Central. Soft tissue and bone infections from puncture wounds in children
14
PubMed Central. Pseudomonas osteochondritis complicating puncture wounds of the foot in children: a 10-year evaluation
15
PubMed Central. Mycetoma (Madura Foot): A Case Report of Misdiagnosis and Recovery in a Young Patient
16
PubMed. Podoconiosis – From known to unknown: Obstacles to tackle
17
PLoS Neglected Tropical Diseases. Epidemiology of Strongyloides stercoralis infection in Bolivian patients at high risk of complications
18
PubMed. Is walking barefoot a risk factor for diabetic foot disease in developing countries?
19
PubMed Central. Children’s Abrasions in Recreational Beach Areas and a Review of Possible Wound Infections
20
Transactions of The Royal Society of Tropical Medicine and Hygiene. Do shoes reduce hookworm infection in school-aged children on Pemba Island, Zanzibar? A pragmatic trial
21
PubMed Central. Combining Footwear with Public Health Iconography to Prevent Soil-Transmitted Helminth Infections