Barefoot Walking (Earthing) Craze and Policy Support Among Community-Dwelling Older Adults in South Korea: A Grounded Theory Analysis

Abstract

Barefoot walking is currently a craze in South Korean communities. In particular, the elderly are participating in barefoot walking (earthing) to improve their physical and mental health due to their increasing desire for a healthy life. The purpose of this study was to analyze causes, processes, and consequences of the barefoot walking craze among the elderly in Korean society. The research method used was the grounded theory method. Thirty-five elderly people participating in barefoot walking were selected as participants. Data were analyzed according to open coding, axial coding, and selective coding proposed by Strauss and Corbin. First, an open coding phase yielded 61 concepts, 18 subcategories, and 7 categories through continuous questioning and comparative analysis. Second, in the axial coding stage, causal, contextual, and mediating conditions, action/interaction strategies, and consequences were presented, centering on the phenomenon. Causal conditions and contextual conditions contributing to the phenomenon of barefoot walking were identified as “motivation to participate” and “barefoot walking environment”, respectively. “Participating in barefoot walking” was identified as a phenomenon in the axial coding paradigm. The intervening condition was analyzed as “information about barefoot walking”. The action/interaction strategy was analyzed as “spreading the value of barefoot walking”. In the axial coding paradigm, consequences that emerged through the action/interaction strategy were “restoring physical and mental health” and “community spread and nuisance”. Third, in the selective coding stage, “barefoot walking as a daily routine” was derived as the core category, and the narrative outline was presented. To create a sustainable barefoot walking environment in Korea, it is necessary to have a healthy civic consciousness that coexists and harmonizes with nature.

1. Introduction

Barefoot walking is currently a craze in South Korean communities. When walking barefoot on the ground, direct contact with the earth’s surface occurs. It has been rumored that this grounding can cure various human diseases. This rumor has spread rapidly through social media, especially after the publish of an article entitled “Barefoot walking cures terminal cancer in two months” on 12 September 2022 [1]. The number of barefooters has increased dramatically. Various studies have shown that barefoot walking and earthing can cure diseases.

Earthing is a wonderfully uplifting way to balance mood, support the central nervous system, and release chronic inflammation that puts wear and tear on the body and mind. Koniver’s research has revealed in full extent that inflammation plays a role in depression, as higher levels of blood markers of inflammation have been found to be directly correlated with a variety of depressive symptoms, including sleep difficulty, decreased energy levels, decreased motivation, and increased or decreased appetite [2]. Earthing can reduce pain and alter numbers of circulating neutrophils and lymphocytes. It also affects various circulating chemical factors related to inflammation. According to Oschman and James [3], cumulative damage caused by reactive oxygen species (ROS) is the cause of aging. Mobile electrons of a grounded person can rapidly neutralize ROS produced by oxidative metabolism, which occurs in all cells and tissues.

Chevalier and Sinatra have hypothesized that grounding could improve heart rate variability (HRV). Their study included 27 final participants. They found that subjects who grounded showed an improvement in HRV beyond basic relaxation (p < 0.01). Because HRV improvement has a positive impact on cardiovascular status, a simple grounding technique could be used as a basic integrative strategy to support the cardiovascular system, especially in situations with high autonomic nervous system tension (i.e., when the sympathetic nervous system is more active than the parasympathetic nervous system) [4].

According to a study by Sinatra et al., earthing may also contribute to a reduction in blood viscosity, which is one of the risk factors for cardiovascular disease. It has been found that earthing can increase the surface charge of red blood cells and reduce red blood cell aggregation, which can help reduce the risk of cardiovascular disease [5].

Recently, there are many elderly people walking barefoot on dirt paths in urban parks, schoolyards, forests, and parks. Barefoot walking has been recognized as a way to regain physical health and cure diseases. A typical example is an article describing that a terminal cancer patient who has given up at the hospital is cured in two months after starting to walk barefoot [1]. As various other healing cases have been reported frequently, barefoot walking is spreading in Korean society. In addition, local governments in South Korea have been building barefoot parks in response to the popularity of barefoot walking [6].

Although there are various experimental studies on the effects of barefoot walking, there is still a lack of research on the process of participation and policy support for barefoot walking. Therefore, this study aimed to explore the participation process and experiences of older adults participating in barefoot walking using qualitative research methods.

Grounded theory, the method of this study, is used when existing theories are insufficient to explain a phenomenon or when there is a lack of existing research. It is useful for understanding social phenomena, processes, and interactions in natural settings. Grounded theory is a flexible and iterative way for researchers to develop theories through qualitative data collected from participants. Therefore, this study employed a grounded theory method within a pragmatic qualitative research framework. As a practical qualitative research method, grounded theory seeks to theorize by explaining the phenomenon of interest, discovering influencing factors that cause the phenomenon to occur and structural relationships between them. A practical qualitative grounded theory is differentiated from a constructivist (interpretive) qualitative grounded theory (phenomenology, narrative, cultural descriptive, case study), which aims to understand a phenomenon in depth based on thick description [7]. In other words, this practical qualitative research method aims to analyze complex causal processes and the creation of new conceptual categories not captured by existing theoretical concepts. Therefore, the purpose of this study was to apply the grounded theory method to analyze causes, processes, and consequences of the barefoot walking craze of the elderly in Korean society.

2. Study Methods

2.1. Study Participants

In grounded theory methods, participants are selected by theoretical sampling, a process of selecting theoretically appropriate subjects [8]. The theoretical sampling method used in this study is snowball sampling, a non-probability technique where existing research participants recruit future participants from their acquaintances. In this case, the researchers initially selected elderly participants engaged in barefoot walking who had developed a rapport with them. These participants then helped recruit additional participants from among their own acquaintances. The participants of this study were 35 elderly people aged over 65 years who participated in barefoot walking at least three times a week (

Table 1. Characteristics of the participants.

Category	Attribute	Sample Size
Gender	Male	15
	Female	20
Age	65~69	17
	70~74	10
	75 and above	8
Occupation	Self-employed	5
	Full-time employee	2
	Short-term employee	8
	Unemployed	20
Educational level	Junior high school and below	8
	High school	20
	College (assoc./bachelor’s)	5
	Master’s degree and above	2

). This study was conducted in Chungnam, a province in South Korea.

2.2. Data Collection

A review of newspaper articles and related literature was conducted prior to conducting in-depth interviews. All in-depth interviews were conducted between 1 May 2024 and 10 August 2024. For each person, an interview was conducted once or twice. The average time of the interview was about one hour. In-depth interviews were recorded with informed consent after explaining the content and purpose of this study before conducting them.

The first interview was conducted with unstructured questions. The second interview was used to collect supplementary data that were lacking in the first interview. After the second interview was conducted, additional information was collected through phone calls and SNS to further clarify the data.

2.3. Data Analysis

Data were analyzed according to open coding, axial coding, and selective coding, proposed by Corbin and Strauss [9]. Open coding is a process of decomposing collected data to conceptualize and categorize them. Axial coding is a process of reassembling decomposed data around one category by considering attributes and dimensions. Selective coding is a process of integrating and refining categories to develop a theory. However, these coding distinctions are artificial. In practice, data collection and analysis (coding) are intertwined rather than back and forth in a series of mixtures and iterations.

This study went through a process of theoretical saturation. The concepts and categories were sampled until no new material was generated in the construction of the concepts and categories. As such, in this study, there were dozens of iterations from open coding to selective coding. Data collection and analysis also went through a zigzag process that continued in a circular fashion. Finally, a paradigm model of the barefoot walking craze in Korea was developed to provide a more complete and convincing explanation of the research phenomenon.

2.4. Ethical Considerations and Assessing the Veracity of Research

Consent to collect data and protection of sensitive and private information were the main ethical considerations when conducting this study. Informed consent was obtained. Data that were deemed potentially risky because they revealed too much personal information were not used in the study.

In this study, original interview data and analyzed data were subjected to member checking. Results of the data analysis were subjected to peer debriefing. We tried to follow the rigor of research based on true value, applicability, consistency, and neutrality [10].

3. Results

3.1. Open Coding Results

In grounded theory, open coding is the initial step in analyzing qualitative data. In this step, the data collected from the in-depth interviews were subjected to textual analysis. The authors line-coded the collected materials as they read them line by line. This involved breaking down data into discrete parts to identify, name, categorize, and describe key concepts. The authors identified subcategories that could describe the named concepts, and then combined the subcategories to derive categories. In this way, this study used a process of continuous questioning and comparative analysis of data obtained through in-depth interviews with participants to name concepts and categorize similar concepts. This process ultimately resulted in 61 concepts and 18 subcategories that unified concepts. From these subcategories, seven categories were derived that further abstracted concepts (

Table 2. Concepts and categories formed by open coding.

Category	Subcategory	Concepts
Motivation to participate	Physical illness	Physical frailty, high blood pressure, high cholesterol, diabetes, insomnia, cancer, arthritis, prostate enlargement
	Mental stress	Nervous nature, stress from children, loneliness
	Invited	Invitations from friends, family persuasion, invitations from strangers
Barefoot walking environment	Good accessibility	Close proximity, convenient, good path for earthing
	No cost	No cost, barefoot walking for seniors
Participating in barefoot walking	From shy to confident	People’s stares, courage, gained confidence
	Barefoot walking as a daily routine	Everyday happiness, my own time, obsession, daily routine
	Connecting with nature	Forest paths, connecting with nature, contact with the soil
Information about barefoot walking	Information from YouTube	YouTube, subscriptions, algorithm
	Information passed down orally	Communication, telling others
Spreading the value of barefoot walking	Starting a club	Exercising together, joining a club, encouraging each other
	Unwavering faith and promoting barefoot walking	Physical fitness and treatment, unwavering faith, promoting
	Getting off medication	Worrying about others, stopping medication, no health issues
Restoring physical and mental health	Healing chronic disease	High blood pressure recovery, healing diabetes, improved immunity, healing insomnia, healing illnesses
	Stress relief	Happy hour, a moment without bad thoughts, sounds and sensations of nature, time away from cares and worries
Community spread and nuisance	Community ordinances	Promoting barefoot walking, ordinance passed, competitive ordinances between municipalities
	Creating barefoot walking parks	creating loess roads, barefoot parks, many across the country
	Overgrown parks and natural degradation	Competition between municipalities, overbuilding parks, destruction of nature, need to protect nature

).

The right photo in Figure 1 shows a map and a sign that says “Yonggok Park Hwangtokgil”; the left photo in Figure 2 shows the barefoot walking club members in action; and the right photo shows them earthing the wet loess.

3.2. Axial Coding Results (Configure a Paradigm Model)

In axial coding, researchers examine the relationships between categories and subcategories identified during open coding. As such, axial coding is the process of recombining the data from open coding. In this study, we followed Strauss and Corbin’s [9] axial coding paradigm model, which consists of causal conditions, situational context, a central phenomenon, mediating conditions, interaction strategies, and outcomes (Figure 3).

In the process of constructing categories, no new material emerged. The paradigm model went through a stage of theoretical saturation, which considered the validity of elements of the paradigm model and the rationale for their construction [11].

3.2.1. Causal Conditions

In the axial coding paradigm, a causal condition is a factor that contributes to the central phenomenon. Causal conditions that contribute to the phenomenon of barefoot walking were “physical illness”, “mental stress”, and “invited”. Together they can be labeled as “motivation to participate”.

• Physical illness

“I was diagnosed with stomach cancer a year ago and started walking barefoot to survive. The moment I was diagnosed with stomach cancer was one of despair”.

(Participant 1)

“I have been suffering from mild headaches and insomnia since I was younger. Recently, I started barefoot walking because my headaches and insomnia have gotten worse”.

(Participant 35)

“I’m 70 years old and I have high blood pressure, high cholesterol, and diabetes. I go to a barefoot park every day because my friends tell me that barefoot walking makes me healthy”.

(Participant 24)

• Mental stress

“I’m a naturally stressed out person, and I’ve tried a lot of sports, but I think earthing is good for me to relieve stress”.

(Participant 2)

“Even though my children are all married, they still call me when something happens, and it’s stressful. I feel better when I touch the ground with my bare feet”.

(Participant 34)

• Invited

“I started walking barefoot because a friend told me it was healthy to walk barefoot, and I walk with her every day”.

(Participant 3)

“I used to walk in the park, and one day a stranger told me to try walking barefoot. I tried walking barefoot”.

(Participant 11)

3.2.2. Contextual Condition

In the axial coding paradigm, contextual conditions represent the environment and circumstances in which the central phenomenon occurs. The contextual condition for the central phenomenon of barefoot walking was “barefoot walking environment”. Its subcategories were “good accessibility” and “no cost”.

• Good accessibility

“There is a forest path for barefoot walking 10 min from where I live. It’s very convenient because it’s so close”.

(Participant 33)

“I used to have to drive 30 min to get to a barefoot park, but the city just built a barefoot park in my neighborhood”.

(Participant 4)

• No cost

“Barefoot walking is the best exercise for seniors because it doesn’t cost anything”.

(Participant 11)

“I’ve been retired for over five years and can’t afford to play golf, which is expensive, but barefoot earthing is free”.

(Participant 34)

3.2.3. Phenomenon

In the axial coding paradigm, the phenomenon is the key concept that explains the phenomenon or topic of the study. The phenomenon is the relationship between categories and the theory of the research problem.

“Participating in barefoot walking” was identified as the phenomenon in the axial coding paradigm. Subcategories of “participating in barefoot walking” were analyzed as “from shy to confident”, “walking as a daily routine”, and “connected with nature”.

• From shy to confident

“Honestly, when I first saw people walking barefoot, I thought they were weird. I didn’t think I could do it, but it turns out I’m into it”.

(Participant 7)

“When I first started going barefoot, people looked at me strangely. Now I don’t care what anyone thinks”.

(Participant 5)

• Walking as a daily routine

“I walk barefoot for two to three hours every day, and if I miss a day, I feel like I’m missing out”.

(Participant 31)

“After I had cancer, I became obsessed with barefoot walking. I do two hours in the morning, two hours after lunch, and an hour in the evening for earthing”.

(Participant 1)

• Connected with nature

“Barefoot walking is an act that unites me with nature ”.

(Participant 6)

“When I walk barefoot in the forest, I feel like I am part of the forest”.

(Participant 30)

3.2.4. Intervening Condition

In the axial coding paradigm, an intervening condition is a broad and specific contextual factor that influences an action/interaction strategy through a phenomenon. An intervening condition is a condition that acts to facilitate or inhibit an action/interaction strategy.

The intervening condition in this study was analyzed as “information about barefoot walking”. Its subcategories were “information from YouTube” and “information passed down orally”.

• Information from YouTube

“I used to use my cell phone for making and receiving calls, but now I get all my information from YouTube”.

(Participant 29)

“I also watch YouTube when I go barefoot. The algorithm keeps recommending videos about the effects of barefoot walking to me”.

(Participant 7)

• Information passed down orally

“I’ve heard a lot about the benefits of going barefoot from people around me”.

(Participant 8)

“When I go to old people’s houses, a lot of my friends talk about the benefits of going barefoot. Old people are easily led, so when someone tells them it’s good, they listen”.

(Participant 19)

3.2.5. Action/Interaction Strategies

In the axial coding paradigm, an action/interaction strategy is a deliberate action or reaction taken in response to a phenomenon. These strategies are methods, processes, or routines employed by participants to deal with or manage the phenomenon.

Participants’ action/interaction strategy was analyzed as “spreading the value of barefoot walking”. Its sub-variables were “starting a club”, “unwavering faith and promoting barefoot walking”, and “getting off medication”.

• Starting a club

“I participate in a barefoot walking group every Wednesday morning. We exercise together and have lunch together. It’s a fun group”.

(Participant 27)

“I barefooted for about three months on my own, and now I’ve joined a club and I’m barefoot walking. It’s nice to be with other people, not alone”.

(Participant 9)

• Unwavering faith and promoting barefoot walking

“I do barefoot walking for therapeutic purposes, not for fitness. I believe that walking barefoot can cure diseases”.

(Participant 10)

“I encourage my friends to go barefoot a lot. Especially in my family, we all walk barefoot”.

(Participant 26)

• Getting off medication

“I stopped taking my medication for high blood pressure and diabetes six months after I started barefoot walking. People around me are worried, but my blood pressure and diabetes levels are normal”.

(Participant 25)

“I took medication for hyperlipidemia for 10 years, and now I don’t take it”.

(Participant 11)

3.2.6. Consequence

In the axial coding paradigm, consequence is the result of utilizing action/interaction strategies in response to a phenomenon. These can be both intended and unintended outcomes. Consequences help us understand the impact or effects of strategies employed in response to a phenomenon.

In the axial coding paradigm, consequences that emerged through the action/interaction strategy were “restoring physical and mental health” and “community spread and nuisance”. Subcategories of “restoring physical and mental health” were “healing chronic disease and cancer” and “stress relief”. Subcategories of “community spread and nuisance” were “community ordinances”, “creating barefoot walking parks”, and “overgrown parks and natural degradation”.

• Healing chronic disease

“My high blood pressure, which was 180/100, came back to normal after 3 months of barefoot walking. Barefoot walking is different from other exercises”.

(Participant 24)

“My immunity improved after I started barefoot walking, and I had no problems with the coronavirus”.

(Participant 12)

“I haven’t slept well in 10 years. Since I started barefoot walking, I sleep seven hours without waking up”.

(Participant 23)

• Stress relief

“My happiest moment of the day is when I’m walking barefoot, because when my bare feet hit the dirt, my bad thoughts disappear”.

(Participant 22)

“Barefoot earthing is a time to feel the sounds and sensations of nature. When I walk barefoot in the forest, all my worries disappear”.

(Participant 13)

• Community ordinances

“Jeonju City was the first in Korea to pass an ordinance to promote barefoot walking”.

(Participant 21)

“Local governments in Korea are now investing a lot in promoting barefoot walking. Many local governments have passed ordinances to create barefoot parks”.

(Participant 12)

• Creating barefoot walking parks

“When I first started barefoot walking, three years ago, there weren’t many places to go barefoot, but now barefoot parks are popping up everywhere”.

(Participant 20)

“I think Korea is really into walking barefoot. Barefoot parks are popping up all over the country, including forests, dirt trails, and beaches”.

(Participant 11)

• Overgrown parks and natural degradation

“Honestly, I think that municipalities are too competitive and indiscriminate in creating barefoot parks. I think they are creating them as a showcase policy for their citizens”.

(Participant 19)

“Nature is being destroyed by the creation of barefoot dirt paths. Parks should be created while protecting nature, and people who do earthing should also not destroy nature”.

(Participant 9)

3.3. Selective Coding

Selective coding is the final stage of grounded theory analysis, where the researcher integrates and refines the categories developed in axial coding to form a coherent theory. At this stage, the researcher focuses on identifying a core category that represents the central phenomenon of the study, and then systematically relates this core category to other categories, creating a theoretical narrative.

Selective coding is the process of discovering core categories of a study and integrating and elaborating other categories around core categories [12]. In other words, in the selective coding stage, core categories of the phenomenon of barefoot walking in Korea are selected and the storyline is written. Therefore, we will present core categories and the storyline of barefoot walking from the relationship of categories derived through open coding and axial coding paradigms.

3.3.1. Core Category

The core category is the one that best explains the phenomenon of barefoot walking in Korea among the categories found in this study. It is the one that connects categories well. It is the most frequent one in the data.

The core category of this study was derived from a continuous comparative method. It was found to be “barefoot walking as a daily routine.” This category best described the enthusiasm for barefoot walking in Korea and explained other categories that emerged from this study. It was also the most frequent one in the data.

3.3.2. Storyline

The storyline can be understood as the process of fleshing out a narrative around a phenomenon among paradigm elements while conducting grounded theory. According to Strauss and Corbin [9], a storyline is the process of systematically connecting core categories with other categories, identifying and describing their relevance, and refining the story around core categories.

Barefoot walking is currently a craze among the elderly in South Korea. The main motivation for the elderly to start barefoot walking is to heal their physical ailments and mental stress. Most participants of this study have more than one disease, including high blood pressure, high cholesterol, diabetes, insomnia, and even cancer. They have a strong belief that barefoot walking will heal them.

Another reason why older people are drawn to barefoot walking is because they are encouraged to do so by people they know who have done it before. In addition, there is a lot of information on YouTube about the benefits of barefoot walking. In particular, YouTube channels dedicated to barefoot walking have played a big role in the spread of barefoot walking. In Korea, it is easy for the elderly to participate in barefoot walking because there are barefoot parks in every city at no cost.

Although the elderly were embarrassed to walk barefoot when they first started practicing barefoot walking, they now participate in barefoot walking with confidence because they have a firm belief in its healing effects. For them, barefoot walking is a moment of unity with nature, a moment of bliss. For them, barefoot walking has become a daily routine that they cannot afford to miss.

Barefoot walking clubs have been organized in different parts of the country, which has helped the elderly to fall in love with the practice. Barefoot walking has cured high blood pressure. Many elderly people have recovered from insomnia. In particular, elderly people with cancer have seen their cancer shrink in size and improve their physical condition. On the mental side, barefoot walking has also been shown to be a great stress reliever. Running in the woods is a side-effect-free therapy for the body and mind.

Many barefoot walking clubs have been formed in South Korea. By exchanging information about their own treatment cases through these clubs, the elderly have developed a stronger belief in the therapeutic effects of barefoot walking.

There have even been cases of people who have stopped taking medication after going barefoot. Thus, the elderly are becoming more active in recommending barefoot walking to others. The number of barefooters is increasing due to this conviction. Local governments are also providing policies to support barefoot walking. Many local governments in South Korea have enacted ordinances that require parks to include barefoot trails. Ordinances to promote barefoot walking have accelerated this barefoot walking craze in South Korea.

However, there are also critics who argue that the recent creation of barefoot parks is damaging nature. Barefoot walking, which has become a daily routine for the elderly in Korea, is a sustainable healing exercise for the elderly.

4. Discussion

4.1. The Science and Criticisms of Barefoot Walking (Earthing)

Barefoot walking on the ground involves direct physical contact with the earth’s surface, which has been shown to influence various physiological processes and health outcomes. The concept is based on the idea that reconnecting with the earth’s electrons can significantly alter the body’s physiology and promote well-being. In support of this, several studies have explored the physiological effects of grounding. For instance, a study by Oschman et al. found that barefoot walking can lower serum concentrations of iron, ionized calcium, and inorganic phosphorus, while also decreasing renal excretion of these minerals. Moreover, continuous grounding has been shown to lower blood glucose levels and affect electrolyte balance in people with diabetes [13]. These physiological mechanisms may explain why participants in this study experienced improvements in their diabetes.

Additionally, inflammation and immune responses are strongly influenced by grounding. In fact, Chevalier et al. found that grounding can alter concentrations of white blood cells, cytokines, and other inflammatory molecules, highlighting the potential for grounding to provide a new perspective on improving inflammation and related conditions [2]. Further research has shown that grounding reduces delayed-onset muscle soreness, pain, and circulating neutrophils and lymphocytes, suggesting a role in modulating immune response and inflammation. In line with this, the concept of “electro nutrition,” discussed by Chevalier et al., suggests that direct physical contact with the earth’s surface produces rapid anti-inflammatory and antioxidant effects. Thus, this research supports the idea that grounding can be a simple yet effective strategy for preventing and treating chronic inflammatory and degenerative diseases. This could also explain why older adults with cancer who engage in barefoot walking report feeling better [14].

Furthermore, a study by Ghaly and Teplitz found that grounding can reduce blood viscosity, an essential factor in cardiovascular health [15]. Specifically, subjects who grounded for an hour experienced significant decreases in both systolic and diastolic blood viscosity after exercise, indicating the anti-inflammatory effects of grounding. These findings might support the testimonials of participants in this study who were able to discontinue their blood pressure and hyperlipidemia medications.

Grounding’s impact extends to cortisol levels and subjective well-being as well. For example, a study by Park et al. found that grounding significantly lowers nighttime cortisol levels and resynchronizes cortisol secretion with natural circadian rhythms, leading to improved sleep quality, reduced pain, and less stress [16]. Additionally, animal studies provide further evidence of grounding’s effectiveness in reducing stress-induced behavioral and neuroendocrine changes. Brown and Chevalier, for instance, found that rats exposed to grounding mats exhibited reduced anxiety-like behavior and decreased expression of corticotropin-releasing factor (CRF) in their brains, suggesting that grounding may modulate stress responses through the corticotropin system. Taken together, these findings may help explain the stress reduction and insomnia relief experienced by most participants in this study [17].

This study and previous research on the effects of grounding through barefoot walking suggest that grounding has multiple benefits, including improving mineral balance, reducing inflammation, enhancing immune response, improving cardiovascular health, and reducing stress [18]. These findings suggest that barefoot walking can be a simple, natural, and accessible strategy for improving overall health and well-being.

A study by Koniver [2] argued that grounding can improve mental health outcomes by connecting the body to the earth’s direct current energy, potentially influencing physiological processes, but the specific role of the placebo effect needs further investigation [2]. There are a few points to think about when it comes to barefoot exercise and the placebo effect. First, the belief or expectation that barefoot walking is good for your health may actually cause a positive effect. This is one of the main mechanisms of the placebo effect. Second, as a psychological benefit, walking barefoot can make you feel connected to nature or reduce stress, and these psychological benefits can act similarly to the placebo effect. Third, walking is a form of exercise, so there may be a combination of actual physical benefits and a placebo effect. Fourth, the act of choosing to walk barefoot may itself reinforce the placebo effect. Tang reported that the placebo effect can be greater when patients are able to choose the treatment [19]. Finally, the environment in which barefoot walking occurs (e.g., nature, beach, etc.) may trigger the placebo effect.

In Korean society, various social factors contribute to the placebo effect of barefoot walking on the elderly. First, information is disseminated through YouTube. Many elderly individuals have come across cases of people who claim to have been cured of various diseases through barefoot walking, leading them to develop a strong belief that similar outcomes can occur for them. Second, there is a prevailing distrust of conventional medical care. The elderly tend to believe that natural remedies will better protect their health than modern medicine.

Therefore, when evaluating the effects of barefoot walking and earthing, it is necessary to distinguish between actual physiological and physical effects and placebo effects. It is also possible that some participants engaged in barefoot walking were receiving other medical treatments, which may have contributed to their improved health. Hence, caution should be exercised when claiming that barefoot walking (earthing) alone leads to improved health. Further studies controlling for other treatments and medical interventions are needed to determine the specific effects of barefoot walking and earthing.

Recently, studies and claims about barefoot walking have been published that have been critically examined. Yoon and Seo point out that the benefits of barefoot walking in South Korea are not scientifically proven but rather spread by word of mouth, and that participants are over-indulging [20]. Dr. Steven Novella, a clinical neurologist at Yale University School of Medicine, is critical of earthing as a pseudoscience. He is not at all impressed with the clinical studies on earthing published in the last decade. They typically have small numbers of participants, focus on subjective outcomes (the usual suspects of pain, “well-being,” and stress), and are poorly controlled. He also claims that he has not seen all the hallmarks of rigor in earthing studies [21].

Dr. Sarah Ballantyne posed an important question: Is there any scientific proof supporting earthing? She expressed concerns about the earthing effect studies, noting that they were performed without sufficient controls and that the conclusions drawn from the findings were overly generalized [22].

Additionally, according to a newspaper article, experts are cautious about rumors such as “terminal prostate cancer patient is cured after two months of barefoot walking”, saying that “there are no objective follow-up cases” and that “there must be complicating factors, such as different treatments”. One doctor said, “It’s a placebo effect, where you have a strong belief that you’re going to get better, and then you actually get better”. A medical school professor who specializes in podiatry has said, “Recently, the number of patients visiting hospitals due to cellulitis, plantar fasciitis, and interstitial neuroma has suddenly increased due to reckless barefoot walking”. “I wonder if the authorities should regulate barefoot walking” [23].

Seniors who walk barefoot every day should heed the critical advice of experts. In order to be safe, seniors should avoid sharp and rough surfaces such as rocky mountains and choose paths with good soil. After walking barefoot, seniors should check their feet carefully to make sure they do not have any cuts. Also, when seniors first start walking barefoot, it is safe to gradually increase the amount of time they spend barefoot. If seniors suddenly go barefoot for long periods of time, it can cause strain on bones, joints, and plantar fascia around their feet. Access to designated barefoot walking parks with safe, well-maintained trails can minimize exposure to hazardous surfaces. In addition, strengthening foot muscles through stretching and exercises may help reduce the risk of injuries like plantar fasciitis. It is clear that barefoot walking is beneficial for the health of the elderly. However, it is important to avoid overdoing it and exposing oneself to negative side effects.

4.2. Senior Health Policy and the Role of Local Government

A number of trends are emerging in different countries around senior health promotion activities. While approaches vary depending on the cultural and social characteristics of each country, they are all aimed at improving the quality of life and healthy aging for older adults. Key trends in senior health include the following:

First, there are multidimensional health programs, with many countries adopting an integrated approach that considers physical, mental, and social health. This focuses on improving the overall well-being of older adults.

The main components of a multidimensional health program can be divided into physical health, nutritional support, mental health, and social engagement. Physical wellness is centered on structured exercise interventions that focus on frequency, intensity, and type of exercise to meet the needs of older adults. These programs improve muscle function and reduce the risk of disability [24]. Nutritional support is essential, such as a sustainable healthy diet. Programs should provide nutrition education and customized meal plans to improve overall health outcomes [25]. Mental health programs include psychological assessments and support to address cognitive functioning and emotional well-being [26]. Social engagement programs that promote social interaction and community involvement are essential to overcome isolation and promote mental health [27].

Second, the spread of digital healthcare has led to an increase in the use of digital technologies such as wearable devices, mobile apps, and telehealth services in developed countries. This enables real-time monitoring of seniors’ health status and personalized health care.

There is a growing body of research on the use of smartphone apps to remotely monitor older adults’ health, assist caregivers, and enhance safety and activity management [28].

Third, many countries are developing programs to help older adults stay active and healthy in their own communities. This prevents social isolation and encourages active living. Senior community-based programs play an important role in improving the well-being of older adults by promoting physical activity, social connections, and access to healthcare. These programs are designed to address the unique needs of older adults, especially in the context of social isolation and health challenges exacerbated by the COVID-19 pandemic. Community-based programs for seniors include day care centers, home visiting services, integrated care, Hospital at Home, and mobile medical units, aimed at improving health outcomes and reducing hospitalization [29].

Finally, intergenerational exchange programs promote social engagement and mental health among older adults through programs that facilitate interactions between older and younger generations. The benefits of intergenerational exchange programs are reported to include cognitive and emotional development, active aging, and social interaction [30,31]. Intergenerational exchange programs foster meaningful relationships between older and younger generations, which improves well-being and social cohesion.

These trends are becoming increasingly important as the elderly population grows, and policymakers in each country are formulating effective strategies to improve the health of the elderly.

Japan, for example, is implementing community-centered integrated care. The community-centered care system integrates medical, nursing, prevention, housing, and supportive living services. Japan is actively promoting the concept of “aging in place” to allow older adults to continue living in familiar environments [32].

The United States has implemented policies to promote the health of older adults that emphasize diversity and choice. The U.S. provides basic healthcare through Medicare but also offers a variety of options through private insurance. Programs such as Silver Sneakers encourage older adults to be physically active, and community-based services support independent living [33].

Nedaland’s “Buurtzorg” model allows autonomous care teams to operate on a neighborhood basis, which contributes to increasing the independence of older people. Innovative residential models, such as dementia villages, improve the quality of life for people with dementia. This culture of respect for older people’s right to self-determination is reflected throughout the program [34].

Barefoot walking is a new health trend in South Korea. Of the 243 metropolitan and basic local governments in South Korea, 167 (68.7%) have ordinances supporting barefoot walking. Seven out of 10 local governments make supporting barefoot walking a responsibility of the local mayor, with a focus on creating and managing barefoot trails. The ordinance covers the creation and expansion of barefoot trails, the installation and maintenance of barefoot facilities, the publicity necessary to revitalize barefoot walking, and cultural, artistic, and academic projects related to barefoot walking [35].

In South Korea, Jeollabuk-do, a local government, created seven barefoot paths in 2023, with a total project cost of USD 2.6 million. In Seongnam, the city of Seongnam has been building the 5.9 kilometer-long barefoot Hwangtot Trail since 2023, with a total project cost of USD 5.22 million. In particular, the barefoot path is being built in a greenhouse so that the elderly can walk barefoot in cold weather such as winter [36].

In addition to local governments, South Korean companies are also supporting barefoot parks. Sun Yang Soju, a local liquor company in Chungcheong Province, has built the longest loess trail in Korea (14.5 km), at Gyeyoksan Mountain, and has donated USD 800,000 annually since 2006 to maintain the trail. As barefoot walking is becoming increasingly popular, local governments and companies are pushing for policy and financial support [37].

However, the creation of barefoot parks also has side effects. While the nationwide barefoot walking craze is gaining momentum, local governments are struggling to manage loess trails. This is because it costs hundreds of millions of KRW to build a single loess road. They are struggling to fill in the loess that washed away during floods and heavy rains. It has been pointed out that the project is not an urgent issue, but it has become a project that is pushed forward in response to neighboring local governments or complaints [38].

There are also many instances where the development of barefoot parks is damaging nature. The creation of barefoot parks has resulted in a loss of wildlife trails and disruption of ecosystems due to nighttime lighting.

Barefoot walking also has negative effects in non-designated areas. The tidal flats of Sorae Wetland in Incheon are over 8000 years old, with a high conservation value. It is also known as a prime habitat for the endangered white-footed booby crab. However, local environmental organizations that have been monitoring the tidal flats claim that barefooters are damaging the ecosystem [39]. The marsh’s ecosystem is being rapidly degraded by some citizens who walk barefoot in mudflats.

Barefoot walking is characterized by a deep connection with the earth and the ecological environment. However, the ecological damage caused by indiscriminate barefoot walking is an obstacle to creating a sustainable barefoot environment. Barefooters need a healthy sense of citizenship to coexist and harmonize with nature. Ethical and environmental considerations are essential for creating a sustainable barefoot park. To balance health promotion with environmental sustainability, local governments should ensure that these parks are built without causing harm to nature. They should avoid wetlands, wildlife habitats, and ecologically important landscapes. Barefoot parks should be designed as nature-friendly, sustainable spaces in consultation with environmentalists, ecologists, and community members.

Limitations of this study include its reliance on qualitative data, lack of objective measures of health outcomes, and the potential for cultural bias. Future research should consider a mixed-methods approach using a combination of empirical and quantitative research methods. Future research should also include comparisons to barefoot walking in other cultures.

5. Conclusions

Barefoot walking offers several health benefits for older adults. These include improved blood circulation, psychological stability, enhanced proprioception, stronger foot muscles, and a boosted immune system. Many local governments in South Korea have enacted ordinances to support barefoot walking. However, it is important to note that indiscriminate barefoot parks can damage nature and ecosystems. To create a sustainable barefoot walking (earthing) culture, we need to create an environment where people and nature coexist.