We've been very fortunate recently to have the expert opinion of podiatrist Simon Bartold on Plantar Fasciitis (or Chronic Plantar Heel Pain as it should really be called!). Today we step, somewhat gingerly, into unknown territory and try and answer the question – what shoes are best for Plantar Fasciitis?
The reason this is 'unknown territory' is that there is little or no high quality research that I'm aware of on specific shoe selection for this condition. So please take my words with a large pinch of salt and follow the wise words of top podiatrist James Welch (aka @Ablefeet);
“There are multiple reasons for plantar heel pain. Always base the treatment programme on accurate assessment and diagnosis”
Without solid evidence to guide us my advice comes from 2 sources 1) theoretical research 2) results seen with patients in clinic. This approach as some theoretical basis and seems to work well in practice.
Plantar Fasciitis is primarily considered a condition where the fascia is subject to excess load and responds with physiological changes and pain. The sole aim (yes, I went there) is to reduce load on the plantar fascia through footwear selection. This will only be a part of the management of the condition but can prove very helpful in reducing symptoms especially in the acute stages.
There are 3 premises to this approach; reduce achilles load, support the arch and reduce effects of the 'windlass mechanism'.
Reducing achilles load
Increase load on the calf complex and achilles tendon has been associated with increase load on the plantar fascia (Wearing 2006). Use of a heel raise has been shown to decrease achilles load (Farris et al. 2012). The theory then, is a shoe with a reasonable heel section and heel to toe drop should help reduce stress on the plantar fascia.
Supporting the arch
Research by Roos et al. (2006) has shown that supporting the arch using orthoses can be effective in managing plantar fasciitis. It would seem then that a shoe that incorporates arch support may help. On a practical note what I've seen clinically is that rigid arch supports sometimes aggravate symptoms due to pressure over the tender plantar fascia so a cushioned arch support may be a good choice.
The windlass mechanism
The windlass mechanism describes how dorsiflexing the big toe increases stress on the plantar fascia;
The aim here is to reduce great toe dorsiflexion by selecting a shoe with a fairly firm inflexible toe section rather than one that allows a lot of movement (see below). Recent research by Lin et al. (2013) examined great toe dorisflexion during walking. They compared range in a standard shoe, the shoe plus a firm carbon fibre insole and range when barefoot. Average great toe dorsiflexion was 28.2° in a standard shoe, this dropped to 24.1° with the addition of the insole. Whether this is clinically relevant and what constitutes a 'standard shoe' is hard to tell from this very small study on just 10 subjects, non of which had plantar fasciitis! One interesting finding though was that, when barefoot, average great toe extension was significantly higher at 48°, nearly double the range seen with a standard shoe with insole. This has implications for barefoot running where you might expect increase load on the plantar fascia from increase great toe extension. However it is important to note the limitations of this study, not least the fact that it's examining walking not running!
Now, before a bunion of podiatrist descend on me for massively over simplifying this process please note these are just some ideas. I'm very open to feedback and yes a 'bunion' is the correct collective pronoun for a group of podiatrists. Look it up.
What I can say with some confidence is that a shoe that has these characteristics is usually more comfortable for someone with plantar fasciitis than an unstructured, flat shoe like this;
Please don't tell FMG that I stole her shoe!
Or that I did this to it!
I've used a non-sports shoe here to highlight an important point – this article isn't just about shoe selection when running, but also about considerations for work and leisure. Prolonged standing and walking at work have been associated with plantar fasciitis so choose the right footwear for this too!
What about barefoot running?
Simon Bartold recently wrote for RunningPhysio on shoe selection…
“Putting an athlete with plantar heel pain into a minimalist shoe, or barefoot, is pretty much a 100% recipe to make them worse”
The reason for this is that barefoot running tends to increase load on the calf muscle, achilles tendon and plantar fascia. Barefoot running encourages a forefoot strike which increases load on the calf complex, this combined with an increase in great toe dorsiflexion (as discussed above) is likely to increase plantar fascial load. Fans of barefoot running may point to theories from Lieberman on how running barefoot may help with plantar fasciitis, Simon discusses this in detail in his article linked above.
My clinical experience with barefoot running isn't positive – I have seen a number of cases of plantar fasciitis that developed shortly after a switch to barefoot as well as a number of other foot injuries not commonly seen in 'shod' runners. I wouldn't class myself as 'anti-barefoot' but for most cases of plantar fasciitis it doesn't seem the best option.
Is there a specific shoe you recommend?
It's impossible to recommend a shoe that will suit everyone. Comfort is key, and may even reduce risk of injury, as discussed by Ian Griffiths (aka @Sports_Pod) in his excellent article on shoe selection. Try out several shoes, see which seem to help your symptoms and feel comfortable. Some clients have had success using the Asics Kayano which has cushioned support, a reasonable heel to toe drop and fairly rigid forefoot. Likewise some report good results with Hooka One Ones which have a supremely cushioned sole (see below, the one on the right!);
Closing thoughts: this is a theoretical piece with little solid research evidence to support it. I accept there are considerable holes in my theory…feel free to point them out! I hope this article promotes some discussion and alternative views via the comments. I suspect the ideal shoe selection for plantar fasciitis comes from advice based on detailed assessment from a podiatrist or physio, combined with choosing what feels comfortable to wear.
Shoe selection is just part of the treatment process, for more information see our articles on plantar fasciitis.