Shoe selection for Plantar Fasciitis

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;

Picture source

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?

No.

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!);

Picture source, via @runblogger

 

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.

Written by Tom Goom, senior Physio at The Physio Rooms Brighton. Follow Tom on Twitter.

 

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13 Responses to Shoe selection for Plantar Fasciitis

  1. simon bartold August 1, 2013 at 11:30 pm #

    Great piece Tom, and all I can add is that it might be worth considering footwear that specifically addresses late midstance/ early propulsive phase overpronation.. there are a couple. One in particular achieves this by what in essence is a “Morton’s extension”, that is, a cradle of EVA that is more dense medially in the forefoot and extends beyond the 1st MPJ (whilst still allowing plantarflexiion of the 1st ray, which is mandatory). The concept here is to increase the supination moment at take off and to facilitate windlass mechanics.
    Has it been scientifically proven to achieve this.? No, but I believe the theory is sound, and this would be my first inclination when implementing footwear as a part of the multifaceted treatment program for plantar heel pain.
    best
    Simon

  2. shawn August 1, 2013 at 11:53 pm #

    I have had success in “firm” shoes in managing my PF. I do know, anecdotely, that the Brooks Ravenna 3 made the PF pain worse. I was running in that shoe when I developed PF and as long as I wore it, the pain got worse, even when I wasn’t running, just walking in that shoe. Too high off the ground, too squishy (marshmallow cushioning). My feet feel the best when they have firm cushioning under them. Also, Powersteps insoles have worked wonders in managing the pain in all shoes. All I can say is a firm/responsive ride has gotten me back to running again. Currently I’m in the Newton Motion and love the firm ride. I too have heard people have had success in the Hokas.

    • Kristen August 12, 2013 at 4:47 pm #

      I didn’t realize the shoe-connection until reading Shawn’s comment above, but I, too, developed PF after switching to the Brooks Ravenna 3 this spring. I’ve been a devoted runner for 23+ years, including high school and college, and have never had any PF problems until April of this year.

      For treatment, I’m currently icing, massaging with a lacrosse ball, stretching and sleeping in a boot… Now, I’m headed out for a new pair of shoes. I found this article to be helpful – Thank you!

  3. Craig Payne August 2, 2013 at 12:46 am #

    Did you somehow miss the memo that minimalism is the best thing for plantar fasciitis? …. go figure that you would recommend shoes for it!

    See this (and the comments!)
    http://www.runresearchjunkie.com/is-minimalism-an-option-to-manage-plantar-fasciitis/

  4. James Speck September 1, 2013 at 1:04 am #

    Hi Tom,

    I definitely have doubts about the use rigid and supportive footwear for the treatment of plantar fasciitis. A big part of this is because I developed the problem while wearing stability shoes, and the condition resolved soon after I switched to less supportive shoes.

    This is just one example, but in general I question whether tensile stress on the fascia is the cause of the injury. This is the prevailing theory, but the evidence that over-stretching or microtearing of the fascia causes the problem is not conclusive. A few alternate theories like non-uniform loading and vascular disturbances have been suggested. Shoe design might be a factor, but it’s an unpredictable one.

    Regarding stability vs. minimalist, there doesn’t seem to be enough information about how the condition develops to make a strong recommendation either way. If tensile stress is not the main factor, reducing stress on the fascia with a rigid shoe wouldn’t make sense as a treatment strategy. For chronic cases, I’m tempted to think that increasing load on the fascia and plantar intrinsics to encourage tissue regeneration will be more effective than limiting motion, so I lean more toward shoes with flexible soles rather than stability footwear.

    • Angela October 12, 2013 at 4:26 am #

      By my experience, I agree with James. I’ve been running 15+ years, lately 40-50 mi/wk. I never had PF problems until earlier this year when I switched to a slightly harder and more supportive shoe (in the process of auditioning shoes to replace my beloved old model that the manufacturer re-designed beyond recognition). The PF carried on for months, and then went away within two weeks when I switched to a softer and more neutral shoe. Those wore out and I tried a different stiffer model for kicks — and the PF came back after a week. Lesson learned! Anecdotal, but for me swapping for less support was the solution.

  5. Matt October 15, 2013 at 11:05 am #

    After switching to a new brand of shoes (Newton’s Sir Isaac), and suffering rather severe PF, my physio has recommended that I go back to what was working for me for the past 20 years, the ASIC’s GT’s… So, I will put this theory to the test.

    For anyone familiar with the Newton’s shoes they have a very prominent action-reaction technology, which may be beneficial to some, would not recommend it with anyone who is suffering from PF..

    Great article by the way…

    Matt

  6. chris nentarz March 3, 2014 at 3:41 am #

    Great thread. The cause and treatment of PF is highly individualized. Acute management should focus on protecting the tissue so it may heal, while long term strategies should focus on enhancing LQ biomechanics, running form and overall athletic development. In later stages, minimalist shoes MAY be of benefit. In acute management, barefoot corrective exercise and running drills can be effective to help remodel the tissues of the foot/ankle. As with any injury, we should consider multiple factors including the hardware of the LE (mm length, mm density, joint mobility, etc), running form, footwear, running load (speed, duration, incline/decline, running surface, etc), overall conditioning, recovery strategies, warm-up strategies, etc. Writings from good practitioners like PhysioTom are invaluable to our insights on treatment and management strategies of running injuries. Look forward to reading and learning from future posts and comments! Chris Nentarz

  7. Best running shoes March 24, 2014 at 1:54 am #

    What are the best shoes to run in if you have plantar fasciitis? Do any of you have any advice or experiences you could share that would be helpful?

  8. alexmangurisra April 22, 2014 at 11:06 am #

    This is very nice informative article, thanks for sharing the useful information
    see post

  9. Cheryl April 24, 2015 at 9:30 pm #

    Just found this article. Spot on. I have been “managing” PF for about 8 months. The 6 months prior to that were absolute agony. I know that it all began with Sperry Topsiders. The lack of support and flexible toe initiated the PF in just a few weeks. My first research put me in 0mm heel to toe and that was pure failure. New research found Birkenstocks (originai not the soft bed). I wore these for several months and slowly things improved. As I was trying different running shoes, I could always count on the pain to subside when I slipped on my Arizonas. Granted it was a bit hard to manage in the snow!. My success with running shoes was the Asics GT2170. I just retired them after 9 months. I complemented them with Birkenstock sport insoles. Have have been able to walk 2 miles almost everyday pain free. The GT’s finally broke down and soreness returned 2 weeks ago. Even though the GT’s were good, I took a try at the Saucony Guide 8. Only an 8mm heel to toe so we’ll see, but they seem to have better balance in the arch and toes and less ankle roll. Other than studying shoes, I found that stretching the calves was essential;. Torquing them in a horizontal direction helps as well. Few people understand how painful and debilitating PF is unless you have it. This is one of the best articles I have read and even reading it after the worst of it, I would strongly recommend you try this regimen.

  10. Plantar Fasciitis Survival Guide August 19, 2015 at 7:46 am #

    Wearing arch support and having a heel to toe drop is going to help in the short term, and take tension off the plantar fascia, but it will not fix the cause of a persons weak feet. Wearing shoes is the true cause of plantar fasciitis.

    I do not think that people should try to walk around barefoot if they have plantar fasciitis, but they need to slowly move towards having no arch support, zero heel drop and wearing shoes that have a wide toe box to accommodate toes lateral movements. If the toes are pushed inward, as in most shoes, your foot muscles will not be able to support the arch naturally. If the muscles of the foot are unable to pump nutrients into the plantar fascia, and wastes out of the plantar fascia, then degeneration will develop. Keep in mind that there are no markers for inflammation in people with plantar fasciitis. It is not an inflammatory problem, it is a degenerative problem from weakness and lack of nutrient waste exchange.

    Keep in mind that in populations where people do not wear shoes, plantar fasciitis does not develop.

    William Prowse IV

  11. Harry November 10, 2015 at 10:20 am #

    Hi, having read through all the comments I was wondering if anyone has the problem just walking?….I have Fybromyalgia and a few other muscualar/bone problems, I am also pretty flat footed, when I walk I get very sore heels and arches and it travels up my shins so Im in extreme pain with it and it causes me to stumble and trip etc as I struggle to lift my foot properly…this is mostly in the left foot..can anyone recommend a pair of support shoes, I was told to get New Balance running shoes (even although I don’t run) as they have cushioned heel and arch support….please can someone help me I cant even walk the dog without being in agony 🙁

    Any comments welcome
    Thanks

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