As podiatrists, a very common question we are asked is “what shoes should I wear to help my plantar fasciitis?”. We will talk about shoe selection in a moment but it is important to note that shoes alone aren’t the answer to the treatment of plantar fasciitis. Understanding why plantar fasciitis occurs is the first step in understanding what features to look for in a shoe.
The plantar fascia is a strap that tethers the front of the foot to the back, and is essential in holding up the arch of the foot. As we walk and the foot spreads out, there is tension applied and the band becomes “loaded”. Plantar fasciitis occurs due to excessive and repetitive loading of the band during day to day activities such as walking and running. By supporting this band with footwear, the strain on the plantar fascia can be reduced.
The peak load on the band occurs when you begin the lift the heel from the ground during gait. The first centimeter or so of the lift is the most physically challenging for the plantar fascia. By wearing a shoe with a small (8-12mm) elevation to the heel, this hardest phase can be avoided. Therefore, choosing a shoe with an adequate heel height is an important consideration when choosing shoes, not only for exercise, but also for day to day activity. Flat shoes, such as fashion sneakers and ballet flats are a bad choice if you suffer from plantar fasciitis.
Another important load time is when the forefoot hits the ground and the fascia has to go from being slack to being taut. Just like a crumple zone on a car, if this loading of the band can be spread out over a longer time, the ‘yank’ (peak force) applied by the loading is reduced. This translates to looking at the density of the shoe. In general a softer, more cushioned shoe is better than a hard shoe. Shoes that are really soft – can in fact be too soft. The material of the sole needs to deform, but with resistance, to effectively slow the elongation of the plantar fascia band.
Another good feature to look for, especially in running shoes, is a dual density midsole. This is a denser area under the inside ankle bone and is commonly found in good brands of joggers. It changes the dynamics of the foot to create a soft touch down on the outside of the heel and firmer resistance on the inside to help hold the heel in a more vertical position, slow the band elongation and to support an orthotic device. Even if you do not currently wear orthotics at the moment, if you have plantar fasciitis, it doesn’t hurt to plan ahead in case orthotics are required to treat your pain.
Generally good brands of casual shoes include Vionic, Keens, Revere, Zierra, Orthaheel, Naot and Merrell. We suggest avoiding the use of all flat shoes, including ballet flats, standard thongs and “barefoot running shoes” as they are too flat, provide no support for the plantar fascia and increase the strain on the band at the point of heel lift. This is so important that if all other things in the lower limb are functioning equally, a hard shoe with a 12mm heel raise would be a better choice than a soft, super flat style of shoe. Keep a pair of shoes with an adequate heel height and some arch support beside the bed to reduce the pain of the first few steps on rising.
Whilst getting the right shoe is important, you may need to consider orthotics to treat the condition. Orthotics can effectively turn nearly every shoe into a ‘good’ shoe and therefore can be cheaper (as well as more effective) than buying a whole collection of ‘orthopaedic’ type supportive shoes.