There is an all too common link between poor, unsupportive footwear and plantar fasciitis. I see this association in my clinics daily. Unfortunately, this is largely due to the modern shoe industry which focuses shoe design on fashion purposes instead of what is supportive for a person’s feet. Shoes which are considered fashionable after often very flat with thin soles and flimsy, meaning they bend excessively in the heel section and midsole. A plimsoll is a classic example of shoe style my plantar fasciitis patients are often wearing. In addition to challenges with shoe style, correct fitting is vitally important, as incorrectly fitted footwear has been linked to various painful foot conditions (Burns e tal 2002; Lopez-lopez et al 2016).
Evidence
An interesting case study published in the medical journal The Foot highlighted the importance of suitable footwear. A patient presented with plantar fasciitis in both heels and had been suffering for one month. Following a footwear assessment, it was noted that the inner material in the heel of the shoes was excessively worn. A simple footwear change to new shoes with no other treatment method applied, fully resolved the pain after 4 weeks (Rajput & Abboud 2004). This study suggests that footwear is often overlooked as a causative factor in the development of plantar fasciitis and is an independent causative factor of plantar fasciitis. But this is just one case study. One could argue, the spontaneous resolution of pain could have happened overtime naturally due to the body's healing ability, as opposed to the change in footwear.
Another study reviewed the existing medical literature on footwear fitting (Buldt & Menz 2018). The reviewers found 18 studies which measured peoples feet. They found a scary number of people are wearing the wrong size shoes for their feet, between 63 and 72%. There was also evidence that incorrect footwear fitting was associated with foot pain (Frey et al 1993; McHenry et al 2015)
The most recent study published compared 60 participants with plantar fasciitis diagnosed with an ultrasound machine into 3 groups:
custom orthotics and new shoes
sham (fake) orthotics and new shoes
sham (fake) orthotics and patients regular shoes
There were 20 participants in each group. The researchers found that the group wearing custom orthotics in new shoes the greatest improvement in pain, however the group that wore fake orthotics and new shoes, also had a good improvement in pain compared with the group that used their regular footwear (Bishop et al 2018).
Overall, the current evidence suggests footwear is a significant factor when considering why someone may develop plantar fasciitis or other foot pain conditions.
What are the risks of changing my footwear?
The only risk here is your fashion status! Most shoes that are considered supportive and helpful for plantar fasciitis aren't considered 'fashionable' with today's trends.
what shoes should I be wearing?
The importance of suitable footwear is paramount in the success of treating plantar fasciitis. Unsuitable footwear can affect the effectiveness of treatment or prolong the condition, which might be alleviated otherwise. This advice is particularly stressed towards female patients as their footwear choices are usually worse than men's. Shoes which often make plantar fasciitis worse are flat slip on shoes or pumps. Ugg boots are also very bad. Flip flops are bad unless there is an arch contour built into the bed of the flip-flop to provide some arch support. Avoid shoes with a no or a low heel. This does not mean you have the live out the rest of your days in "ugly shoes". The aim of wearing supportive shoes is to reduce strain on the plantar fascia and avoid aggravating the condition. Once the plantar fascia is healed one may return to unsupportive footwear gradually and monitor their symptoms. For some people, they will be lucky enough to go back to wearing whatever shoe they please. Unfortunately, others may have to be a bit more sensible with their footwear options. There is no way of predicting this. The take home message here is that footwear choice is just as important as all the other treatment components and is not to be overlooked.
Knowing what shoes to wear is very difficult for most people. In my experience, most of my patients don't know what shoes are considered good or bad and unfortunately, in many cases, what they think is a good shoe is often not very good at all and likely one of the reasons they developed plantar fasciitis in the first place. See my video on basic footwear advice and recommendations here.
Thanks for reading. Comments welcome.
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