Categorized | Injury

The Arch Isn’t a Nemesis for Runners: How The Foot Can Naturally Cure Plantar Fasciitis

Posted on 17 March 2013

Screen shot 2013-03-16 at 11.47.05 PMA personal essay titled “The Mighty Arch: A Natural Cure for Plantar Fasciitis?” by Elf Martin on Softstar Shoe’s website recently caught our attention, and as a result, we posted a link to it on our Facebook page. Martin writes, “The explanation from the barefoot/minimalist shoe community is that arch supports act as a crutch that prevent you from flexing and strengthening your arch muscles properly. Therefore, arch supports used to treat plantar fasciitis are basically lessening pain by preventing you from using those muscles, with the result that they never heal and become weaker and more susceptible to further injury over time. By going barefoot or wearing shoes without arch support, I was able to strengthen my arch muscles and recover.”

Martin’s essay was then followed by this informative piece on Arches by Dr. Ray McClanahan. See below. (The essay is also part of the Natural Running Center’s Injury-Free Running guide that can be downloaded at no cost by subscribing to our newsletter.)

Ray’s podiatry practice, Northwest Foot & Ankle in Portland, Oregon, is based around a simple yet often overlooked truth: that most foot problems can be corrected by restoring natural foot function. In addition to being a health and medical advisor to the Natural Running Center, he is also the inventor of Correct Toes, silicone toe spacers. –NRC

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Screen shot 2013-03-16 at 11.42.55 PMArch Support
By Ray McClanahan, D.P.M.

Since much of the current treatment for foot and ankle disorders is centered on supporting the arch, we thought it would be helpful to discuss what arch support really means and discuss whether it is necessary or desired in the active foot.

In order to understand the treatment of rendering an arch support, one must understand the architectural principle of an arch, and liken that principle to the multitude of arches that naturally occur in the human foot. When you study the structure of the foot and the shapes of the bones of the foot, you quickly realize that most of the weight-bearing bones of the foot are indeed arches themselves by being shaped to have support ends at either end of the bone and an open space or boney arch in between the support ends of the bones.  For the purposes of the current discussion, we will concentrate on what might be considered one of the primary arches of the foot, sometimes called the medial (inside of the foot) longitudinal arch, the arch that spans between the rearfoot or heel bone and the forefoot or ball of the foot and toes.
Webster’s dictionary defines an arch as “a curved structure that supports the weight of material over an open space.”

Said another way, an arch is a structure that is able to support weight over an open space, by providing support on either end of that open space. Applying this logical definition to the arches of the foot necessitates support on either end of the arch, and is exactly the opposite of the type of “arch support” that is available to consumers, either over the counter (i.e. Dr. Scholl’s or similar product), or from their healthcare professional (footbed, arch support, orthotic). These products attempt to “support” the arch, not by supporting the ends of the foot arch, but rather by lifting up under the open space of the foot arch. This does not make sense.

Screen shot 2013-03-16 at 11.43.14 PMTrue support of the arches of the foot would suggest that the ends of the arches, on either end of the foot’s open space are the structures to be supported. This would mean that the heel and the forefoot joints (metatarsophalangeal joints and interphalangeal joints) are the structures that should be supported, and not the structures in between the ends of the arch.

As was mentioned above, current commercially available “arch supports” (which, by the way, are packaged under a number of names – arch support, footbed, orthotic, etc.) push up under the open space of the foot arch and not up under the ends. Many people feel a positive influence on their posture and walking comfort when wearing the current type of arch support, but this is not because they have a problem foot, but rather, because nearly all footwear that is available to today’s consumer expects the wearer to function well while walking on a ramp (the heel is elevated higher than the forefoot) with their toes bunched together (from tapering toeboxes) and the toes held above the supporting surface by footwear industry standard toespring, which is the elevation of the ends of the toes above the ball of the foot (the metatarsophalangeal joints).

But wait, didn’t we just confirm that in order for the arch of the foot to be supported, we need to support the ends, and not the middle, or open space?  Indeed we did, and as you can see from the description above, current footwear available to consumers is improperly positioning the support ends of the arch, by elevating the heel, which is one end of the arch, and unnaturally pinching the toes and holding them above the ball of the foot (metatarsophalangeal joints), which is the other end of the foot arch.

True support of the foot arch would then necessitate getting the heel bone (calcaneus) flat on the ground to provide support for the rearfoot support end, as well as getting the toes flat on the ground as well, so that the toes can help the ball of the foot to provide support for the other end of the foot arch in the forefoot.

Individuals who grow up barefoot, naturally have the support they need for both ends of their foot arch, and this is likely part of the reason why their foot arches function perfectly throughout their lifetimes, and their feet do not break down, unlike 80% of Americans who by nature of their habitual shoe wearing and compromised arches, will suffer some form of foot problem at some point in their lives.

This is not to suggest that we should all ditch our shoes and begin walking around barefoot, but it does suggest that our shoes are made improperly and are the cause of the arch problems and the associated deformities that many Americans experience.

Although there is scientific evidence that spending time barefoot is exactly what our weak arches need, the reason why it would not be a good idea for most Americans, is because much of our immediate environment is not compatible with our thin, moist skin and weak arches. We live in a world of cement and asphalt and multitudes of sharp materials, such as glass, that can become imbedded into our skin. Interestingly, the skin of the feet becomes thickened and resistant with prolonged exposure to hard objects such as gravel, cement and asphalt. Unfortunately, most Americans will never experience this hypertrophying and strengthening of the skin and arches of the foot, which is taken for granted in many developing countries, where all out sprinting over sharp rocks causes neither pain, nor injury.

What is suggested and recommended is that we make shoes that meet the need for protection of the skin of the feet, and that shoe manufacturers do not presuppose that the fashionable design features of heel elevation, tapering toeboxes, and toespring, are without significant deforming consequences.

In conclusion, the most likely reason for needing arch support is because today’s footwear removes the structural integrity of the foot arch by altering the support ends in favor of supporting the open end, which is no longer an arch support, but an open space support.

Pushing up in the open space of the foot has the significant long term consequence of weakening of the muscles that span the open space of the arch, which are called the intrinsic muscles of the foot, as well as the numerous muscles in your lower leg which send tendons into their final insertions, many of which are in the ends of the toes.

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23 Responses to “The Arch Isn’t a Nemesis for Runners: How The Foot Can Naturally Cure Plantar Fasciitis”

  1. Cody R. says:

    interesting article, more info for my research paper as well, awesome!

    in my time i spent in shoes…at least i never had arch support, so that’s ONE somewhat okay thing

    off to run barefoot now, see ya!

  2. Tom T says:

    You know, I always wondered why we needed arch support, especially since we evolved on a flat earth for millennia. Why all of a sudden do we need to stick a big bump in the middle of our foot? The arch had to be there for some naturally selective reason. I think, one day, everyone is going to look back at our whole misguided approach to healthy footwear and laugh hysterically.

    Think I’m nuts?
    Consider This: Do you remember those back brace/lifting support/girdles all the warehouse guys HAD to wear or get fired? It was some years ago at nearly every large chain store? We don’t see a single one today, do we? The reason is they weakened the body’s own natural strengthening mechanisms and caused more harm than good. It’s the same thing with shoes peeps. Get something thin, flat, open and flexible to keep the glass out when you’re on man-made stuff and go barefoot when you can. Your feet will get the exercise they need thank you for it…

    • Jerry G says:

      Tom T hit the nail on the head. It was a bit painful to transition from technical running shoes to minimal (Luna sandals) running shoes, but I feel so much better when I run now. I do walk around barefoot a lot and do some running on bare feet to keep my form on target and build up the skin on my feet. It also took me about a year to convert. I learned a lot during that time, but most of all I rediscovered how much fun it is to run.

  3. Beth Monnin says:

    I have very high arches and pronate instead of suppinate. What about my feet? I go barefoot frequently but am afraid to run without orthotics.

    • Jannine T says:

      I’d be interested in an answer to this question too. I walk (and run) on the insides of my feet.

      • Jan says:

        Me too. High arches . Been running over 30 years. Last year developed planters fasciitis, also. cortisone injections so far (3) unsuccessful. Anyone else have input! Getting ready to cast the foot for orthotic.

  4. Paul says:

    I tore the legiments supporting the muscle that supports the arch. Gone. Not there. Two years with horrible plantar fasciitis. Arch support, it was gone in 3 days. Now I don’t train with shoes again, karate. Seems to me that your conclusions are a bit dogmatic.

  5. Paul C says:

    I am a big believer in barefoot walking/running/living. I have been practicing this for years, specifically as a result of “Born to Run”. When I first started, I went too far too fast and wound up with a Stress Reaction. On the second try, I eased in and did a lot of strengthening, etc. for over a year/year and a half. Following my first “barefoot” marathon, I developed Plantar Fasciitis. I rested. Then started running in “minimalist” shoes, which helped develop shin splints. So now I alternate between “barefoot” running which makes the Plantar Fasciitis worse and the “minimalist” shoes which makes the shin splint worse. HELP!

    • Jason says:

      Paul – slow or even stop running for now. Your form isn’t right if you are getting these injuries. Take it easy, and re-start very slow, barefoot, focusing heavily on good form before increasing mileage.

  6. John Andersen says:

    Beth, I think one of the great things about the natural running movement is that is has brought to light that having high arches or low arches, and whether or not you pronate or supinate does not matter. Running shoe companies focus on this, but biomechanic experts like Jay Dicharry focus on foot strength, proprioception, posture, cadence, etc.
    Choosing footwear based on your arch height or whether your pronate or supinate is not evidence based. But it does take time to strengthen your feet if they’ve been supported by orthotics and traditional running shoes.
    I will use my wife as an example. Years ago, diagnosed by running store as an overpronator, recc motion control shoes, ran in heavy, inflexible hunkers. Still got injured. We found natural running information, a year later she’s running 10+ miles in ultraminimal shoes. But there was a lot of transition that year to get here. No looking back now.

    • Manny says:

      John, You hit the nail on the head. We have believed for so long that our feet were imperfect by design. Even more so, I get angry sometimes when I get asked if I pronate or supinate or I can’t wear a particular type of shoe because of my low arches. as for taking time to adjust to minimalist or even barefoot running, I really wish, in big bold 96 font size letters, all advertisement would tell folks to take it really slow. I wore my vibram five fingers for a year before I started running in them and even then, I developed my running program in the same manner I would have if I were recovering from an injury–SLOW.

      There is a contradiction in the human body; the body was designed to endure difficult things and yet the brain likes to make things easy. I believe, in time, the brain will make the body obsolete.

  7. Jason says:

    His “conclusions” are based on normal usage in healthy individuals. You tore ligaments – they need to heal, and minimising usage for a while is necessary. Once they’ve begun to heal sufficiently, continuing to coddle them with “supportive” footwear prevents them from growing stronger, and only predisposes you to more injury. Unstressed tissues are weak, stressed tissues grow stronger.

  8. Gabe says:

    So, I have some plantar pain. Do I need to stop running all the way? Can I keep going and icing and strengthening? I’m really hoping not to have to stop running again…

    I’m pretty flat footed, and am wondering if maybe I’m not cut out for the barefoot thing, feeling a bit discouraged…

    Gabe

    • Fraser says:

      Gabe, dont feel discouraged, you might just need to strengthen your feet. Like with any other muscle if we dont use them they atrophy. Picture wearing a cast which prevents you from moving your arm; when you take the cast off your arm is smaller and weaker. the same thing happens to your feet in cushioned, over-supportive shoes. Some foot strengthening exercises like picking up marbles or pens with your toes might help strengthen your arches and prepare you for an easier transition to barefoot running.
      Cheers.

  9. Another problem with crutches being used for support, is that they irritate parts of our body that are not meant to have pressure pushing up against them, like under our arm … or under the foot arch, thus not only allowing the arch not to flex naturally, but also causing an irritant to the tendons there. … and people wonder why their arches hurt?

  10. simon says:

    I broke my ankle in 1999 and had to have two screws (2-3 inches each) inserted permanently in the bone. After the surgery and during recovery, I lost considerable flexibility. While I was not a runner at the time, I played tennis and racquetball 4-5 times a week and developed severe plantar fasciitis, first in the foot with the screws and eventually in the other foot as a result of altering my movement due to the screws in the other ankle. I went to specialists and tried every kind of arch support and it never went away. I got into running two years ago and started wearing flexible shoes to let my feet move and within two months, my pf was gone. Currently, I run in Altras and usually hit about 30 miles a week and am pain free. I’m not a doctor and I’m not a shoe company, so I really have nothing to gain by sharing this. I simply want to attest to the fact that allowing my foot to work the way it is designed to work has cured my condition.

  11. Want to share a few thoughts:
    1. Many times plantar fasciitis can be helped by specific chiropractic adjustments to the calcaneus (heel). If the heel misaligns slightly posteriorly, every time you walk or run, it will overstretch and aggravate the fascia underneath the foot causing pain and inflammation, eventually even causing a bone spur on the heel. Ask – not all are familiar with this adjustment. Also other modalities like electric muscle stimulation, ice, cold laser, etc can be helpful therapies along with the adjustment.
    2. Most people can be helped with specific rehab exercises to develop or strengthen the arch.
    3. In special cases flexible orthotics can be helpful, depending on the circumstance.

  12. bikesandcars says:

    I’m suprised that nobody states a few obvious items
    1) this was said, but ideally you should be skinny, in shape, and a good runner BEFORE you go minimalist. I am not and was not and it gave me a wicked case of P.F.
    2) Why not get a set of minimalist shoes and work them in occassionally once or twice a week with your old shoes until you are in good shape.. I am doing that now and enjoy it more.
    3) stretching in the morning and at night. I’ve found that P.F. can be greatly aleviated by common calf / hamstring stretches done before you run, at morning, and at night

  13. This is an awesome article and you hit on a lot of really good points. I think it’s extremely important to use simple structures that people can understand, such as the arch in architecture, to explain to people why certain elements of footwear and “support” are bad. For so long people have just believed that they need “support” and “cushion” however they never have asked why and how it is helping them. They simply accept it as the status quo. I am always baffled by this especially applying it across the board to other sports and activities. Running is one of the few sports where up until recently, the motivations and reasons were never questioned.

  14. Charles Brown says:

    I suffered a severe PF tear in August playing tennis. It was diagnosed along with a strained peroneal tendinitis (attaches around ankle to side of foot). I walked in a boot for 6 weeks, and now heavily tape my ankle plus wear an ankle brace when playing. No issues whatsoever. However, I believe that I just did the same thing to my other foot playing tennis.
    I have been wearing Adidas Barricade tennis shoes, which now I see that they have a huge heel and very tapered toe box. I like the shoes, but am thinking they could be contributing to my PF. Any other tennis players have any ideas about a hardcourt shoe to play tennis/raquetball or even basketball?

  15. Amy Y says:

    I have been barefoot as much as possible most of my life (kicked my shoes off in the office) and always barefoot at home. Never used any type of arch support. One year ago, I developed PF. I bought several pair of Orthaheels, Powerstep Pinnacle inserts, was fitted with Brooks Ravenna + inserts, to no avail. Spent 3 months with a sports chiro who I think exacerbated the problem. Switched to a podiatrist and had the cortisone injection + 6 weeks in a cast. A few months later, I opted for the release surgery. I was just released from the temporary cast, and now my other foot is hurting. I think it’s all of the arch support! I’ve spent a year terrified to walk barefooted and spending untold amounts of money on shoes with arch supports and/or inserts. If I was not 7 weeks post-op (and have hardwood floors) I would throw them all out and go back to my old ways. Any advice??

  16. L J Booher says:

    I spent $400 on Mr. Goodfeet foot supports two years ago….do I need to pitch them? They support the heel as well as the arch, but not the front of the foot and the toes. I am a very active 62 year old who had plantar fasciitis prior to this. I have never had a problem since I bought them, but now I am contemplating what to do. Four months ago I had a stress fracture of my 4th metatarsal while running in a Cross Country run through a rugged forest. I believe it was a stone or a root I stepped on. I had on the orthopedics of course like I always do…. Hmmm… the break occurred about where the support ends. Never thought of this before…Hmmmm….comments please…


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