Categorized | Injury

How Runners Can Avoid Plantar Fasciitis: Go Minimalist or Barefoot

Posted on 06 October 2013

Screen shot 2013-10-05 at 5.23.33 PMby Jim Hixson.

If you have plantar fasciitis and have been told by a doctor to wear a stability shoe, orthotics, and never go barefoot, do yourself a favor and immediately switch to another doctor, preferably one who has read about how the foot functions, and not just knows all the names of the bones, tendons, muscles, and ligaments.

I speak from experience, since I was given this advice by a well-meaning podiatrist when I had plantar fasciitis over a decade ago. After he finished telling me of the dire consequences which would affect my feet if they were not externally stabilized, I asked him how long I would have to follow his program. His answer was simple: for ever!

I wisely didn’t follow his instructions, but I did do a little research about feet and the maladies which affect them, and then I did some more fact-finding, and I never really stopped my quest because what I discovered was fascinating: barefoot populations do not have the foot problems that afflict people who wear supportive shoes. In fact, the characteristics of traditional shoes are often the most harmful, but which sound the most positive and comforting: supportive, stable, and cushioned.  These features areactually the ones that are the worst for the strength and health of your feet.

So much of what I was reading was different from what I had been taught that I had to suspend my previous beliefs about shoes. So, although I knew that weak feet were obviously more prone to dysfunction, I initially found it difficult that high-quality shoes could be the major cause of this weakness. If I had been more systematic in my thinking I would have realized that injuries associated with running had not decreased, despite all the the technological advances advertised by the major shoe companies.

One of the most common foot problems, both for runners and the general population, is plantar fasciitis a (de)condition that seems to have reached almost epidemic proportions, since it eventually affects one out of ten U.S. residents. Among certain populations, including runners, those who stand for long periods of time, the overweight, and sedentary, the rates are much higher.

Eventually I found the evidence overwhelming and was willing to enter a finding for the prosecution: traditional shoes are the major source of maladies affecting the foot and a significant contributing cause of other structural problems further up the chain of movement. I was now able to ask one major question and give a simple and accurate answer. But before we get there, let’s go into some detail about the exact nature of plantar facsiitis.

The plantar fascia is a broad band of connective tissue stretching from the front of the bottom of the calcaneus (heel) to the phalanges (toes).  Its purpose is to transmit stress through the foot by acting as a truss to help support the weight of the body when standing and to stabilize the foot and improve its function as a lever as part of the windlass mechanism while walking, running, and jumping.

Plantar fasciitis (PF) is an inflammation of the plantar fascia caused by excessive stress.  The major symptom is pain of varying intensities near the origin of the tissue, right where it attaches to the calcaneus. The dysfunction or excessive stress is caused by the foot being forced to operate in an unnatural way and without the full muscular capacity that is often caused by the construction of traditional (rigid, heeled) shoes, both running and casual.  A shoe with a difference between the height of the heel and forefoot immediately places the foot in a weaker mechanical position by shortening the effective length of the plantar fascia and the Achilles tendon which, in turn, forces both to become overworked.  Depending upon the frequency, duration, and intensity of the exercise, the plantar fascia can become inflamed.

Q. What can you do to maintain or retain healthy feet and avoid plantar fasciitis?

A. Be barefoot or wear minimal shoes for as many activities as possible.

Just like minimal running shoes minimal casual shoes should fit the anatomy and function of your feet. With no restriction of its natural range of motion, the foot is able to maintain its strength, balance, flexibility, and responsiveness. The truth is, theoretically we should always be barefoot, but in today’s world that is not always possible of feasible. Fortunately, by wearing minimal shoes, almost all of the advantages of being barefoot are preserved.

a1c32448a85b93c62ac6b6f94c566909Several companies (Vibram FiveFingers, Merrell, Altra, Skora, Xero Shoes) make excellent minimal running and athletic shoes, but there are relatively few companies that make true zero-drop minimal casual shoes. In addition to Merrell, two footwear brands excel: The first is Vivo Barefoot. This company, which is part of a larger U.K.-based corporation, Terra Plana, makes approximately ten models of minimal casual shoes, half for men and half for women. Some have laces and others are slip-on models, but all are lightweight, flexible, and very comfortable. The other is a fairly new U.S.-based company called Lems, and their zero-drop casual shoes have ample-sized area for your entire foot.

Each step you take with a minimal shoe, no matter what the activity, allows you to strengthen your feet and reinforce proper patterns of movement

This essay originally appeared here: http://motioncenterstl.com/minimal-casual-shoes-plantar-fasciitis/

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15 Responses to “How Runners Can Avoid Plantar Fasciitis: Go Minimalist or Barefoot”

  1. dvmfoj says:

    Merrell makes great causal shoes for work as well.

    • Jim Hixson says:

      Yes, you’re correct, especially the Reach Glove, Radius Glove, and even the Jungle Glove and Tour Glove for casual settings. The more “business” and the less “casual” the environment is, the more I would recommend Vivo Barefoot, especially the Ra.

  2. Jesse says:

    Great article Jim.

    I agree completely that the choice of shoes can have a detrimental affect of postural mechanics. Maintaining healthy postural mechanics is a huge factor in preventing injury. As a movement specialist for over 15 years, I consider poor bio-mechanics to be the number one cause of injury. And shoes absolutely play a role in how we move through the world.

    I would like to add more to the conversation, especially about plantar fasciitis.

    The issue that causes plantar fasciitis are not limited to the foot. In fact, the foot is usually only the source of pain, but not the problem. The problem goes all the way to the hips, usually the gluteus maximus being a big culprit. Due to the fact that we sit all day, and then put heels on our feet when we move, the gluteus maximus does not get fired the way it is supposed to. Eventually it shuts down and the muscles further down the chain must compensate to provide hip stability. This usually happens at the calves, which are continuous with the plantar fascia. The calves get over worked causing stress throughout the supporting tissue. This can cause pain anywhere in the line of tissue from the calves (achilles tendonitis) to the toes (plantar fasciitis) and even up the front of the shin (shin splints). The unfortunate thing is that once these compensation patterns are set into our nervous system, simply changing shoes or taking our shoes off isn’t enough. The dysfunctional bio-mechanics are set. The only way to change them is to have them assessed and follow a corrective strategy.

    Here is an article I just posted going into more detail as well as some self care exercises to help treat the pain of plantar fasciitis.

    http://tao-fit.com/plantar-fasciitis

    Thanks for the article.

    Jesse James

  3. Jim Hixson says:

    Jesse, I completely agree with your assessment. It’s impossible to isolate one segment of the chain and only consider its effects on other parts of the body or to think that the movements which caused the dysfunction were restricted to that same segment.

    Sitting in the classic western tradition is probably the worst (non)movement a person can do and efforts should be made to stand as much as possible when at work. Even athletic Americans often have poor hip mobility. The Sports Injury Bulletin has a good article: http://www.sportsinjurybulletin.com/archive/sitting.html

  4. max says:

    This is an excellent discussion. I will only add that footwear is not the only remedy or culprit for the injured runner/athlete. Too often they are overtrained and neglect important stretching and strength work. Running and athletics is far more than natural foot mechanics.

    Active Isolated Stretching, especially with focus on the posterior chain along with regular YOGA and Pilates exercises, are essential for maintaing foot and postural health for runners.

    Yes, natural or proper and healthy foot mechanics are importnat but pushing the body beyond its natural cycle or mode of operating is often the reason our body parts break down.

    As an avid and experienced runner, i need to do regular drills, strengthening and stretching along with foot work, in order to stay healthy and run with energy and force on a regular basis.

    I believe every situation and or runner/athlete should be examined individually vs making general statements regarding footwear, etc.

    The body and the mind of an athlete are complex and must compliment one another.

    run with grace and intelligence

  5. MIB says:

    What about Camper casual walking shoes? I would recommend Camper Peu.
    http://www.camper.com/en_NO/men/shoes/peu/camper-peu-17665-011

  6. Chad Wolak says:

    What if the inflammation is caused by too much too soon barefoot / sandal running? Is it beneficial for me to continue to wear my barefoot shoes?

    In brief, I’m fit and active but only dabbling in running. I’ve worn Sanuk’s daily for 5 or 6 years and started sandal running a year ago and ramped it up a little this summer (10 miles / wk). However, I’ve pretty much lived in Luna Sandals for the last 4 months and am on my feet a lot. A couple months ago the arch / heel pain started… I supposed it could be called plantar fasciitis, heel spurs, or just inflammation and pain from too mush too soon.

    Thanks,

    Chad

  7. Peter Bird says:

    Why do so many minimilist runners get plantar fasciitis? I see just as much plantar fasciitis in barefoot or minimalist runners as I do in those that wear a typical running shoe.

  8. pepijn says:

    From my opinion as a Barefoot Coach the most barefootstyle runners / sporters want there results to fast. Please take your time to strengthen your feet and get in to a proper running technic. Better safe than sorry……

    Plantar fasciitis isn’t a “normal” transition pain. It’s a real problem. When your feet are strong and your technic is nice (not even close to perfect) you will not have chronical problems with your PF. Heel spur isn’t possible with a proper running technic. Heel spur only appears when your are a heel stroke runner.

    Like Max says: Listen to your feet and give them time to transfer to strong barefootstyle “feet”. Besides your feet your whole body has to adapt to barefootstyle walking / running / etc.

  9. richard says:

    I had been running minimalist successfully for about six months when I developed a stress fracture in my left ankle. Of course, I was off running for several months of recovery and it has healed fine. I’ve returned to running, but have developed plantar fasciitis, especially in my left heel. Are there any strategies for dealing with this, or do I just have to rest again until the pain abates?

    • Paul says:

      Richard, I’m sure you’re long gone but there are plenty of things you (and others) can do. You mentioned resting, which you should do at least initially. Support your arches at all times – at work, when you get home and even consider a night splint. Many studies prove night splints to be beneficial in the treatment of plantar fasciitis. Good luck!

  10. josh says:

    This article isn’t just misinformed, it is irresponsible in that it gives people advice which might cause them harm. The main cause of plantar fasciitis is simply growing older. Our feet continue to grow as we get older even after the epiphiseal plates in our other bones have stopped in their function. As the space between the bones of the foot become larger, their ligaments are put on stretch, tears develop in the plantar fascia, and bone spurs develop at the points where there is ligament trauma. (these are almost always asymptomatic though.)In my case, I followed my podiatrists advice which you admonished and i couldn’t be happier. whenever i go barefoot anywhere my fasciitis IMMEDIATELY flares up to the point of limping. If i wear sneakers around the house (or at all times to be specific) my feet are singing. no need for ice, dexamethazone injections, anti inflammatories or ultrasound, not to mention increased energy. oh, and my orthotics are a godsend. money well spent. source: I’m a physical therapist and I know more about the foot and its physiology than someone who “just knows all the names of the bones, tendons, muscles, and ligaments.”

    • Meg says:

      josh, you’re describing exactly the issue of having elevation in the heel and toe spring will do. Stretching the calves, legs and feet evenly equally on each side will help greatly.

  11. Eric johnson says:

    Agree this article is really dangerous for someone with PF, which is probably fasciosis in mos people.

    Research does not support barefoot activity for this pain.

    Agree it’s often about muscle imbalances but it’s probably multifacrotial. I do not believe there is any evidence that footwear contributes to it.

    I’m having a hard time following the logic of how an elevated heel causes shortening, which then overworked them and causes inflammation. That doesn’t make sense.

  12. Michael says:

    I’ve had Plantar Fasciitis in both feet and I couldn’t seem to find any relief from the pain. I took 5 shockwave therapies till now and have been stretching exercising and putting night split, ice rolling, shoes. And I couldn’t even walk without pain. I’ve been using MEDICOVI Twin-heels orthopedic insoles. There’s extensive information for patients on their page – http://www.medicovi.com . It’s a new type of orthopedic from Scandinavia, Denmark. I’ve been using theese for months now and I’ve just bought my second pair. I’ve always suffered from pain in my feet, especially around the heels. Since owning these my life has literally changed. I can now walk with a smile on face. Can’t recommend them highly enough.


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