Plantar fasciitis has become an epidemic in our society not only amongst runners, but even more so to the average person who may not even exercise. Over the last 30 years we have been able obtain a better understanding for the condition and discovered that, contrary to the belief of many, heel spurs are not the cause of heel pain. The pain is due to an inflammation of the plantar fascia- a band of tissue that supports the arch, originating on the heel bone and extending out to the toes. Chronic overuse of the foot can lead to inflammation of this structure, very similar to the way tennis elbow effects the tendons of the forearm.
So now that we understand the condition better, how do we fix it? Well, it’s not exactly that simple. Most of the time we can resolve the problem with stretching exercises and anti-inflammatories such as ibuprofen and ice. However, some patients can go on to have recurrent episodes that may do not resolve for years. These cases are typically due to biomechanical factors usually directly related to shoe gear.
In this particular case, the patient was a 50 year old male who works in remodeling and is required to wear steel toe work boots. He had suffered from plantar fasciitis for over 3 years and was able to control the situation with cortisone injections periodically but was never able to fully overcome the pain. He did notice his pain would improve when he was out of his work boots and either barefoot or in a more comfortable shoe but was unable to form any correlation other then his boots were making his condition worse. He had spent hundreds of dollars on different work boots and currently was wearing the popular Red Wing Shoes steel toe boots.
We discussed with him the principals of why a heel was detrimental in a shoe and had advised for him to try cutting a heel off of a pair of work boots that he had to see if this changed his symptoms. An injection was not an option at this point as he had already received the recommended limit of three in the past year.
He was able to remove the heel from his boot without ruining the sole and began wearing it gradually each day for an hour and then increasing each week.
After six weeks of this routine he had improved considerably and was 80% better. At his last visit he had felt the best he had in the past three years and really attributes this to the change he has made to his boots.
How can this be explained biomechanically? It’s actually pretty simple- our feet were designed to function best with nothing interfering with it’s normal motions especially between the sole of the foot and the ground. There is no scientific or clinical basis to put a heel under the foot that is non pathologic (no deformity). This is really hard to swallow as the majority of shoes designed have a heel. Even 90% of running shoes sold today have a large cushioned heel (this is actually a decrease since minimalist shoes were introduced and have now gained a 12% share in the market.)
This philosophy is now becoming increasingly more common in running shoes as we have seen the category of zero-drop shoes emerge (shoes creates with no height difference between the forefoot and the rearfoot – no heel . With the large interest seen in barefoot running and running in minimalist shoes we hopefully will begin to see a decrease in plantar fasciitis as runners forms will change and their feet inadvertently will become stronger.