Shoes and Plantar Fasciitis

The Great Ergonomic Shoe Debate and How it Relates to Plantar Fasciitis

In the greater ergonomic/body mechanic community there is a vivid debate about shoes.  This debate brings in advocates from a “natural” living point of view and others from the traditional medical point of view.  And the two don’t see eye to eye when it comes to shoes and the effect they have on your feet.  This can have a major impact on  treating your plantar fascists.

The Great Shoe Debate can be simplified down to one word, “support”.

  Is support for your foot good or bad.  Does supporting your foot provide extra strength to the sole of your foot or does it weaken the body mechanic structures to the point that they can not support themselves.  

Foot Mechanics and the Plantar Fascia

In plantar fasciitis you have an injury to your plantar fascia.  The plantar fascia is a wide, ribbon like tissue that makes up the sole of your foot.  The tissue is a tough, collagen based tissue similar to a tendon.  In the plantar fascia, the tissue is laid out in such a way that it stretches in one direction, like an accordion.

The plantar fascia stretches as the bottom of your foot is elongated, like when you step down on your foot.  When you lift your foot back up, the tough fascia fiber snaps back to it’s original length.  

The plantar fascia is attached to the front side of the heel and the back side of the toes.  From those two points there is a linkage of boss that culminate in the metatarsals.

  The metatarsal bones create the top of your foot.  The metatarsals, the heel bones, and a number of other little bones make up two sides of a triangle while the plantar fascia creates the base of the triangle.  Since the plantar fascia can stretch the angle of the two other sides of the triangle can flex so that the entire triangle can be flattened out.

This flattening of the triangle is one important aspect of the miracle of walking on two feet, which is what makes the human race so much more capable in the environment.

Walking on two feet takes a complicated bit of body mechanics.  You need stability and shock absorption.  And flattening the arch of the foot provides both.  Most importantly as it relates to plantar fasciitis we are concerned with shock absorption.

When you strike your foot to the ground you are transferring a great deal of force into your skeleton.  And there is a complicated relay mechanism that moves from the arch of your foot to you ankle to your shin to your knee to your hips to your spine.  But it all begins with the arch of your foot and the main shock absorption starts with the stretching of the plantar fascia.

When the plantar fascia develops the micro-tears in it that we know as plantar fasciitis then it is weakened and it becomes more susceptible to further injury with every step you take.  But it is important to remember, as we talk about shoes, that the key to that shock absorption is the flex of that triangle (the arch of your foot).

Shoes and What They Do to Your Foot

If we follow the scientific and medical approach of shoes that have been developed over  the last hundred plus years as the disciplines of podiatry and orthotics have developed then we see a strong push to provide the arch of your foot with support.

  In providing support to your foot the idea is to provide a mechanical distribution of pressure over your entire footpad during the entire foot strike.

By distributing the pressure over the entire sole of your foot the idea is that the body can handle the stress better since nothing has to absorb that much of it at once.  Much like walking across a frozen lake, if you walk with big, wide snow shoes you are much safer.  However if your walk in high heeled stiletto shoes you can poke through the ice in no  time.  A woman stomping down with the point of a high heeled shoe can exert as much pressure as an elephant, just as a point of reference.

On top of distributing pressure over the entire base of your foot a shoe is designed to control your step.  The typical medical/scientific breakdown of a step is the “heel-ball-toe”.

  This idea has you striking the ground first with your heel then the foot is rolled forward, with most of the contact taking place along the outside edge of your mid-foot, to the ball of your foot.  The ball of your foot is the pad on the bottom at the front of your foot right behind where your toes begin to separate.  

During this step your foot continues to roll forward with the final push off happening with your toes.  An in-line heel-ball-toe foot strike is what many in the medical profession view as “proper”.  If your foot strike doesn’t follow this, or it deviates from the line, then they believe it should be corrected.  And shoes are usually what corrects this.

If you deviate during your foot strike it is usually in a rolling motion known as supination or pronation.  When this happens your ankle rolls either in or out when your foot is in the air.  The result is that when you strike with your heel one of the edges of the heel takes the brunt of the strike instead of the center of the heel pad.  So your foot strike follows along the edge of your foot instead of in-line from the center of your heel through the center of your toes.

Other deviations include rotation of the foot to where they are either splayed outwards to far or pigeon toed inwards too much.  In the standard medical view these deviations have a negative effect on your body mechanics and put extra stress on the rest of your joints, most notably the knees, hips and spine.

Shoes, braces, or orthotic insoles try to correct these deviations through mechanical means, like having a wider heel that forces contact to the bottom of the heel instead of the outside edge.

  By supporting the striking surface of the foot to better stay in-line and by more evenly distributing the pressure throughout the foot you can use technology to strengthen your body mechanics.

The counterpoint to this argument is that by using technology in this way you are actually weakening your body mechanics.

Going Barefoot and the Health of Your Feet

The main argument from the “Barefoot” enthusiasts is that by wearing shoes you distort your natural mechanics to something that supports walking in shoes and not what a barefoot walker would use.  And that by wearing shoes you do not use the body mechanics of your foot enough to keep them strong and healthy.

In the medical view point the basic strike is the heel-ball-toe.  In a barefoot strike it is believed that the heel should hardly ever strike the ground, and if it does it is definitely not the first thing.

The arch of your foot is like a spring loaded double hinge.  The arch of the foot has a hinge to flatten things out and absorb the impact and the ankle has a stabilizing hinge that can use the absorbed energy as a spring board to kick off the next step.  So where a heel-ball-toe strike may seem appropriate for a leisurely stroll where your trunk is directly above your hips, when you are engaged in a run things are different.

When you are moving fast the upright posture shifts to a forward leaning one.  Your trunk is over the front of your pelvis and not your hips.  This shift in your center of gravity shifts the angles of your legs to your hips.

  The result is that you are more comfortable and more natural on the balls of your feet.

Look at any high performing athlete, when a boxer is moving around the ring they are on the balls of there feet.  When a sprinter is running the heels hardly ever touch the ground.  Instead the foot strike is on the ball.  The arch of the foot is compressed.  As the heel moves towards the ground the shin and lower leg lean forward as the other foot begins its forward progression.  The strike is then moved forward through the toes for stability.  The ankle flexes and the arch starts to decompress as you kickoff.

This is what many consider the “natural” mechanic and one that should be used instead of the heel-ball-toe method.  There are some other peculiar foot strike issues that different individuals deem more important, like if the heel strike should be positive, negative or neutral, but those are much smaller in comparison to this core argument.

Shoes to the Answer

It’s long been known that shoes are there to change your posture.  Even high heels main purpose is to change a woman’s posture by causing them to firm up their leg muscles and have a more upright, confident carriage with a tighter derrière as well.  But modern research and shoe design has some better postural aids.  And there are options to support both sides of the argument.

Athletic Shoes

Modern athletic shoes go a long way to supporting the heel-ball-toe foot strike.  Certain construction elements can help correct a pronation or supination, or most other deviations.  There also some shock absorption built in.  With a large variety of insoles you can even get orthotic support without the need to have a custom insole made.

This kind of shoe needs to be fitted to you personally, however.  Companies like New Balance, Nike and Fleet Feet have stores with trained shoe fitters that can help.  They will often have you walk on a tread mill and/or stand on a pressure pad.  With this they can see what deviations you have when walking.  

With a good knowledge of their product line they can often find an off the shelf shoe, in conjunction with an off these shelf insole, that can provide you with the support you need to stay in-line during a heel-ball-toe foot strike.

Rolling Shoes

Another take on support for the heel-ball-toe strike is that of a rolling shoe.  In these shoes the sole of the shoe is arched downward so the middle of the sole is thicker than the heel or toe.  With this type of sole you really roll your foot through the foot strike.  

These shoes have also been marketed as trainers and formers since the accentuated motion of the heel-ball-toe is thought to help firm up your core muscles and rear end.  However, in the United States these claims have had to be retracted as there is lack of scientific evidence to support such a claim.  It is important to note that these shoes are typically intended for walking, not running.

Negative Heels

A negative heel is when, during a heel-ball-toe strike, the heel strikes the ground below where the ball does.  This is usually accomplished with the use of a heel cup or a special shoe with a negative heel, such as from the brand Earth Shoe.  

The negative heel is another take on a “natural” strike mechanic.  Since many shoes provide thick padding to cushion the heel strike there is often a pronounced positive heel to the foot strike.  The negative heel shoe is an attempt to correct that “shoe” problem.

Barefoot Shoes

There is another type of shoe that has become much more popular, the barefoot shoe.  Since it is a typical custom in many parts of the world that one has to wear shoes, the barefoot shoe allows you wear a shoe while minimizing the sole of the shoe so that it does not affect your body mechanics.

Barefoot shoes, like the Vibram Five Fingers, keep the structure of the shoe to a minimum so that the ankle and arch of the foot are free to act as they should.  The sole itself is typically thin and incredibly flexible so it fits the sole of your foot like a glove and offers little resistance to the stretch of the plantar fascia.  

The barefoot shoe also typically keeps the toes separated, which is another problem with traditional shoes.  Most shoes cup your toes inwards.  When your toes are allowed to spread naturally your balance and stability are greatly increased and that final kickoff has a little more oomph.

The Ergonauts Opinion

Which side is right?  What type of shoe should I use?  That’s not as simple as you might think.  Though this argument may seem silly to some people, those that get involved in it tend to be quite passionate.  And since the strike of your foot can lead to problems and pain all the way up to your neck, there is a lot riding, or walking, on it.

I tend not to answer definitively on the issue.  Not because of a lack of knowledge on the subject, but rather because there is too much knowledge on the subject.  All of the arguments have a lot of data, both scientific and anecdotal, to back them up.  And a strong case can be made to both the pros and cons of each.

But what works for most people doesn’t really matter.  What matters is what works for you.  Every body’s body mechanics are personal and are made up of a number of asymmetrical and anatomical issues that cause minor to major deviations from the ideal model.  As such, what shoe works for me may not work for you.

And to complicate matters worse your body mechanics will change as you grow, age, gain or loose weight, change sports, become pregnant or any number of other things occur in your life.  So the best thing I can say is to try things out, dispassionately, and determine if it feels good or feels bad.  And if it feels bad will it continue to feel bad or will it eventually make you feel better.

I personally love my Vibram Five Fingers.  I also love my properly fitted New Balance athletic shoes with orthotic insoles.  I think too often the debate goes to extremes.  They can support each other well.

Keeping you foot strong and healthy is imperative.  Barefoot shoes can help with that.  So can just walking around barefoot for  awhile each day.  You will also need to wear shoes to go places.  So when you do wear whose you should wear good, supportive shoes.  This can be an athletic shoe, a casual shoe or even a dress shoe.  They should support your foot while letting it remain active with each step.

If you find your foot is tired wear something more supportive.  If you find your foot is getting tired easily, then try to exercise it in an un-supported way so that it can strengthen back up.  

If you exercise a lot (like running everyday) then your shoe becomes a key factor to your entire boy mechanic while running.  If you just walk down the hall from your desk to the water cooler a few times a day then it isn't such a problem.  For my feet, variety is the key.

If we expand on the theory of cross training we should wear different shoes all the time.  In cross training you engage in different activities than your primary focus so that muscles that aren’t strongly engaged in the [primary activity stay strong and healthy so that they can support the primary activity.  If you switch your shoes out and wear two or three different types in a week then you are in essence cross training your feet.  

I personally do not go on a trip (vacation or work) where there is going to be considerably more walking than my typical day without at leaf three pairs of shoes.  I then try to change them up during the day.  I’ll have a good athletic shoe and typically a pair of sandals with a conforming sole (one that molds to your foot over time like a Birkenstock).  If sandals are not appropriate then I have a good dress shoe with a different type of insole than my athletic shoes.  

Those are my base two pairs.  I wear them for the majority of a day than swap them out for the other the next day.  In the evenings or during some other break I switch them out with my Vibram Five Fingers or a pair of Crocs.  Crocs can be a great change of pace shoe, especially if you are not going to wear them for more than 4 hours.  I then try to actually go barefoot for a period of walking each day.  I never use flip-flops, mules or any other slip on shoe that doesn’t have a heel, however.  These types of shoes cause you to shuffle and cling to them with your toes to keep them in place.  And while that may be fine for walking to the mail box or the pool, and distance walked in that type of shoe can truly mess up your body mechanics and cause some serious pain.

This kind of shoe rotation may seem excessive, but it can really take down the level of stress placed on your body by being on your feet all day, wether you are used to it or not.  Another tip you may find handy is to give your feet an ice bath every night for 10-15 minutes.

Shoes and Plantar Fasciitis

If you are suffering from plantar fasciitis you probably just want to know what type of shoe you need to stop the pain.  Unfortunately I can’t answer that, as I have hopefully illustrated.  It is going to take some trial and error on your part to find something that works for you.  A supportive shoe, a barefoot shoe, even a negative heel can help relieve plantar fasciitis.

And you are going to have to try it for a couple of weeks at a time before you can determine if it helps or not.  And just because Marge from down the street says this one thing is the answer, it doesn’t mean it will work for you.  But once you have found something that works you can keep using that even after you have recovered from plantar fasciitis.  So hopefully it won’t ever come back.