Plantar Fasciitis: What Works, What Doesn't

Alan: I just returned from two weeks in Mexico where I guided a group of 14 8th graders (and teachers) over, under and around the Yucatan peninsula. I knew in advance that lots of walking on torrid surfaces would probably inflame my plantar fasciitis. As it happened, my feet felt better than they had since onset of pain during a vigorous 90 minute game of Ultimate Frisbee on New Year's Day (2014). Although it is difficult to determine if a patient is cured by a particular "intervention" -- or simply by "the passage of time" -- I believe that a combination of physical therapy, "Brooks Dyad 7" shoes and Spenco polysorb shoe inserts (the green ones with the yellow soles which sell for about $15 dollars online) "did the trick." I will also pass along the good news that my orthopedist communicated during my first consultation. Right "out of the gate," Dr. P (a veteran at Duke Medical Center's orthopedic clinic) assured me I would get better. 'If you faithfully practice physical therapy for 3 to 8 months, I can tell you this: your feet will get well.'

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Alan: My physical therapist friend, J, sent the following counsel. (My earlier correspondence with J follows.) 

Hi Alan,

The handout she sent you has the usual suggestions.  Unfortunately there is no  treatment for plantar fasciitis that is definitive... and the list is long!  In fact, a good rule in medicine is that the more treatments there are for something, the less likely it is than any one of them will really work.

That being said, it is possible that Dr. P could recommend a cortisone injection... they work maybe about 50% of the time, but are painful as you might imagine.

Keep up the stretching, but eliminate the "lifting and loading" part...just do a slow, long gentle stretch and repeat frequently throughout the day.

For severe cases sometimes immobilizing the foot in a cast boot for a few weeks helps.

The arch supports are usually helpful, but maybe you might benefit by a more custom orthotic but he'll talk to you about that option if he thinks it's indicated based on your foot type.

The best thing about PF is that it almost always goes away, it just takes a long time.  When I had it I tried everything without a lot of help.  It lasted about a year and a half, but then I went on a trip to Europe and when I came back it was gone.  So maybe traveling abroad will be just the thing for you! :)

J

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Dear J,

I hope you are well.

I am writing today because I will guide a group in the Yucatan during the first two weeks of May and my plantar fasciitis is still flaring so severely that I am concerned about my ability to "hold up" under the rigors of "continual" walking on blazing hot surfaces.

I consult with Dr. P on April 23rd and hope he offers a pharmaceutical crutch to get me through.

In the meantime, I'm taking a closer look at footwear and wonder what you recommend by way of footwear and "orthotic insoles."

The appended email is from an acquaintance named JC who works as book keeper for a physician in Rochester, New York.

I suppose there are as many opinions as there are people - and as many reactions to specific products as their are users of those products.

But it occurs to me that you are in a good position to collate such "data" and may have useful views on what works best.

It may be useful to know that I have fairly high arches which have not fallen.

Although my original fasciitis pain felt like a fallen arch in my left foot, that under-arch pain has pretty much gone away.

Now the pain is mostly focused in the heel with new manifestation of burning pain along the front part of the sole of my foot. (In my upcoming consultation with Dr. P. I will ask if my therapeutic exercises themselves -- particularly the one where I position the ball of my foot on the tread of stair, then "lift, load and lower" my heel below the plane of the tread -- could be causing the new burning sensation in the front part of my feet.)

I will conclude this tale of woe by saying that pain in the mid-section of my foot sole is not really an issue and that pain in the mid-section actually worsened when I used an insole featuring arch support.

Once again, thanks for helping me navigate this thicket.

Pax

Alan

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Email from JC, a friend who works for a physician in Rochester, New York.

Alan,

Hello, I hope this email finds you doing well.  F gave me your email to send along the plantar fascia exercises for you.  Also Dr. B. informed me that going online to order the Spenco inserts is much less than purchasing them in an orthotics store, about $16. online.  She has always told me that New Balance sneakers were the best ones and take out the very thin insert that comes in them and replace it with the Spenco.  I have found that the mesh type sneaker is much more comfortable than the vinyl or leather ones.  Also another hint for the sneakers is if you can twist the sneaker’s bottom they do not have very good support in them so if when twisting them they really don’t move much that is good. 

The exercises really do help but do them first thing in the morning before putting any weight on your feet.  

I hope this all helps you some.

Joan

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Email from Seattle physician friend, EM

Hi Alan:   

The list of shoe brands on your blog (prior to recent entry) tells the story of my experience:  it makes no difference (they ALL work) IF the shoe has a good arch.   But along with arch support, best results come with stretching out the Achilles and soleus once each day:  that keeps it from coming back  :)   My patients concur. 

Note:  I've worn many different brands of footware since my episode while traveling thru Turkey, Syria and Jordan (6 wks) in the mid 1990's, but the only time it gave a hint of coming back was when I quit doing the stretches about 3 yrs after the episode.   So,  I stretch daily (not a bad idea for an old fart anyway).  Cheers, E

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Shoes We Use for Plantar Fasciitis: What Works, What Hurts

I'm not a doctor. I'm a long-time sufferer of heel pain caused by plantar fasciitis, and from physicians, my own experiences, and research, I've learned more than I ever wanted to know about this painful foot condition, the idiosyncrasies of my feet, and the shoes that help the pain or make it worse.

This article has detailed suggestions for therapeutic shoes, specific brands and models, tips on what to look for, and general advice for healing. For an even more in-depth look, you can also see my new website on the footwear that worked for me.

Also on this page, don't miss the awesome poll on the best plantar fasciitis footwear brands. It has received over 5,000 responses from readers, and over a hundred comments from fellow heel pain sufferers who offer their own suggestions, experiences, and advice.

Plantar Fasciitis Footwear: Why Is It Important?

As you probably know by now, when you have heel pain in the foot caused by plantar fasciitis, the problem is that the fibrous plantar fascia on the bottom of your foot has gotten inflamed, probably due to a stress injury or sports injury. Pain in the heel occurs along with the inflammation. You may have noticed that the pain is usually worse in the morning and after any period of rest, noticeable as soon as you put your foot down and start to bear weight; heel pain after sitting or sleeping is a common complaint. The pain is much more manageable if you step straight into a pair of anatomical slippers and throughout the day and during exercise you wear shoes designed to help this injury. Barefoot equals bad, for the most part.

The right foot support isn't enough, of course. When I have a flare-up, I get rid of the pain by doing an assortment of therapies involving exercise, stretching, massage, and hot/cold treatment. But first and foremost, I use specialized inserts and insoles, bandages, arch support, and special shoes for heel pain. (This article is about shoes; for more details about a wide assortment of treatments, read my article about plantar fasciitis treatment options.)

Update July 1, 2013

Since my affected foot has improved beyond recognition, I've moved on to a new level of personal footwear - minimalist. Specifically, moccasins. Since "barefoot" walking can exacerbate a plantar fasciitis injury, I do not advise this unless you're already well on the way to complete healing, and then only with much care. The rest of this article is written with conventional therapeutic footwear in mind, and I still think that's the best way to go while still in the trying-to-get-rid-of-it stage.

It's something of a platitude, but it's true - every foot is different. When I started having heel pain many years ago and my doctor told me I had plantar fasciitis, the first thing I did was get new therapeutic footwear - new brands, new styles, everything. I still wear the same shoe brands today to prevent flare-ups: Birkenstock, Haflinger, Brooks, Lowa, and Chaco. There are a lot more these days, and many are listed below. You may want to do what I do and use different brands for different activities, like running, walking, working, puttering around at home, and such.

Expect it to be a trial and error process. No matter what the hype and sales pitches tell you, there's no single best shoe model for plantar fasciitis. I mean, not only are your feet different from other people's, but your left foot is probably different from your right foot, and your stride and posture are an individual thing, too. The best thing you can do is to talk to your doctor and read the recommendations below and assess the shoe models yourself.

If you are a runner or other athlete, you'll find lots of footwear suggestions, and a number of leads for dress shoes, sandals, house slippers, and more.

One more note about my background: remember that I am not a health care practitioner. My expertise comes from having and treating my own plantar fasciitis and obsessively researching the subject each time I bought new shoes.

Poll: Which Shoes Help Your Plantar Fasciitis?

What Brand of Shoes Helps Prevent or Treat Your Plantar Fasciitis?

• 12% Birkenstock
• 7% Brooks
• 13% New Balance
• 9% Asics
• 3% Saucony
• 3% Clarks
• 4% Merrell
• 8% Dansko
• 1% Haflinger
• 3% Ecco
• 1% Mizuno
• 2% Naot
• 2% Mephisto
• 4% Nike
• 1% SAS
• 0% Converse
• 8% The shoe that helps me is another brand. (Please tell us what in the Comments section)
• 6% I don't wear special shoes for plantar fasciitis, but I wear arch support inserts. (Please share what type in Comments)
• 12% I don't have any particular footwear or insoles that help me.

6668 people have voted in this poll.
Go back and vote

Heel Spur or Plantar Fasciitis?

Plantar fasciitis is sometimes erroneously called a heel spur, which is a calcium deposit that builds up on the bone of the back of the foot, but doesn't generally cause pain. Typically, it's the inflammation of the plantar fascia following degeneration of the collagen fibers that causes the heel pain, arch pain, and pain on the side of the foot.

Why Worry About Shoes With This Foot Condition?

The reason is simply that your feet need proper arch support and good cushioning in a shoe in order for the injured foot to heal. As I learned years ago, going barefoot or wearing the wrong shoe for the activity can slow down improvement by weeks or months.

When choosing boots, sandals and shoes, make sure that the shoe has a removable footbed, also called an insole or insert, if its inbuilt footbed does not have contoured arch support that matches your foot.

If you're a runner, play tennis, or play racquetball - which is the sport that gave me the sports injury that caused my plantar fasciitis (my doctor said the side-to-side motion twisted the fascia) - or do any high impact activity, correct arch support as well as flexibility and shock-absorption is essential.

The kind of arch support you need depends on

• your foot arch - do you have a flat or high arch?
• whether your feet supinate as you walk (when the inner foot turns out) or pronate (when the inner foot turns in).

Your podiatrist can tell you whether you're a supinator or over pronator, or if there is anything irregular about your stride.

Your podiatrist might recommend custom orthotics. I, personally, have used the cheaper option - heat moldable orthotics. I use the Sole brand (find a link in my related article on footbeds). These inserts have a hard layer of support and a layer of dense cushioning. They fit into shoes after the removable insoles that come with the shoes are removed.

Whether or not you need orthotic inserts, plantar fasciitis is helped by good arch support. The shoes you pick will decide it.

Tips for Treatment

• The use of old and worn-out shoes can contribute to the problem of plantar fasciitis. Replace your shoes, not when they look ragged, but when the arch support or cushioning has worn down.
• If you're not used to arch support for your feet, break in your shoes, insoles, inserts, or orthotics slowly. I can't emphasize this enough.Wear them just a few minutes the first day and gradually increase according to your podiatrist's recommendations.
• If you buy heel lifts or insoles for your plantar fasciitis, wear them on both feet, not just one foot, even if only one foot is affected (which is usually the case), so as not to set your posture out of alignment.
• Plantar fasciitis lasts so long because people get reinjured regularly - like every time they get up. Massage the feet and do calf stretches for plantar fasciitis regularly, and especially after resting, to condition the muscles, and not the injured plantar fascia, to take the strain of weight-bearing and help it heal.
• Consider changing your exercise. It may not be necessary to stop walking - in fact, walking can help plantar fasciitis in some cases. But stop doing the exercise that caused the injury for a while.
• If you don't have arch support insoles, tape your foot for plantar fasciitis support regularly during the day to help support the arch, and if your doctor recommends it, wear plantar fasciitis night splints at night.
• Remember, check with your foot doctor about your foot pain to make sure it's plantar fasciitis instead of achilles tendonitis, a stress fracture or some other foot problem.

Best Running Shoes

I wore the Brooks Adrenaline for athletic walking to help my foot with plantar fasciitis. The American Academy of Podiatric Sports Medicine recommends that you get the proper shoe for the kind of motion control you need to correct overpronation or oversupination and that the shoes has good cushioning to help control trauma to the foot.

Check with a physical therapist or occupational therapist about what kind of motion control you need, as not everyone needs the very stiff motion control of some shoes, and the light motion control of others is insufficient to do the job.

Some models they recommend with extreme motion control include:

• New Balance 1123
• Asics Gel-Foundation 7 WSC or Evolution 3
• Brooks Beas
• Saucony ProGrid Stabil

Models with moderate motion control include:

• Brooks Adrenaline GTS 8
• New Balance 90
• Ecco RXP 1660
• Mizuno Wave Alchemy 7 WSC

Light motion control models include:

• New Balance 1010 / W / S
• Asics GT-2130
• Mizuno Wave Nexus 2
• Saucony ProGrid Echelon Score - 35

I also read that Ecco has designed the Ecco Women’s RXP 3060 to treat plantar fasciitis to help take the pressure off the heel. Reviews at FootSmart were very positive - 21 reviewers gave the shoe 4 1/2 stars. There is also a men's version that got a 5-star review from one user.

Plantar Fasciitis Treatment Options

The pain of plantar fasciitis can seriously crimp your style when you put weight on your injured foot. Here areexercises, stretches and other treatment options to help you heal your heel pain effectively.

Best Sandals for Plantar Fasciitis

If you're looking for the best sandals orflip flops for plantar fasciitis, there are special considerations, as arch support insoles won't work with sandals. Make sure they have enough support, cushioning and flexibility.

I have had good results with Chaco sandals and Birkenstock sandals, both of which have extreme arch support. Many models come in a wide width option. (The Birkenstock link goes to a soft foodbed version of the Florida Sandal, which I have the not-soft version of. I used to link here to an inexpensive waterproof sandal that seemed similar to a model mentioned by one of the commenters below, but the link kept breaking so I removed it. It's called the Pacific sandal by Birki's if you want to research it.)

Some people might find Merrell, Mephisto or Teva work - or avoiding sandals altogether. But remember - doctors usually say you shouldn't go barefoot with plantar fasciitis if you want your foot to get better as fast as possible.

Walking, Work and Dress Shoes

Shoe makers such as Clarks, Dansko, Birkenstock, Ecco and other European comfort shoe manufacturers regularly produce shoes with above-standard arch support.

If you're a nurse or other medical professional, chef or somebody else who stands on their feet all day, you may want to look at Birkenstock Nursing Shoes to find shoes with good arch support that would be suitable for nurses with plantar fascia pain.

The CrocsRX Cloud clog for women and men has great ratings by users, although it's not always indicated whether or not the users have heel pain.

I, personally, wore Birkenstocks for dress, work, and walking almost the entire year, and they helped a lot. Note that I worked in a casual environment, so the style was right. Birks have a contoured cork footbed that molds to the natural contours of the feet.

I have a normal arch - not high, not flat - and I supinate slightly. I wore Birkenstocks Florida sandals, and Paris shoes, as well as the now discontinued Santa Fe and Phoenix models. The Boston clogs never fit me properly, but I also wore Haflinger clogs as plantar fasciitis house slippers, and they were as good and supportive as Birkenstocks. I would not necessarily recommend the Birkenstock Footprints collection, as these often have a lower arch, but shoes in the Classic collection have done very well for me. For plantar fasciitis sufferers with a high arch, the Tatami line may be the answer.

In later years, I also wore the Ecco Alpha sandal, a fisherman-sandal style shoe that they don't make anymore. It had excellent arch support and cushioning.

Finally, be sure to check out the poll above. As of this writing - the middle of 2011 - New Balance and Birkenstock lead the way as the most popular brands of shoes for plantar fasciitis.

When you choose the shoe, make sure the width is correct and the shoe feels comfortable at first wearing. Don't buy a shoe that a sales person says will need "breaking in" - shoes shouldn't need to stretch out in order to fit. However, if you're not used to good arch support, you may need to accustom yourself gradually. Begin wearing the new shoes or inserts with arch supports just a few minutes a day and gradually increase until you get used to the feeling.

See the author's disclosure statement about compensation for this article.