About 18 months ago, I wrote a blog about some interview questions that I had been asked regarding how running shoes affect knee pain.  It was our most read blog EVER so I realized I had found a topic that can be expanded upon for most running-related injuries.  So we will be doing an entire blog series following the same model.  I will be using some statements with each blog because they will ALWAYS hold true, no matter the injury or the body part.  Excuse my repetition; I believe some things need repeating to help runners learn they are in control of their body.

The success of my blog also made me understand that as much as I try to fight for runners to understand that shoes are a piece of equipment, most runners will continue to believe that shoes fix problems.  In <1% of injury cases this may be true, but for the vast majority of runners, changing your shoe will not fix the pain you are experiencing.  The answer lies in understanding running technique and strengthening, however most runners are looking for a quick fix so I am hoping with this running injury series and how they relate to shoes, we may be able to continue to educate runners to keep asking questions and learning about their bodies over relying on shoes. 

What is Plantar Fasciitis?

• What is it?

  • The plantar fascia is a connective tissue on the bottom of your foot that runs from the heel to the toe.  It is designated as an aponeurosis, which is similar to a tendon in that it connects muscle to bone, provides strength and stability, but it also helps transfer energy during movement.  There is a limited blood supply and it is difficult to “stretch” this type of structure.  Plantar fasciitis is irritation or irritation of the plantar fascia.  You may also hear the term plantar fasciosis, which means there is irritation but it usually has been going on longer and now there is some sort of damage to the fascia.  
  • The symptoms can include pain in the arch of your foot, pain to the back of the heel, pain to the inside of the heel.  It will be painful when first stepping out of bed but get better after a few steps; it may also be sore when first standing/walking after sitting for a long time or may be sore after a long day of standing.  For runners, it may be sore after running or with the first few steps of running. You can watch this video for more information about different diagnosis of plantar fasciitis,.

• Why does a runner get plantar fasciitis?

  • This is the most physical therapy answer you will ever hear . . . it depends. The causes of plantar fasciitis can be as simple as you wore the wrong shoes and your foot is mad and can be as complex as you have a leg length difference.  Most of the time, the system of the lower leg and/or back is not functioning properly so the fascia is working harder than it likes, causing irritation which leads to pain.  Sometimes it is misdiagnosed and can really be posterior tibial tendonitis or a heel spur that is inflamed.  A trigger point in the calf, a problem in the low back, a spasm in a small muscle in the bottom of your foot, a pelvic problem, or even tension through the whole back of the leg can also be the cause of the fasciitis.  Decreased strength in your foot, a lack of hip mobility, and poor running technique (or a combo of all these!) can be a big driver of these issues. One of the biggest running technique flaws that lead to plantar fasciitis is overstriding – you can watch a video on how overstriding can lead to irritation of the foot by clicking HERE   It is important to consult your local physical therapist to help you figure out what is driving the symptoms. Some people will try something like arch supports or a night splint to help reduce the symptoms, which can be helpful.  However, this does not address the cause of the fasciitis so it is important to do some detective work on your body.  

Can running shoes cause plantar fasciitis?

• Yes they can!  If a shoe has too much stability, too much cushioning, or is not fitting correctly on your foot can cause the bottom of the foot to work in a way that it is not used to working, causing irritation of the fascia.  Sometimes runners will choose a motion-controlled shoe but that can also cause problems, making the leg work in way that it is not designed to do and the fascia can end up irritated (or other things like low back pain, knee pain, or shin splints can develop).

Can running shoes fix plantar fasciitis?

• In a previous blog, I compared running shoes to a golf club: both are pieces of equipment that an athlete (runner and golfer, respectively) use to improve their performance or may affect injuries.  Can a golf club fix someone’s elbow pain?  What are some causes of elbow pain that can be fixed with a golf club?  How can you solve an overuse problem with a golf club? What are the most important things to look for in a golf club to help and prevent elbow pain?  As someone who is a terrible golfer, I am slowly learning that no matter what golf club I chose, my golf game (and any pain associated with my swing) will not be fixed by changing the club.  More importantly, my ailments (either in performance or injury) will improve once I fix the skill of my golf swing.  Only then can I choose the best piece of equipment to enhance my performance during my 18-hole journey.
• If I use that thinking to the question “can shoes fix plantar fasciitis,” I am likely to give the answer that is true for most PT yes/no questions: MAYBE. Sometimes shoes that are minimalist shoes can help runners become more aware of their technique and form because now the runner can feel what their foot is doing as it contacts the ground.  This awareness can lead to changing running technique, allowing the runner to address any kinetic chain or form issues that may be occurring because of weakness or instability (like a problem at the hip or ankle).   

What are some causes of plantar fasciitis that can be helped with proper running shoes and what should someone look for?

• Runners often think that adding more cushioning to their shoe or trying a motion-controlled shoe may fix their plantar fasciitis. One of the running technique flaws that can cause plantar fasciitis is overstriding. It is usually caused by landing ahead of your body weight, which is part of overstriding.  Heavily cushioned shoes (like the Hoka Bondi) mask the excessive impact at the heel that occurs with overstriding.  Because of the cushioning, the impact is not felt by the runner because they are basically running on a pillow.  You cannot stop force – it just transfers to somewhere else, usually up the kinetic chain into the knee, hip or back.  These shoes might actually cause pain somewhere else in the body when a runner is trying to fix their plantar fasciitis.  

• As discussed above, causes of plantar fasciitis can actually be due to a variety of issues.  Sciatica from the low back can cause plantar fasciitis – shoes will not fix that.  A leg length difference after a hip surgery can cause plantar fasciitis – shoes will not fix that.  A loose ankle after an ankle sprain can cause plantar fasciitis – shoes will not fix that.  Plantar fasciitis can cause a runner to change where they are landing on their foot –  shoes will not fix that.  Even a tight shoulder on the opposite side can cause plantar fasciitis.  The bottom of the feet have to help support our body weight and try to manage any abnormal movement patterns.

Can you solve an overuse injury with new shoes?

I would like to change the terminology from “overuse” to “misuse.”  Overuse implies that all runners have some sort of threshold that we hit and then are no longer able to run because of an injury.  If that were true, all runners would have the same injury at the same time/distance.  But if we are using structures (tendons, ligaments, muscles, joints) incorrectly, they have to work harder, causing a pain that eventually leads to an injury.  So misusing a structure because of poor running technique is really what is causing the pain, not the act of running.  Certain running shoes can help runners become more aware of their form.  When combining that awareness with a professional (like a physical therapist or certified running technique specialist) to help recommend technique drills, strengthening exercises, and the benefits of video analysis, a runner can use the awareness and new skills to make long-term changes to their running form. 

What are the most important things to look for in a running shoe to help and prevent plantar fasciitis?

• I use the rule of 3C’s: not too much cushioning (to allow the foot to feel how it is interacting with the ground), you like the color (because who really wants to wear an ugly shoe??), and are you comfortable wearing the shoe (could you tour downtown Chicago wearing that shoe without any severe achiness to your foot?). 
• Go back to the golf club analogy: after you work on your technique and you become a more skilled golfer (which does not necessarily mean you are the best!), then you choose the golf club that best fits what you need.  You want to drive the ball farther, you choose a driver or higher iron.  You want to be more precise coming out of a bunker, you chose a lower iron to improve the arc of the ball.  So the most important thing to look for in a running shoe to help and prevent plantar fascia pain is deciding what the goal of that shoe should be for you.  You want to run on a trail, choose a trail shoe.  You want to do a technique run that will be shorter in distance but you need to really feel your foot, choose a lower drop or minimal shoe.  You want to run a longer distance, choose a shoe with a little more cushioning that matches what you need for your skill.  Work on your skill of running by improving your technique and strength, then pick your favorite shoe.  

Conclusion

I have a love/hate relationship with shoes.  I feel that shoe manufactures often take advantage of runners and profit from pain. But I LOVE shoe stores like the Running Depot here in Crystal Lake and Dick Ponds. (especially the St. Charles location)  I love that they educate their employees on understanding the kinetic chain and partner with us to make sure that injuries and technique flaws are addressed first. Then, properly fit the runner with the shoe that fits their need.  This prevention model serves the runner and the culture of running, which is our main goal as a company.  So support small businesses when choosing your running shoes because they have the time, talent, and education!

Interested in learning more about technique and form? Talk with one of our running technique specialists