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Are your shoes making your plantar fasciitis worse?

Dr. Foot Solutions - Thursday, February 15, 2018


Plantar Fasciitis - A ‘Dis-ease’ of modern and overly supportive footwear, says foot strengthening podiatrist Bronwyn Cooper. Currently, almost endemic, along with weak back muscles from prolonged sitting, and overeating, is lifestyle related. We hardly saw this in the seventies, says Cooper, when sports shoes did not take over the work of the foot muscles. Think Dunlop Volleys, Adidas ‘Rome’ and Onitsuka ‘Tiger’, plus racing flats in general – all if which were able to be flexed to varying degrees along the long axis of the sole, as well as transversely across the waist of the shoe sole. These features allowed natural foot motion, whereas the ‘stability’ and ‘motion control’ excesses of the ‘overprocessed’ shoe era, tried to inhibit foot motion. Like over-processed vegetable oil (‘margarine’), the concept was good in theory, but did not bear out in practice and now has been discredited. See Professor Benno Nigg’s work on footwear that allows ‘preferred movement pathways’.

Continual supporting of the arch can lead to plantar fasciitis, says Cooper, due to weakening of the foot muscles. She sees this all the time in patients who were wrongly advised by shoe store salespeople and health professionals to wear support footwear – thereby splinting and bracing the foot. Question, Why does the foot need to be continually supported, but other injured body regions do not – think knees, hip, spine, neck, shoulder, elbow? If these are continually supported, and movement inhibited, muscles are weakened. Why do we think the foot is any different? Because it’s not!

In particular, overly supportive and cushioned shoes can interfere with the messages sent via the 200,000 sensory nerves of feet to brain (called ‘proprioception’) and alter movement patterns. An overstriding gait can create extra stress on back of heel and increased tension on plantar fascia at toe off/push off in gait.

If you are like the many who have spent thousands of dollars on failed treatments, including ‘support’ orthotics and footwear, help is at hand. It is also easy to implement and cost effective, even for chronic, debilitating foot syndrome – present in many where symptoms have persisted for years. Cooper defines debilitating foot syndrome as:

1) an inability to stand on one leg, perform a knee lunge with the knee in line with the foot, while holding good balance – on either the pain-affected side or the ‘pain free’ side

2) inability to stand and walk around the home in barefoot

3) inability to walk a few blocks in barefoot, due to pain.

Excessive cushioning and ‘crash pads’ in the soles of shoes can result in the wearer’s gait changing, such that they land heavily on the rear of the heel at footstrike. The acid test is to 1) check whether you walk in exactly the same way when barefoot 2) listen to whether you have a heavy landing when walking. See video link on how to assess.

If your gait sounds like this, you will almost certainly have a ‘shoe affected gait’. You will not be free of your problems or strengthen feet until this is addressed. Both of these walking defects can be easily retrained to a softer heel strike, with the correct landing spot being more towards the front edge of the heel (in line with the ankle). Good walking technique does not overload the plantar fascia. Until this is addressed, you cannot expect to be free of your plantar fasciitis. Click here to see a patient suffering from plantar fasciitis responding to Bronwyn’s techniques.

So, where does support fit into the RICER (Rest, Ice, Compression, Elevation, Rehabilitation) model for true recovery? It is helpful as a short term measure only, not long term. Why then are sufferers of plantar fasciitis told they are need to support the foot arch continually with moulded, custom-made (splinting/bracing) orthotics? Note – there are now over 200 types of ‘ready-to-wear’ orthotics available in the Australian footcare market, which can be adequately utilised for your-term “support”. Unfortunately, most patients are unaware of this when they sign up for custom-made orthotics, all too often started at the first visit in this modern era of CAD-CAM orthotics. Cooper sees many patients who have failed these treatments, but worse, weren’t offered the less expensive option.

She goes further to say that since a neuromuscular approach is possible with a progressive strengthening orthotic for plantar fasciitis (as well as most conditions of weightbearing joints), which she has used over the past 7 years. This approach is both a short term as well as long term approach – as it addresses the underlying cause of most plantar fasciitis – weak feet, and ‘shoe affected’ gait! As well, treatment should not be painful. For this and other reasons, Bronwyn’s treatment of choice is photobiomodulation (laser), not shockwave. Also, soft, unstable rubber thongs and sandals can be utilised in lieu of barefeet until the inflammatory phase settles. Cooper has used OOfos and FitFlops as an important part of therapy for some years now.

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