What Running Shoes Help Plantar Fasciitis?Aug 14, 2023
Plantar Fasciitis is one of the most common running injuries1 and many runners use shoes that worsen symptoms. There are several shoe misconceptions surrounding plantar fasciitis. Examples of false beliefs among runners include preferences for shoes with high cushion, minimal support and zero heel drop. New research points towards correlating anatomical and biomechanical makeup with specific footwear components. Here's what to consider when recommending running shoes for runners with plantar fasciitis.
Why Does Plantar Fasciitis Worsen With Running?
Plantar fasciitis is caused by micro-tears of the plantar fascia developing from repetitive overstretching. While causation can be multifactorial, risk factors to plantar fasciitis include pes cavus, pes planus, reduced dorsiflexion, reduced functional muscle length of the gastrocnemius/soleus and limited ankle eversion and inversion2. Some patients will present with heel spurs but rarely are they the cause for plantar fasciitis. While running, often plantar fasciitis symptoms worsen due to the high impact forces runners sustain at the initial contact phase of gait and tension placed on the plantar fascia during terminal stance/toe off3. During initial impact the stress placed through the plantar fascia can be aggravated in two ways. First, the arch can collapse due to the impact of the ground reaction forces. Secondly, pressure can be placed on the plantar fascia from either footwear or biomechanical changes such as forefoot external rotation, reduced dorsiflexion ROM and limited gastrocnemius/soleus mobility.
How Can Running Shoes HURT Plantar Fasciitis?
Runners with plantar fasciitis may be injuring themselves with every step they take. Many athletes look for supportive shoes with high arch support. Conversely, other runners look for minimally supportive shoes with little support. Other common footwear selections include shoes with high cushion, zero drop and rocker soles. Unfortunately many of these footwear options can worsen symptoms for runners with plantar fasciitis. One example is runners with low arches should avoid high arch support shoes due to increased pressure on the plantar fascia. Another example is soft, high cushion soles cause more impact and stress on the foot/lower extremities3 which correlates to increased plantar fascia pain. Lastly, minimal shoes do not support the arch of the foot and allow the arch to collapse in many runners, aggravating plantar fasciitis.
How Can Running Shoes HELP Plantar Fasciitis?
Finding the right pair of shoes for runners is essential in improving their plantar fasciitis. While some clinicians rarely change running footwear, running experts agree several features of running footwear are important to help patients with plantar fasciitis. Emerging evidence shows that a stiff midsole3 decreases the stress put on the plantar fascia while running. In recent years experts agree that moderate cushion shoes reduce ground reaction forces and impact on the lower extremities compared to high cushion shoes3. Additionally, excessive arch support for patients with low to moderate arches increases external pressure and thus worsens symptoms of plantar fasciitis. Therefore, it’s recommended for runners with plantar fasciitis to consider shoes with high midsole rigidity, moderate cushion and arch support that corresponds with their arch shape.
What Should Runners With Plantar Fasciitis Look For In A Running Shoe?
Running experts agree, selecting the right running shoe starts with integrating a runner's anatomical makeup and running gait biomechanics into their footwear decisions2. Several key factors on a running gait analysis should be considered including foot strike, foot progression angle (forefoot internal or external rotation), presences of arch collapse, genu valgum and hip drop. Additionally, footwear should be selected depending on arch support, midsole rigidity, sole cushion and heel cup support. While there are many variables dictating different footwear selections among runners here are examples of runners and their corresponding footwear, all examples assume the runner has plantar fasciitis.
- Heel striker with forefoot external rotation, excessive arch height (with collapse).
- Footwear: High arch support and deep heel cup, moderate cushion and high midsole rigidity
- Clinical reasoning: The high arch support and deep heel cup will help prevent the runner from collapsing their arches and overstretching their plantar fascia. High midsole rigidity reduces ground reaction forces and pressure from the impact of the ground on the runner’s lower extremities.
- Midfoot striker, low arch height (with collapse), genu valgum, hip drop, ankle instability with excessive ligamentous laxity.
- Footwear: Low to moderate arch support and shallow heel cup, moderate cushion with high midsole rigidity
- Clinical reasoning: Since the patient has a low arch they only need a minimal arch support in their shoe to avoid footbed pressure on their plantar fascia. The high midsole rigidity will help to support their ankle instability and ligamentous laxity.
- Heel striker, moderate arch height (without collapse), no presence of genu valgum or hip drop
- Footwear: Neutral shoe with moderate arch support, moderate cushion and high rigidity in the midsole.
- Clinical reasoning: The patient's arch doesn't collapse while running therefore they can run in a neutral shoe with high midsole rigidity to help alleviate stress on the plantar fascia.
How To Become More Confident In Your Running Gait Analysis
Performing a running gait analysis and making shoe recommendations can be intimidating for many clinicians. If you are interested in learning more about providing a running gait analysis and making evidence based footwear recommendations check out our continuing education course “The Essentials of Running Gait Analysis”. Lastly, if you have questions about this content or the course feel free to reach out to us to discuss and we will personally respond to your questions.
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- Zhu X, Liu J, Liu H, Liu J, Yang Y, Wang H. Effects of Midsole Hardness on the Mechanical Response Characteristics of the Plantar Fascia during Running. Bioengineering. 2023; 10(5):533. https://doi.org/10.3390/bioengineering10050533
- Buchanan BK, Kushner D. Plantar Fasciitis. [Updated 2022 May 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK431073/
- Laurent Malisoux, Paul Gette, Anne Backes, Nicolas Delattre & Daniel Theisen (2023) Lower impact forces but greater burden for the musculoskeletal system in running shoes with greater cushioning stiffness, European Journal of Sport Science, 23:2, 210-220, DOI: 10.1080/17461391.2021.2023655