Going Barefoot to heal plantar fasciitis?
Original article by Stuart Gordon, Sports Therapist, All About Balance (UK) with contributions from the team at Barefoot Science
Last updated June 2022
One in ten people suffer from plantar fasciitis, a painful condition and a frustrating one for patients and therapists alike! In the UK alone, that statistic means plantar fasciitis could affect approx. 6 million people - particularly those who spend a lot of time on their feet.
Individuals who spend a large portion of time standing or walking as part of their work (waitstaff, chefs, nurses, construction workers, retail works, etc.) or even their hobby and leisure activities are particularly susceptible to plantar fasciitis.
Athletes of all ages and those with a very active lifestyle are no stranger to the pain of plantar fasciitis. We know that 100,000’s of runners, golfers and men, women and children worldwide are affected. Furthermore, significant numbers of serving and veteran soldiers suffer from foot related conditions and numerous lower limb injuries as well. In fact, one top US military podiatrist has shared with Barefoot that 60% of the cases he sees are plantar fasciitis!
So, what is Plantar Fasciitis?
Put simply, plantar fasciitis is a condition that causes pain, discomfort & inflammation on the sole of the foot, usually near the heel.
The general medical consensus is that plantar fasciitis is caused by;
- excessive load
- over-stretching of the plantar surface (sole of the foot)
- overuse of the foot
- poor biomechanics
Additional factors include:
- poor shoe selection (too tight, too large, worn-out, etc.)
- inefficient gait
- poor balance
- over-pronation (associated with flat feet)
- over-supination (associated with high arches)
- weak intrinsic foot muscles
How do you treat Plantar Fasciitis?
There are many different suggested treatments for plantar fasciitis backed by numerous studies - all of which present varying and often, inconsistent results in healing or alleviating plantar fascia pain. Success is mixed and recurrences of plantar fasciitis can be frequent, leaving therapists and patients equally frustrated. Which begs the question ‘what are we missing’?
I was one of those frustrated therapists, having treated people from all walks of life for over 29 years. I love helping my patients recover from painful or debilitating conditions that prevent them doing the things they enjoy, but finding an actual solution to this tricky condition eluded me for many years. In fact, it’s fair to say that treating plantar fasciitis was a frustrating pain in the ar…area on the bottom of the foot!
That is at least until I discovered Barefoot Science insoles about 6 years ago.
I have since found Barefoot Science to be incredibly effective at eliminating pain and getting people back on their feet quickly and safely. Not just by treating the symptoms but by stimulating, strengthening and retraining the feet which means:
- enhanced performance
- pain free movement and
- minimal chance of recurrence!
If you are reading this you’ve probably had a run in with plantar fasciitis, or perhaps you're currently suffering and wondering if there's anything you can do? The most well-intentioned professional advice, online research studies, folk-lore, late night Google diving, blind faith and sheer frustration have probably led you to try some or all the following methods:
- Rest, Ice, Compression & Elevation
- A gradual return to pain free exercise
Perfectly logical approaches to injury treatment!
You’ve probably been told to stretch your plantar fascia;
- To make your feet more flexible, and less likely to suffer injury or pain.
- To increase circulation, which could help your fascia heal.
However, given that one of the suggested causes of plantar fasciitis is over-stretching, is more stretching really a logical approach?
Strengthen the muscles of the feet
A number of recent studies suggest that strengthening the intrinsic muscles (20 muscles in the sole of each foot that support the arch and create ‘toe off’) will help. For example;
- heel raise exercises with the toes sitting on a rolled towel, and
- picking up pencils or marbles with your toes.
Here’s the thing…
Wearing Barefoot insoles is like having your own ‘in-shoe’ personal trainer constantly reminding you to do foot exercises to build up & strengthen your intrinsic muscles. With every Barefoot step you'll activate your proprioceptive nerves to improve balance… A 97.6% success rate says they work! Nearly 3 million people worldwide say they work!
Strengthening the intrinsic muscles in each foot seems to have become the widely accepted way to improve foot function and prevent plantar fasciitis, a view supported by a highly respected study by; Patrick O. McKeon, Jay Hertel, Dennis Bramble, Irene Davis titled “The foot core system: a new paradigm for understanding intrinsic foot muscle function“. Full details are available via this link;
In summary the study suggests;
- Foot core training begins with targeting the plantar intrinsic muscles via the short foot exercise, similar to the abdominal drawing in manoeuvre (made popular by Pilates), for enhancing the capacity and control of the foot core system.
- The plantar intrinsic foot muscles within the active and neural subsystems play a critical role in the foot core system as local stabilisers and direct sensors of foot deformation.
Rolling on a ball
Rolling has become a feature of pretty much every gym in the world, and as a Sports Therapist for 29 years I’ve recommended such methods on many occasions. However, I always stress the need to roll slowly, with clear intention and only 3-4 times on the affected area. In other words focus on keeping the pressure constant and bearable…be kind to yourself!
- Rolling on a golf ball or a foam roller or a spiky ball or
- Rolling the foot on an ice cold bottle.
These methods have been known to offer benefit for some people, but equally not for others.
Change your shoes for more supportive ones
Now, here is a massive area of debate. There are many different types of shoe, and a plethora of sports shoes that offer;
- arch support
- shock absorbency
- mid-foot control
- motion control
- pronation control
But the question is; should we be prescribing a shoe type based on an individual’s need for support’? A study by Dr Joseph Knapik et al on thousands of military personnel concluded:
“Despite the common thinking that we should support based on foot arch height, there was in fact no difference in injury rate when a ‘supportive’ shoe was worn“
That study throws a wrench in the ‘support and cushioning’ solution offered by traditional orthotics and medical practitioners.
As does another study by Freddy Sichting, Nicholas B. Holowka, Oliver B. Hansen & Daniel E. Lieberman, featured in the Guardian newspaper. This particular study explored the effect of shoes with an upward curvature of the sole (at the front) which holds the toes in a constantly dorsiflexed (bent upward) position.
The study suggested that “habitually wearing shoes with toe springs could inhibit or de-condition the force generating capacity of intrinsic foot muscles. While the direct consequences of weak foot muscles are not fully known, it is likely that they could increase susceptibility to flat foot and associated problems such as plantar fasciitis“.
I’m not by any means the first person to point out that in 50 years of ‘advanced technology’ in shoe design the percentage of runners getting injured has continued to increase year over year, currently standing at nearly 80%.
It seems pretty clear that something is being missed! But that’s a subject for another blog.
But, what about Orthotics?
As many of you will know, Orthotics been around for many years and have helped and will continue to help certain conditions.
If you are experiencing pain associated with plantar fasciitis it is often suggested that Orthotic insoles will help by supporting the medial foot arch and stopping the foot from over-pronating. It’s also true to say that a high arch (over supinated foot) could cause plantar fasciitis, so how does your treatment in that instance differ and will orthotics help with that? In either instance do Orthotics retrain the feet to function better or simply prop them up?
My personal opinion based on 1000’s of assessments looking at the whole bio-mechanical chain rather than just the foot, is that orthotics don’t provide any consistent or lasting benefit to Plantar fasciitis, whereas I’ve found that because Barefoot Science insoles work to retrain the intrinsic muscles of the feet and reorganise neuromuscular patterns of engagement through the body, they create better movement and successfully reduce the risk of plantar fasciitis recurring.
Current clinical guidelines include the use of foot orthotic devices for heel pain and plantar fasciitis, but lack any reference to strengthening of the foot. Temporary support may be needed during the acute phase of an injury but it should be replaced as soon as possible with a strengthening programme just like with any other part of the body.
In fact many people I’ve treated arrive with a carrier bag full of orthotics that haven’t helped or are simply uncomfortable.
https://allaboutbalance.co.uk/first-the-orthotic/ describes that scenario.
Other Treatment methods for Plantar Fasciitis
If you’ve visited a Physiotherapist or Podiatrist with plantar fasciitis they will almost certainly recommend you try some of the techniques above. Additionally, they may use treatment protocols including;
- Shockwave therapy
- Ultra Sound therapy
- Non-steroidal anti-inflammatories
Here again the success of such treatments is variable and recurrence is not uncommon so what is being missed?
Barefoot Science insoles…‘the missing link’ …how do they help treat Plantar Fasciitis?
Barefoot Science insoles are specially constructed insoles with a patented dome shape in front of the heel in an area of the foot called the mid-arch. On the underside of the dome there is a socket in to which you insert 6 or 7 progressively large plugs which provide a gradually increasing amount of nerve stimulation to ‘switch on’ your proprioceptive system and to retrain and strengthen the intrinsic muscles of the feet with every step. Barefoot Science insoles will improve your balance and help control pronation and encourage re-supination of your feet which means your feet and legs can function as nature intended. Giving you;
- Better foot control at ‘ground contact’
- Improved propulsion at ‘toe off”
- Better balance
- Pain free movement
- They are not an Orthotic
- Neither do they focus on providing support or cushioning.
- Pretty much every person who tries them says the same thing… ” they just make sense“!
What is Proprioception and why is it so important?
Any article about plantar fasciitis or in fact pretty much any injury wouldn’t be complete without an explanation of Proprioception…the Body’s Built-In Injury Avoidance System.
There are 200,000 proprioceptors (nerve endings) in the sole of each foot. On every step they transmit information about movement, balance and spatial awareness, nourishing the brain with sensory information that;
- tells us where we are in space relative to things around us.
- tells each bone where it is relative to the bones adjacent to it.
- provides information about movement and balance.
Proprioceptive nerves also trigger the ‘stretch reflex’ without us consciously thinking;
- Our “Stretch Reflex” is activated when the proprioceptors sense too much stretch or force on a muscle or tendon that could lead to injury. The stretched muscle or tendon responds by contracting or shortening in a fraction of a second, automatically protecting us from injury.
- Olympic Coaches have commented that Barefoot Science insoles have reduced their athlete’s ankle sprains by 50% due to this natural injury prevention gift.
Barefoot Science insoles were developed by a Chiropractor some 22 years ago specifically to stimulate proprioception from the feet up, and in 2019 became an approved product by the British Chiropractic Association.
Don’t take my word for this, read the comments of one of the US military’s leading foot specialists. He says it far better than me;
Mr Olden stated that 60% of the cases he has treated during his 30 year career are Plantar fasciitis.
His report continues as follows;
“I’ve been using Barefoot Science insoles on my patients for the past 7 years with a 97.6% success rate on plantar fasciitis“.
“I have constructed and tried many orthotics but found most of them were more accommodating to ‘functional foot conditions’ keeping the foot aligned and rigid, yet never strengthening the foot, although there is a myriad of devices that claim they do so. In my experience none of them worked for the purpose of strengthening the intrinsic muscles. I started working with Barefoot Science a few years ago, and it has really turned our practice into a healing clinic”.
He goes on to say; “Strengthening the arch and feet and their respective intrinsic muscles effectively allows the patients feet to become self-supportive over time and eliminates revisits for the same issues”.
“We’ve moved away from bracing the feet with orthotics which tended to provide short term benefits but caused additional weakness and instability, to progressively strengthening the feet with every step my patients take“.
Mike Olden H.t; Ost; C-Ped; Pmac. American Board for Certifications in Orthotics, Prosthetics and Pedorthics. *Board Certified Pedorthist cert no: Cped0724.