The Xero Blog

It is estimated that around 10% of the population suffers from heel pain caused by plantar fasciitis. Interestingly, though the condition is quite common, we don’t know as much as you might expect about what causes it and how to treat it. I often hear from runners who have switched to barefoot-style running that they have experienced freedom from the plantar fasciitis that used to bother them. In this article, I’d like to share a bit about some research that points to a reason why this may be happening. If you suffer from plantar fasciitis, you may find this opens up some new directions to explore as you seek optimal foot health. I’ll start off with some important background about what plantar fasciitis is, what seems to cause it, and how it’s often misdiagnosed. Then we’ll look at some research that points to an interesting new approach to helping people find relief. What is plantar fasciitis? On the bottom of your foot, there is a thick band of tissue, called the plantar fascia, that connects the front of the foot with the heel bone. The plantar fascia helps to support the arch of the foot and absorbs shock when our feet hit the ground. The plantar fascia can become inflamed and cause stabbing pain in the heel. Typically, symptoms are at their worst upon waking in the morning and improve once you get up and move around. What causes plantar fasciitis? Many people believe that plantar fasciitis is caused by repetitive stress. Stresses to the plantar fascia can cause small tears and these, in turn, can lead to inflammation and heel pain. What causes this kind of stress? In the literature, certain risk factors are associated with a greater likelihood that a person will experience plantar fasciitis, like doing lots of running, having a higher weight, or being in an occupation that keeps you on your feet all day. This seems to make sense. If plantar fasciitis results from repetitive stresses to your plantar fascia, those factors sound like ways of ramping up the demands placed upon your feet. But what if it’s not repetitive activities, or weight, that’s the real cause of the problem? For example, what if running form is the issue? Some ways of running place a lot more stress on your feet than others. So, the standard description of the cause of plantar fasciitis encourages us to think in terms of a simplistic picture: that repetitive stress is the input and plantar fasciitis is the output. And yet you’re about to discover that there is an important mediating factor that has a lot to do with the stresses we’ll actually experience, whatever our activity level, and how those will impact our feet. Is it really plantar fasciitis? But first, plantar fasciitis can be easily misdiagnosed. Sometimes the symptoms of PF can be caused by overly-tight calf muscles which pull on the plantar fascia. Here’s how to check: try using a foam roller and/or deeply massage on your calf muscles and see if the symptoms improve. If they do, you know that you should pay attention to releasing that calf tension. What is the best treatment for plantar fasciitis? This is where things get interesting. There is a common protocol for treating plantar fasciitis. It involves rest (to give your feet a break from whatever is thought to cause the repetitive stress damage in the first place), stretching, and the use of ice and NSAIDs (think ibuprofen) for pain. The essence here is to treat the foot pain associated with plantar fasciitis by giving the feet a rest. Recently, some researchers are proposing a different tack. Patrick McKeon and colleagues, for example, suggest that perhaps what the foot needs most isn’t rest but exercise. This isn’t to say an acute inflammation of the plantar fascia might not need time for recovery, but they argue that the core strength of the foot is the key factor that determines how likely we are to experience injuries like plantar fasciitis in the first place. In other words, greater foot strength is the key to greater foot health, both when it comes to plantar fasciitis as well as with other repetitive stress injuries, including those typically associated with running. A clinical trial backs this hypothesis up. It found that strength training exercises for the foot and ankle resulted in better outcomes than stretching alone for those suffering from plantar fasciitis. Barefoot shoes and plantar fasciitis So what does this research have to do with barefoot shoes? Barefoot shoes (sometimes also called minimalist shoes) are designed to let your feet move as naturally as possible, as they would when walking barefoot. Barefoot shoes have zero heel-to-toe drop (also called “zero drop”), meaning the heel and forefront are level and the sole of the shoe is completely flat. In comparison, typical running shoes come with things like arch supports, thick padding, and elevated heels. Wearing “supportive” shoes keeps your feet from moving the way they ordinarily would. And guess what? Immobilizing your feet, which happens with arch support and stiff shoes, can make your feet weaker. Research by Katrina Protopapas showed that adding arch support in the shoes of healthy people reduced their foot muscle size and strength by as much as 17% in just 12 weeks. Conversely, when your feet are allowed to move, they can get stronger. Research by Dr. Sarah Ridge and others have shown that walking in minimalist shoes indeed strengthens the foot as much as doing a foot exercise program (And, by the way, she says Xero Shoes should give you the same benefits as the shoes used in her study.) So we can put these two ideas together: one group of researchers says strengthening the core foot muscles will help avoid injuries like plantar fasciitis. Another says walking barefoot (or in minimalist shoes) is effective in strengthening the muscles of the foot. What’s the conclusion? It looks like the evidence suggests barefoot shoes (or walking in bare feet) could be helpful for avoiding plantar fasciitis pain. Here I want to point you to just one more piece of research. It reports on a case where barefoot running was successfully used to treat plantar fasciitis in a female athlete. I know; it’s just one case. There is more research needed to confirm barefoot running (or walking) as a way to prevent or treat plantar fasciitis. But the evidence so far is encouraging. If you have ever developed plantar fasciitis, it is certainly worth looking into. If you’d like to try out wearing shoes that are designed to let your feet and toes move naturally, find your pair of Xero Shoes right here. The content of this post does not constitute and is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a physician or other qualified medical professional with any questions or concerns you may have about your health or a medical condition. Common questions you may be wondering about going barefoot I’ve been talking with people about going barefoot for a long time. I know there are a couple of common questions that come up. Just in case, I’m giving some brief answers here (and a pointer to where you can find more information). Are barefoot shoes really the same as going barefoot? Obviously, they aren’t exactly the same. When you wear shoes, you have a layer between you and the ground. You do lose something here; we all know that irreplaceable feeling when we kick off our shoes and feel our bare feet on the green grass. But there are downsides to bare feet. They don’t offer you much protection on rough or sharp surfaces and they don’t do much for you in the cold. Barefoot shoes are designed to get you as close to the barefoot experience while still providing protection to the foot. If you want barefoot running shoes (or any kind of barefoot shoes), just keep in mind what you should be looking for. Dr. Irene Davis defines barefoot, or minimalist shoes with these characteristics: They’ll have a wide toe box to give your toes plenty of room to move, splay, and breathe. They are zero drop, meaning they won’t have an elevated heel which can negatively impact posture. Barefoot shoes do not have unneeded cushioning. (Research from Dr. Christine Pollard shows, much to her surprise, that cushioning does not actually reduce impact forces.) Barefoot shoes won’t have unnecessary arch support. (Research from Katrina Protopapas shows that adding arch support to the shoes of healthy athletes reduced foot strength and muscle mass by as much as 17% in just 12 weeks.) They will have a thin sole that allows both flexibility and ground feel. The end result is that your feet will be moving as you walk and run, using and therefore can strengthen the muscles of your feet. If I’m interested in starting to walk barefoot or in barefoot-style shoes, how should I get started? The short answer is that you begin slowly and listen to your body. If you’re willing to listen, the feedback you’ll get from your feet will teach you how to walk in a natural, pain-free way. Think of it like going to the gym after a long break – you don’t do 8 hours of bench presses. You do one set, see how you feel the next day, and as your body tells you it can handle the load you add reps, or weight, or, eventually, sets. Use that same attitude and strategy when switching to minimalist shoes. If you want to maximize your chances of beginning well, you’ll want to have a look at our post on how to walk barefoot.

As barefoot running and walking (and hiking, and kayaking, and anything else you can do barefoot) become more popular, the one question that comes up more and more is:Will being barefoot or in Xero Shoes cure me of my problems?And the list of problems includes: Flat feet High arches Leg length differences Plantar fasciitis and heel pan Achilles tendonitis Pain in the ankle, foot, knee, hip, back ... and a LOT more This is a good question.And if you hang out in the barefoot world, you will definitely hear from someone who says that being barefoot cured them of pretty much anything and everything.So, will being barefoot cure you of what ails you?The short answer is:Who knows?It's not as simple as: take off your shoes and you'll be instantly cured of every injury you've ever had, able to run without effort for days at a time, and awarded the key to every city you breeze through on your double-marathon-a-day cross country jog.Running and walking barefoot is an invitation.An invitation to, first, listen to the sensations in your feet and the rest of your body. And then, secondly, an invitation to change what you're doing based on that information.It's not a contest to see if you can endure pain until "your feet toughen up" nor is it an instant cure-all.(For the record, if you check out the feet of any good barefoot runner, they are NOT calloused, blistered, or tough. And, for the record, I'm not talking about Kenyans or Tarahumara who grow up doing everything barefoot... that's a completely different situation than running for 5-50 miles a week in a controlled fashion.)So, back to the question at hand...If you listen to your body (that is, pay attention to when something is uncomfortable), and adjust your form, and continue to explore the question, "How can I make this easier, lighter, softer, faster?" then guess what you'll probably clear up:Any problems or injuries you had from not doing the above.If your injuries and aches and pains were caused by bad form, then changing your form to something better could heal what ails you. Seems pretty obvious, yes?But, again, this doesn't happen just because you've taken off your shoes. It's possible to be barefoot and still do everything wrong, namely, not listening, and not changing.Going barefoot, or wearing Xero Shoes gives you an opportunity to listen, to adapt, to explore, and to discover what can happen for you... if you take the opportunity.Some medical professionals (most of whom, it seems, have never run barefoot at all, let alone on a hard surface) will argue, "There are no studies that show that PROVE the value of barefoot running!"Absolutely correct.There are also no studies that prove it causes more problems than running in shoes, even though some medical professionals make that claim.And it seems that claim is based, as far as I can tell, from their lack of understanding of statistics and sample bias -- that is, they only see the ones who are injured, not the ones who aren't... and don't know the total number of barefoot runners so they can't tell if this is more/less problematic than shod running. Plus, again, it's not just a question of whether someone is running barefoot (or minimalist), but HOW they're doing it. Besides, there's no studies that show running shoes prevent injuries either!Look, I'm not a die-hard "Everyone must be barefoot!" guy. Granted, since 2009 I've spent less that 7 days in any footwear other than Xero Shoes or my sprinting spikes (I'm a competitive sprinter). And, yes, running barefoot did improve my form and eliminate a number of injuries that had plagued me. I used to have flat feet and I wore orthotics for 30+ years... now I no longer have flat feet and love that I'm not spending $2-500/year on foot inserts.But "barefoot vs. shoes" is still a conversation. And a new one at that.There's been some suggestive research, but nothing definitive. And this is more a function of how hard it is to do good research than anything else.I hope the conversation can continue long enough, and with enough attention that we have some real answers, answers that help people run and walk with lightness, freedom, and fun.The content of this post does not constitute and is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a physician or other qualified health provider with any questions or concerns you may have about your health or a medical condition.