Plantar Fasciitis, Fasciosis, and Going Barefoot - The Other Side of the Story
Recently, I was asked an interesting question by an interviewer who was talking about Plantar Fasciitis. He said podiatrists were very anti-barefoot (except that it would give them more business) and would I share the "other side" of the story. And then he asked an interesting question, would I recommend going barefoot to someone who does NOT currently have any foot problems.
Below is my response, along with an addition by Dr. Ray McClanahan, a leading podiatrist in the Pacific Northwest who specializes in getting people's feet back in shape again.
Thank you for reaching out to me, I'm happy to respond to your question about going barefoot for people who are not struggling with Plantar Fasciitis yet, and whether they would benefit from some barefoot time. Thank you for giving me the opportunity to share the "other side" of the story.
However, it's strange that you call it the "other side" of the story...presuming there's an argument. There's no argument, though admittedly, some podiatrists say they're happy for the increased business from "barefoot running" (typically, from people overdoing it in their "barefoot running shoes.) But we're all SUPPOSED to be in this together; the goal, to help people have happy healthy bodies, whether for running, for walking, or for living a quality life and being able to get things done pain-free.
Podiatry has their methods of doing this, typically, they involve a crutch, such as propping up the arch with orthotics, assuming the foot is too weak, and that the "intrinsic" muscles can't grow strong enough to support our body weight...something that makes no sense in evolutionary terms. But in the short term the orthotics often help tremendously. I know I really benefited from them (or so I thought) many years ago. Trouble is, it's a short-term solution, because if you lean against something, you inherently get weaker and less stable...needing a stronger and stronger crutch until there's no place to go.
Plantar Fasciitis in its simplest terms is a social condition created by a weak foot. If the foot muscles aren't strong enough to do the job of supporting our body weight, it falls on the rope like connective tissue on the bottom of our foot. Unfortunately, CONNECTIVE tissue, inherently is designed to CONNECT, not to support, and it fails miserably at doing the job the muscles couldn't do. So it gets ticked off, inflamed, and if you push it long enough, either begins to rip and tear (major OUCH!), or it pulls on it's attachments, creating bony calluses called HEEL Spurs. This is all corrected by getting the foot STRONG, once the inflammation has gone down of course (you can't strengthen until acute inflammation is down...and no, I'm not a doc, please always seek professional medical advice, I'm a coach, I'm the guy they come to when they want to get running or walking again).
Orthotics weaken, supportive shoes weaken, and the worst offender? 99% of today's shoes which are mis-shapen to the foot. They nearly ALL are tapered in front for the 3rd toe to be the longest...but no-one's is. This means that it forces all of the other toes together, making a less-stable platform (the foot is supposed to be shaped like a triangle, not a tube or an ice-skate blade). This inherently makes the foot wobbly, doesn't allow the toes to engage and support the arch (the muscles of the arch attach in the back at the heal, and in front at the toes, if you cram the toes, they get weak, and they can't support the arch. And so the shoes themselves cause your arch to "collapse" and create a plantar fasciitis condition.
So why get people out of shoes who do not have any condition?
Well, I'd say a middle-road in everything is best. If you're not injured now, then it's the perfect time to work on injury prevention. And how do we do this? By strengthening things, by getting you out of the offending footwear, by reducing your need for "support" or orthotics/insoles. So spending a modest amount of time training barefoot (beginning with only 100 yards, every-other-day, and adding a maximum of 100 yards each time you go out...and always BEFORE your shod runs, when your muscles aren't fatigued, and your skin isn't sweaty, is always best). Small, modest amounts can help you build the strongest, healthiest feet out there, AND by feeling the ground, and the feedback you get (for instance, if you hit your heel on the ground barefoot ONCE, you'll never ever do it again!) you begin to learn the lightest most, natural stride possible, helping not just your feet, but your ankles, shins, knees, hips, back, shoulders, and neck.
Barefoot time will also help increase circulation throughout the legs, because when you go barefoot, your feet have to do more work, requiring the body to send them more blood flood, nourishment, and oxygen. So you get better circulation (perfect for the hot weather, and especially for the cold next fall) and become even more injury resistant.
And you get better posture too, helping your whole body feel better. Often we don't think we have anything going wrong as runners, but typically, an overuse injury is just around the corner. Tight IT bands (caused by the high heeled running shoe) can be completely avoided with some barefoot time...as well as a tight or sore back, and so many problems of the knees. By spending a bit of time fully barefoot, we help strengthen the ENTIRE body, by working small muscle groups oft neglected when we're in a shoe, helping build the strongest, most injury-resistant runner body...one that runs light, more efficiently (aka less effort), with less impact, who stands taller, has better balance, and a better cooling system (aka better circulation) to boot...PLUS there are even more health benefits, such as reflexology (stimulating the bottom of the feet helps boost all systems of the body, such as the immune system) and even can reduce blood pressure.
So just because you don't have a foot problem today, doesn't mean you couldn't benefit from a modest amount of barefoot time. Oh, and did I mention, it's FUN. Just ask any five year old out there...they'd LOVE to strip off their shoes and run through the grass.
And so would we!
Michael and Jessica
P.S. I forwarded this question along to Dr. Ray McClanahan, and here's what insight he had to share.
I agree with everything you have written. I would also like to
suggest that attention be given to the a fairly new study (10 years old),
done by one of my mentors, Dr. Harvey Lemont, of Philadelphia.(Journal of
the American Podiatric Medical Association). His study confirmed
pathologically, that the irritated tissue of plantar fasciitis is actually
dead/necrotic tissue. This was seen in all 50 of the subjects in his study.
For that reason, he suggested a more appropriate, accurate clinical term for
the condition, would be plantar fasciosis. His study should be on my
website. I have also published on this entity with Dr. Glenn Ingram, our
article is also on my website, titled plantar fasciosis.
The only thing I would add to your excellent description Michael, is that there is often a
circulatory component to this problem, that originates for the malposition
of the big toes, of most shoe wearing people. When the big toe is pushed
towards the second toe, and lifted above the ball of the foot(tapering
toebox footwear, and footwear with toespring), the abductor hallucis muscle
partially strangulates the inflow and outflow of blood to the plantar medial
heel. This can be demonstrated easily. I have a video of this on my site https://nwfootankle.com/
Thanks for including me Michael.
Best to you!
Ray McClanahan, DPM, BS Ed.