Plantar fasciitis is one of the most common causes of heel pain, affecting runners, walkers and people whose occupations require prolonged periods of standing. The conventional advice is familiar: rest, stretch the calf and plantar fascia, consider an orthotic and wear supportive footwear.
Increasingly, however, that last recommendation appears to have become synonymous with buying a pair of running shoes.
There is an obvious logic to this. Modern running shoes offer generous cushioning, sophisticated midsole materials and carefully engineered geometries. Yet there is also a question worth asking:
Is a shoe specifically engineered to alter the biomechanics of running necessarily the best footwear for somebody recovering from plantar fasciitis who primarily needs to walk and stand?
The answer is considerably more complicated than simply choosing the softest shoe available.
What Is Plantar Fasciitis?
The plantar fascia is a strong band of connective tissue extending from the calcaneus, or heel bone, towards the toes. It contributes to maintaining the longitudinal arch of the foot and plays an important role in transforming the foot from a relatively flexible structure during initial contact into a more rigid lever during propulsion.
One important component of this is the windlass mechanism. As the toes dorsiflex during the latter part of the walking gait, the plantar fascia winds around the metatarsal heads. This increases tension through the fascia, raises the longitudinal arch and helps stiffen the foot for propulsion.
The condition traditionally called plantar fasciitis is increasingly referred to as plantar fasciopathy, particularly when chronic. This distinction is important. Persistent plantar heel pain is not necessarily simply an inflammatory condition that can be cured by suppressing inflammation. Repetitive mechanical loading can produce degenerative changes and impaired tissue repair within the fascia.
Treatment therefore needs to consider not simply inflammation, but why the tissue is being overloaded and whether it currently has sufficient capacity to tolerate the forces being placed upon it.
How Does It Present?
The presentation can be remarkably characteristic.
Pain is normally felt underneath the heel, frequently towards the medial aspect of the calcaneus. The classic symptom is severe pain during the first few steps after getting out of bed in the morning.
Similar pain can occur after sitting for an extended period.
After several minutes of walking the symptoms may improve, only to return following prolonged standing, walking or exercise.
This produces the familiar pattern:
Rest → first-step pain → improvement with movement → deterioration following prolonged loading.
The NHS identifies heel pain after resting, difficulty raising the toes from the floor and pain that improves during exercise but becomes worse afterwards as characteristic features of plantar fasciitis.
That pattern provides an important clue to the underlying problem. The fascia can tolerate some loading, but its current capacity to tolerate repeated or prolonged loading has been exceeded.
Why Does Plantar Fasciitis Develop?
There is rarely a single cause.
Contributing factors can include a sudden increase in walking or running volume, prolonged occupational standing, increased body mass, restricted ankle dorsiflexion, tightness through the gastrocnemius–soleus complex, altered foot mechanics and inappropriate footwear.
A useful way of understanding the condition is therefore as a load-versus-capacity problem.
The plantar fascia is being asked to tolerate more mechanical stress than it can currently accommodate.
This has important implications for treatment.
Completely unloading the tissue indefinitely is unlikely to restore its capacity. Equally, continuing the activity that caused the overload without modification is unlikely to allow recovery.
Successful rehabilitation therefore requires a balance between reducing excessive loading and progressively rebuilding the tissue’s ability to tolerate load.
Treating the Condition
Conservative management is successful for many people.
Initial treatment commonly includes temporarily reducing aggravating activities, avoiding prolonged barefoot walking on hard surfaces, ice for symptomatic relief and appropriate analgesia where required.
More importantly, rehabilitation should address the mechanical system surrounding the plantar fascia.
This can include plantar-fascia-specific stretching, calf stretching, improving ankle mobility and progressive strengthening of the calf and intrinsic foot musculature.
Foot orthoses can also be useful as part of treatment.
The important words, however, are “as part of.”
Neither an orthotic nor a particular shoe should be regarded as a cure in isolation.
Why Are Running Shoes Being Recommended?
Modern running shoes possess several characteristics that can initially appear ideal for somebody experiencing heel pain.
They are cushioned.
They are comfortable.
They reduce the sensation of impact.
Many also incorporate considerable heel-to-toe drop and pronounced rocker geometry.
But these features exist for a reason.
A running shoe is fundamentally a piece of equipment designed around the biomechanics of running.
Three characteristics deserve particular consideration: stack, drop and rocker.
Stack
Stack height describes the amount of material between the foot and the ground.
Modern maximalist running shoes can place the foot surprisingly high above the walking surface. The obvious advantage is cushioning and potential reduction in perceived impact.
The disadvantage is that increasing the distance between the foot and ground can affect stability and proprioceptive feedback.
That may be relatively insignificant when running along a predictable road surface.
It may be considerably more relevant when walking over broken pavements, trails, rocky ground or uneven terrain.
Heel-to-Toe Drop
Drop describes the difference between the height of the heel and forefoot.
A shoe with a 10 mm drop, for example, positions the heel approximately 10 mm higher than the forefoot.
This can be beneficial.
Raising the heel can reduce the ankle dorsiflexion requirement and potentially reduce loading through the gastrocnemius–Achilles–plantar complex. For somebody with limited ankle dorsiflexion or significant calf tightness, this may provide considerable symptomatic relief.
But again, this represents an alteration to biomechanics rather than correction of the underlying problem.
The question should therefore not be:
“Is drop good or bad?”
It should be:
“How much drop is appropriate for this individual and why?”
Rocker Geometry
The increasingly pronounced rocker incorporated into modern running shoes is particularly interesting.
Rather than requiring the foot to move conventionally through heel strike, mid-stance and toe-off, the curved sole assists forward progression.
This may reduce the amount of metatarsophalangeal dorsiflexion required during propulsion and consequently modify loading through the plantar fascia and windlass mechanism.
For somebody with painful plantar fasciopathy, that may be extremely useful.
But it also deliberately changes gait.
A technology designed to facilitate running should not automatically be assumed to represent the optimum long-term walking platform for every patient.
Symptom Relief Is Not Necessarily Rehabilitation
This distinction is fundamental.
If a highly cushioned rocker shoe allows somebody with plantar fasciitis to walk without pain, that is valuable.
But reducing symptoms and restoring normal function are not necessarily the same thing.
The shoe may be reducing the mechanical demands placed upon the affected structures.
During the acute stage of rehabilitation that can be precisely what is required.
The problem arises when the shoe itself becomes the treatment.
The objective should ultimately be to increase the capacity of the foot and plantar fascia rather than permanently requiring increasingly sophisticated footwear to compensate for reduced capacity.
What About an Approach Shoe?
There is another possibility which receives comparatively little attention.
A good-quality approach shoe or conventional walking shoe combined with an appropriate orthotic offers a very different philosophy.
Approach shoes were originally designed for travelling across mixed terrain towards climbing routes. Consequently, they generally possess a relatively secure upper, stable platform, controlled sole flex and good torsional stability.
They place considerably greater emphasis upon foot control and stability than many lightweight running shoes.
For somebody whose activity predominantly consists of walking and standing rather than running, that deserves consideration.
It does not mean that every approach shoe is suitable for plantar fasciitis.
A very flat, extremely stiff or low-drop approach shoe could potentially aggravate symptoms, particularly in somebody with restricted ankle dorsiflexion.
But an appropriately selected model provides something extremely useful:
a stable platform upon which an orthosis can work.
The Orthotic Question
Foot orthoses are frequently recommended for plantar heel pain, but another misconception needs addressing.
Custom orthotics are not automatically superior to good-quality prefabricated devices.
Clinical research has found that appropriately selected prefabricated orthoses can provide useful improvements in plantar heel pain, while evidence that expensive custom devices consistently produce superior outcomes is limited.
This makes products such as Superfeet and comparable structured prefabricated orthoses particularly interesting.
Rather than relying entirely upon the shoe to manipulate gait, the two components can perform different functions.
The shoe provides the platform: a secure heel, appropriate sole stiffness, torsional stability, durable outsole and predictable walking geometry.
The orthosis manages the foot–shoe interface: providing an appropriate heel cup and arch contour, redistributing pressure and modifying the way the foot interacts with the shoe.
That is potentially a very rational combination.
The Problem With Assuming Softer Is Better
There is an understandable assumption surrounding heel pain:
If the heel hurts, put more cushioning underneath it.
But softness and support are not the same thing.
An extremely soft midsole deforms under load.
Place a supportive orthotic inside a very soft, unstable shoe and the platform underneath the orthotic can itself deform.
An analogy would be placing a supportive mattress on top of a hammock.
The mattress may possess excellent structural characteristics, but the unstable structure underneath it compromises its ability to provide support.
A moderately firm, stable shoe can therefore provide an excellent foundation for an orthotic.
This is one reason why an approach shoe, conventional walking shoe or relatively stable running shoe may sometimes provide a more logical platform than an extremely high-stack maximalist running shoe.
Running Shoe Versus Approach Shoe
There is therefore no simple winner.
| Characteristic | Modern Running Shoe | Approach/Walking Shoe |
| Cushioning | Usually high | Usually moderate |
| Stack height | Moderate to very high | Generally lower |
| Heel-to-toe drop | Highly variable | Usually moderate/low |
| Rocker | Often significant | Usually less pronounced |
| Torsional stability | Highly variable | Generally greater |
| Upper structure | Often lightweight | Usually more structured |
| Uneven-ground stability | Model dependent | Generally good |
| Orthotic compatibility | Variable | Often good |
| Primary design purpose | Running | Walking/mixed terrain |
The mistake would be to conclude from this that approach shoes are universally superior.
They are not.
The equally questionable conclusion, however, is that running shoes are universally preferable simply because somebody has plantar fasciitis.
Perhaps There Is a Third Option
The argument does not actually have to become:
Running shoe versus approach shoe.
A potentially excellent compromise is a relatively stable, moderately cushioned walking or running shoe combined with an appropriately selected orthosis.
This can provide sufficient cushioning to make walking comfortable without necessarily introducing extreme stack heights or aggressive rocker geometry.
The correct solution depends upon the individual.
Someone with significant restriction in ankle dorsiflexion may benefit considerably from moderate heel-to-toe drop.
Another person working eight hours on their feet may benefit more from stability.
Someone predominantly walking over uneven terrain may have completely different requirements from a road runner.
This is why footwear prescription should ideally begin with the patient and the activity rather than the shoe category.
Rehabilitation Rather Than Footwear Prescription
Ultimately, plantar fasciitis should not become a footwear problem.
It is a musculoskeletal condition requiring rehabilitation.
A rational conservative programme combines:
- temporary modification of aggravating activity;
- plantar-fascia-specific stretching;
- gastrocnemius and soleus stretching where appropriate;
- restoration of ankle mobility;
- progressive calf and foot strengthening;
- gradual restoration of walking or running load;
- appropriate footwear; and
- an orthosis where clinically beneficial.
Footwear creates the environment in which rehabilitation takes place.
It should not replace rehabilitation.
Conclusion: Are Running Shoes Really the Answer?
Sometimes.
A modern running shoe can be an extremely useful tool in treating plantar fasciitis. Cushioning can reduce discomfort, heel-to-toe drop can reduce dorsiflexion requirements, and rocker geometry can reduce some of the mechanical demands associated with propulsion.
For the appropriate patient, those characteristics may be precisely what is required.
But this does not justify the increasingly simplistic equation:
Plantar fasciitis = running shoes.
Running shoes are engineered around running biomechanics. High stack, heel-to-toe drop and rocker geometry deliberately alter the interaction between the foot and ground.
That may be therapeutic.
It may also be unnecessary.
For somebody whose principal activities are standing and walking, a well-constructed approach or walking shoe combined with an appropriately selected prefabricated orthosis may offer an equally rational—and in some circumstances preferable—solution.
The most appropriate question for the clinician therefore isn’t:
“Which running shoe should this patient buy?”
It is:
“What mechanical problem are we attempting to solve, what activity does this person actually need to perform, and what combination of footwear, orthotic support and rehabilitation will allow them to return to it?”
That distinction matters.
Because the objective of treating plantar fasciitis should not simply be to find a shoe in which the patient cannot feel their heel pain.
The objective should be to restore a foot capable of tolerating the activities the patient needs it to perform.
