Common ignorance, major problem: the role of footwear in plantar fasciitis

B Rajput and R J Abboud

The Foot

December 2004, Volume 4, Issue 14, Pages 214-218

Foot specialists in Scotland have reported the case of a 37-year-old male who was suffering plantar fasciitis in both heels. The plantar fascia is a fibrous sheath that runs most of the length of the sole of the foot. It attaches between the heel bone and the bones at the base of the toes, covering the small muscles in the sole of the foot. Plantar fasciitis refers to inflammation of the plantar fascia, usually at the point where it attaches to the heel bone.

The patient seen by Rajput and Abboud reported a gradual onset of heel pain over one month. The pain was worse on awakening but, unlike the typical presentation of plantar fasciitis where the pain subsides over the course of the day, the pain continued to be present throughout the day. The most striking finding was that the pain was slightly increased when the patient was wearing shoes in comparison to when the patient was barefoot. The patient had worn the same pair of shoes for the major part of a year preceding his problem.

On examination by the authors, the patient's shoes appeared as a standard pair of lace-up mens footwear. Initial inspection of the inner-sole revealed no apparent change in the structure of the shoe. However, on further examination, an indentation was felt at the heel area of the inner-sole. Further examination of the mid-sole revealed the disintegration of the air cushion mechanism of the columnar structures. Temporary heel supports were used until the patient could get a replacement pair of shoes and the condition cleared up rapidly.

The authors stressed that shoe construction and wear must be routinely examined by clinicians to ensure that proper support is being provided to the patient's foot. Unsuitable footwear can affect the effectiveness of treatment or prolong a condition, which might be alleviated otherwise As demonstrated in this case study, shoe construction methods can be the cause of the problem and effective treatment consists simply of suggesting alternative shoes.

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