Could Flip Flops be Good For Plantar Fasciitis?

We were told it’s all about the right shoes. We were told shoes should give us more stability and have an arch. This was not based on science and has potentially led to harming our feet. Plantar fasciitis is a debilitating, knife-in-the-foot kind of pain. Instead of getting into the right shoes, maybe it’s getting out of the wrong shoes. As you’ll see, the approach to treating plantar fasciitis has been very wrong. 

We were told that this is an inflammatory condition (also wrong). In 2003, Harvey Lamont analyzed the tissues of 50 of his patients that had plantar fasciitis, and found none of them had inflamed tissue, rather they had necrosis (dead tissue). This was even found in younger patients. It turns out that an adducted position of the big toe (pointed laterally towards the second toe) causes a muscle known as abductor hallucis to compress an artery in the foot; namely the lateral plantar artery near the heel. This leads to decreased blood vessel diameter and blood flow. In a study in 2019, (Jacobs et al.) found that immediately following passive adduction of the big toe, there was a 60% decrease in blood flow, which in some individuals corrected to a 22.2% decrease, suggesting some individuals may be able to adapt. This may explain why some do fine with the wrong shoes, and some do not. 

When you decrease blood flow to a tissue, over time it dies. So it appears that plantar fasciitis is more of a problem of dead tissue, not inflamed tissue. So already out of the gate, we have a problem with the diagnosis. Let’s discuss how we were told to treat this condition and break down what we’ve been doing wrong, and what we should be doing. 

As a therapist, we were taught that you ice something inflamed. Well turns out that is a bad idea. You should never ice something that is inflamed, and if you want the details on that, check out this podcast I did with Gary Reinl. Although, this is a necrotic situation, so icing would reduce blood flow and still not be a good idea. 

We were told to strengthen and stretch the area. We got the strengthening part right but the stretching part totally depends on what you are stretching. This gets more into shoeware and how it probably causes plantar fasciitis in the first place. Here is a video explaining it:

So a shoe that has a narrow toe box, a toe spring, and elevated heel is bad for you. It causes the extensor tendons of the big toe and the gastroc (calf) to stiffen and shorten, and places the plantar fascia in an elongated and tensed position. On top of that, we have the toe box placing the big toe into adduction, cutting off blood supply and causing some of the plantar fascia to die and weaken. One of the roles of the plantar fascia is to support and stabilize the foot. Well a half dead and elongated tissue will not do a good job of stabilizing the foot. 

On top of all that, overly rigid shoes allow the muscles of the foot (especially the intrinsics) to relax and weaken over time. These intrinsic muscles play a vital role in supporting the arch. So if we have weak muscles and a destabilized plantar fascia, we have the recipe for a painful, collapsed foot. 

Be sure you put your feet in the right place, then stand firm. -Abraham Lincoln

So like Abe says, get those feet firm. That’s priority number 1. That brings in the flip flops. As I mentioned in the video, the toe extensors become shortened. You can stretch them like so: 

Now, you want to strengthen the foot. I would start by being barefoot more often and not allowing the arch to touch the ground. If you were to wear flip flops, such as Haviannas (as I am obsessed with), your big toe has to press downward to keep the flip flop on, strengthening what is weak. 

So, get out of the wrong shoes, stretch the toe extensors, don’t ice, and be barefoot. Maybe even wear flip flops. Sound like the opposite of what you’ve been told? Well if your plantar fasciitis keeps coming back and you’ve been doing the classic rolling on a frozen water bottle and stretching your plantar fascia, it’s probably not working. 

Want to rebuild your arch? We’ve put a program together that you can do at home. Check it out here.

A special thanks to Dr. Aaron Horschig and Dr. Ray McClanahan, whose podcast inspired this line of thought. Listen here. 

References: 

Lemont H, Ammirati KM, Usen N. Plantar fasciitis: a degenerative process (fasciosis) without inflammation. J Am Podiatr Med Assoc. 2003 May-Jun;93(3):234-7. doi: 10.7547/87507315-93-3-234. PMID: 12756315.Lemont H, Ammirati KM, Usen N. Plantar fasciitis: a degenerative process (fasciosis) without inflammation. J Am Podiatr Med Assoc. 2003 May-Jun;93(3):234-7. doi: 10.7547/87507315-93-3-234. PMID: 12756315.

Jacobs JL, Ridge ST, Bruening DA, Brewerton KA, Gifford JR, Hoopes DM, Johnson AW. Passive hallux adduction decreases lateral plantar artery blood flow: a preliminary study of the potential influence of narrow toe box shoes. J Foot Ankle Res. 2019 Nov 4;12:50. doi: 10.1186/s13047-019-0361-y. PMID: 31700547; PMCID: PMC6829837.

Pain in the Lateral Foot: Cuboid Syndrome

If you have pain on the outside of your foot, it may be cuboid syndrome. This is often misdiagnosed and is not well understood, but we do know that it is common following an inversion sprain, or “rolling your ankle. 

The cuboid is a bone that is situated between your heel bone and your fifth metatarsal; the bony bump on the middle/outside of your foot. The bone can be slightly out of place and will be very acutely painful. Walking or any weight bearing will be painful. The good news is that there is usually a quick fix, which we’ll get to later.

So why does this happen? It’s a combination of dysfunctions. If the subtalar joint is pronated (think flat foot), then the whole ankle/foot structure is less stable. Then other muscles have to work harder to stabilize the foot. In this case, peroneus longus. This muscle starts on the upper part of the fibula (not the shin, the other one), and wraps under the cuboid. So if this muscle has to forcefully contract, it can theoretically stress the cuboid and pull it slightly out of position. This begs the question, why is the subtalar joint pronating? This is usually due to lack of dorsiflexion which could be a capsular and/or muscle restriction. 

How do we treat it? There are a couple of manual techniques you can do to correct the position and you may get immediate relief. First, have it checked out because there are other more insidious diagnoses that you’d want to rule out. Once you’ve done that, you can see a physio or try to treat it on your own like this:

Then you want to restore dorsiflexion like this:

Got Flat Feet? Check out our program specifically designed to restore your arch.

Restore Your Arch

Got flat feet? I have news for you, you weren’t born with them. This is something that develops over time? Why? The short answer is: shoes. Shoes do the work for your feet, like a brace or cervical collar. The muscles that line the arch get to relax and overtime, get weak to the point where you can’t stand while maintaining an arch. 

In 1992 (Rao & Joseph), a survey looked at 2300 children between the ages of 4 and 13 and found that flat feet was most common in the group that wore shoes. Furthermore, the group that wore slippers or sandals were less likely to have flat feet, and even more so, a group that didn’t wear shoes. 

So why are we told shoes are so important? The shoe companies have done a great job of convincing people that they are vital. Of course they did and I don’t blame them, that’s what companies do. However, it has trickled its way into practitioners' advice. 

Shoes have their place, to protect your skin from cigarette butts and glass. However, we need to spend time barefoot. If we don’t do that, then we have to spend time working on the muscles of our feet to at least get them to baseline strength. 

There are layers of muscles that line the arch of the foot, and one of their major jobs is to maintain the arch. The arch is meant to be non-load bearing, that’s why it’s called an arch. If you have cold tile floors, great. Use that. Walk around barefoot not letting your arch touch the ground and let the cold tile be a cue. Standing in line somewhere? Great, use that. Take the time to work on standing with a neutral foot. How do you do that? Drag your toes slightly in towards your heel until the arch rises. Don’t force it, you don’t want to be just standing on the sides of your feet.

It may not seem like a big deal, but a flat foot can lead to consequences up the kinetic chain. The majority of knee pain is caused by a foot and ankle problem. If your foot pronates (as a flat foot does), the shin will rotate inward, and set up the knee in a less than advantageous position, and can expose the meniscus in a position such as a squat. A flat foot can also affect the hip and back. 

It will take time and consistency, but you can restore your arch typically in about 3 months. You could buy an orthotic, but then you are stuck wearing that orthotic all the time. Plus they usually cost between $300-$600. Why buy something that you have to rely on when you have the ability to strengthen your foot? You literally have a muscular orthotic just laying there, dormant.

Here is a simple way to start working on the arch:

Want to learn more? I have built a 3 month program that is designed specifically to fix your arch. Check it out at www.restoreyourarch.com. 

Reference:

Rao UB, Joseph B. The influence of footwear on the prevalence of flat foot. A survey of 2300 children. J Bone Joint Surg Br. 1992 Jul;74(4):525-7. doi: 10.1302/0301-620X.74B4.1624509. PMID: 1624509.