Plantar Fasciitis
According to the American Academy of Orthopaedic Surgeons, more than 43.1 million Americans have trouble with their feet. One condition that can cause foot pain is plantar fasciitis, an inflammation of the tough fibrous band of tissue (called fascia) that connects the heel bone to the base of the toes.

Normally, the fascia provides support and cushioning for the arch. If the fascia becomes stretched too far (from force or pressure), it can develop small tears. These tears cause irritation of the tissue and inflammation. Initially, patients may complain of heel pain, especially with the first steps in the morning or after a long period of inactivity. The symptoms can gradually progress, leading to sharp heel pain. Eventually, the condition may lead to changes in walking patterns to compensate for the pain. But this can increase tension and pressure on other areas of the body and lead to pain in the knees, hips and/or back.

Plantar fasciitis is the most common cause of foot pain requiring medical consultation. Researchers estimate about 10 percent of Americans are affected by the condition. In up to one-third of patients, the symptoms occur in both feet. People who walk or run for exercise, those with flat feet or very high arches and pregnant women are at highest risk for plantar fasciitis.

Sensible Shoe Selections
According to the American Apparel and Footwear Association, nearly 2.4 billion pairs of shoes were sold in the U.S. in 2007. Since ancient times, shoes have been selected for comfort, protection and style. They also support a considerable amount of weight, equaling several hundred tons of force during an average day of walking.

Despite the great importance of shoes, many people choose fashion and style over fit and comfort. The American Academy of Orthopaedic Surgeons reports 90 percent of foot deformities in women can be attributed to tight shoes. Improperly fitting shoes can lead to a number of foot problems, like bunions, corns, hammertoes and, in some cases, plantar fasciitis. Studies show improperly fitting shoes can also increase the risk for falls.

Andrew Cassidy, D.P.M., Podiatrist with Lone Star Podiatry in Austin, TX, says some women mistakenly believe that foot pain is normal because their grandmothers and mothers often complained of foot problems. But he emphasizes that foot pain is not normal and, wouldn’t occur if women made sensible shoe choices. Here are some things to consider when shopping for shoes:

Get the proper shoe size. Cassidy says many women underestimate their shoe size by one to one-and-a-half sizes. Don’t go by size alone because fit may differ between manufacturers. Measure both feet because one foot may be slightly wider or longer than the other, then choose a shoe that accommodates the larger foot. It’s important to have your feet measured regularly because feet tend to grow larger with age. In addition, shoe shop at the end of the day, when feet are swollen.

Try on both shoes. One foot is often shaped a little differently than the other. See that both shoes fit well and are comfortable. Then, walk around in them to make sure they aren’t too loose or tight.

Look for a wide toe box. Make sure you have enough room to wiggle your toes inside the shoe. Avoid narrow, pointy shoes that crowd the toes and force them into unnatural positions.

Check the shoe for adequate support. The best way to check for this is to fold the shoe. It should bend at the toes, not in the middle. Cassidy says if the shoe bends in the middle, there is no support for the arch, allowing the arch to collapse and the fascia to stretch.

Limit heel size. According to the American Podiatric Medical Association, a three-inch heel creates 7 times more stress on the ball of the foot than a one-inch heel. Experts recommend women wear shoes with no more than a two-inch heel. Cassidy also says women should wear shoes with a closed heel to prevent the back of the foot from sliding and causing excess stress on the fascia.



Sensible shoes don’t have to be boring, it just may take time to find a pair that look as good as they feel. For those occasions when fashion overrules practicality (like a party or special event), experts recommend women limit the amount of time they spend on their feet and take along an extra pair of shoes to slip into before arriving and after leaving.

AUDIENCE INQUIRY
For general information on footwear:
American Apparel and Footwear Association, http://www.apparelandfootwear.org

For information on shoe fitting or foot problems:
American Academy of Orthopaedic Surgeons, http://orthoinfo.aaos.org
American Orthopaedic Foot and Ankle Society, http://www.aofas.org
American Podiatric Medical Association, http://www.apma.org

BIBLIOGRAPHY
Au, E., and R. Goonetilleke, “A Qualitative Study on the Comfort and Fit of Ladies’ Dress Shoes,” Applied Ergonomics, November 2007, Vol. 38, No. 6, pp. 687-696.

Carl, T., and S. Barrett, “Computerized Analysis of Plantar Pressure Variation in Flip-Flops, Athletic Shoes, and Bare Feet,” Journal of the American Podiatric Medical Association, September-October 2008, Vol. 98, No. 5, pp. 374-378.

Menant, Jasmine, et al., “Effects of Footwear Features on Balance and Stepping in Older People,” Gerontology, 2008, Vol. 54, No. 1, pp. 18-23.

Menant, Jasmine, et al., “Effects of Shoe Characteristics on Dynamic Stability When Walking on Even and Uneven Surfaces in Young and Older People,” Archives of Physical Medicine and Rehabilitation, October 2008, Vol. 89, No. 10, pp. 1970-1976.

Murley, G., et al., “Effect of Foot Posture, Foot Orthoses and Footwear on Lower Limb Muscle Activity during Walking and Running,” Gait & Posture, February 2009, Vol. 29, No. 2, pp. 172-187.

Yu, J., et al., “Development of a Finite Element Model of Female Foot for High-Heeled Shoe Design,” Clinical Biomechanics, 2008, Vol. 23, Suppl. 1, pp. S31-S38.