Home

Run:
Writings:

Insoles and Fasciitis

Publication date
Estimated reading time
6 min read

I haven’t worn open-toed shoes in nine years, all because of $700 insoles for fasci­itis.

Do you want to change that? Or are you good with it? If you’re happy with the status quo, feel free to skip this. But if you’re inter­ested in chang­ing it, I’ve got some thoughts.

This mes­sage caught my atten­tion because almost every runner deals with plan­tar fasci­itis at some point, but most over­come it within a rea­son­able time­frame.

Fasci­itis is inflam­ma­tion that occurred because the fascia couldn’t handle the load. Why couldn’t the fascia handle the load?

  1. It degraded due to lifestyle (see „risk factors for the disease include a sedentary lifestyle, work requiring prolonged sitting, constant wearing of high-heeled shoes”) — use it or lose it.
  2. It received a load it wasn’t ready for — excess weight, too rapid increase in running volume, structural issues.
  3. Weak foot muscles. Jay Dicharry in his book Anatomy for Runners writes:

    „The arch doesn’t plum­met to the floor and bounce up on its own. While the joint sur­faces and plan­tar fascia pro­vide pas­sive guid­ance for this motion to occur, the foot is under active con­trol. Spe­cific mus­cles inside the foot, espe­cially the big toe, are at work to keep things in check through­out the twist­ing and untwist­ing. While forces from above are trying to col­lapse the arch, you have struc­tures in your body designed to keep the foot under con­trol. If a defi­cient flexor hal­lu­cis brevis (FHB) does not pro­duce ten­sion to sta­bi­lize the arch, increased strain is trans­mit­ted across the plan­tar fascia. This is the typ­i­cal mech­a­nism for plan­tar fasci­itis, as well as a host of other lower leg injuries.”

So to fix this, we need to:

  1. Remove inflammation by unloading
  2. Strengthen the fascia, prepare it for load
  3. Strengthen foot muscles, prepare them for load

What does an insole do? The insole removes load as much as pos­si­ble to get you out of the acute inflam­ma­tion phase (first point). But then you need to start rein­tro­duc­ing load for points two and three. Oth­er­wise, the foot degrades more and more. The sit­u­a­tion is sim­i­lar to crutches, or a sling for your arm, or a neck brace. Chronic, life­long use of these orthoses is never rec­om­mended, as it leads to life­long degra­da­tion of what they’re sup­posed to sup­port1.

The Research Shows Both Sides (But One Is More Con­vinc­ing)

Here’s where it gets inter­est­ing: there’s an actual debate in the pro­fes­sional com­mu­nity about this.

Some podi­a­trists and researchers argue that orthotics don’t cause muscle weak­ness and might even increase muscle activ­ity. They’re quick to dis­miss con­cerns about atro­phy as unfounded claims from the „bare­foot cult.”

But here’s the prob­lem: when researchers actu­ally mea­sured what hap­pens to foot mus­cles after wear­ing custom orthotics for just 12 weeks, they found sig­nif­i­cant muscle atro­phy:

The researchers’ con­clu­sion? Orthotic pre­scrip­tions should include a strength­en­ing pro­gram to pre­vent disuse atro­phy. That’s pretty damn­ing.

And it’s not just one study. Research con­sis­tently shows that people with plan­tar heel pain have sig­nif­i­cant atro­phy and weak­ness in foot mus­cles com­pared to healthy indi­vid­u­als — espe­cially pro­nounced in those with long-term orthotic use. Mean­while, strength­en­ing these mus­cles shows promise as an effec­tive treat­ment.

So yes, there’s debate. But one side has the muscle mea­sure­ments to back up their claims.

Short-Term Tool, Not Long-Term Solu­tion

The sci­ence is clear on timing: orthotics improve pain and func­tion within 1–3 months with min­i­mal risk. That’s their sweet spot. They’re excel­lent for acute phase man­age­ment.

But beyond that? You’re poten­tially trad­ing short-term relief for long-term depen­dence. Stud­ies show effec­tive­ness in the short term specif­i­cally — not as a per­ma­nent solu­tion. Even sources that rec­om­mend them empha­size they should be „part of your broader treat­ment plan,” not the entire plan.

The excep­tion? Some people with seri­ous struc­tural prob­lems may legit­i­mately need long-term orthotic sup­port. But that should be the excep­tion, not the default — and def­i­nitely not for nine years with­out reassess­ment.

The AI Rec­om­mends Insoles (Sur­prise: It’s Citing Insole Sell­ers)

Fun fact: I asked per­plex­ity.ai whether orthotic insoles are effi­cient for long-term treat­ment of plan­tar fasci­itis. Per­plex­ity.ai emphat­i­cally said „YES!”

Are Ortho­pe­dic insoles effi­cient in long term treat­ment of plan­tar fasci­itis?

Yes, ortho­pe­dic insoles are effi­cient for long-term treat­ment of plan­tar fasci­itis. Sev­eral stud­ies have demon­strated their effec­tive­ness.

The prob­lem? It backed this up with links to insole sell­ers and quotes from… insole sell­ers 🤷‍♂️.

And where the sources weren’t from sell­ers, the second link actu­ally said not to use them long-term, but some­how that didn’t make it into the answer:

Don’t think of insoles as a cure

They may help you feel better and reduce pain in the short term, but insoles (no matter what type) can’t cure plan­tar fasci­itis. So instead, use them as a tool to sup­port your recov­ery as part of your broader treat­ment plan.

https://www.exakthealth.com/en-US/blog/orthotics-insoles-for-plantar-fasciitis

Med­ical Sci­ence Has Changed

Med­ical sci­ence, phys­i­cal ther­apy, and reha­bil­i­ta­tion have under­gone major changes in the past nine years. I’m cur­rently read­ing research papers from the 2020s that over­turn many reha­bil­i­ta­tion pre­scrip­tions that were stan­dard prac­tice just five years ago. So even if some­one pre­scribed insoles nine years ago, there’s a good chance they wouldn’t do so today — or at least would com­bine them with a strength­en­ing pro­to­col from day one.

What I’d Rec­om­mend Today

With all this infor­ma­tion, here’s what I’d sug­gest:

Per­son­ally, I’d do a pro­gres­sion of var­i­ous calf raises and jump rope, keep­ing pain below 4 out of 10.

  1. Why Orthotics May Not Be the Right Answer for Plantar Fasciitis ↩