John Lee/Aurora Select for NPR
Podiatrist-turned-Pilates instructor Colleen Schwartz says she goes barefoot when she exercises indoors. But when she's outside, it's shoe time.
If you've ever had heel pain when you first put your bare feet on the floor after waking up in the morning, it's very likely the beginnings of a common condition known as plantar fasciitis. And shoes can contribute to the problem.
Walking Down a Painful Path
Elizabeth Kinkel has never had heel pain or heard much about plantar fasciitis.
But a quick inspection of the 24-year-old architect's work shoes of choice do not make podiatrist Steve Pribut happy.
When we approached her on the street in Washington, D.C., she was on her way to work and wearing flip-flops.
"They're pretty comfortable," she says, adding that they keep her feet cool. "I just wear them walking back and forth to work, and then put on heels once I get into office."
Pribut, who is not a fan of flip-flops, interrupts her, "I notice a Band-Aid on that foot. Is that from a heel?"
"Yeah," says Kinkel, "they're from some really cute wedge sandals. But they dig in because they're new."
Kneeling down for a quick examination, Pribut explains that both of Kinkel's workday shoe choices — the flip-flops and the backless sandals — pose the same potential problem and could lead to plantar fasciitis.
He says when your heel doesn't stay attached to your shoe, there's too much extra motion in the foot.
"Wearing an open-backed shoe, when the heel lifts off the ground, there's a lot of tension that develops in the plantar fascia, and it increases the angle that the whole foot makes with the ground, and toes bend up further and that just stretches the plantar fascia more."
The plantar fascia is a band of connective tissue in the foot, similar in texture to a ligament. It runs all the way from the heel up through the ball of the foot, and strands wrap around each toe.
It's vulnerable to injury, especially as people age. But shoe choice can make a difference.
To prevent injury, people don't have to toss out flip-flops or high heels entirely. But when walking a lot, presumably on hard sidewalks, Pribut says it's better to wear shoes with some support.
Back at his office, he picks up a pair of Asics jogging shoes that he says are ideal. They're lightweight and don't have too much heavy cushion. Most important, they do not bend in the middle.
"When I take this shoe and press it down, it bends just at the ball of the foot, where the toes attach to the foot. That's right where the shoe should bend," he says.
When shoes have too much bend in the middle, Pribut says it puts tension on the plantar fascia.
Biggest Foot Offenders
One of the biggest offenders among fashionable shoes today is the ballet slipper, or very thin flats. Out on the street outside Pribut's office, we see lots of women wearing them.
Dominque Arvanitis says she likes them because they're comfy.
"I walk around a lot, so the flats are good for me," she says.
Perhaps they are, compared with heels. But Pribut says swapping them out for Crocs or sandals with a little support and a strap around the back would be an improvement.
"The ballet slippers scare me just about as much as the flip-flops do," he says.
If you're now wondering whether there are any fashionable dress shoes that may actually be good for your feet, it might be time to ask a different question: What can you do to strengthen or stretch your feet when you're not wearing shoes?
That's where foot doctor Colleen Schwartz comes in. She has merged podiatry with Pilates for a more preventive approach.
"We ask a lot of our feet," says Schwartz of Pleasanton, Calif. "There are so many bones, there are 26 bones, 33 joints and 100 muscles, ligaments and tendons. And in order to give them the attention they deserve, spending a little time every day can be so beneficial."
A little time means just three or four minutes of stretching and toning. And Schwartz says the best time to do this is first thing in the morning, before you even get out of bed.
Before even getting out of bed she starts with an Achilles tendon stretch.
The idea behind a good toe stretch is that the fibers of the Achilles tendon go all the way to the heel. So there's a strong connection between a limber Achilles and a healthy plantar fascia.
Schwartz says all the foot exercises she does at home, she does barefoot. When she goes about her daily life outside the home, though, she does advocate shoes
Pribut says the barefoot movement may be gaining some attention for its novelty. And the idea that thousands of years ago, shoeless civilizations had healthier feet could be true.
But back then, he notes, the average life expectancy was about 30 years. And cavewomen didn't have to contend with glass, nails, hard concrete — or fashion.