The Berman Method
The Berman Method
Episode #229: Why Orthotics Are Making Your Plantar Fasciitis Worse
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In this episode of the Berman Method Podcast, Dr. Jake and Jenni Berman break down one of the most common causes of foot and heel pain: plantar fasciitis. They explain why symptoms are often worse in the morning or after long days on your feet, and why the real problem usually isn’t the heel itself—but weakness and dysfunction in the muscles of the feet.
The conversation challenges the common belief that more support is the answer, arguing instead that highly cushioned shoes and orthotics can actually weaken the feet over time. Using the analogy of a cast, they explain how constantly supporting the foot prevents the muscles from doing their job, ultimately leading to more pain and dysfunction.
If you’ve been relying on supportive shoes, inserts, or braces to manage foot pain, this episode will completely shift your perspective. It highlights the importance of strengthening the feet, improving movement mechanics, and addressing the root cause rather than simply masking symptoms.
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Welcome Back And Big Claims
Speaker 1We are back, baby, with the Berman Method podcast, treating problems, not symptoms.
SpeakerThe health insurance companies, the pharmaceutical companies, they do not have your best interests in mind.
Speaker 2No way.
SpeakerHow is that for a changeup?
Speaker 2Yeah.
Speaker 1We're David going against Goliath. Goliath being the corporate medical system, big pharma, your health insurance companies. How are you doing? I keep asking that question like I'm gonna get an answer back.
Speaker 2I'm great. Thank you for asking. Great! Yeah.
Speaker 1You're not good. Nobody's good.
Speaker 2I didn't say I was good.
Speaker 1I'm just saying from last week's episode.
Speaker 2Yeah. You're great.
Speaker 1How are you doing? Good.
Speaker 2Well, it's just like good morning. Is it? Is it a good morning?
Speaker 1What's so good about it?
Speaker 2Or is it just morning?
Speaker 1Morning.
Speaker 2Good morning.
Speaker 1Oh my goodness.
Speaker 2Are you gonna introduce yourself?
Speaker 1Dr. Jake Berman here with my beautiful co-host.
Speaker 2Jenni Berman, physician assistant.
Speaker 1Who always keeps me on my A game? I'm like, squirrel, I'm gonna go over here. And you're like, no, you're not. Get back over here right now. Focus. Focus.
Speaker 2Focus.
Speaker 1Focus.
Speaker 2I think between you and Stella, I say focus a multitude of times a day. Come on.
Speaker 1Between me? How many times do you have to say that to me?
Speaker 2Focus. Get back on it. Yeah. What's the topic today?
Heel Pain And Classic Symptoms
Speaker 1Topic today is planner fasciitis, foot pain, heel pain. Holy cow. It's been a lot lately. I don't know what's going on. Maybe because we're transitioning out of our winter slash spring into summer, and you're wearing flip flops more. You were wearing shoes constantly. Now we're getting out of shoes into flip-flops. But holy guacamole, it has been a common thing. Foot pain, plantar fasciitis, heel pain. A lot of people are presenting with heel pain, not knowing what it is, and asking about all different types of diagnosises, and I'm going minimum of 30% of plantar fasciitis presents as heel pain.
Speaker 2Yeah, that's how I get it. Whenever I have plantar fasciis, I was gonna say a flare-up, it's not really a flare-up, but whenever it comes on, like it's my heel that hurts more than my foot.
Speaker 1Yeah. A lot of people will describe it as it feels like I stepped on a pebble and I've got a bruised heel. And here's the crazy thing is there's nothing under your heel. It's bone and a fat pad. There's no muscles, like it's nothing. It's bone, fat pad, that's it. That's your heel. So for that to hurt, the only way that it would truly be hurt, traumatized, would be if it was like a bone bruise where you landed on your heel really hard. You fell off of a second story and you landed on your heel real hard. Okay, yeah, your heel, your bone is bruised. But when you didn't have a trauma like that, then it's more likely the origin of your planner fascia originates in the front of your heel. So if you go under the arch of your foot and you poke on the front of your heel, so not the bottom of your heel, but the front of your heel, the part that's closest to your big toe, that's where your planner fascia originates. And when it gets tugged on and tugged on, it will actually refer pain to your heel.
Speaker 2Right.
unknownYes.
Speaker 1And a couple of ways that you notice it is it's usually worse with the first couple of steps out of bed in the morning and later in the day.
Speaker 2Right.
Speaker 1Those are the two most common ways that it presents. First couple of steps in the morning are like, oh my gosh, what the heck's going on? And then as you get more and more active, it flares up on you.
Speaker 2Oh. More active, huh? Well, just by the end of the day, you think because people have been on their feet more and walking more and using their feet more. So it's worse and then it gets better and then it gets worse again.
Speaker 1Yeah, usually worse first few steps out of more out of bed in the morning. But then you get moving and it kind of lo loosens up. Air quotes there kind of loosens up.
Speaker 2Okay.
Speaker 1But then when you keep flaring it up throughout the day, it gradually gets worse and worse and worse towards the end of the day where you're like, oh my god.
Speaker 2Okay.
Speaker 1I just need to put my foot in a pair of nice cushiony hokas. Or Brooks. Or Brooks or OnClouds, and I'm going, oh my gosh, stop the insanity.
Speaker 2What do you think these new Adidas that are three ounces?
Speaker 1I can't I can't comment on them because the only thing you've given me is they are three ounces. Like you haven't given me any visuals. I haven't held them in my hands because you're talking about the two people that just broke world records.
Speaker 2On the marathon, they ran a marathon in an hour and 59 minutes. A marathon, 26.2 miles.
Speaker 1Here's one thing I can tell you with 100% certainty is they were not wearing hocus.
Speaker 2They probably were walk barefoot all the time outside of running.
Speaker 1Yeah, it's an Ethiopian and a Kenyan. Yeah. They don't wear shoes. Yeah.
Speaker 2Which is probably why they're so fast and so mobile. But their shoes were three ounces. That's insane. But they I wonder how what they're like. I mean, I would assume they're not that cushion-y and supportive because they can't. They don't normally wear shoes all that often.
Shoes As Casts Analogy
Speaker 1Let's use this analogy real quick. So bear with me for a minute. I'm going somewhere with this, and you'll see in a second. If you break your arm.
Speaker 2I love when you start out stories like that.
Speaker 1If you break your arm and you're in a cast, you're in a cast for six weeks.
Speaker 2Yes.
Speaker 1When you take the cast off, is your arm visually bigger than it was six weeks prior?
Speaker 2No.
Speaker 1It's smaller.
Speaker 2Yes.
Speaker 1Why is it smaller?
Speaker 2Because the muscles wasted away from being immobilized.
Speaker 1The muscles shriveled up because you weren't using them.
Speaker 2Correct.
Speaker 1Yep. So you don't use it, you lose it.
Speaker 2Yes.
Speaker 1So it's crystal clear. Everybody knows what that visual looks like. If you didn't break your arm personally, you've known somebody who's broken their arm and had to be in a cast for six weeks. They take the cast off, and the arm is visually smaller than the other arm.
Speaker 2Yes.
Speaker 1Because the muscles wasted away, you didn't use them, they got small, and it took time for those muscles to build back up.
Speaker 2Yes.
Speaker 1The same damn thing happens every single day. You put your foot into a shoe and you lace it up real tight. You're essentially putting your foot into a cast. It gets more and more exaggerated if you're putting your foot into a supportive shoe like a hoka. It gets even more exaggerated if you put your foot into a supportive shoe like a hoka with an orthotic in there. You are literally walking around in casts. They're very comfortable casts. The only difference from a Hoka with an orthotic in it compared to a walking boot.
Speaker 2Is that your calf is working?
Speaker 1Kind of.
Speaker 2I don't even know if it's moving. Maybe not working efficiently, but it's moving.
Speaker 1I was gonna say the only difference between a Hoka with an orthotic in it and a walking boot is the cushion on the bottom of the boot.
Speaker 2Yeah, and the boots aren't cushiony for sure.
Speaker 1I really think that's the only difference.
Speaker 2Well, I mean, the ankle is moving. Oh my gosh. In a shoe, you're not totally immobilized. But the foot is immobilized. Yes. So the muscles in the football.
Speaker 1Sorry, I should have specified. Not the ankle, not the calf. I'm talking about the muscles in your foot. So to be clear, there are 16 muscles in the arch of your foot alone. Four layers of four muscles. So four muscles all next to each other in a perfect line, four muscles on top of that, four muscles on top of that, four muscles on top of that. So sixteen muscles stacked on top of each other in the arch of your foot.
Speaker 2So like the plantar fascia.
Speaker 1No.
Speaker 2Fascia is not, yeah, yeah.
Speaker 1Fascia is a ligament. Yeah, yeah. So your plantar fascia is a ligament. Ligaments attach bone to bone. So bear with me here. Ligaments attach bone to bone. So your plantar fascia is a ligament. It attaches your heel bone to your forefoot. So the bones in your forefoot, your toes, essentially. So for very oversimplified purposes, let's just say the plantar fascia is a ligament that attaches your heel to your toes.
Speaker 2Yes, very simplified, yes.
Speaker 1Ligaments do not contract. Correct. Because they just attach bone to bone.
Speaker 2Yes.
Speaker 1Tendons attach bone to muscles.
Speaker 2Yes.
Speaker 1So when the muscle contracts, it moves the bone.
Speaker 2Yes.
Speaker 1But not to get too confusing, your plantar fascia is a non-contractile piece of soft tissue.
Speaker 2Under the muscles, the 16 muscles.
Speaker 1No. Oh. The plantar fascia is superficial and the muscles are underneath the plantar fascia. So if you put your fingers on your arch of your foot, the first thing that you touch would be your plantar fascia. Yes. And if you dig real deep underneath that, that's where those 16 muscles are.
Speaker 2Yes. I think I thought that's what I said, but okay. Yes.
Speaker 1Okay. So those 16 muscles are the muscles I'm talking about. So if you wore an orthotic in a hoka compared to a walking boot, I'm saying there's no difference in that with those 16 muscles. Those muscles are not working in either scenario.
Speaker 2Not working. Correct.
How Shoes Weaken Feet
Speaker 1And you do this for years and years. Essentially, since you're three years old, and mommy says, Oh, these shoes are cute. Let's put these cute shoes on three-year-old Vera.
Speaker 2How many shoes have I bought? And you go and you bend them and you're like, nope, they're not wearing them.
Speaker 1Absolutely. I cannot. No way. I don't care how cute these shoes are. Throw these in the truck.
Speaker 2He's like, nope, throw them away. And I'm like, can we at least return them and get the money back? He goes, no kid should be wearing them, so just throw them away. Oh my gosh.
Speaker 1No, you cannot return them because I do not want any other kid to ever have to suffer wearing these cute shoes that are horrible for you.
Speaker 2And I'm like, well, there's only 10 billion other ones being made, but whatever. So yes. Poor kids. Actually, we went to paint pottery one day for the one weekend for Cella's birthday, and Vera takes her shoes off and walking around the pottery place with no shoes on. I'm like, what are you doing? I cannot keep that kid in shoes. Walker won't wear shoes. He takes them off all the time. Um my gosh. That's my boy and girl. Father's children, for sure. So, anyways, you shouldn't wear shoes.
Speaker 1We haven't gotten there yet. I'm just trying to help people understand why your feet hurt. The answer to foot pain and plantar fasciitis is not more support. It's not orthotics. It's not Dr. Shoals. It's not Hokas or OnClouds. That's not the that's not the solution. Oh my gosh, here's the worst solution ever. Is wearing that freaking stretchy brace at night, sleeping in the stretchy brace? No. That is the worst thing that you could possibly do.
Speaker 2Then what should we be doing?
Speaker 1Jeez, you just want to jump straight into the solution that quick? You don't want me to keep teeing it up?
Speaker 2Is it a weak butt? Should I strengthen my butt to get my feet stronger? Yes. That's usually the answer.
Speaker 1Oh my gosh, if you've been listening to our podcast for any amount of time, you should have gotten that inside joke. The cause of all non-traumatic pain is weak ass syndrome.
Speaker 2It's your butt. So we're with our friend, she's like, it's probably my butt. I'm like, yeah, your butt's weak. Ask Jake.
Speaker 1It's funny you say that because it's a part of it. I'm serious. So when I first opened up Berman Physical Therapy, I un unintentionally started to specialize in helping male senior golfers with back pain get back out on the golf course. Who would have thought there would be an overabundance of male senior golfers with back pain in Naples, Florida?
Speaker 2No way.
The Dad Who Hates Shoes
Speaker 1No way. So I ended up getting really, I'll humbly say I ended up getting really, really good at fixing that problem or helping you fix that problem. But the thing that I started to specialize in was planner fasciitis to the foot and the ankle because it's so interesting to me. This all stems back to my dad, where my dad has never worn shoes. I it is I'll never forget, I think I was in middle school, and it was one of those rare days in Naples where the temperature had gotten down into the 40s and he had to wear shoes because it was cold out. And it was no later than 11 a.m.
SpeakerAnd he's like, kick these damn shoes off my feet. Starting to give me a headache.
Speaker 2A headache from his feet being in shoes.
Speaker 1And I'm going, like, I don't even understand that. What do you mean your shoes are giving you a headache? Oh, and I didn't think anything of it. Fast forward to 2015. 2015 is when we got married. And we were all wearing boots. It was just one thing that we were doing. And my dad doesn't own boots, so I had given him a pair of my boots, a spare pair of my boots, to wear for the wedding. And one of my buddies had these really nice, almost loafer-esque brown shoes because he didn't have boots. And it wasn't 10 minutes. And my dad's like, hey Zach, trade shoes with me. These things are giving me a headache. And I'm going, and this is 2015, mind you. So I still didn't completely understand. I I had not started specializing in plantar fasciitis yet. This is 2015. But it was at that moment where I'm going, What? Why is he being so dramatic? What do you mean these shoes are giving you a headache? I didn't understand it. Now check this out. 2015, a month later, is when I opened up my business. And the first rule that I made was I'm not wearing shoes anymore. Right?
Speaker 2Right?
Speaker 1Not wearing shoes anymore.
Speaker 2But you didn't wear shoes all that often anyway. At work I did. Well, work and at school. But like outside of that, you were barefoot most of the time.
Speaker 1Yeah, but how how many hours a day was I in school? How many hours a day was I at work?
Speaker 3Right.
Speaker 1Right? So the first rule that I made when I opened up in 2015 was I'm not wearing shoes anymore. And that was when I went from not wearing shoes before work or after work to not wearing shoes all day long. Five years later, I'm I'm just making it up right now. I don't know the exact time period, but I do remember it was around five years later, I started to really get bothered wearing shoes when we were traveling. Because I I used to wear tennis shoes when we would travel through airports, a lot of walking, like wear shoes.
Speaker 3Yeah.
Speaker 1And I was like, man, these things are getting really annoying on my feet when I'd be sitting on the airplane. Like, kick these things off. Like I was in such a hurry to kick off my shoes. Like, I can't wait to sit down so I can kick these damn shoes off. And I'm going, oh my gosh, this is what my dad was talking about. But here's what happened. As I was being barefoot throughout the day, my foot started to splay out. It started to get wider. It started to adapt to working again, working full-time versus working part-time. Think about it that way. Prior to me opening up my own business, my foot only, my feet only had to work part-time. They only had to work before work and they only had to work after work.
Speaker 3Right.
Speaker 1But now they had to work time and a half. They had to work full-time throughout the day, they had to work before work, and they had to work after work. So now they're working time and a half. So my foot started to evolve, it started to adapt, it started to get more endurance, strength, mobility, ability. So then when I had put my foot into a shoe and it didn't have to do it anymore, it felt confined.
Speaker 2Right. Yes.
Speaker 1That was the big thing that I didn't realize was happening.
Speaker 2Like it had a cast on it.
Less Support Done Strategically
Speaker 1It felt like it had a cast on it. It felt like it was in a stray jacket. If you have claustrophobia, it's just imagine that. That's how I feel when I have shoes on my feet. I'm going, oh my gosh, get these things off of me. So now I'm going, uh, it's funny. Now I know exactly what my dad was talking about. It's a real thing. It's a real thing. So to come back full circle, what is the solution? The solution is not more support, it's less support, but it has to be very strategic. Because there's 16 muscles in the arch of your foot. How many times can I say that in a 20-minute episode? It's important that you know how to work those 16 muscles. You can't just say, all right, I'm gonna take my shoes off and I'm gonna start doing heel raises to strengthen the muscles in my feet.
Speaker 2That's not how it works. Yeah.
Speaker 1That's gonna work two muscles that aren't even in your feet. It's gonna work your calf, your gastrock, and your soleus. It's not even gonna work your posterior tibialis. You've got to be very strategic with it. And if you can get very strategic, then you can get your muscles to wake up in your feet. Get your muscles to wake up in your feet. This is where it comes all first full circle, right here. The muscles start to do their job. And when your muscles and your feet do their job, your plantar fascia doesn't have to do the job that your muscles should be doing.
Speaker 3Got it.
Speaker 1So the reason why you have plantar fasciitis is because the muscles in your feet are not doing their job, which is relying over stretching, over stressing the plantar fascia, which is just a ligament that attaches your heel to your toes.
Speaker 2So then it gets inflamed and that's what causes the pain?
Speaker 1Yeah, inflammation of the plantar fascia is where your pain comes from.
Speaker 2Got it.
Speaker 1So you, Jenni, you've got a nasty history of heel striking when you run.
Speaker 2Yes. Unless I'm running fast for vault. Like in gymnastics.
Speaker 1Fast for vault. Or fast for 5K. Didn't you just win over the weekend?
Speaker 2Yeah.
Speaker 1First female and third overall, only two dudes beat you.
Speaker 2Two guys beat me.
Speaker 1Because you're so fast. So fast.
Speaker 2Do you think I was heel striking? I don't think so.
Speaker 1Not in that last mile. I would almost put money on it. You can't heel strike and run fast. It's not possible.
Speaker 2Yeah.
Speaker 1Because heel striking is a deceleration phase of the gate cycle. So you should not be landing on your heel. Where were we going with that? How did we get there?
Speaker 2I'm not sure. You said I'm a heel striker.
Speaker 1Yeah, you're a heel striker. And that's what will cause your foot to flare up because you don't realize that you're doing it. Because you're a runner, I'm not a runner. So if you land on your heel enough times, you're gonna flare the foot up. Same thing happens with people who wear shoes all day and then take your shoes off and then walk around your house on a hard tile floor or hard wood floor. You're like, oh my gosh, my feet are hurting like crazy. And then you think it's the hardwood floors.
Speaker 2Or hard floors in general, yeah. No, it's not. It's just your feet are weak.
Speaker 1Your feet are weak. From 2017, we bought our new the new office in 2017, and it was concrete floors. I walked around on concrete for until this past year when we put hardwood floors in there and no foot pain.
Speaker 3Right.
Speaker 1Right. So the the hard floor hard floor is not the problem. Your weak ass feet are the problem.
Speaker 2Or your gait. Yeah. Like how your I mean, but your gait changes because of the weakness of your feet.
Speaker 1Your gait changes because of the weakness in your feet.
Speaker 2And your butt. Yeah. Don't forget don't forget your butt.
Ditching Hokas And Orthotics
Speaker 1Yeah, don't forget your butt. So there's a um hopefully a little more information on why you should. If you got hokas, I know at least 25% of you listening to this right now are wearing hokas right now. Please pull over on the side of the road, take the hokas off, throw them out the window. Yeah, roll the window down or push the button because we don't. Don't roll anymore. Just push the button to lower the window. Gently place the shoes outside and then drive away.
Speaker 2Don't return them because nobody else should be wearing those.
Speaker 1Nobody should be wearing those. Oh my gosh. It's so brutal. Oh my gosh. Uh no, there's another 25% of you minimum listening to this right now. You cannot survive without your orthotics. And you've been wearing them religiously for 28 years because 28 years ago a chiropractor or a podiatrist told you you need to wear these. Yeah. And you've never questioned it. Because anytime you don't wear them, your feet hurt.
Speaker 2And you probably have back pain.
Speaker 1So yeah, you got back pain, knee pain, you got all these other pains, but your feet don't hurt anymore. So 28 years later, you're still wearing these freaking orthotics. Same thing. Pull over to the side of the road.
Speaker 2Gently put them on the road.
Speaker 1Lower the window down. Take your shoe off. Strategically wiggle that orthotic out of your shoe. And then whip that orthotic like a frisbee as far as you possibly can out the open window.
Speaker 2Oh, you don't have to gently place it.
Speaker 1No, no, whip it. We're gonna get in trouble for telling people to litter right now.
Speaker 2Oh, yeah. That'll be our next lawsuit.
Speaker 1Somebody's gonna get a $500 fine. Why is it only $500 for littering? Why wouldn't you make it $5,000? Like, do you really want people to not do it? Like make it $5,000.
Speaker 2I yeah, I guess I feel feel where you're coming from. $500's enough for me to not litter too, though.
Speaker 1Yeah, but you're a deadly do-right. You get somebody like me, I look at it fine, $100 fine for not doing for doing this? I'll take my chances.
Speaker 2Oh my gosh.
Speaker 110,000? Okay, I'm gonna think twice about this one.
Speaker 2And here's the difference between you and me a rule follower and not.
Longevity Score Link And Closing
Speaker 1Oh my goodness. Don't forget, go to bermanboomers.com to check out what your longevity score is. We had a ton of people opt in last week after last week's episode. And we've had a ton of fun with you guys who have done that over this past week. So go check it out, bermanboomers.com. If you've got family members that are getting up there in age, send them to bermanboomers.com. It doesn't matter if you're here local in Naples or you're virtual anywhere in the world. We can do this through FaceTime if we have to. Jenni's shaking her head no, because it's not the right way to do it. We have to do it through our EMR. But we can do it virtually. BermanBoomers.com. Anything else?
Speaker 2Happy Monday. Sunday. Good? Yeah, good happy now.