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A Prospective Study on Maximalist Athletic Shoes as Part of a Comprehensive Approach to the Medical Management of Early-Stage Plantar Fasciitis

Robert Fridman, Kayla N Obradovic

Plantar fasciitis (PF) is the most common musculoskeletal disorder of the foot and has significant impact on quality-of-life. The vast majority of cases respond to conservative treatment, which includes wearing supportive shoes. Highly cushioned, maximalist athletic shoes are thought to reduce stress and strain of impact forces and may suggest a possible benefit in the management of early plantar fasciitis. 38 patients with clinical heel pain and ultrasonographic confirmation of PF (>4.0 mm) were randomized to either a maximalist athletic shoe (HOKA Bondi 6) or standard athletic shoe (New Balance 880v9) in conjunction with standard of care (SOC) for a period of 12 weeks. Pain assessment and ultrasonographic measurements were made pre- and post-treatment. Those who wore maximalist shoes as part of SOC reported a significant decrease (p=0.003) in their pain Visual Analog Scores (VAS, mean decrease of 6 points) as compared to standard athletic shoe group (mean VAS decrease 4.12 points). A greater mean decrease in plantar fascia thickness from pre-treatment to post-treatment was observed for the maximalist group (1.46 mm) than the standard group (1.14 mm), but this did not reach statistical significance. 95% of patients randomized to maximalist group reported that the shoes helped in their recovery process, as compared to 76% of patients randomized to standard group. This study tested the effect of highly cushioned maximalist athletic shoes as compared to standard running shoes part of a comprehensive approach to the medical management of plantar fasciitis. We conclude that highly cushioned maximalist athletic shoes, such as the HOKA Bondi 6, may be considered as part of standard of care for management of plantar fasciitis.