Rocker Shoes Research Articles

Inertial Sensor-Based Quantification of Movement Symmetry in Trotting Warmblood Show-Jumping Horses after "Limb-by-Limb" Re-Shoeing of Forelimbs with Rolled Rocker Shoes.

Hoof care providers are pivotal for implementing biomechanical optimizations of the musculoskeletal system in the horse. Regular visits allow for the collection of longitudinal, quantitative information ("normal ranges"). Changes in movement symmetry, e.g., after shoeing, are indicative of alterations in weight-bearing and push-off force production. Ten Warmblood show jumping horses (7-13 years; 7 geldings, 3 mares) underwent forelimb re-shoeing with rolled rocker shoes, one limb at a time ("limb-by-limb"). Movement symmetry was measured with inertial sensors attached to the head, withers, and pelvis during straight-line trot and lunging. Normalized differences pre/post re-shoeing were compared to published test-retest repeatability values. Mixed-model analysis with random factors horse and limb within horse and fixed factors surface and exercise direction evaluated movement symmetry changes (p < 0.05, Bonferroni correction). Withers movement indicated increased forelimb push-off with the re-shod limb on the inside of the circle and reduced weight-bearing with the re-shod limb and the ipsilateral hind limb on hard ground compared to soft ground. Movement symmetry measurements indicate that a rolled rocker shoe allows for increased push-off on soft ground in trot in a circle. Similar studies should study different types of shoes for improved practically relevant knowledge about shoeing mechanics, working towards evidence-based preventative shoeing.

Plantar pressure reduction in the heel region through self-adjusting insoles with a heel cup in standard and individualized rocker shoes

BackgroundEffectiveness of therapeutic footwear in reducing peak pressure in persons with diabetes and loss of protective sensation to prevent diabetic foot ulcers varies due to manual production and possible changing foot structure. A previous two-way approach to address this issue, featuring individualized 3D-printed rocker midsoles and self-adjusting insoles, proved effective in the forefoot but less in the heel. To address this, new insoles incorporating a heel cup are developed. MethodsIn-shoe pressure was measured, while persons with diabetes and loss of protective sensation with high peak pressure (≥ 200 kPa) in the heel walked on a treadmill with control and individualized rocker shoe paired with control and new insole. FindingsGeneralized estimating equations revealed significant decrease in peak pressure in the proximal heel with the new insole alone and combined with rocker shoe compared to rocker shoe alone. For the distal heel, significant decrease in peak pressure is shown with the combination of new insole and rocker shoe compared to control shoe. For the forefoot and toes (excluding hallux) significant decrease in peak pressure is shown using the rocker shoe alone or combined with the heel cup compared to control shoe. InterpretationThe new insole paired with rocker shoe is effective in reducing peak pressure in the distal heel. To have similar (or more) success in proximal heel, one could replace the rocker midsole with more compliant materials. The rocker shoe used separately or combined with a heel cup effectively reduces the peak pressure in the forefoot and other toes.

Human-in-the-loop optimization of rocker shoe to reduce plantar pressure and collision work simultaneously

BackgroundRocker shoes can be used to reduce foot pressure and adjust lower limb kinetics for various patient population, such as people with diabetic peripheral neuropathy. Selecting adequate properties of the rocker sole is of great importance for its efficacy. This study investigated the capability of human-in-the-loop optimization (HILO) to individually optimize apex position and angle of rocker shoe to reduce peak pressure and collision work simultaneously. MethodsPeak pressure, kinetic, and kinematic data were recorded from 10 healthy participants while walking at preferred speed wearing rocker shoes with adjustable apex position and angle. An evolutionary algorithm was used to find optimal apex parameters to reduce both peak pressure in medial forefoot and collision work. The optimized shoe (HILO shoe) was compared with generic optimal rocker settings (Chapman settings) and normal shoe. FindingsCompared to normal shoe, the HILO shoe had lower plantar pressure (pHILO = 0.007; pChapman = 0.044) and Chapman shoe showed higher collision work (pHILO = 0.025; pChapman = 0.014). Both HILO and Chapman shoe had smaller push-off work than normal shoe (pHILO = 0.001; pChapman < 0.001) with the Chapman shoe exhibited earlier push-off onset (pHILO = 0.257; pChapman = 0.016). InterpretationThe Human-in-the-loop optimization approach resulted in individualized apex settings which performed on average similar to Chapman settings but, were superior in selected cases. In these cases, medial forefoot could be further offloaded with apex angles larger than generic settings. The larger apex angle might increase the external ankle moment arm and push-off work. However, there is limited room for improvement on collision work compared to generic settings.

Effects of individually optimized rocker midsoles and self-adjusting insoles on dynamic stability in persons with diabetes mellitus and neuropathy

BackgroundPersons with diabetic peripheral neuropathy (DPN) may face challenges such as balance issues due to reduced somatosensory feedback and an increased risk of developing diabetic foot ulcers (DFUs) due to increased plantar pressure. Pressure reducing footwear is thought to further impair balance. We introduced 3D-printed rocker midsoles and self-adjusting insoles that are able to reduce elevated plantar pressure values and aimed to prevent balance deterioration. However, their effect on the balance during walking (dynamic stability) is not analyzed yet. Research questionIs dynamic stability of persons with DPN impaired compared to healthy individuals and what is the effect of the 3D-printed rocker midsoles and self-adjusting insoles on the dynamic stability in this population? MethodsDynamic stability, specifically the margins of stability (MOS) in the anterior-posterior (AP) and medio-lateral (ML) direction, was measured in ten healthy and nineteen persons with DPN. Independent-samples t-test was applied to analyze the difference in the MOS between groups. One-way repeated measures analyses of variance (ANOVA) was conducted to test the difference between the therapeutic footwear combinations within the DPN group. ResultsThere is no significant difference between the healthy and DPN group in MOS-AP. MOS-ML is significantly larger in DPN compared to the healthy participants. Using the self-adjusting insole shows a significantly lower (negative) MOS-AP compared to when using a rocker shoe within the DPN group. SignificanceThis study provides valuable information on whether DPN and our therapeutic footwear have a negative effect on the dynamic stability. DPN does not have a negative effect on dynamic stability in the AP direction. For the ML direction, DPN seems to cause larger MOS-ML by likely using a compensation strategy (e.g., wider steps) while our experimental footwear does not further impair the MOS-ML.

Human-in-the-loop optimization of rocker shoes via different cost functions during walking

Personalised footwear could be used to enhance the function of the foot–ankle complex to a person’s maximum. Human-in-the-loop optimization could be used as an effective and efficient way to find a personalised optimal rocker profile (i.e., apex position and angle). The outcome of this process likely depends on the selected optimization objective and its responsiveness to the rocker parameters being tuned. This study aims to explore whether and how human-in-the-loop optimization via different cost functions (i.e., metabolic cost, collision work as measure for external mechanical work, and step distance variability as measure for gait stability) affects the optimal apex position and angle of a rocker profile differently for individuals during walking. Ten healthy individuals walked on a treadmill with experimental rocker shoes in which apex position and angle were optimized using human-in-the-loop optimization using different cost functions. We compared the obtained optimal apex parameters for the different cost functions and how these affected the selected gait related objectives. Optimal apex parameters differed substantially between participants and optimal apex positions differed between cost functions. The responsiveness to changes in apex parameters differed between cost functions. Collision work was the only cost function that resulted in a significant improvement of its performance criteria. Improvements in metabolic cost or step distance variability were not found after optimization. This study showed that cost function selection is important when human-in-the-loop optimization is used to design personalised footwear to allow conversion to an optimum that suits the individual.

Human‐in‐the‐loop optimized rocker profile of running shoes to enhance ankle work and running economy

AbstractIncreasing the efficiency at which muscles generate mechanical power could improve running economy. A potential way to reduce muscle fiber shortening velocities and enhance energy storing of the Triceps Surae is changing their gear ratio at the ankle via optimization of shoe rollover profile. The aim of the current study was to individually optimize rollover profile of rocker shoes via human‐in‐the‐loop optimization to maximize positive ankle work to redistribute joint work from the hip and knee to the ankle and improve running economy. A total of 10 runners ran on a treadmill with experimental rocker shoes in which apex position and angle were optimized using an evolution algorithm to maximize positive ankle work. We compared experimental shoes with optimal settings, standard settings, and control shoes in terms of biomechanics and running economy. Optimal apex parameters differed considerably between participants. The optimal condition resulted in higher positive ankle work and a higher proportional share of the ankle in the total positive lower limb work compared to the standard condition. A difference in running economy between these conditions was not found. Human‐in‐the‐loop optimization can redistribute joint work from the hip and knee to the ankle by individually optimizing apex parameters. Although this did not improve running economy, the study showed that human‐in‐the‐loop optimization could improve the effectiveness of footwear with respect to the selected optimization parameter on an individual level.

Effects of heel apex position, apex angle and rocker radius on plantar pressure in the heel region

IntroductionRocker shoes and insoles are used to prevent diabetic foot ulcers in persons with diabetes mellitus and loss of protective sensation, by reducing the plantar pressure in regions with high pressure values (>200 kPa) (e.g., hallux, metatarsal heads and heel). However, forefoot rocker shoes that reduce pressure in the forefoot inadvertently increase pressure in the heel. No studies focused on mitigating the negative effects on heel pressure by optimizing the heel rocker midsole, yet. Therefore, we analyze the effect of different heel rocker parameters on the heel plantar pressure. MethodsIn-shoe pressure was measured, while 10 healthy participants walked with control shoe and 10 different heel rocker settings. Peak pressure was determined in 7 heel masks, for all shoes. Generalized estimating equations was performed to test the effect of the different shoes on the peak pressure in the different heel masks. ResultsIn the proximal heel, a rocker shoe with distal apex position, small rocker radius and large apex angle (100°), shows the largest significant decrease in peak pressure compared to rocker shoes with more proximally located apex positions. In the midheel and distal heel, the same rocker shoes or any other rocker shoes, analyzed in this study, do not reduce the PP more than 2 % compared to the control shoe. For the midheel and distal heel region with high pressure values (>200 kPa), rocker shoes alone are not the correct option to reduce the pressure to below 200 kPa. ConclusionWhen using rocker shoes to reduce the pressure in the forefoot, a heel rocker midsole with a distal apex position, small rocker radius and apex angle of 100°, mitigates the negative effects on proximal heel pressure. For the midheel and distal heel, other footwear options as an addition or instead of rocker shoes are needed to reduce the pressure.

Plantar pressure reduction through self-adapting insoles with a heel-cup in standard and rocker shoes

Plantar pressure reduction through self-adapting insoles with a heel-cup in standard and rocker shoes

Human-in-the-loop optimization of rocker shoes via different cost functions during walking

Human-in-the-loop optimization of rocker shoes via different cost functions during walking

Effect of submaximal running in rocker shoes on gluteal muscle activation under different running conditions

Iliotibialis syndrome is one of the most common types of running injury of the lateral knee. Earlier studies have mainly focused on the relationship between iliotibialis syndrome and hip muscle forces, since the latter are often the target of intervention during rehabilitation. The results suggest that a curved shoe sole may affect lower limb mechanics during running. The main purpose of this study was to assess the effects of different curves of rocker shoes on activation of the musculus gluteus medius and maximus under various running conditions. Fifteen recreational runners (1.77 ± 0.44 m height, 74.25 ± 6.68 kg weight, 23.73 ± 1.79 kg/m 2 BMI) were recruited to test three rocker shoes with different forefoot curvatures on a flat laboratory floor and a treadmill at flat, uphill, and downhill gradients. Surface electromyography data were collected for musculus gluteus medius and maximus, resulting in a three-way within-subject design (running condition (4) x shoe (3) x muscle (2)) with 24 measurement combinations for each runner. A linear mixed model was fitted to the data to quantify running condition, shoe curve and muscle effects. The main effects of running condition, shoe and muscle were estimated. While running uphill, significant decreases were observed in both peak ( P = 0.021, log%MVC) and duration ( P = 0.015, log%MVC) compared to running on a flat laboratory surface. Both average (0.033 log%MVC) and peak muscle activation (0.069 log%MVC) were increased with a smaller radius of shoe curvature. In conclusion, the study shows that rocker shoes appear to affect gluteal muscle activation and could potentially assist in stabilising the pelvis during running. This knowledge might be of interest for runners with an increased risk of ITBS and may therefore gain health benefits from wearing rocker shoes. Le syndrome de l’iliotibialis est l’un des types les plus courants de blessure en course à pied du genou latéral. Les études précédentes se sont principalement concentrées sur la relation entre le syndrome iliotibialis et les forces musculaires de la hanche, puisque ces dernières sont souvent la cible d’interventions lors de la rééducation. Les résultats suggèrent qu’une semelle de chaussure incurvée peut affecter la mécanique des membres inférieurs pendant la course. L’objectif principal de cette étude était d’évaluer les effets de différentes courbes de chaussures à bascule sur l’activation du muscle fessier moyen et du muscle grand fessier dans diverses conditions de course. Quinze coureurs récréatifs (1,77 ± 0,44 m taille, 74,25 ± 6,68 kg poids, 23,73 ± 1,79 kg/m 2 BMI) ont été recrutés pour tester trois chaussures à bascule avec différentes courbures de l’avant-pied sur un sol de laboratoire plat et un tapis roulant à plat, en montée et en descente. Des données d’électromyographie de surface ont été recueillies pour le musculus gluteus medius et le maximus, ce qui a permis d’obtenir une conception à trois voies au sein du sujet (condition de course (4) x chaussure (3) x muscle (2)) avec 24 combinaisons de mesures pour chaque coureur. Un modèle linéaire mixte a été adapté aux données pour quantifier les effets de la condition de course, de la courbe de la chaussure et du muscle. Les principaux effets de la condition de course, de la chaussure et du muscle ont été estimés. Lors de la course en montée, des diminutions significatives ont été observées tant au niveau du pic ( p = 0,021, log%MVC) que de la durée ( p = 0,015, log%MVC) par rapport à la course sur une surface plane de laboratoire. L’activation musculaire moyenne (0,033 log%MVC) et maximale (0,069 log%MVC) a augmenté avec un rayon de courbure de la chaussure plus petit. En conclusion, l’étude montre que les chaussures à bascule semblent affecter l’activation des muscles fessiers et pourraient potentiellement aider à stabiliser le bassin pendant la course. Cette connaissance pourrait être intéressante pour les coureurs présentant un risque accru de SII et qui pourraient donc tirer des avantages pour leur santé du port de chaussures à bascule.

The effect of toe-only rocker sole shoes on gait variability of the elderly.

Gait variability could associate with fall risk in older people. Rocker sole shoes are commonly prescribed to reduce plantar pressure and facilitate forward movement. Thus, it may affect gait stability. The purpose of this study was to investigate the effects of toe-only rocker shoes on gait variability in the elderly. Seventeen healthy elderly participants walked on a treadmill under six different conditions including barefoot (BF), normal shoe (NS), and four types of toe-only rocker sole shoes with various degrees of rocker angle (RS10, RS20, RS30, and RS40). Then the step length variability (SLV), the step time variability (STV), the step width variability (SWV), and the stance time variability were measured. Increasing rocker angle in toe-only rocker did not significantly affect gait variability more than the standard shoe. It seems that different rocker angles in toe-only rocker sole shoes do not pose a threat to gait variability compared to the standard shoes in healthy elderly. Findings of the study suggested that the toe-only rocker sole can be used to facilitate forward progression in the elderly. Further investigation is also required to examine the long-term effects of toe-only rocker sole shoes on gait variability in frail elderly.

The interaction effects of rocker angle and apex location in rocker shoe design on foot biomechanics and Achilles tendon loading

The influences of rocker shoes on foot biomechanics were controversial because the interaction between two design factors—rocker angle and apex location, was usually omitted. This study investigated the interaction effects of rocker angle and apex location on plantar foot pressure, metatarsophalangeal/ankle angle, and Achilles tendon force during walking. Ten participants performed walking trials under six rocker shoe conditions: 2 rocker angles (mild and severe) ​× ​3 apex locations (distal, standard, and proximal), wherein the plantar foot pressure was measured and the movement data were processed by musculoskeletal modeling to report joint angle and Achilles tendon force. A two-way ANOVA repeated measures was used for statistics. Significant interaction effects were reported in examinations of forefoot pressure, midfoot pressure, and metatarsophalangeal dorsiflexion. The standard apex significantly reduced peak forefoot and midfoot pressures (p ​= ​0.008–0.034, Hedges'g ​= ​0.75–0.84), which was further decreased by a severe rocker angle (p ​= ​0.006, Hedges'g ​= ​0.51–0.81). Moving the apex proximally reduced Achilles tendon forces (p ​< ​0.001, Hedges' g ​= ​0.80) and facilitated both metatarsophalangeal dorsiflexion and ankle plantarflexion during push-off (p ​= ​0.003–0.006, Hedges' g ​= ​0.03–0.82). Rocker angle seemed to have fewer effects on ankle joint angle and Achilles tendon force. We concluded that apex location was likely the dominant design factor of the rocker sole in influencing foot biomechanics, yet its interactions with rocker angle should be considered. The configuration of the two features could be varied to possess different therapeutic merits and adapt to specific application purposes.

The effects of ankle-foot orthoses with plantar flexion stop and plantar flexion resistance using rocker-sole shoes on stroke gait: A randomized-controlled trial.

Objectives This study aims to evaluate the effect of two ankle-foot orthoses (AFOs), AFO with plantar flexion stop (AFO-PlfS), and AFO with plantar flexion resistance (AFO-PlfR), while wearing standard shoes and rocker-sole shoes. Patients and methods Between November 2017 and July 2018, in this randomized-controlled study, a total of 20 stroke patients (8 males, 12 females; mean age: 48.1 years; range, 33 to 65 years) in chronic phase were randomized to AFO groups (AFO-PlfS group, n=10 and AFO-PlfR group, n=10). Each group received the allocated AFO along with two kinds of shoes (standard shoe and rocker shoe) for a two-week adaptation. Two effects were separately evaluated: The orthotic effect and rocker shoe effect were defined as the evaluation of using an AFO wearing standard shoe compared to only standard shoe, and evaluation of using an AFO wearing rocker shoe compared to an AFO wearing standard shoe, respectively. The gait of each group was measured by three-dimensional motion analysis. Results A significant orthotic effect was found in both AFO groups in spatiotemporal parameters and maximum ankle dorsiflexion in the single-support phase. Additionally, the AFO-PlfR group showed a significant improvement in the parameters related to the first rocker of gait, but not for AFO-PlfS group concerning the orthotic effect. The rocker shoe effect was found in significant reduction of peak ankle plantar flexor moment and power ankle generation during preswing for both AFO groups. Conclusion According to the orthotic effect, an AFO-PlfR can create better function in the improvement of parameters related to the first rocker. Although a rocker shoe can facilitate rollover for weight progression in the third rocker of gait, it cannot make a strong push-off function in stroke survivors.

Effects of rocker radii with two longitudinal bending stiffnesses on plantar pressure distribution in the forefoot.

Outsole parameters of the shoe can be adapted to offload regions of pain or region of high pressures. Previous studies already showed reduced plantar pressures in the forefoot due to a proximally placed apex position and higher longitudinal bending stiffness (LBS). The aim of this study was to determine the effect of changes in rocker radii and high LBS on the plantar pressure profile during gait. 10 participants walked in seven shoe conditions of which one control shoe and six rocker shoes with small, medium and large rocker radii and low and high longitudinal bending stiffness. Pedar in-shoe plantar pressure measuring system was used to quantify plantar pressures while walking on a treadmill at self-selected walking speed. Peak plantar pressure, maximum mean pressure and force-time integral were analyzed with Generalized Estimated Equation (GEE) and Tukey post hoc correction (α = .05). Significantly lower plantar pressures were found in the first toe, toes 2-5, distal and proximal forefoot in all rocker shoe conditions as compared to the control shoe. Plantar pressures in the first toe and toes 2-5 were significantly lower in the small radius compared to medium and large radii. For the distal forefoot both small and medium radii significantly reduced plantar pressure compared to large radii. Low LBS reduced plantar pressure at the first toe significantly compared to high LBS independent of the rocker radius. Plantar pressures in the distal forefoot and toes 2-5 were lower in high LBS compared to low LBS. Manipulation of the rocker radius and LBS can effectively reduce peak plantar pressures in the forefoot region during gait. In line with previous studies, we showed that depending on the exact target location for offloading, different combinations of rocker radius and LBS need to be adopted to maximize treatment effects.

Effects of Longitudinal Bending Stiffness of forefoot rocker profile shoes on ankle kinematics and kinetics.

Rocker profile shoes with a proximally placed apex are currently one of the most prescribed shoe modifications for treatment and prevention of lower leg deficits. Three geometrical rocker design parameters apex position (AP), apex angle (AA) and rocker radius (RR) influence both plantar pressure redistribution and kinetic and kinematic alterations of the lower leg. In addition, longitudinal bending stiffness (LBS) of the outsole influences these parameters as well. This study aims to investigate the effects of the LBS in combination with different forefoot radii of rocker shoes on kinematics and kinetics of the lower limb. 10 participants walked in standard shoes and six experimental shoe conditions with high and low LBS and three different forefoot rocker radii with the same (proximal) AP and AA. Lower extremity kinematics and kinetics were collected while walking on an instrumented treadmill at preferred walking speed and analysed with a repeated measures ANOVA and Statistical Parametric Mapping (SPM) (α = .05; post hoc α = .05/6). SPM analyses revealed no significant differences for LBS and interaction LBS*RR for most research variables in terminal stance (ankle angle, ankle moment, ankle power, foot-to-horizontal angle, shank-to-vertical angle, external ankle moment, ground reaction force angle). A significant LBS effect was found for anterior-posterior position of the centre of pressure during pre-swing and peak ankle dorsiflexion angle. No relevant significant differences were found in spatio-temporal parameters and total work at the ankle between low and high LBS. This study showed that longitudinal bending stiffness does not affect the biomechanical working mechanism of rocker profile shoes as long as toe plantarflexion is restricted. Providing that the forefoot rocker radius supports at least a normal foot-to-horizontal angle at toe-off, there is no reason to increase sole stiffness to change ankle kinematics and kinetics.

Effect of different forefoot rocker radii on lower-limb joint biomechanics in healthy individuals

IntroductionPrevious studies showed that rocker shoes with a stiff forefoot rocker profile significantly reduce peak plantar flexion moment at the ankle (PFM) and peak ankle dorsiflexion (DF). Both parameters are related to Achilles tendon and Plantar Fascia unloading. The shape of an outsole with a forefoot rocker is described with multiple rocker design parameters. The aim of this research is, to determine the relation between different forefoot rocker radii on peak DF and peak PFM at a self-selected walking speed. Methods10 participants walked in standard shoes and three experimental pairs of shoes with different forefoot rocker radii. Lower extremity kinematics and kinetics were collected while walking on an instrumented treadmill at preferred walking speed and analysed with Statistical Parametric Mapping (SPM) (α = .05; post-hoc α = .05/6). ResultsPeak value analyses showed significant decreases in peak DF, peak PFM, and peak ankle power generation for the rocker conditions. No relevant significant differences were found in spatio-temporal parameters and total work at the ankle joint. SPM showed a significant decrease (% gait cycle) in DF (40–69 %), PFM (7–15 %; 41–68 %; 69–81 %), ankle power (10–15 %; 32–51 %; 55–64 %; 64–67 %; 72–80 %) and foot-to-horizontal angle (FHA) (0–4 %; 40–62 %; 92–100 %) and an increased shank-to-vertical angle (SVA) (44–84 %) for the rocker conditions. ConclusionThe results of this study suggest that rocker shoes with a proximally placed apex significantly reduce DF and PFM during the third rocker compared with control shoes. This effect is mainly explained by a change in the FHA. Smaller radii cause the largest reductions in DF and PFM, so therefore, a uniform standardisation of the forefoot rocker radius is essential.

Do commonly used postoperative orthopaedic shoes help off-load the forefoot?

The aim of the experiment presented in this study was to determine the pressure distribution within the forefoot depending on the type of orthopaedic footwear used. The study included 27 women aged 20 to 25. The Zebris FDM-2 dynamographic platform was used in foot pressure measurements. The load distribution was measured in three types of orthopaedic footwear: MedSurg, MedSurgPro and OrthoWedge. The full gait cycle was recorded. The Cavanagh masks were applied to the load distribution results processed into a graphic form. The data were analysed using Statistica v.13.1. In the forefoot area, i.e. the metatarsal bones and toes 1-5, the lowest loads were reported in the shoes that off-load the forefoot (0.2 N/cm², p < 0.001). In the area of the first to fifth metatarsal bones and the hallux, the highest load was observed in the rocker shoe, accounting for 19.7 N/cm² ( p < 0.001). For comparison, high pressure in the flat shoe was found in the area of toes 2 to 5 ( p < 0.001). In the area of the metatarsal and toe bones, the pressure exerted was highest in the commonly used rocker shoe. The flat shoe provides an even and uniform load in all areas of the forefoot, while this type of shoe does not significantly reduce the pressure forces on the forefoot. The shoe that was the most effective in off-loading was the forefoot off-loading shoe (OrthoWedge). Barefoot walking puts less load on the forefoot compared to the flat and rocker shoes used after orthopaedic procedures.

Plantar pressure distribution and wearing characteristics of three forefoot offloading shoes in healthy adult subjects

Forefoot offloading shoes are used to reduce pressure on specific regions of the foot. Aim of the pressure reduction is to aid healing of the soft and bony tissues and prevent complications by treating foot disorders. A great variety of forefoot offloading shoes are available. In a first step to investigate the appropriate use of these footwear in orthopedic settings, we studied plantar pressure distribution and wearing characteristics of three forefoot offloading shoes namely the Mailand, OrthoWedge and Podalux in a healthy population.Twenty subjects walked in a randomized order wearing three forefoot offloading shoes and a reference shoe for six minutes. The Pedar system was used to measure the pressure in 7 regions. Peak pressure and pressure time integral were analyzed as measures of pressure distribution. Furthermore, wearing characteristics were addressed using a Numeric Rating Scale. Pressure distribution and wearing characteristics of the forefoot offloading shoes were compared to a reference shoe.The Mailand and OrthoWedge shoes significantly reduced peak pressure with more than 80% under the hallux and more than 45% under MTH1 (p<.001). The Podalux did not show significant peak pressure reduction under the forefoot compared to the reference shoe. Under the lesser toes, the MTH4-5 region and heel region the Podalux shoe showed even a significant increase in peak pressure (p=.001). Looking at wearing characteristics, the Podalux and reference shoe scored significantly better than the other two forefoot offloading shoes (p<.01).In this study the differences between different forefoot offloading shoes was assessed. The Mailand and OrthoWedge shoes gave the best pressure reduction in the forefoot but are less comfortable in use. The Podalux rocker shoe showed opposite results. Next step is a patient study to compare our results in a patient population.

Rearfoot disorders and conservative treatment: a narrative review.

Rearfoot disorders are frequently encountered in clinical practice. We reviewed common rearfoot disorders and present conservative treatments, focusing on shoe modification and the application of insoles or orthoses. Achilles tendinopathy is caused by excessive mechanical loads on the gastrocnemius and soleus muscles. Heel lifts, rocker shoes, and the AirHeel Brace can be used to reduce symptoms. Haglund's deformity is an osseous prominence of the posterosuperior part of the calcaneus bone, the pain from which can be alleviated by reducing pressure on the affected area by appropriately modifying the back of the shoe to prevent contact with the lesion. The pain from retrocalcaneal bursitis can be controlled by lifting the heel and loosening the shoe counter. Plantar fasciitis causes plantar heel pain, and its orthotic treatments include the application of a heel cup, heel pad, heel wedge, Thomas heel, and night splint. Calcaneal stress fractures are generally caused by repetitive loads and occur mainly in sporting activities. Patellar tendon-bearing (PTB) orthoses are helpful in reducing the load on the calcaneal bone. Heel fat pad atrophy refers to the loss of the fat pad that absorbs shock in the heel. To reduce pain caused by heel fat pad atrophy, rocker soles, heel pads, and solid ankle cushion heels (SACHs) may be used. Tarsal tunnel syndrome is caused by compression of the tibial nerve within the tarsal tunnel and its symptoms can be managed by rocker soles, supporting medial arches, Thomas heels, and SACHs. Shoe modification or application of orthoses can be helpful for managing rearfoot pain. However, for the active and wide application of these conservative treatment methods, more clinical studies should be conducted.

Effect of rocker-sole footwear on knee joint biomechanics while walking in people with ACL-reconstructed knees: a cross-sectional biomechanical study

Background: Reinjury has occurred at a high rate after anterior cruciate ligament (ACL) reconstruction. Low knee flexion angles and high peak posterior ground reaction forces in landing tasks increase ACL loading. Some studies reported that rocker-sole shoes increased knee flexion angle in the early stance phase of the gait. The aim of this study was to investigate the biomechanics of walking with a custom-made heel-to-toe rocker shoe design, with special attention to the sagittal knee joint kinematics of patients after ACL reconstruction. Methods: This study examined 10 male participants with ACL-reconstruction participants. Three-dimensional gait analysis was performed under two conditions of level walking that were tested in random order using either modified footwear adapted with a heel-to-toe rocker sole or baseline footwear with a flat sole. The knee flexion angle at initial foot contact with the ground, average knee flexion angle from heel strike to 25% stance phase, and first peak knee flexion angle were compared across footwear conditions. Results: Walking with the heel-to-toe rocker shoes increased the knee flexion angle at the early stance phase of the gait cycle when compared with the baseline footwear. Conclusions: Rocker-shoe intervention was found to have potential as a rehabilitation tool to modify gait patterns in the sagittal plane of people with ACL-reconstructed knees and may protect against high reinjury rates. Further research is required to evaluate whether prolonged wear of rocker-sole shoes can modify lower extremity biomechanics of participants who have undergone ACL reconstruction. Level of Evidence: Level II.