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Negative heel shoes
Section:  Biomechanics

Lately I've observed a surge in the number of my patients wearing athletic shoes with rocker forefoot and negative heels.  Sketchers makes one of these, and as I interview patients the vast majority are very happy with the performance of these shoes.  They describe a short break-in period with early calf ache (likely secondary to the increased calf function with decreased heel stability) but then feel very comfortable.  Pathologies that patients have noticed improvement with these shoes in my practice have been predominantly plantar fasciitis/fasciosis and lesser metatarsalgia.  I can see the reason why theoretically these shoes may be beneficial (decreased forefoot pressures with the forefoot rocker and maybe a decrease in equinus with the forced stretch).  Examining these shoes myself I've found them to have supportive heel cups, more rigid shanks, and appropriate toe box bending - all good things in my experience.  I haven't seen any research behind these shoes, though.  

 

Is anyone aware of some better science behind these shoes?  Do you suggest them in your practice and if so in what patient population?  Do those biomechanics experts out there have any comments?

MEMBER COMMENTS
Re: Negative heel shoes

Interesting. I have a personal experience with the 1970's version of these (without the forefoot rocker.) Some of the older posters may remember the Earth Shoe. That is if they remember any of the early '70s.

earthshoesAlthough I lived in Southern California at the time, I do remember the late '60s and early '70s and I loved the Earth Shoe. My mother was convinced that it actually improved my posture.

It had a negative heel, lower to the ground in relation to the heighth of the forefoot. That was really the only unique feature of the Earth Shoe other than its rather "earthy" look.

HippyGirlWhen we hippies, or flower children, of the time, wore them we essentially looked like we were walking up a hill. We leaned forward a good 15 to 20 degrees I would say, to keep our balance. Some probably leaned forward more than others.

It was not an especially pretty sight. Of course you have to add the bell bottoms, love beads, peace symbols, somewhat slovenly look, leaning Tower of Pisa appearance and well, you've got the look.

Now that you mention it, I wonder if this is how I ended up with my L4-L5 back problems 25 years later? Makes you wonder.....

But at 17, they did feel good. Of course, at 17, in Southern California, most everything felt good! But only those things that were legal. That's the way I rolled.

Re: Negative heel shoes
Quote:

Lately I've observed a surge in the number of my patients wearing athletic shoes with rocker forefoot and negative heels.  Sketchers makes one of these, and as I interview patients the vast majority are very happy with the performance of these shoes.  They describe a short break-in period with early calf ache (likely secondary to the increased calf function with decreased heel stability) but then feel very comfortable.  Pathologies that patients have noticed improvement with these shoes in my practice have been predominantly plantar fasciitis/fasciosis and lesser metatarsalgia.  I can see the reason why theoretically these shoes may be beneficial (decreased forefoot pressures with the forefoot rocker and maybe a decrease in equinus with the forced stretch).  Examining these shoes myself I've found them to have supportive heel cups, more rigid shanks, and appropriate toe box bending - all good things in my experience.  I haven't seen any research behind these shoes, though.  

 

Is anyone aware of some better science behind these shoes?  Do you suggest them in your practice and if so in what patient population?  Do those biomechanics experts out there have any comments?


Like everyone else, i seem to have more and more patients who are asking about the rocker-bottom toning shoes, and i've found that there are several brands that have been evaluated by a team of APMA podiatrists, and hold the American Podiatric Medical Association's Seal of Acceptance.  A list of these can be viewed below:

 

Toning
American Sporting Goods (Avia and Ryka)
330 Walking, Avi-Motion, Ryka Reform, Ryka Rocker

FitFlop Limited
Dass, Electra, Fiorellam Hyka, Hyker, Leather Boot Short, Medical/Professional Shoe, Oasis, Pietra, Rebel, Riata, Rockstar, Roma, Shakoha, Strap, Ultra Lounge, Walkstar 1, Walkstar 3

The Keds Corporation, dba Grasshoppers
Performance Platforms Get Fit™ Lace and Performance Platforms Get Fit™ Slip On

Reebok International Ltd.
EasyTone ReeInsprie

 

While certainly not for everyone, it seems that there is biomechanical evidence to support --at least in some instances--the use of a rocker bottom or negative heel shoe.  For example, i have had success in placing ankle arthrodesis patients into these types of shoes following their procedure to reapproximate a more normal gait pattern....

 

 

Re: Negative heel shoes

I have been placing Hallux limitus patients in the MBT models for a few years

 

I have also found them helpful for plantar fasciitis.

 

My theory on these shoes is that they reduce the long digital/hallucis and intrinsic muscle function in lieu of compensation by the tricep surae musculature. This occurs because the shoe does not bend or bends very little, thus there is less need for hallux muscles and stabilzation during propulsion because the foot is remaining flat while the ankle is moving thoughout proplusion  over the rocker base sole, at which time the tricep surae continues to fire through propulsion where the hallucis longus and associated intrinsics would be pushing off the hallux to propel the body forward. 

 

With minimal dorsiflexion of the toes there is the potential to aid in forefoot propulsive pathologies such as predislocaion syndrome, IPKs and metatarsalgia.  Since the met heads are plantar flexed as the digits dorsiflex--reducing this mechanism may help.  I don't have enough patients using the shoes with forefoot pathology to render a verdict yet. But I would love to hear from everyone else.  

 

If the above theories are true, this will greatly change the way we make orthotics and our conceps of bioehanical patholgy as a whole.  In my opinion, we do need to own this subject which may mean shaking our base out of the notion that all biomechanical issues are answered in the writings of Root, Weed and Orian.  Not that RWO is wrong but the focus is somewhat narrowly concerned with midstance position and function.  To advance the science of treatment of biomencahical pathology the effect of these shoes needs to be studied in our colleges.

 

 

 

 

Re: Negative heel shoes
Quote:

Lately I've observed a surge in the number of my patients wearing athletic shoes with rocker forefoot and negative heels. Sketchers makes one of these, and as I interview patients the vast majority are very happy with the performance of these shoes. They describe a short break-in period with early calf ache (likely secondary to the increased calf function with decreased heel stability) but then feel very comfortable. Pathologies that patients have noticed improvement with these shoes in my practice have been predominantly plantar fasciitis/fasciosis and lesser metatarsalgia. I can see the reason why theoretically these shoes may be beneficial (decreased forefoot pressures with the forefoot rocker and maybe a decrease in equinus with the forced stretch). Examining these shoes myself I've found them to have supportive heel cups, more rigid shanks, and appropriate toe box bending - all good things in my experience. I haven't seen any research behind these shoes, though.

 

Is anyone aware of some better science behind these shoes? Do you suggest them in your practice and if so in what patient population? Do those biomechanics experts out there have any comments?

I guess I may qualify as a biomechanical expert but I consider myself a podiatrist incorporating foot structure and function as the fundamental base for my EBP.


Podiatrists have been writing Rx's to pedorthists and shoe repair clerks to add rocker bottoms to shoes for many, many years, as a last resort for feet with irreversible biomechanical pathology.

Examples would be post ankle fusion, advanced autoimmune arthritis, Charcot Feet and end stage pathological flat feet.


The principle is that one or more of the intrinsic rockers of the foot (Dananberg) is irreversibly damaged.
The calcaneal rocker
The talar dome rocker or
The 1st met head rocker
are not capable of allowing the swinging leg to move forward over the planted foot in the rearfoot contact gait cycle.

It is an heroic, last ditch effort, short of additional surgery, to drive a more normal gait from these individuals because it leads to acceptable reductions in function and quality of life.


The rocker of the shoe is REPLACING the mechanical rockers of the foot that will never work again.

 

In faulty mechanics (one simplistic example is FHL) the gait cycle is compensatorily weak and the non functioning rocker of the foot is dampening the ability for the hip and gluteal muscles to work as the gait pattern is shortened and perversed.


The increased foot rocker function that occurs when the exercise shoe rocker is used instead causes activation of the pelvic, gluteal and lower back muscles, hence the research that when you wear rocker soles you will use more of these muscle and the claims of + effects when exercising with rocker shoes but it will allow the patients underlying biomechanical pathology to worsen (Grade 1-4 FHL) eventually marrying the patient to the rocker shoe or a life of suffering.

In addition, when a rocker shoe is used for other functional cycles during ones lifetime, such as forefoot contact gait, moving sideways, backwards, lifting, etc. these activities would be greatly dampened and the patient would be exposed to injury. So rockers are only good for walking and very little else. Try playing basketball on a rocker shoe and I'll see you as an emergency add on the next day.


If you are practicing a level of biomechanics that allows you to improve performance of muscle engines and natal foot type specigic pathology, such as The Foot Centering Theory (personal bias) then there are other things to do short of rocker bottom therapy before becoming the practitioner that married the patient to a reduced quality of life in order to reduce or avoid the pain of FHL as a complaint (pathology specific care).


There are adjunctive uses for rocker shoes in therapeusis that can be discussed at another moment but in my opinion, they have specific applications and should be used as one would use roller skates to improve speed of getting from point A to point B instread of rearfoot contact gait but not as a substitute for healthy internal mechanics.


If you actually believe that a rocker is the best method of function for human feet, why is a midfoot charcot foot so pathological biomechanically?

I look forward to other opinions.

 

Dr Sha



 

Re: Negative heel shoes

Hello all. I was thinking of getting a negative heeled shoe to counteract the effects of wearing high heels for too long.

I develop a sharp pain in my lumbar region every now and then, and especially when I've been wearing them for too often (for work, for nightlife). As a very short woman (5'0) I wear them for work so that I can see beyond the clothes racks and monitor the store. I do plan to drastically cut down on my high heel wear.

In addition, I already have a hyperlordic posture from sitting in front of the computer for too long. Could negative heeled shoes help correct this posture as well? 

I appreciate any response!

Re: Negative heel shoes
Quote:

Lately I've observed a surge in the number of my patients wearing athletic shoes with rocker forefoot and negative heels.  Sketchers makes one of these, and as I interview patients the vast majority are very happy with the performance of these shoes.  They describe a short break-in period with early calf ache (likely secondary to the increased calf function with decreased heel stability) but then feel very comfortable.  Pathologies that patients have noticed improvement with these shoes in my practice have been predominantly plantar fasciitis/fasciosis and lesser metatarsalgia.  I can see the reason why theoretically these shoes may be beneficial (decreased forefoot pressures with the forefoot rocker and maybe a decrease in equinus with the forced stretch).  Examining these shoes myself I've found them to have supportive heel cups, more rigid shanks, and appropriate toe box bending - all good things in my experience.  I haven't seen any research behind these shoes, though.  

 

Is anyone aware of some better science behind these shoes?  Do you suggest them in your practice and if so in what patient population?  Do those biomechanics experts out there have any comments?

The response, from patients that I've seen is that some people really like them and some people hate them.  When I recommend them, I tell my patient to check the return policy.  A lot of the negative heel rockers have the rocker point around half way.  The literature shows that you want the rocker 60-65% of shoe length (behind the met heads) for maximum reduction of pressure on the forefoot.   What the 50% rocker length with negative heel does is to force you to choose between standing with your weight toward your heel or standing with your weight toward your forefoot.  When your weight is more on your heel you have to really dorsiflex your ankle and those with an equinus cannot do that.  When you choose to put your weight on your forefoot you have to constantly contract your ankle plantar flexors and this would explain the calf soreness.  (Jarod, is this what you meant by decreased heel stability?)

The other thing that most rockers have is stiffness in the forefoot.  What this does is prevent heel lift (relative to the shoe) so there is no dorsiflexion of the toes.  This will certainly help feet with long metatarsals and some other forefoot problems. Rigid shoes, that don't flex at the mpj's, have been shown to create a slight reduction in pressure on the forefoot.   The negative heel rockers will probably give you that effect, but may not be as good as the "normal" rockers.  There are some OTC non negative heel rockers like the Hoka One One.  Also, a rigid shoe may give you enough of a pressure reduction effect that you don't have to get the negative heel rocker.  The rigid shoe will prevent hallux dorsiflexion which increases tension in the plantar fascia.

There is a big difference between the negative heel rockers and rockers with even midsole thickness in the posterior half of the shoe.   The even thickness rockers will be much better for Achilles tendonitis as you won't need to increase Calf activity and the lever arm of ground reaction force is reduced at the ankle joint so calf muscle activity can actually be reduced. 


Eric