Rocker Bottom Shoes: A Position Paper

By Dennis Shavelson, DPM
Biomechanics Editor, PRESENT Podiatry

Rocker Bottom Shoes have become a hot topic of discussion in the podiatry, exercise and shoe industries, with more than 100 models to choose from. They are the first new shoe style in decades marketable to women, and more and more shoe styles are getting a rocker makeover, with predictions that it will be a multibillion dollar industry¹.

The public is being bombarded with claims and hypes that include improved balance and posture, rapid increases in muscle strength and tone, more calories burned during each workout and reduced joint stress, backed with studies showing that meager gains exist but don’t rise to throwing away your Nike Waffle Trainers^2-4. Further claims involving eliminating foot, leg and back pain remain anecdotal at best and a Joe Montana endorsement will not cure any arthritic knees including Joes.

However, there is one obvious placebo effect which makes these shoes at least temporarily acceptable and that is the fact that many of us are walking more as we acculturate to these so called Toning, Wellness and Fitness shoes. This fact alone labels the category as considerable for Podiatry to recommend in appropriate cases.

It is my opinion that a permanent switch away from conventional shoes to rockers should be reserved for very few of our patients. This means that they can play a useful part time role in many peoples lives, once educated and mentored by a knowledgeable, biomechanically oriented podiatrist.

The Biomechanics of Rockers

Using Dananberg’s Sagittal Plane Blockade Theory5-6 and Functional Foot Typing® language^7-8, here is a brief overview of the biomechanics of the Rocker Bottom when incorporated into shoe gear.

Ideally, the internal sagittal plane rockers of the foot carry us from point “A” to point “B” in gait over our lifetime. However, for most of us, these rockers, especially the 1st MP Joint rocker, fail because of foot type-specific biomechanical pathology that lengthens, widens and collapses the pedal bones. The rocker blockade that results causes reduced motion and arthritic degeneration to the 1st MP Joint (FHL), the ankle joint and secondary compensation throughout the foot and posture that lead to the majority of the complaints that bring one to a podiatrist.

At different ages, these compensations, left untreated, produce predictable, progressive foot type-specific pathology, deformity, degeneration and pain and overuse syndromes. In a wellness and preventive sense, biomechanical care should be attempted in order to arrest or repair their impact on functional life expectancy, rather than allow sagittal plane pathology to result in clinical life altering sequelae.

As has been used by DPM’s for decades, Rockers added to shoes obviate the need to have properly functioning sagittal plane rockers in order to navigate forward, but until the development of the “Shape-up and Exercise” Rocker Shoes, they were reserved for those with end stage inability to perform efficiently or for those with injured or operated on feet.

When used short term, rockers allow for healing and repair, as they replace the natural rockers with their external versions. However, long term use of external rockers allow our internal rockers to become vestigial. This fact reduces the blanket use of rocker shoes.

Another factor that comes into play is that Rockers Shoes come in two varieties, soft and firm. This relates to the amount of instability or oscillation that the insole allows in the frontal and to a lesser extent, the transverse plane. Soft Rockers such as MBT, Sketchers and Xsensible have forgiving and thick insole material that collapses and springs with every step when active or even when the wearer is standing still⁹. These shoes tend to be the ones that claim to provide more calorie burning and muscle toning, but they also are the ones that shut down the internal rockers of the foot the most. Firm Rockers, on the other hand, have a relatively tight and unforgiving sole material that prevents frontal and transverse plane motion. These shoes serve best for patients who present as salvage cases. Brands such as RYN, Cogent, Mephisto Sano and Chung Shi Shoes fit into this category.

In summary, Rocker Bottom Shoes are being hyped as replacements for conventional footgear for exercise and daily life, as revolutionary and therapeutic, when in fact, they may be promoting unhealthy biomechanics for most of its users and therefore denying the very wellness and fitness they claim to promote.

The Podiatric Position On Rockers

When all feet are profiled as to foot types, there are some “healthy” types that should be encouraged to use rockers for exercise or biofeedback muscle training, but at no other time. There are other extremely “unhealthy” feet with biomechanical pathology such as the flat rearfoot and forefoot types and those with hallux rigidus or advanced systemic pathology such as RA, that should be encouraged to use these shoes ad lib, as they would upgrade their atrophied lifestyles immediately.

That leaves the rest of us with some level of foot type-specific pathology capable of being treated by biomechanically oriented podiatrists that, if led to exclusive use of these Rocker Shoes, will continue to degenerate, pain and symptom free, until they are married to their Rockers without responding to biomechanical care because foot orthotics have little effect when overridden by an external rocker. The prime example of these feet would be the flexible forefoot types.

This means that biomechanical care in the form of orthotics OR a Rocker Bottom is the Rx, NOT BOTH. As low-level proof, I am already beginning to see dress shoes with rockers replacing conventional shoe gear, as I get e-mails from DPM’s anecdotally providing evidence of “miraculous cures” using biomechanics.

Summarily, podiatry should be discouraging the use of Rockers in healthy or repairable feet, other than for short-term exercise or biofeedback repair and encouraging their daily use as salvage for irreparable feet.

In addition, Podiatry should be promoting the fact that only a DPM can determine a patient’s biomechanics and offer the healthiest options for shoes, orthotics, muscle engine training and the use of Rocker Shoes and that Podiatrists are The Closed Chain Specialists.

Disclaimer: I am the developer of patent-pending Functional Foot Typing® and have economic bias in its use.

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References:

Sitek, T, Healthy Feet, Footwear Insight, Formula 4 Media, March/April 2010
Landry, SC, Nigg BM, Tecante, KE, Standing in an unstable shoe increases postural sway and muscle activity of selected smaller extrinsic foot muscles, Gait & Posture, corrected proof online May 2010.
Ramstrand, N, Thuesen, HA, et al. Effects of an unstable shoe construction in women over age 50 years, Clinical Biomechanics, Vol 25, #5, June 2010, 455-460
L. Stewart, J. Gibson, C. Thomas, In-shoe pressure distribution in “unstable” (MBT) shoes and flat-bottomed training shoes: A comparative study Gait & Posture, Volume 25, Issue 4, Pages 648-651 (April 2007)
Sagittal plane biomechanics. American Diabetes Association
Dananberg J Am Pod Med Ass: 2000; 90: 47-50
Dananberg H, Guiliano M, Chronic Low-Back Pain and Its Response to Custom-Made Foot Orthoses, J Am Pod Med Ass: Volume 89 • Number 3 • March 1999 JAPMA
Shavelson, D. A Closer Look at Neoteric Biomechanics. Podiatry Today,Volume 20(9), Sept 2007.
Shavelson, D. Neoteric Biomechanics, Podiatry Management, Sept 2008, 123-127.
Gasser, BA, Stauber AM, et al. Does wearing shoes with unstable shoe construction stimulate metabolic activity in lower limbs? University of Bern Switzerland, 2008

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