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MBTs and windlass mechanism

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Asher, Oct 23, 2007.

  1. Asher

    Asher Well-Known Member


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    I'm trying to understand what MBTs do to feet.:(

    I realise there is not much meaningful research other than to say MBTs reduce pressures under the heel and midfoot and increase pressures under the forefoot and toes. And they make tibialis anterior work harder. Is there anything else at this stage that can be stated with backup from research.

    I'm concerned that MBTs disallow the windlass mechanism from taking place and that for most feet, this is a bad thing. I have read the previous MBT threads and there is no mention of the windlass.


    Does anybody have any comment on this?

    Rebecca
     
  2. Admin2

    Admin2 Administrator Staff Member

  3. Craig Payne

    Craig Payne Moderator

    Like any rocker shoe that limits hallux dorsiflexion, then the windlass is either not going to work or be inhibited. I recall a study a while back on rocker sole shoes (not MBT's) in which lateral forefoot loads increased with the rocker shoe --- this is consistent with the lack of medial column loading expected when windlass is not doing its job.
     
  4. Asher

    Asher Well-Known Member

    Thanks Craig.

    So do we need the windlass mechanism if we roll off the toe of the shoe?:( Is it a big deal?
     
  5. Craig Payne

    Craig Payne Moderator

    I thinking out load here .... what do we need the windlass for .... hmmmm

    1. To make the mid foot stable during propulsion (--> midfoot collapse if not working)
    2. The reverse windlass is responsible for keep proximal planlanx of ALL toes on the gound during propulsion (--> claw toes if not working)
    3. Windlass supinates rearfoot at same time as contralateral leg swing externally rotates the weightbearing limb ( --> asynchrony if not working)
    4. Windlass accompanies first ray plantarflexion which achives at least a couple of things, such as transfer of weight to first met head, which is needed for:
    a) Bigger lever arm from met heads 1-2 to achilles for more efficient gait asychrony( --> shorter lever arm from 2-5 if not working)
    b) Transfer weight medial to the other foot during late stance ( --> more proximal effort needed to achieve this if not working)

    There is probably more....but the Arena'ettes are demanding some attention...
     
  6. Asher

    Asher Well-Known Member

    Far out, and podiatrists sell these things (MBTs) ... Mind you, as I have mentioned before, I have recommended them for painful hallux rigidus with success. Not only that, I bought a pair myself a short time ago 1. in the hope that my gluts and pelvic floor would stay tuned (turn to jelly in the hockey off-season:empathy:) - and I have noticed an improvement, and 2. to see what all the fuss was about. Only thing is I got a bit worried about what was happening to the old feet. Don't think I'll be wearing them for my morning walks, I like my windlass ;) and think my feet need it going up the hills especially.

    Thanks Craig, now I've got some real explanation for my inquisitive patients (and me). Let me know if you think of anything else.

    And can anybody tell of their experiences (patients or self) that have MBTs in regard to the cushy heel bit bottoming out in either significant over-pronators or over-inverted foot types? It looks to me like it would deform quickly, I may be wrong.

    Rebecca
     
  7. Craig Payne

    Craig Payne Moderator

    While MBT's are detrimental to windlass function and create an inefficient gait (ie increase energy consumption), what really put me off them was the cellulite reduction claims --> that puts them in the "snake oil" category.

    However, since thinking about it and chatting with Beno Nigg at the recent SMA mtg, I would be willing to give them a go (but not for the prices they are asking). There may be some merit in being "unstable" for varying periods of time per day due to the impact they have on 'other' muscles that are not predominantly used during a "stable" gait. It may just be a matter of trade-offs in function that may benefit some people, but not as the primary footwear for the daily useage. We may need or benefit from some periods of 'instability'. .....BUT, I am still not fully convinced and much more work is needed (eg as the response to them will be subject specific, how can you pick them etc etc)
     
  8. conp

    conp Active Member

    Would you expect an increase or a decrease in demand for the windlass mechanism when in an unstable environment?

    Yes I am a podiatrist and I do from time to time recommend MBT's to a minority of patients. As I have work closely with MBT's and acquired some experience with them, I am more and more confident as to who will benefit. Some are easier than others.

    For example, the 'no brainer' ones are pain associated with arthritic ankle and/or STJ joints. These will almost always provide a significant pain reduction. Some Foot and Ankle Orthopods in Australia that have gained confidence with the product from positive experiences are now recommending these shoes frequently in these cases, both as pre or post op applications.

    However due to the fact the MBT's are based on a different paradigm of instabilty (compared to conventional shoes) and the anatomical and biomechanical variances of each individual, it is indeed difficult to predict how pt's will react and what outcomes they may produce. There are some cases that I would not recommend them for.
    For example, some members of this forum have recommended them for pl fasciitis. I would not recommend them in the acute setting. Although they will give them immediate relief due to the soft heel, the increased intrinsic activity may be contraindicated. This is the same for achilles tendonitis in the acute setting (contraindicated).However there is a place for them in the chronic setting as a rehab tool. Similarly to gradual strengthening and stretching of the achilles as commonly is recommended for this condition.

    The other example of MBT's recommended frequently in this forum is for Hallux Limitus. This is very pt specific. This is predictable as the anatomical and biomechanical differences of this condition and the individual involved is diverse. Some pt's will experience little or no change in pain intensity and some will have complete resolution of pain. This type of pt will almost know immediately if the MBT's will help or not once they try them. I recommend this pt to just go and try them. Easy!

    The above examples and their subsequent outcomes can be reasoned and explained with confidence. Some others are not as easy and need to be explored in future.

    There are other applications that I recommend them as I have noted some predictive indicators that would suggest and from positive experiences.

    Let me stress that I am not 'fanatical' about MBT's but am excited that on the odd but right occassion I can refer a pt to this application and usually they have a great result and ......they love me very much!:cool:

    Best Regards
    Con
     
  9. Asher

    Asher Well-Known Member


    Con, there is an inevitable decreased ability of the windlass mechanism to work as the hallux can not dorsiflex at the 1st MPJ.

    Rebecca
     
  10. conp

    conp Active Member

    Rebecca,

    I agree that the MBT sole is 'stiffer' than conventional shoes but not as stiff as the traditional rocker shoes. Therefore there is still room for some bend in the MPJ area enabling the windlass mechanism to occur. In fact MBT had to change the composition of the shank in the sole from carbon fibre like (with a sharp edge at the MPJ end) to hard plastic (with a skived edge at the MPJ region) as the carbon fibre like shank cut into the softer PU midsole during repetative bending during propulsion.

    This is why the MBT is such a success with people who are uncomfortable with a traditional rocker (uncomfortable). This provides with a rocker shoe that is comfortable.

    Just like you Rebecca I am only speculating as what I believe is happening in my feet and in patient's feet whilst wearing them (educated theoretical discussion is healthy). That is why I would like to see more research performed with MBT's to explain why they work for people. ( I am working on one at the moment and encourage students to do so too)

    I will give you only one example of why I scratch my head some times with this product.........Actually no I wont, as I am starting to sound 'fanatical'. If you want to know some of the more 'unusual' results let me know and I will email you.

    Regards
    Con
     
  11. Asher

    Asher Well-Known Member

    Not sure about that one Con, the MBTs I have seen there is no way they are going to bend at the forefoot.

    I'd prefer you posted here so we can all theorise and debate. Sincerely, I'm not that clever so I need the open discussion.

    Respectfully
    Rebecca
     
  12. conp

    conp Active Member

    Hi Rebecca,

    Well the ones I am wearing and all the ones I have worn in the last 4 years do bend . They wont bend when attempting by hand but they will when applying the large force during normal propulsion.

    It is important podiatrists know and seek more about the product (just like you and others on this forum) as others are making un/ill-informed comments about MBT's to their pt's. E.g. Today I saw a lady in The Athlete's Foot store that I attend weekly, who was ruthless in her attack against her podiatrist. (This patient was in store to buy her second pair of MBT's as her first was a big success). This lady was upset that her podiatrist had told her 2 years ago that MBT's were "rubbish" and and detrimental to her case (which was a "no brainer" ankle arthritis case). As the pt got worse she saw her an orthopaedic specialist 6 months ago who sent her immediately to buy a pair and she has never looked back.

    A bad comment on a podiatrist is a bad reflection on the whole podiatry profession. We will never prevent every detrimental comment but we can reduce these to a minimum.

    It is also important that the opposite does not happen whereby some health professionals are referring pts for mbt's that will probably not benefit their pathology.

    Best Regards
    Con
     
  13. CraigT

    CraigT Well-Known Member

    Agree 100%- however it is also very frustrating when you have uninformed people advising the use of these shoes as if they are a panacea for every kind of lower limb problem. For example- I sent a patient off to a local store for stable footwear (as I knew they stocked what he needed) only to have him return with a brochure for MBTs which the store's proprietor had tried to sell him as an alternative. Do you think this is the type of shoe someone with progressive Parkinson's disease should be trying???
     
  14. musmed

    musmed Active Member

    Dear All

    These are the souls that were wearing the shoes for the study.

    Notice how they all took to them....http://www.podiatry-arena.com/images/smilies/pigsfly.gif
    :pigs:

    What happens to ones posture is far more important.

    You begin to walk like early man. Your stride is reduced with a step that never extends. Shoulders drop and internal rotation of the arms occurs.

    Have a banana position with chin sticking out.

    If you doubt this, send off for their DVD and have a look. All sagittal plane motion. No sense in that.

    Why load the forefoot? Bad posture is all about forefoot loading.

    musmed
     

    Attached Files:

  15. Craig Payne

    Craig Payne Moderator

    Now that I have transitioned to the dark side and have a pair, I can confirm that my windlass is not working in these shoes and I get next to no first MPJ dorsiflexion ...
     
  16. musmed

    musmed Active Member

    Dear Craig
    No windlass= no fascial winding of the body= soon lumbar lordosis= decreased arm swing= chin stuck out= no exstension in stride= thoracic kyphosis=
    recognise him.
    neo man remade.
    appointmets by booking only and cash up front
    Regards to your new aches and pain
    musmed
    Paul Conneely
     
  17. conp

    conp Active Member

    Haven't been on Pod arena lately but this thread came through to my email.

    ..mmmmmmm where do I start?

    Long ago I had vested interest in MBTs as I was approached to help the company (for a short term) in promoting their product to health professionals. I was approached as I had worked with rocker soled shoes/additions and MBT's (before they entered the Australian market.)

    My personal mission then was to promote the product for it's true therapeutic benefits and not for rubbish speculation.(toning and workout stuff).

    Although MBT's can be used for a few applications, the one I had campaigned for was the arthritic ankle and/or stj and/or mtj pt.

    If your not well versed with this product FORGET ALL OTHER therapeutic applications and concentrate ONLY on this one.

    Many years down the track and now everybody is copying the shoe.
    What is going on? I have to laugh. New Balance, Reebok, Sketchers (I went to London last year and they had a 200m2 store on rocker soled shoes Sketchers) mitre, Ryn, Saucony (under another name), copies from China and Korea)

    I laugh now because some technical directors caught up with me at a conference many years ago and said the rocker sole concept was ridiculous (they were more diplomatic than that)! .......and now they are making them!!!! (and advertising them purely as toning workout shoes).

    The price for being a pioneer I suppose.

    What astounds me is that MBT had to put up with an amazing amount of uniformed negative publicity and sceptisism. I suppose they still are. Some deservedly. Sceptical is what everyone should be. However I am amazed when I see some new products with no scientific evidence or even theoretical basis being accepted. The one I really laugh at is the 'power balance wristbands'. Yet everyone is prepared to pay $70 for a wristband!!

    Back to the present.

    It will decrease 1st MPJ dorsiflexion to a degree but not stop it. (picture attached). Yes my shoes are dirty.
    This is why some people with Hallux limitus pain may still have pain during propulsion with MBTs. Remember also the additional MPJ dorsiflexion in the shoe. Stopping Dorsiflexion of 1st MPJ is amazingly hard to do even with thick carbon fibre insoles. It still occurs in the shoes.

    There are some other gait issues that will decrease amount of MPJ dorsiflexion like....how far back you 'heel strike.' etc etc.

    Remember also, rockersole additions have been around for ages before MBTs. I liked them and still do because pts are much more compliant in these. pt's I believe the trick is the subtle progression of the rocker from rearfoot to forefoot.

    Anyway I hope in future to try on all the rockersoled shoes and give a verdict for performance. Give me some time though.

    Cheers,
    Con
     

    Attached Files:

  18. JB1973

    JB1973 Active Member

    Hiya
    What a lot of patients ask me is can they wear their insoles or orthoses with MBTs and I'm never really sure what to say. My gut feeling is that if you are wearing them for therapeutic reasons then you shouldn't need insoles as well. What is the general opinion on this
    Cheers
    JB
     
  19. Craig Payne

    Craig Payne Moderator

    As I commented in the other MBT thread, I developed severe bilateral neuroma pain with 10 minutes of wearing the MBT's ... I had no choice but to use my orthotics. The pressure in the arch from the orthotics is much greater when wearing the MBT's
     
  20. JB1973

    JB1973 Active Member

    Hiya Craig,
    what thread is the best to contiue with here rather that going between the two do you think.
    Anyway, back to the question. Say for instance the patient has a functional hallux limitus and wants to wear/try MBTs to try and help her pain but orthoses with a 1st ray cut out for example would be what i would give to this particular person. would she wear those orthoses in MBTs? because both modaliries are looking to do the same thing.
    cheers
    JB
     
  21. CamWhite

    CamWhite Active Member

    Insoles, arch supports and orthoses are designed to stabilize the foot, and they are designed/cast with the assumption that the devices should be placed in an ordinary shoe with removable depth.

    MBT & Skechers are designed to induce instability in all planes of motion.

    If you place a stabilizing device on an unstable foundation, don't the two cancel each other out?
     
  22. Only if they are equal and opposite. The stability and instability factors that is.

    I recon this MBT and no orthotic is a myth started by MBT.
     
  23. CamWhite

    CamWhite Active Member

    I tend to agree. MBT also promotes that the instability of the shoe turns walking on concrete into the sensation of walking on soft earth or sand. They suggest the shoe recreates the environment man was meant to walk on - barefoot on grass or sand.

    What the manufacturers of unstable rockers downplay or omit is; "What happens if you wear them on grass, sand or uneven surfaces?" The instability of the shoe will give way to terrain fluctuations, making them much harder to wear.

    To test this, try lacing up a pair of unstable rocker sole shoes and take a walk in a field. You will quickly notice that the experience is not very fun. So you teach yourself very quickly to limit the wear of unstable rocker sole shoes on flat, level, predictable surfaces.
     
  24. efuller

    efuller MVP

    How are they designed to induce frontal plane instability. I'll grant you that they are not designed to promote frontal plane stability, but why are they more unstable, in the frontal plane, than any other shoe?

    It depends on what you are trying to do with your orthotic. Youv'e got the rigid part of the shoe and the rocker part of the shoe. A lot of times the rocker, when placed at the midfoot, will force you to put your weight on your forefoot (When standig as opposed to walking). The rigid part of the shoe is the part above the rocker and is essentially a flat hard surface. When you put your weight on your forefoot, you will be putting more stress there. If you have a forefoot problem/symptoms then the midfoot rocker won't help when you are standing in the shoes. Now, if you moved the rocker more anterior, then to balance in stance, you will tend to place your weight more posterior and reduce the stress on your forefoot.

    Gait, is another story. It depends on how the person with rocker chooses to walk.

    Eric
     
  25. CamWhite

    CamWhite Active Member

    The soft durometer PU/EVA sensors in unstable rocker sole shoes have no real structure, and therefore little medial/lateral stability or frontal plane control. Some manufacturers liken the design of their unstable rocker sole shoes to incorporating "wobble-board" technology into their shoes.

    Here's my take on wobble-boards. Using a wobble board is a controlled exercise that you do for a finite period of time in a gym for core muscle development. I am not convinced that humans should take 8,000 - 10,000 steps each day wearing mini-wobbleboards on their feet.
     
  26. efuller

    efuller MVP

    Good points.

    I agree with your earlier comments about putting these shoes on uneven terrain (not good).

    Eric
     
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