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Proximal rocker bar on shoe can relieve tension on Achilles tendon in runnersFull story
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Is there any images available of what this rocker bar looked like?
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Attached Files:
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Thanks to sobhani_sobhan, here is the abstract from the congress:
A proximally placed rocker bar (profile) and external ankle moments during walking and running
Authors:
K. Postema1, S. Sobhani1, E.R. vd Heuvel2, J. Zwerver3, J.Hijmans1, R. Dekker1,3
1) Department for Rehabilitation Medicin, Center for Rehabilitation, University Medical Center Groningen, University of Groningen
2) Department for Epidemiology, University Medical Center Groningen, University of Groningen
3) Center for sports medicine, University Medical Center Groningen, University of Groningen
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Bruce -
Dear Bruce,
I didn`t understand your question. The apex of the rocker profile is positioned proximal to the metatarsal region. Of course the apex could be placed even more proximal.
Cheers
Sobhan -
So, are up calling a forefoot rocker a "proximal forefoot rocker" just because it is proximal to the MPJ's?
And yes, if you truly wish to affect the forces and tension at the Achilles insertion you should move the apex even more proximal and study what affect that will have on the tendon.
Most running shoes already have a rocker component built into them, so why the need to add a significant heel / foot lift combined with a rocker that is already present?
Did you add lift to the opposite shoe as well to counter this affect and did you evaluate for any potential limb length prior to testing and control for that?
Bruce -
I had the same terminology question. I've heard of "heel rockers" where there is a thickened midsole and as viewed in the sagittal plane a curved heel that puts the contact point more anterior and allows the shoe to "roll" into forefoot contact. I've also heard this called a posterior rocker. I would tend to call the rocker in the picture in the picture above an anterior rocker. I think better terminology might be to call it a rocker at ~60-70% of shoe length. Or just a rocker just proximal to the metatarsal heads.
The results of the study do make mechanical sense though and support the tissue stress approach to biomechanics.
Eric -
I agree with you on the terminology part. I disagree with you on the mechanical part.
If you really want to solve the issue for achilles issues then address the AJ equines that is always present AND decrease the potentially problematic forces via using a forefoot rocker as well if you feel it is necessary.
In my opinion the heel lift will do much of what is necessary so long as it is skived to thin as it extends distally towards the mpj's. In most running shoes there is decent MPJ extension at the area of the MPJ's so why the need for the rocker?
If the patient has a structural limitation of the 1st MPJ then I agree it is a good option. If not then w/o some sort of quantification to prove otherwise, I disagree on the need.
I appreciate the attempt to study the change in forces in the paper, but I have seen far to many shoes modified that way and the patients limp around like they have a peg-leg. They are far better off in a cam-walker that has a real rocker bottom that is affective.
I know this is "how it's always been done" in the pedorthic manuals but it just is rarely affective in helping the overall situation.
I have at times used a widened medial and lateral shank in patients with sever PTTD issues and extreme lateral abduction to their feet and lower limbs. I'll then add a diagonal rocker bottom modification to assist them in their gait. If it is done correctly and at the correct proximal level of the foot they will have great benefit. It is an imperfect art no doubt, but there is a method to the madness.
sincerely,
Bruce -
Eric -
I agree that there is a little confusion on terminology here. Since rocker shoes have been commonly prescribed to offload the pressure in the metatarsal region, the term “proximal” or “distal” usually relates to this region. However, I have seen in some paper terms such as “toe-rocker shoe” which according to me is distally placed rocker. The term “anterior” or "forefoot" seems too vague to me because the apex could be placed anywhere in the front.
Would please elaborate on “controlling the potential limb length”? After each measurement the markers were replaced, new height and weight were measured and taken into account for the new measurement. Have we missed something? :bang:
Cheers
Sobhan -
Regarding limb length: 1). If the sole of the rocker shoe is thicker than the control or opposite shoe then you very likely created an artificial LLD on the rocker side.
One way the body will seek to decrease load a the Achilles is knee flexion. At least as far as the gastroc is concerned. How do you know that the reduced forces were not from the artificial heel lif of the rocker shoe?
2) if the patient has a functional or structural LLD, then your unilateral rocker / heel lift could have controlled for their discrepancy, and / or made it significantly worse. If you don't examine them before hand you can't know whether this may have occurred or not.
Again, how do you know whether this affected your results negatively or positively in your subjects?
I'm not trying to split hairs here, I think these a very real and valid considerations and I get frustrated when the majority of studies do not take these types of things into consideration.
Sincerely,,
Bruce -
All the best
Sobhan -
Bruce -
All the best
Sobhan -
The modified shoe looks very like a Hoka, was this intended or have comparisons been drawn with these shoes? They too have a rocker and a very high midsole, had you considered just using that rather than a modified shoe?
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Indeed they are similar! No we were not aware of this model! That`s why we designed our own. Have you tried them? Is the sole stiffeness adequate to be effective during push-off? There were two drawbacks regarding our model: weight and too much stiffness at the heel (perhaps results in higher impact forces). To me this model could be an alternative for our future research. Thanks so much for this information.
All the best
Sobhan -
The Hoka shoes are extremely light for their size. There are two main models for road running, the Bondi B and the Stinson Tarmac. The Bondi has a heel-to-toe differential of 4.5mm and the Stinson 6mm. I believe the midsole stiffness to be almost identical in both perhaps the Stinson slightly stiffer. I have tested them out on a treadmill a few times but do not own a pair. Most people I know who have a pair love them but I imagine they would find it hard to run in other shoes afterwards. I know a few people on this site rotate them into training like they would with a minimalist trainer. What you really need is some boost midsole from Adidas, then your patients will be bounding around the roads with no problem ;) Hope this helps.
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We talked about the Hoka One One shoes last year here:
http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=67853
I have two pairs of them, my wife wears them and my son runs in them also. They have also become a very popular shoe for trail runners here in Northern California. I think these "maximalist shoes" will become more and more popular as time goes on.....for both running and walking.
My guess is that the Hokas are one half the weight of the shoes used in Sobhan's experiment..they are amazingly light for their size. -
Thank you all for useful information. I am really curious to try them. This new concept (maximialist shoes) was really new to me although apparantely I have done some research on them (or similar one) :))
There are two other studies done by our group on the rocker shoes:
1) plantar pressure distribution during running with the rocker shoes
2) Running economy (comparing rocker shoe with minimalist and standard shoes)
I would love to see how our findings would differ when using the Hoka as the rocker shoes.
Probably for our future research!
Cheers -
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Last year we modified 20 left shoes like the above picture for a research project.
To keep the weight down we created a number of cavities inside the build up material.
This is common practice in any build up greater than 20mm for us. -
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What was the research about? -
l am not the researcher, just the supplier of the footwear & modifications, it was a research project that a Physio student was undertaking, left shoe modified the right was not.
The cavities will effect the flexibility if you place the cavities at the fulcrum, of course the amount of flexibility created is not as the product was before modification, to retain the stiffness simply stop the cavity proximal of the fulcrum.
Once you get past the 20mm of build up the question of flexibility, cavity or not, is questionable in gait with children and small adults. -
ok! I guess you are right. Probabely these cavities should be avoided at the apex.
Thanks you for the response.
Cheers
Sobhan
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Effects of customized foot orthotics on reported disability and analgesic use in patients with chron
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Internet Interest in Vibram FiveFingers Declining at Rapid Rate
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