Evaluation of combined prescription of rocker sole shoes and custom-made foot orthoses for the treatment of plantar fasciitis.
Fong DT, Pang KY, Chung MM, Hung AS, Chan KM. Clin Biomech (Bristol, Avon). 2012 Sep 3
I think this is all about decreased pressure/forces on the foot. Orthotic with rocker shoe place less pressure on the Heel and less worry about functioning windlass mechanism due to rocking motion instead. Makes sense that it works.
Good for recovery of patient with pain but you will need to dispense with rocker shoe eventually to re establish the normal gait pattern else other joints and soft tissue structures will eventually weaken.
We sometime recommend and fit the Stretch walker by Xsensible for plantar faciitis patients, with on the whole good results, sometime with and without FO's. We often try shoes first, then review outcome - usually do quite well in shoe only.
The Stretch walker is a "soft" rocker shoe and we are always wary of recomending this shoe if there are significant amounts of pronation-supination or ballance issues that are of concern.
I have seen a few patients with other brands of "soft" rockers that are completely collapsing and deforming the shoe - mostly medial border.
Patients we still want to fit with rocker soles but have pronation/supination concerns are better fitted in "stable" rockers - we use the FinnComfort Finnamic in this instance.
There is a good article on soft vs stable rockers here - probably been posted before. http://comfortshoereport.blogspot.com.au/2011/12/outlook-for-rocker-sole-shoes-in-2012.html
Does anyone have access to the full study .pdf and wouldn't mind sharing/posting?
I'm curious to know what the VAS scores were for the other two conditions:
VAS Score (scale is 0mm to 100)
1) _________
Unshod
2) _________
Baseline shoes (no orthotics)
3)
29.5mm
Baseline shoes w/orthotics
4)
30.9mm
Rocker sole shoes (no orthotics)
5)
9.7mm
Combination: Rocker sole shoes w/orthotics
Does the study specify what brand of rocker sole shoes were used?
I would be hesitant to issue rocker sole shoes to plantar fasciitis patients, as I often find trigger points at the myotendinous junction of the gastrocnemius. From what I have understood about rocker shoes is, they create instability of the ankle- thereby increasing work for the posterior muscle groups of the leg and thigh.
These shoes are also very expensive, and most patients cant afford them. Adding to this, as was mentioned, there are issues with balance.
I just came back to this thread and re-read the intro in the abstract:
Since when has it been: "It is a routine practice to prescribe a combination of rocker shoes and custom-made foot orthoses for patients with plantar fasciitis. " I have never seen or heard of it being used at all, yet alone "routine"!
I have also seen no debate anywhere on:"there has been a debate on this practice, and studies have shown that the individual prescription of rocker shoes or custom-made foot orthoses is effective in treating plantar fasciitis". I searched Google for this "debate" and found zilch!
I would disagree with the assertion that rocker sole shoes, with rocker point just proximal to the metatarsal heads, cause ankle instability.
Instability is such a loose term.
Usually ankle instability refers to inversion motion of the foot relative to the leg.
This motion is more STJ than ankle.
Also rocker shoes, with the break just proximal to the met heads, will decrease resistance to plantar flexion of the ankle by shortening the lever arm of ground reaction force.
This should decrease the work load of the gastroc and soleus muscles.
Goodaye Eric, wouldn't there be an increase in the magnitude of the GRF at the thickest sole depth? which would counteract? / make up for the shortened lever arm?
Possibly if the shoe was very flexible.
However, if the topside of midsole functions as a rigid plate there won't be a high pressure area under the forefoot.
Peter cavanaugh has published some papers that show in a rigid rocker shoe the length of time of pressure on the heel is increased.
The rigid rocker shoe effectively transfers force from the forefoot to the rear foot.
(The rocker point needs to be just behind the met heads.)
Unfortunately, your predictions, hypotheses and what your believe should happen remain personal speculations backed up with little to no EBM.
Thats not what happens in reality here and in the existing EBM.
Can you relate any of your theoreticals to SERM? (oh wait, wrong thread)
Biomechanical effects of rocker shoes on plantar aponeurosis strain in patients with plantar fasciitis and healthy controls.
Greve C et al PLoSOne. 2019 Oct 10;14(10):e0222388.