2015 ISAKOS Biennial Congress ePoster #137

Biomechanical and Neural Changes Evaluation Induced by Prolonged Use of Non-Stable Footwear

Rocco Papalia, MD, PhD, Prof., Rome ITALY
Giovanni Di Pino, MD, PhD, Roma ITALY
Domenico Formica, PhD, Roma ITALY
Gianluca VadalĂ , Roma ITALY
Andrea Tecame, MD, Parma ITALY
Lorenzo Alirio Diaz Balzani, MD, Roma ITALY
Vincenzo Denaro, MD, PhD, Prof., Rome ITALY

Campus Bio-Medico, Roma, ITALY

FDA Status Not Applicable

Summary: Functional outcomes of daily usage of shoes with thicker-than-normal sole with rounded heel




Several strategies have been tested over the years to improve stability during locomotion, and in this study we analyzed the functional outcomes of daily usage of shoes with thicker-than-normal sole with rounded heel.


From November 2012 to April 2013, 20 healthy subjects were enrolled to take part in this prospective study. They never wore rocker sole shoes before. A 3D gait analysis and electromyography of predetermined muscles (Glueteus medius, Tensor fasciae, Tibialis anterior, Gastrocnemius) was carried out on these subjects during execution of simple activities (walking, running, going up and down the stairs) barefooted or wearing rocker sole shoes to evaluate the difference in patterns. We then evaluated the change in outcomes 1 week, 2 weeks and 4 weeks after they started wearing the shoes for a minimum of 8 hours per day.


The comparison of kinematics and muscle activity during the gait cycle showed substantial changes in the gait pattern and higher muscle activity of specific groups of muscles of the lower limbs induced by the use of the shoes: increasing of tensor fasciae and gastrocnemius and decreasing of glueteus medius and tibialis anterior electromyographic activity. Moreover, we found a reduction in mean hip flexion of 10°, of knee flexion of 13° and an increase of mean dorsal flexion of the ankle of 5° when compared to baseline values during the gait analysis.


Unstable footwears were shown to immediately alter the stability in gait during daily life activities. The center of body pressure is moved posteriorly with a consequent posterior displacement of the upper part of body in order to regain an appropriate body balance, and these postural changes are associated with an overall increase of the activity of lumbar erector spine muscles, as well as certain lower limb muscles.
We support the idea that the use of rocker soled shoes can improve the recovery of functional stability and proprioception when combined to physiotherapy for a particular condition or a traumatic event.