Rocker shoes reduce Achilles tendon load in running and walking in patients with chronic Achilles tendinopathy.

Rocker shoes reduce Achilles tendon load in running and walking in patients with chronic Achilles tendinopathy.

Most likely this is common knowledge for most followers here on The Gait Guys and our podcast (another one will launch this weekend btw).

But reducing the plantar flexion moment in the late stance phase of running and walking can make notable changes in the loading response to the posterior plantarflexor mechanism (the gastroc-soleus-achilles complex). A rocked shoe, according to this study, can reduce the plantarflexor moment without substantial adaptations in triceps surae muscular activity.
This of course brings to mind the HOKA family of shoes that have purposefully added a gentle rocker mechanism to some of their shoe line, some with an early and some with a late stage metarocker built in. Are you a HOKA hater? We were not fans in their early development because of the volume of stack height foam, but they have many more options in their line up now. But do this for us, do not pass judgement until you put one of these metarockered shoes on, and you will understand the function of it, and their place for your chronic posterior compartment clients. Don't reflexively judge until you try them. It is good to have options for your clients, because "stop running" is not an option for runners, for our runners, unless all else has failed.

Shawn Allen, the other Gait Guy

#thegaitguys, #gait, #hoka, #metarocker, #achilles, #tendinitis, #gaitproblems, #gaitanalysis, #calfpain, #running

J Sci Med Sport. 2015 Mar;18(2):133-8. doi: 10.1016/j.jsams.2014.02.008. Epub 2014 Feb 14.

Rocker shoes reduce Achilles tendon load in running and walking in patients with chronic Achilles tendinopathy.

Sobhani S1, Zwerver J2, van den Heuvel E3, Postema K4, Dekker R5, Hijmans JM6.

Chronic achilles tendonitis? Transferring a tendon ?

On occasion we understand extreme measures are necessary, some things just do not heal sometimes. But tendon transfers have always boggled our mind. We can see the value in someone of senior age who is not all that active anymore and won't express some of the more extreme side effects of a tendon transfer, and benefit more from the positive effects of the outcome.
But, this article outlines just a portion of the concerns we discuss with our clients who have had these types of issues proposed.
First of all, what is crazy to us, is that these were just chronic achilles cases. We wonder if these cases had undergone some similar work following Jill Cooks tendon reloading paradigm. One has to wonder if ever outlet was attempted, surgery should always be the last option.

But, if you are tendon transferring the FHL (long hallux flexor) or the FDL (long digit/toe flexors) to the achilles to piggyback load, there is gonna be changes in biomechanics obviously.
- the balance between long and short hallux flexors and extensors will be disrupted, possibly leading to windlass mechanism impairments, leading to 1st MTP joint impairment and thus toe off impairment. This could also create complications in hallux extenson (dorsiflexion) which we know can change the foot's arch dynamics.
- the balance between long and short toe flexors and extensors will be disrupted, possibly leading to hammer toes, swan neck deformities of the toes and thus impairment of the lumbricals and thus proper metatarsal loading at late stance phases of gait, there might be fat pad migration issues, gripping attempts for foot stability, more or less pronation-supination events etc. The possible lists are long and winding.

This study also mentioned some changes in "single leg heel rise test in the operated extremity, although there was significant difference when comparing operated and uninvolved sides. One patient reported weakness for plantar flexion of the lesser toes, without balance or gait disturbances."
There are going to be biomechanical changes, and knowing the normal mechanics and gait cycles will help you determine what the post-operative impairments mean, are, and what things you might do to help your client in terms of coming up with some new forced compensations to teach your client.
However, we say, exhaust all of your options. For these chronic achilles problems, safe, pain free, progressive isometric loading does really well for these cases. It just takes time and lots of work for the client. Progressive loading seems to be a huge key though.

Foot Ankle Surg. 2017 Dec 19. pii: S1268-7731(17)31364-4. doi: 10.1016/j.fas.2017.12.003. [Epub ahead of print]
Outcomes of flexor digitorum longus (FDL) tendon transfer in the treatment of Achilles tendon disorders.
de Cesar Netto C1, Chinanuvathana A2, Fonseca LFD2, Dein EJ3, Tan EW4, Schon LC2.