RESPONSES 1-8: AFO & Skechers "Shape-Ups" Shoes
Description
Collection
Title:
RESPONSES 1-8: AFO & Skechers "Shape-Ups" Shoes
Date:
10/15/2010
Text:
Dear List Members:
Below, following my original question posted to OANDP-L, you will find the responses to my post. As you will read the opinions and experiences are rather varied, much of which I concur with. Sketchers actually provides a good deal of information regarding the shoes when they are purchased, including an informational video, which supports what you will find on their web site and can be viewed as educational or just marketing info. Although I feel I fully understand the concept behind the shoes, I plan to monitor my patient closely, given my own concerns and unknowns of their use with AFO's.
Many thanks to all who responded!
John N. Billock, CPO/L
Orthotics & Prosthetics Rehabilitation Engineering Centre
Warren, Ohio 44484 USA
Original Questions:
I would be interested in hearing your input and/or opinions, positive or negative, regarding experiences you may have had with individuals using any type of Custom Molded AFO in conjunction with Skechers Shape-Ups Shoes?
Responses 1-8:
I just had an unloader ko with lateral strut delivered last week. patient was in one of those shoes. it was all good, more or less, in the office. The very moment she stepped out, on a decline, due to total lack of any forefoot lever in the shoes, her knee shoot into hyperflexion. along with pain, of course. I immediately recommended to switch to regular shoes. Personally, I do not believe into those shoes. very unstable, and we are continuously balancing lower extremities using foot levers. Those shoes are made to roll forward, not to provide any biomechanical stability.
Cushion heel, rocker sole with steel shank. I don't think it would kill them, but certainly not worth the money, in my opinion. Might make the transition from heel strike to toe off a bit more smooth. MBT did some research studies in the past on the same design, but nothing with AFOs. They actually didnt' recommend even wearing insoles in them.
My understanding of Shape up shoes is they keep you off balance and work your glutes and hanstrings as a result.
The concept behind them is to rocker the shoes in all planes and make you continually have to use our proprioceptors which (in theory) tightens everything up and uses more energy.
I would not put anyone in AFOs in them as they are exactly opposite to what we want as a shoe for AFOs; level, even, consistant and with a wide base of support. These are not level (rockered), uneven, gives an inconsistant base of support and are not wide enough to give stability.
I look at them like Crocks or UG boots. Beware! They are for showin', not for goin'.
I just saw one of my kids in them. She is wearing Phat braces Dynamic AFOs for several years. Wore the Shape ups for 2 months developed and developed Patello-femoral pain at the knees. Took away the shoes pain went away in one week. Just one experience. I would suggest you see her ambulation in them to decide. You would think it would act like a SACH Heel but it did not. Gave my girl a very strong knee flexion moment at heel strike in them. Good luck
I wear the shoes but not a brace. At first the shoes pushed me forward and I had to use my calf muscles to keep my balance. It took a couple of days. Now with the use of a brace the shoes may provide a soft sach heel strike and smoother rocker at toeoff. They might work with an arthritic ankle using a Arizona afo scenario. But might be difficult on a patient with balance issues.
The MBT, Sketcher ShapeUp, Reebok Easy Tone, etc shoes do nothing to help get a person in shape, but they're great for any patient who could use a rocker bottom shoe. We've been recommending MBT rocker bottom shoes for years to patients who have metarsalgia or forefoot arthritis and need to decrease movement of the MTP joints. With the popularity of these shoes and the decrease in price (the orrigional was MBT and they run about $300), I've also been advising patients who wear solid ankle AFOs or Arizona style AFOs to try them out for a more normal heel to toe gait.
I think a rocker bottom sole is something they taught us in school that should accompany a solid ankle AFO design, to minimize the effect at the
knee and hip. I think it may have even been a question on the ABC exam. But in practice is something that is often forgotten. That being said the
Sketchers version is a very soft sole and leans into pronation, so I am not a fan. I think the MTB shoe which started this craze has much better
construction and I have witnessed a patient with a solid ankle AFO have less of a medial whip and improved heel toe progression with those shoes. They are also extremely expensive. I have not yet had the opportunity to try any of the other shoes, but am interested in the New Balance. Have had good experience with the New Balance shoes that have the rocker bar built into them.
I looked at the Shape-up video and my opinion does not change. There is no doubt that the shoes cause muscles to fire that otherwise would be more dormant. After all, this is a rocker sole shoe. Standing balance has to be more difficult and should require more energy just to stand. As for walking, it is no different than playing around with SACH feet, but without the resting balance afforded by SACH. Just like with a soft SACH, foot flat should be achieved earlier and this will cause a hyperextension moment at the knee. Agree? Conversely, on toe-off, the quadriceps have to go into action earlier than otherwise would be expected. In my opinion, rocker soles are a much over-rated after thought for solving gait problems. Shoes with a SACH heel (a true SACH heel) and a metatarsal bar are a much better option than most rocker sole solutions. I do have patients who require rocker soles, but this is the exception, not the rule. And most of those could have been converted early on, but not later because of habits, etc. I am against the rocker sole with AFOs, primarily because of the mechanical complications, particularly at rest standing.
I'm always open to new ideas and stand to be corrected if I'm wrong, but for now, I vote against the rocker sole shoe and I think I can support my opinions. You don't need to post this, because I don't want to argue online with some of the folks out there who would undoubtedly want to take issue with my position on this. But I see a lot of orthotic gait problems and I believe the prosthetic principles that have taught most of us more than we would have learned otherwise make problem solving in orthotics very much come to life. I've always said that being a prosthetist makes you a better orthotist and visa-versa. Frankly, as I think about it, lower limb prosthetics really makes lower limb orthotics problem solving come to life because we are able to experiment with and visualize the mechanical consequences of changes. You agree? But at the end of the day, orthotics is more complicated than prosthetics, biomechanical-wise, for the lower limb. My .02 worth.
Below, following my original question posted to OANDP-L, you will find the responses to my post. As you will read the opinions and experiences are rather varied, much of which I concur with. Sketchers actually provides a good deal of information regarding the shoes when they are purchased, including an informational video, which supports what you will find on their web site and can be viewed as educational or just marketing info. Although I feel I fully understand the concept behind the shoes, I plan to monitor my patient closely, given my own concerns and unknowns of their use with AFO's.
Many thanks to all who responded!
John N. Billock, CPO/L
Orthotics & Prosthetics Rehabilitation Engineering Centre
Warren, Ohio 44484 USA
Original Questions:
I would be interested in hearing your input and/or opinions, positive or negative, regarding experiences you may have had with individuals using any type of Custom Molded AFO in conjunction with Skechers Shape-Ups Shoes?
Responses 1-8:
I just had an unloader ko with lateral strut delivered last week. patient was in one of those shoes. it was all good, more or less, in the office. The very moment she stepped out, on a decline, due to total lack of any forefoot lever in the shoes, her knee shoot into hyperflexion. along with pain, of course. I immediately recommended to switch to regular shoes. Personally, I do not believe into those shoes. very unstable, and we are continuously balancing lower extremities using foot levers. Those shoes are made to roll forward, not to provide any biomechanical stability.
Cushion heel, rocker sole with steel shank. I don't think it would kill them, but certainly not worth the money, in my opinion. Might make the transition from heel strike to toe off a bit more smooth. MBT did some research studies in the past on the same design, but nothing with AFOs. They actually didnt' recommend even wearing insoles in them.
My understanding of Shape up shoes is they keep you off balance and work your glutes and hanstrings as a result.
The concept behind them is to rocker the shoes in all planes and make you continually have to use our proprioceptors which (in theory) tightens everything up and uses more energy.
I would not put anyone in AFOs in them as they are exactly opposite to what we want as a shoe for AFOs; level, even, consistant and with a wide base of support. These are not level (rockered), uneven, gives an inconsistant base of support and are not wide enough to give stability.
I look at them like Crocks or UG boots. Beware! They are for showin', not for goin'.
I just saw one of my kids in them. She is wearing Phat braces Dynamic AFOs for several years. Wore the Shape ups for 2 months developed and developed Patello-femoral pain at the knees. Took away the shoes pain went away in one week. Just one experience. I would suggest you see her ambulation in them to decide. You would think it would act like a SACH Heel but it did not. Gave my girl a very strong knee flexion moment at heel strike in them. Good luck
I wear the shoes but not a brace. At first the shoes pushed me forward and I had to use my calf muscles to keep my balance. It took a couple of days. Now with the use of a brace the shoes may provide a soft sach heel strike and smoother rocker at toeoff. They might work with an arthritic ankle using a Arizona afo scenario. But might be difficult on a patient with balance issues.
The MBT, Sketcher ShapeUp, Reebok Easy Tone, etc shoes do nothing to help get a person in shape, but they're great for any patient who could use a rocker bottom shoe. We've been recommending MBT rocker bottom shoes for years to patients who have metarsalgia or forefoot arthritis and need to decrease movement of the MTP joints. With the popularity of these shoes and the decrease in price (the orrigional was MBT and they run about $300), I've also been advising patients who wear solid ankle AFOs or Arizona style AFOs to try them out for a more normal heel to toe gait.
I think a rocker bottom sole is something they taught us in school that should accompany a solid ankle AFO design, to minimize the effect at the
knee and hip. I think it may have even been a question on the ABC exam. But in practice is something that is often forgotten. That being said the
Sketchers version is a very soft sole and leans into pronation, so I am not a fan. I think the MTB shoe which started this craze has much better
construction and I have witnessed a patient with a solid ankle AFO have less of a medial whip and improved heel toe progression with those shoes. They are also extremely expensive. I have not yet had the opportunity to try any of the other shoes, but am interested in the New Balance. Have had good experience with the New Balance shoes that have the rocker bar built into them.
I looked at the Shape-up video and my opinion does not change. There is no doubt that the shoes cause muscles to fire that otherwise would be more dormant. After all, this is a rocker sole shoe. Standing balance has to be more difficult and should require more energy just to stand. As for walking, it is no different than playing around with SACH feet, but without the resting balance afforded by SACH. Just like with a soft SACH, foot flat should be achieved earlier and this will cause a hyperextension moment at the knee. Agree? Conversely, on toe-off, the quadriceps have to go into action earlier than otherwise would be expected. In my opinion, rocker soles are a much over-rated after thought for solving gait problems. Shoes with a SACH heel (a true SACH heel) and a metatarsal bar are a much better option than most rocker sole solutions. I do have patients who require rocker soles, but this is the exception, not the rule. And most of those could have been converted early on, but not later because of habits, etc. I am against the rocker sole with AFOs, primarily because of the mechanical complications, particularly at rest standing.
I'm always open to new ideas and stand to be corrected if I'm wrong, but for now, I vote against the rocker sole shoe and I think I can support my opinions. You don't need to post this, because I don't want to argue online with some of the folks out there who would undoubtedly want to take issue with my position on this. But I see a lot of orthotic gait problems and I believe the prosthetic principles that have taught most of us more than we would have learned otherwise make problem solving in orthotics very much come to life. I've always said that being a prosthetist makes you a better orthotist and visa-versa. Frankly, as I think about it, lower limb prosthetics really makes lower limb orthotics problem solving come to life because we are able to experiment with and visualize the mechanical consequences of changes. You agree? But at the end of the day, orthotics is more complicated than prosthetics, biomechanical-wise, for the lower limb. My .02 worth.
Citation
“RESPONSES 1-8: AFO & Skechers "Shape-Ups" Shoes,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/231930.
