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Toning shoes for plantar fasciitis?

A study published in Clinical Biomechanics (online Sept 2012) looked at pain levels in people aged 40-65 with plantar fasciitis. Using a visual analogue pain scale, they compared the use of foot orthotics to toning shoes to foot orthotics and toning shoes.

The pain scores on the VAS for the 3 conditions were:

Rocker shoes and foot orthotics:  9.7mm
Rocker shoes: 30.9
Foot Orthoses 29.5

So the rockers shoes combined with foot orthoses produced the best results and the authors concluded:

The findings indicate that a combined prescription of rocker sole shoes and custom-made foot orthoses had greater immediate therapeutic effects compared to when each treatment had been individually prescribed.

– this is not a very commonly used intervention for treating plantar fasciitis
– this was an acute intervention and the participants were not followed over time
– the VAS is not the most validated measure for pain levels in plantar fascitis

For more on plantar fasciitis, see this post.and this essay. Run Junkie has one of the sensible approaches to it.

Do Toning Shoes Casue an Achilles Tendon Rupture?

A recent news report talks about litigation against Skechers from a male who claims that his Achilles tendon was ruptured from the use of their Shape Up toning shoes. The case has not been heard yet and there is no statement from Skechers.

Is the claim valid?

Toning shoes do alter the way you walk. They do alter the loads on different tissues, and yes they do make the calf muscles work harder, so they do place a greater load on the Achilles tendon. Much more is needed to rupture it though (more on Achilles ruptures), so to claim it is the cause is, in my opinion, a bit of a stretch. There must be a number of other risk factors present first and an Achilles tendon rupture is usually accompanied with simultaneous ankle dorsiflexion and knee extension. That will possibly be increased somewhat in toning shoes that have a rocker bottom. Generally a number of risk factors need to be in place for the rupture to happen, so the toning shoes can only be one of them.

As by way of analogy, there was the controversy when the Cox-2 inhibitor, Vioxx which was used as an anti-inflammatory agent was withdrawn from the market due to the increased risk for cardiovascular events. A number of people who had heart attacks or strokes while on this drug sued. Most of the cases failed, as they already had the risk factors for the heart attack or stroke (see this Wikipedia discussion) and Vioxx was not found to be the causative factor.

It will be interesting to see which way this Skechers case goes, or if it is just settled (which would be shame, as I would like to know which way the courts would rule!). Would they rule in favor of the litigant that the shoes caused the Achilles rupture or will they rule like in the Vioxx cases that other risk factors were already present?

The problem of illegal knock offs

Ever since MBT started the footwear category for the toning shoes, they have been plagued with the illegal reproduction of their shoes. Like any company they are constantly having to fight this on many fronts. One of these fronts is to try and get the websites that sell the illegal copies removed from the search engines. In order to maintain transparency, Google reports the number and some information on the copyright removal request that it gets and actions. Here is the details on the requests received from Masai Marketing and Trading AG for the MBT shoes. This give an indication of the extent of the problem.

Target Settles TrimStep Lawsuit

Along with the settlements reached with Skechers and Reebok, Target have settled their suit involving their TrimStep range of toning shoes after failing to get a judge to throw out the case. According to Minneapolis/St. Business Journal, the terms of the settlement are confidential. Target have discontinued the shoe.

MBT files for bankruptcy

MBT shoes seem to be in trouble. The parent company, Masai Marketing & Trading AG, in Switzerland has filed for bankruptcy and the United Kingdom distributor has been placed in administration.

Skechers settle with the FTC for $40 million

The Federal Trade Commission have announced that Skechers have agreed to pay $40 million to settle the charges it misled consumers with claims that its toning sneakers could do everything from help users lose weight to make their “bottom half their better half” without ever going to a gym. The settle will be used to provide refunds to the buyers of shape-ups. This follows the previous settlement with Reebok for $25 million

As part of the settlement, Skechers are barred from making unsubstantiated claims about the health and fitness benefits of Shape-ups and related footwear. The commission alleged Skechers also made deceptive claims about its Resistance Runner, Toners, and Tone-ups shoes.

They also claim a chiropractor named Steven Gautreau recommended the product based on a clinical study he claimed was “independent” and tested the shoes’ benefits compared to regular fitness shoes, the FTC said. The study did not produce the results claimed in the ad, the FTC said. Skechers also failed to disclose that Gautreau is married to a Skechers marketing executive and Skechers paid him to do the study, the FTC said.

In a statement Skecker’s stated:

“While we vigorously deny the allegations made in these legal proceedings and looked forward to vindicating these claims in court, Skechers could not ignore the exorbitant cost and endless distraction of several years spent defending multiple lawsuits in multiple courts across the country,”

Shoes that employ toning technology have been sold in the United States for more than 15 years and have been the subject of numerous research projects with at least 19 reports published in peer-reviewed clinical and sports medicine journals. Researchers from around the world have analyzed various models of toning shoes and found demonstrable fitness benefits from walking and standing in such shoes, as compared to flat-bottomed athletic footwear.

Link to the FTC press release.
Link to the Skechers Press Release

Minimalist Running Shoes

Minimalist shoes are the opposite of the toning shoes. While the toning shoes are unstable and use this instability to increase muscle activity, the minimalist shoe relies on the lack of support to change the gait to get a training effect. The minimalist or barefoot movement is a hot topic at the moment in the running community.

The first part of the debate that is going on is just what is a minimalist running shoe? A minimalist running shoe is supposed to be so minimal that the way the foot functions is supposed to mimic the motion of barefoot without any shoes. Some believe anything covering the foot is enough to interfere with foot function. Others believe otherwise. A minimalist shoe has no cushioning like the traditional running shoe. They have no support like the traditional running shoe and they have no differential in heel height between the forefoot and rearfoot.

Are there any advantages to minimalist running shoes? They are not for everyone. The transition to a minimal running shoe from a traditional running shoe is a long slow and gradual process (at least it should be). Minimalist running shoes encourage a forefoot strike and eliminate the impacts associated with heel striking. TO run more lightly this way in the minimalist running shoes requires greater muscle activity and does predispose those muscles and associated tendons to greater injury risk. A large number of people who have made the transition are claiming that they are getting less injuries since doing so. However, all those who work in running injury clinics are also aware of the higher injury rate that is occurring. There is no clear evidence on any advantages of heel striking vs rearfoot striking, just a lot of opinions.

Toning Shoes and Heel Pain

According to MBT:

MBTs can be helpful for plantar fasciitis as they reduce the pressure in the arches of the feet where the plantar fascia lies. You will need to gradually wean into wearing the MBTs and over time they will help to gently stretch the plantar fascia whilst protecting it and strengthening the muscles which support it.

Heel Pain Resources:
Pain in the Heel | Heel Pain | Heel Pain | Heel Pain | Heel Pain | Heel Pain

Rocker sole shoes improved symptoms of intermittent claudication

Intermittent claudication is the name given to the symptoms that occur, usually in the calf muscle, in those with poor circulation. It occurs after walking a set distance because the oxygen supply to the muscle cannot meet the muscles’ needs. This pilot study from researchers at the University of Salford in the United Kingdom and published in the Journal of Vascular Nursing looked at the use of a rocker sole shoe which mimics the action of toning shoes in a group of people with intermittent claudication. The participants were given two therapeutic shoes that were identical, except that one had a specific three-curve rocker sole. Participants then did walking trials to determine the distance until the claudication pain occurred and the intensity of the pain. They found that while wearing the rocker sole shoes, the distance until claudication increased and the intensity of the claudication pain was less.

This study is promising. It was only in eight people and was only done in one session. It is not known if the benefits demonstrated would be apparent after a longer period if adaptation to the rocker soles shoes was allowed to occur.

Link to study

Vibram Five Fingers Class Action Suit

Not exactly a toning shoes issue, but Vibram Five Fingers have had a class action suit filed against them that has all the hallmarks of the Reebok settlement with the Federal Trade Commission and the class action cases filed against Skechers. Vibram Five Fingers are a minimalist running shoe offering no support or cushioning. They are very popular with the barefoot and minimalist runners. The suit alleges that the health gains promised by wearing the shoes did not eventuate. Vibram have issued a statement denying the claims and stating they will vigorously defend them

Link to the suit.
Runners World’s legal analysis of the suit.
There has been a lot of online discussion and debate about the merits of the case (eg see: Vibram Five Fingers facing class action over health claims).

There is a good analysis of the more recent unsuccessful attempt attempt by Vibram to get the case dismissed here.

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