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The purpose of this study was to discuss (a) the conceptual idea behind unstable footwear and (b) the validity and scientific support of some selected claims made with respect to unstable shoes. The concept is that unstable shoes are built to provide a training device that uses instability as a strategy to train and strengthen muscles in the human locomotor system. Specific claims are: (1) evidence shows that unstable shoes currently on the market produce a substantial and significant increase in instability. The effects are most evident during standing but are also apparent in walking. (2) Unstable shoes increase the activity in certain muscles in about 80% of the population. The affected muscles change between different subjects. The highest relative increases were found in the small muscles crossing the ankle joint complex. (3) ‘Muscle toning’ is not defined and experimental data associating ‘muscle toning’ with unstable shoes are not available. (4) There is evidence that unstable shoes improve the static balance performance of users whose balance skills are low. (5) There is indirect evidence that unstable shoes reduce forces in the joints of the lower extremities. (6) There is evidence that unstable shoes can reduce the level of perceived pain. This has been confirmed in subjects suffering from pain in the knee joint and for subjects with low back pain. Based on these results, it seems that unstable shoes are associated with several possible benefits. However, the effects are not consistent between different subjects. In our experience, positive effects can be shown for about 80% of the test subjects.
The influence of two unstable shoe modifications on lower extremity kinetics during walking and postural balance in elderly men
Ann-Kathrin Hömme, Ewald M. Hennig, Christoph Müller & Christian Ninck Footwear Science; Volume 4, Issue 2, 2012
Introduction: Various instability shoe concepts have been promoted by claiming several positive effects. As a result, the elderly have become especially interested in wearing these shoes to train their postural balance. So far, many of the promoted claims have not been proven. This study aimed to identify the effects of different unstable shoe constructions on the walking and balance performance in elderly men.
Methods: A conventional running shoe (CRS) was modified by an orthopaedic shoe technician in two different ways (MLI, API). The MLI was unstable in the medio-lateral and the API in the anterior–posterior direction during walking. Seventeen healthy elderly men answered a questionnaire judging fit, comfort and walking behaviour of the three different shoe types. They also walked across a force platform in each shoe type at a given speed of 1.6 m s−1. During this task, ground reaction forces, plantar pressures, pronation and shock absorption were measured. They then had to perform three balance tasks (bipedal standing with open eyes, bipedal standing with closed eyes, one-legged standing with open eyes) on a force platform in all three shoe conditions as well as barefoot. During the balancing tasks, the path of the centre of gravity (COG) and the muscle activity of the m. vastus lateralis (VL), m. biceps femoris (BF), m. tibialis anterior (TA) and the lateral side of the m. soleus (SO) were measured.
Results: A clear influence of the shoe modifications was revealed on the roll-over process during walking as well as a notable effect on balance during two-legged standing with closed eyes.
Conclusions: This study shows that small changes in perceived stability, induced by shoe modifications, have a clear effect on walking and balance performance in elderly men.
Unstable shoe constructions may counteract balance deficits and underutilization of lower limb muscles. The Masai Barefoot Technology (MBT) concept has been widely analysed in terms of footwear-induced instability. However, previous experiments investigated predominately one specific MBT shoe model. Therefore, the purpose of this experiment was to evaluate the effects of differently shaped MBT soles on stance biomechanics. Mean velocity of centre of pressure (CoP) displacement, root mean square (RMS) tibialis anterior (TA), peroneus longus (PL), gastrocnemius medialis (GM), vastus lateralis (VL) and biceps femoris (BF) activity, as well as subjective perception of instability were recorded in 31 young asymptomatic adults during standing with three different MBT models and a standard control shoe. Statistical analysis included repeated-measures ANOVAs with Bonferroni–Holm adjusted post-hoc tests. MBT footwear, regardless of shape and structure, significantly increased postural sway compared to the control condition. Additionally, there were significant differences between the MBT shoe types. These results coincided with those obtained from instability assessment testing. No significant effects of MBT footwear were detected for the GM and BF muscles. A consistent increase in TA, PL and VL RMS activity was only found for one MBT model. On a muscular level, within-MBT differences were statistically less pronounced than for CoP and for instability rating measures. These findings suggest that specific variations in MBT sole construction criteria differently challenged the postural control system without forfeiting the principal feature of simulating a less firm surface for the user. Further investigations are warranted to examine the framework of instability within the MBT concept, as well as associated intrinsic and extrinsic influences related to rehabilitation and prevention programmes.
Walking in an unstable Masai Barefoot Technology (MBT) shoe introduces kinematic and kinetic changes at the hip, knee and ankle before and after a 6-week accommodation period: a comprehensive analysis using principal component analysis (PCA)
Scott C. Landry, Benno M. Nigg & Karelia E. Tecante Footwear Science Volume 4, Issue 2, 2012 pages 101-114
Background: Scientific and anecdotal evidence suggests that some individuals who wear the unstable Masai Barefoot Technology (MBT) shoe experience a reduction in back and joint pain. A more comprehensive biomechanical gait analysis is needed to better understand the mechanisms for symptom relief and what the long-term implications of wearing these shoes might be on the body.
Objective: The aim of this study was to determine the gait changes introduced at the hip, knee and ankle before and after wearing an unstable MBT shoe for a 6-week accommodation period.
Methods: Three-dimensional joint angles and moments were measured for 23 healthy individuals while walking in an unstable MBT shoe and a stable control shoe, both before and after a 6-week accommodation period of wearing the unstable shoe at their workplace. Principal component analysis (PCA) was used on the stance phase waveforms to identify differences between the two shoes and two testing sessions.
Results: Joint angle and moment differences between the two shoe conditions were identified both before and after wearing the unstable shoe for the accommodation period. Notable kinematic changes included reduced hip flexion–extension and ankle adduction–abduction range of motion, increased early stance dorsiflexion and increased knee internal rotation for unstable shoe walking. Ankle moments tended to be greater for the unstable shoe and at the hip and knee, both increases and decreases in moments were observed.
Conclusions: While many of the identified changes agree with previous research, this is the first study to report increases in some joint moments for the unstable MBT shoe. These increases along with other notable changes do, however, require further investigation to better understand the long-term implications of the unstable MBT shoe.
Wearing rocker bottom shoes such as Masai Barefoot Technology (Masai Marketing & Trading AG, Winterthur, Switzerland) during quiet standing and comfortable walking results in greater lower limb muscle activity in comparison with conventional (flat-bottomed) shoes. This contribution will review current literature in the area of rocker bottom shoes by summarizing the acute and chronic effects associated with increased muscle activity. Compared with conventional shoes, the acute use of rocker bottom footwear for standing and walking could promote physiological benefits, such as increased energy expenditure, reflex excitability, and venous return from the foot that may prove useful to improve neuromuscular and general function. On the other hand, inappropriate or excessive use of rocker bottom footwear could also result in possible concerns, such as increased physiological tremor and impaired proprioception (fatigue-related), as well as excessive forefoot loading that could increase the risk of overuse injury or even falling risk. However, the scientific proof indicating that ergonomic rocker bottom footwear can effectively promote long-term health benefits or problems is scanty. Considering that rocker bottom shoes are increasingly adopted by the general population, additional efforts are needed to provide objective evidence and recommendations.
Magnitude and variation in muscle activity and kinematics during walking before and after a 10-week adaptation period using unstable (MBT) shoes
Thomas Stöggl & Erich Müllera Footwear Science Volume 4, Issue 2, 2012
Objectives: The purpose of this study was to compare the magnitude and variability of electromyographic (EMG) and kinematic variables during treadmill walking using unstable (Masai Barefoot Technology, MBT) shoes and conventional shoes, before and after a 10-week training period.
Methods: Twelve Sport Science students were analysed while walking on a treadmill with both conventional and unstable shoes, before and after a 10-week training intervention consisting of more than 4 h of use of unstable shoes during daily activity. Cycle characteristics, plantar pressure distribution, whole-body three-dimensional (3D) kinematics and EMG signals of selected leg muscles during the entire gait cycle and its subphases were recorded. The coefficient of variation of 20 consecutive cycles in each variable analysed was taken as the measure of variability.
Results: A trend towards higher variability but equal magnitude was observed with MBT shoes compared with conventional shoes at the pre-intervention test (pre-test) regarding kinematic and EMG variables. The training period led to interaction effects (p < 0.05 to 0.01) demonstrating a global attenuation in the variability of kinematic and EMG variables in both shoe conditions, with greater reduction in the MBT situation, or an increase in variability with conventional shoes to higher post-test variability compared with MBT. Both situations revealed equal cycle times (1.05 s) but a shortened duration of loading response (136 vs. 146 ms) and terminal stance (211 vs. 223 ms) and an increased duration of midstance (293 vs. 282 ms) and swing time (408 vs. 386 ms) when comparing MBT with conventional shoes (all p < 0.05 to 0.001). Training led to a global reduction in cycle time (p < 0.05) and ground contact time (p < 0.01) in both shoe conditions.
Conclusions: The results support the idea that the unstable shoe serves as a motor constraint applicable during everyday activity, inducing changes in the gait pattern with both MBT and conventional shoes. In selected EMG and kinematic variables, an interaction effect towards a greater decrease in movement variability in MBT compared with conventional shoes or an increase in variability with conventional shoes towards a higher post-test variability compared with MBT was observed.
Balance control and muscle activity in various unstable shoes compared to barefoot during one-leg standing
Andresa M. C. Germano, Günther Schlee & Thomas L. Milani Footwear Science; Volume 4, Issue 2, 2012
The purpose of this study was to compare muscle activity and balance control of young healthy subjects during one-leg standing using various unstable shoes, a stable reference running shoe and barefoot condition. Twenty athletic female subjects participated in this study. The protocol consisted of quiet one-leg standing measured in six randomized conditions: four different unstable shoes, reference shoe and barefoot. The data were measured using the Pedar-X® insole system and a surface electromyography (EMG) system. Activity of eight muscles of the right leg was measured and integrated EMG (IEMG) and root mean square (RMS) values were calculated. For the balance control analysis, centre of pressure (CoP) total, medial–lateral and anterior–posterior excursions were calculated. A descriptive analysis and also one-way repeated-measures ANOVA (α = 0.05) and post-hoc tests were performed. The results indicate larger CoP total excursion as well as CoP medial–lateral excursion in barefoot compared to all shoe conditions (p < 0.05), whereas no differences were observed within the shoe conditions. Higher muscle activity (IEMG) was identified for the lateral gastrocnemius, vastus medialis and rectus femoris during barefoot standing with no difference between shoe conditions. No differences in RMS values could be observed for all analysed conditions. In conclusion, this study could not find any relevant differences between the shoe conditions for any of the analysed variables. Surprisingly, the barefoot condition showed the greatest instability (CoP excursions) and the highest muscle activity compared to all shoes analysed in the study. Further studies with unstable shoes are needed to investigate their instability effects.
Purpose: Development of a multifactorial equation to define lower body muscle toning with quantitative variables.
Methods: Eight subjects with different levels of toning were used as an input. A set of 11 parameters covering soft tissue characteristics and body composition were correlated with a subjective rating of toning using a visual analogue scale (VAS). The variables with the highest correlation were combined using a principal component method. A subspace spanned by principal components explaining 95% of the variability was used for the further analysis. This subspace was rotated until the first axis had the highest correlation with the subjective toning rating. An equation based on this first axis was used to calculate a quantitative toning rating.
Results: Five discrete variables including both body composition (body fat, ectomorphy and endomorphy) and soft tissue characteristics (trunk forward flexion and normalized peak torque of knee flexion) lead to a high correlation with the expert rating of toning. The coefficient of determination was r 2 = 0.977 ± 0.008.
Conclusion: The method developed in this paper allows for a quantitative calculation of lower body toning. The presented method allows for easy integration of more subjects, which would lead to a stable definition of the level of lower body toning based on the combination of quantitative measurable variables.
The purpose of this study was to examine the external work performed by individuals wearing a rocker bottom shoe compared to a standard shoe. It was hypothesized that individuals wearing a rocker bottom shoe would have changes in the amount of work over the course of contact with the ground. External work on the body's centre of mass (BCOM) was calculated for individuals in both conditions. Comparisons for external work were done for positive and negative work for the entire stance phase as well as the initial double support, single support and terminal double support periods. The results revealed that while wearing the rocker bottom shoes, individuals performed an increased amount of negative work and decreased positive work in the initial double support followed by increased positive work in single support compared to a standard sole shoe. Individuals also performed a decreased amount of positive and negative work in terminal double support when wearing the rocker bottom shoes. There were no differences, however, when the stance phase was considered undivided to subphases for either positive or negative work. The results indicate that use of rocker bottom shoes redistributes external work to earlier in the gait cycle, which may not be as energetically efficient. This shift will probably result in increased metabolic energy expenditure as it will require more energy output from proximal hip musculature, which is not as mechanically efficient as the ankle joint in late stance. This could be desirable for individuals who are wearing the shoes for increased caloric burn such as an exercise setting. Furthermore, the increased external work in single support may be causing additional work from the hip extensor musculature (i.e. gluteus maximus). This could possibly be desirable for strengthening and conditioning of the hip extensors.
The purpose of this study was to evaluate the effects of Masai barefoot technology (MBT) shoes on lower extremity joint loading in overweight males during level walking. Therefore, lower extremity kinematics, kinetics, and muscle electromyographic signals of the vastus lateralis (VL), biceps femoris (BF), and gastrocnemius medialis (GM) were recorded in 10 overweight males at a self-chosen walking speed with MBT shoes and conventional shoes. Selected peak joint moments, maximal joint force loading rates, mean muscle intensities, and co-activation indices of the VL/BF, as well as of the VL/GM were analyzed and compared for the two shoe conditions using paired Student's t-tests (α=0.05). Results showed that walking with MBT shoes reduced first peak knee adduction moments in overweight subjects. During midstance and terminal stance, increases in VL/GM co-activation, accompanied by increases in VL and GM (only terminal stance) intensities were found for the MBT situation. Kinetic variables analyzed to assess ankle and hip joint loading did not exhibit any statistical differences. These results suggest that using MBT shoes diminishes medial compartment loads at the knee without overloading hip or ankle joints in overweight males. However, the additional muscle loading should not be overlooked, and warrants further investigation.
The Masai Barefoot Technology (MBT) shoe was developed as a walking device to improve gait stability and reduce the joint load. Kinematic changes with MBT shoes have been reported; however, kinetic characteristics with MBT shoes have not been adequately assessed. The purpose of this study was to investigate the immediate effects of using MBT footwear on the kinetic and kinematic changes in the lower extremity in healthy males. Fourteen healthy male subjects (mean age: 25.6 ± 5.1 years) underwent three-dimensional gait analysis. Ground reaction forces (GRF) during the shock absorption phase were significantly decreased with MBT shoes compared with stable shoes. Gait with the MBT shoes showed significantly decreased knee extension angle in the early stance phase, a decreased hip extension angle, and an increased ankle dorsiflexion angle in the late stance phase. The peak value of the ankle planter moment, ankle negative power, and vertical component of the GRF significantly decreased with MBT shoes in the late stance phase compared with stable shoes. Therefore, MBT shoes could assist with shock absorption in the early stance phase and maintain the progression force while reducing joint moment and power. The results of this study suggest that MBT shoes might be effective to improve shock absorption, increase knee extensor muscle activity, and assist ankle push-off.
An unstable rocker-bottom shoe alters lower extremity biomechanics during level walking
Songning Zhang, Maxime R. Paquette, Clare E. Milner, Carolyn Westlake, Erin Byrd & Lucas Baumgartner Footwear Science Volume 4, Issue 3, 2012
Biomechanical data for gait in unstable rocker bottom shoes reported in the literature is not comprehensive across available shoe types.
Purpose: The objective of this study was to comprehensively evaluate centre of pressure (COP), ground reaction force (GRF), joint kinematics and kinetics, and electromyography (EMG) of selected muscles while walking in an unstable shoe compared to a control shoe.
Methods: Fifteen subjects performed five walking trials at 1.3 m/s and 1.8 m/s in control and unstable shoes. Kinematic, GRF and EMG data were simultaneously collected.
Results: The unstable shoe caused an increased mediolateral COP displacement. Greater loading rate of initial peak vertical GRF, reduced ankle plantarflexion range of motion (ROM) and greater total sagittal-plane ankle ROM were also observed for the unstable shoe compared to the control shoe. Peak dorsiflexion and plantarflexion moments, peak knee flexion moment as well as EMG activation of tibialis anterior and rectus femoris were reduced in the unstable shoe. Finally, the peak inversion moment and hip abduction moment were increased in the unstable shoe.
Conclusion: These results suggest that the unstable shoe presents challenges to the body to maintain mediolateral stability and therefore helps improve involved ankle and hip muscles. Furthermore the demands for the lower extremity muscles related to the sagittal-plane motions were reduced in the unstable shoe.
Evaluation of lower limb electromyographic activity when using unstable shoes for the first time: A pilot quasi control trial
Helen Branthwaite, Nachiappan Chockalingam, Anand Pandyan, Gaurav Khatri Prosthet Orthot Int November 30, 2012
Background: Unstable shoes, which have recently become popular, claim to provide additional physiological and biomechanical advantages to people who wear them. Alterations in postural stability have been shown when using the shoe after training. However, the immediate effect on muscle activity when walking in unstable shoes for the first time has not been investigated.
Objective: To evaluate muscle activity and temporal parameters of gait when wearing Masai Barefoot Technology shoes® for the first time compared to the subject’s own regular trainer shoes.
Study Design: A pilot repeated-measures quasi control trial.
Method: Electromyographic measurements of lower leg muscles (soleus, medial gastrocnemius, lateral gastrocnemius, tibialis anterior, peroneus longus, rectus femoris, biceps femoris and gluteus medius) were measured in 15 healthy participants using Masai Barefoot Technology shoes and trainer shoes over a 10-m walkway. Muscle activity of the third and sixth steps was used to study the difference in behaviour of the muscles under the two shoe conditions. Temporal parameters were captured with footswitches to highlight heel strike, heel lift and toe off. Paired samples t-test was completed to compare mean muscle activity for Masai Barefoot Technology and trainer shoes.
Results: Indicated that the use of Masai Barefoot Technology shoes increased the intensity of the magnitude of muscle activity. While this increase in the activity was not significant across the subjects, there were inter-individual differences in muscle activity. This variance between the participants demonstrates that some subjects do alter muscle behaviour while wearing such shoes.
Conclusion: A more rigorous and specific assessment is required when advising patients to purchase the Masai Barefoot Technology shoe. Not all subjects respond positively to using unstable shoes, and the point in time when muscle behaviour can change is variable.
Clinical relevance Use of Masai Barefoot Technology shoe in patient management should be monitored closely as the individual muscle changes and the point in time when changes occur vary between subjects, and evaluation of how a subject responds is not yet clear.
The current study was conducted to evaluate the effects of unstable footwear on spine kinematics and trunk muscle activity during bipedal stance. Therefore, spinal alignment and concurrent angular velocity measures were assessed in 27 asymptomatic adults while standing with unstable Masai Barefoot Technology (MBT) shoes and standard footwear, respectively, employing a multisegmental three-dimensional trunk model. Electromyographic (EMG) analyses included recordings of the rectus abdominis, internal oblique, external oblique, upper thoracic paraspinals, lower thoracic erector spinae, and lumbar erector spinae. Kinematic and EMG variables were compared for the two shoe conditions via paired Student's t-tests (α = 0.05). Results showed that wearing unstable MBT shoes increased flexion at the mid-thoracic level (0.8°; P = 0.001) and led to greater mean velocities of angular displacement at the thoracolumbar (11.2%; P = 0.003) and at the lumbopelvic (10.8%; P = 0.02) regions, accompanied by more lumbar erector spinae activity (18.2%; P = 0.003). Accordingly, using MBT shoes may have potential implications in promoting spine tissue health, notably at the low back area, through expected improvements in terms of muscle conditioning and/or motor performance. However, additional investigations are warranted to further examine the framework of unstable footwear constructions within prevention and rehabilitation settings.
The effect of unstable sandals on instability in gait in healthy female subjects
Carina Price, Laura Smith, Philip Graham-Smith, Richard Jones Gait & Posture; Article in Press
Unstable footwear generally lacks thorough peer-review published research to support concepts and marketing claims. The purpose of this study was to investigate the instability induced by four (FitFlop, Masai Barefoot Technology, Reebok Easy-Tone and Skechers Tone-Ups) commercially available unstable sandals and one stable control sandal (Earth) in walking in 15 females (mean±SD age was 29±6.7 years, mass 62.6±6.9kg and height 167.1±4.2cm). Three-dimensional motion with synchronised electromyography and kinetic data were collected. Walking speed and step length remained consistent between conditions, however double support time decreased in Masai Barefoot Technology. Centre of pressure data identified no consistent difference between the stable control and the unstable sandals, however Masai Barefoot Technology reduced the anterior–posterior range of centre of pressure. Muscle activity differed significantly at the ankle in the unstable footwear. FitFlop, Reebok and Skechers increased peroneal activity during pre-swing, whereas Masai Barefoot Technology increased medial gastrocnemius and decreased tibialis anterior activity in loading response and mid-stance. The larger rocker sole of the Masai Barefoot Technology altered gait and muscle activation with regard to braking and progression in the sagittal plane. Reebok, Skechers and FitFlop, with softer, less stable foreparts increased evertor action at toe-off, having their effect in the coronal plane. The study highlighted that any instability induced by the shoes is design-specific.
► Instability in unstable footwear has been measured in healthy females walking.
► The unstable footwear conditions altered centre of pressure and electromyography variables compared to a control.
► The nature of the instability induced by the shoes is design-specific.
The Reebok Easy Tone shoe concept was developed to induce instability during walking and standing with the primary purpose of increasing muscle activity of the lower extremity muscles. To the authors' knowledge, no scientific work has been published, which analyzed neuromuscular and biomechanical effects when walking and standing with Reebok Easy Tone shoes. Therefore, the purpose of this study was to investigate the immediate effects of using such footwear on gait biomechanics for the lower extremity in healthy participants.
Five healthy female and seven healthy male participants volunteered to participate in this study. During quiet standing, centre of pressure excursion was determined. 3D gait analyses were performed with simultaneously collecting surface electromyography data of the leg muscles when walking with regular shoes and with Reebok Easy Tone shoes.
Centre of pressure excursion did not show any significant differences. For walking, only slight differences were found in kinematics and kinetics. When walking with Reebok Easy Tone shoes, the first vertical peak of the ground reaction force was significantly increased as well as the maximum plantarflexion moment during initial contact and loading response. Mean muscle activation for vastus medialis and lateralis showed an increase during the second half of stance, but failed to reach significance.
Results of this study did not show any increased instability during standing and only a slight increase of vastii activity during stance. Thus, the marketing claims that “toning shoes” could serve as a sort of training devices for lower limb muscles during walking, cannot be supported.
there are problems using mbt or similar shoes with custom orthotics inside ??? some physician in italy tell to patients don't use custom orthotics with mbt shoes but i don't know why . thanks alessandro
There is no reason not to wear foot orthotics in toning shoes. it all depends on what you are trying to achieve.
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The effect of unstable sandals on single-leg standing
Carina Pricea, Laura Smitha, Philip Graham-Smitha & Richard Jonesa
Footwear Science (in press)
Purpose: Unstable footwear lacks peer-review published research to support concepts and claims. The present study was therefore undertaken to quantify and compare the effect of commercially available unstable sandals on single-leg balance in a healthy female population.
Methods: Fifteen participants stood on their right-leg in one control sandal (Earth) and four sandals that are marketed as unstable footwear (FitFlop, Masai Barefoot Technology, Reebok Easy-Tone and Skechers Tone-Ups). Centre of pressure trajectory, lower limb kinematics and lower limb muscle activation were recorded as participants undertook three 30 second trials in each sandal.
Results: The unstable sandals altered parameters related to stability in participants. Namely Masai Barefoot Technology increased centre of pressure range in the anterior-posterior direction and concurrently increased sagittal ankle motion. Reebok Easy-Tone had a similar effect in the coronal plane at the ankle. Muscle activation increased in the unstable sandals, with significant differences apparent in the medial gastrocnemius, soleus and rectus femoris, predominantly in Masai Barefoot Technology. Findings were attributed to the large rocker sole on the Masai Barefoot Technology sandal and more subtle outsole designs in the other sandals.
Conclusions: Overall minimal differences from the control sandal were evident and it is expected that dynamic tasks may elicit greater differences in stability. The instability imposed by the sandals is design-specific and consideration should be given to this when the footwear is recommended to specific individuals.