What are the benefits and risks of wearing MBT™ footwear?

In this blog, I will discuss the benefits and risks of wearing MBT™ footwear if you have a specific foot and lower leg problem.  To help answer this question, I have summarized feedback from various chiropodists and podiatrists from Canada and the USA gathered by Dr. Chris MacLean, Director of Biomechanics at Paris Orthotics Ltd in Vancouver, BC.

Some of the benefits of wearing MBT shoes are definitely due to the rocker shaped outer sole.  A pilot study in 2005 by Department of Orthopaedic Surgery at the Edinburgh Royal Infirmary used pressure sensing insoles inside of MBT footwear while the study participants were either standing or walking. They compared the pressure readings in the MBT™ shoes to pressure readings inside of a flat soled running shoe. The study specifically compared the peak pressures of the heel, midfoot, ball of the foot (forefoot) and toes between the two shoe groups.

Results of this study showed:

1.       MBT’s decreased peak pressures in the forefoot and midfoot when walking,

2.       MBT’s decreased peak pressures and in the midfoot and heel when standing,

3.       Peak pressure was raised in the toes in MBT’s in both standing and walking conditions,

4.       The most dramatic difference was during standing, where the MBT shoes increased peak pressure in the toes by 76%, and lowered peak pressure in the midfoot and heels by 21% and 11% respectively and

5.       The most consistent finding, when both standing and walking, was decreased pressures in the midfoot in MBT’s.

These results of the Department of Orthopaedic Surgery at the Edinburgh Royal Infirmary study are consistent with the feedback that Chris MacLean gathered on the benefits of wearing MBT footwear. 

What foot problems can benefit from MBT footwear?

1.       Stiffness in the big toe joint(hallux limitus)

2.       Bunions

3.       Heel pain or plantar fasciitis

4.       Pain in the forefoot( metatarsalagia)

5.       Decreasing weight away from the ball of the foot

6.       Painful callus on the ball of the foot

7.       Inflammation of the joint capsule in the forefoot

8.       Neuroma ( irritation of nerves between the metatarsal bones of the foot)

9.       Foot osteoarthritis

10.   Someone who mostly stands while they work.

In my last blog, I discussed the effects of wearing MBT footwear. I have summarized these effects.

1.       Wearing MBT shoes increased the activity of many of the lower leg and thigh muscles while subjects stood or walked wearing MBT shoes. 

2.       Wearing MBT shoes is similar to balancing on a wobble board.  Wobble boards are used for rehab after an ankle sprain which helps to strengthen muscles around an injured ankle joint and promote balance.  Postural sway increased while wearing MBT shoes. 

3.       Wearing MBT a shoes while walking caused an increase in ankle joint dorsiflexion (dorsiflexion of the ankle happens when you move your foot towards your leg) from initial heel contact through to midstance (midstance is the time when your swinging leg is even to your weight bearing foot and leg). Increased ankle dorsiflexion at contact to midstance makes your calf muscle stretch more while walking as compared to subjects wearing the New Balance shoe.  If you have tight calf muscles the use of MBT footwear may cause strain on the tendo Achilles resulting in tendinitis.

If you are considering MBT footwear you probably should have good balance, good muscle flexibility and an intact nervous system.  

These are problems that are considered too risky to use MBT footwear:

1.       Achilles tendinitis or peroneal tendinitis(these tendons are found on the outside of the foot and are damaged during ankle sprain),

2.       Poor balance,

3.       History of ankle sprains,

4.       Loss of nerve transmission to the lower extremities such as diabetic neuropathy,

5.       Neurological deficits such as multiple sclerosis,

6.       Stress fractures especially while standing and

7.       Knee problems

Before you consider buying a pair of “Toning or Physiological shoes you should be aware of the risks and benefits of wearing these types of shoes.  Most if not all of the research has been conducted using MBT footwear, therefore, the MBT footwear benefit and risk profile cannot be applied to the other “Toning and Physiological” brands of footwear.

In my next blog entry I will discuss the topic of minimalist running shoes used for barefoot running.
www.painfreefeet.ca

MBT™ footwear: A chiropodist’s view of the “Physiological” footwear.

Over the past year,  I have been asked on several occasions to express my opinion on the benefits and risks of wearing  unconventional footwear such as  MBT™ (Masai Barefoot Technology) shoes , Sketchers “Shape Up”™ shoes and other similar shoes.  

I have reviewed research presented at scientific seminars, talked to a MBT footwear medical representative and I have also received feedback from a few patients over the past year who have used MBT shoes or other similar shoes.  In this blog I will discuss the design of MBT footwear and its effects on the thigh and lower leg muscles while standing and walking in MBT footwear.  I will also discuss the effects on ankle joint motion while walking in MBT footwear.

MBT footwear was developed in Switzerland in 1996 and came to North America in 2003.  The unstable MBT shoe has been promoted as the original “barefoot” function shoe. This shoe has a rounded sole starting from the heel and continues to the toe and a cushioned sensor under the heel area that creates a natural degree of instability. This instability is felt from both the back to front directions and from inside to outside directions. The basic concept behind the unstable shoe is to transform flat and hard surfaces such as concrete sidewalks into uneven surfaces such as grass or sand. The design of the MBT footwear has been promoted to provide some of the benefits of barefoot walking.

The features of MBT footwear are thought to specifically activate, strengthen and condition the smaller neglected extrinsic foot muscles that originate in the lower leg and attach via tendons into the foot.  This muscle activation is thought to occur while standing or walking in MBT footwear.  By activating these neglected muscles, posture and gait could be improved and the loads or stresses on the lower limb joints may be reduced to help prevent injuries and reduce pain.

MBT footwear has been studied by a few university based biomechanics research laboratories. It is important to note the findings of these research papers can only be applied to MBT shoes and cannot be compared to similar type shoes such as Sketcher™ “Shape Up” shoes because of the shoe design differences.   

In 2005, the University of Calgary Biomechanics laboratory conducted one study observing the effect on muscle activity while subjects just stood while wearing MBT shoes. When we stand, the muscles in our legs and thighs are active to prevent us from buckling at our hips, knees and ankles. The results of this study demonstrated an increase in the activity of many of the lower leg and thigh muscles while subjects stood wearing MBT shoes.  These results seem to be consistent with the muscle activation benefits as promoted by the makers of MBT shoes.  The researchers also measured postural sway of the upper body while standing and wearing a MBT shoe.  Postural sway is the phenomenon of constant displacement and correction of the position of the center of gravity within the base of support.  In layman’s terms this describes our ability to keep balanced without falling over. Using a MBT shoe is similar to balancing on a wobble board.  Wobble boards are used for rehab after an ankle sprain which helps to strengthen muscles around an injured ankle joint and promote balance.  Postural sway increased while wearing MBT shoes compared to a New Balance shoe. 

In 2005, the University of Calgary Biomechanics Laboratory conducted a second study where they compared subjects wearing a New Balance 756 running shoe and subjects wearing MBT shoes while walking.  The investigators measured the differences in muscle activity and ankle joint motion.  They found increased muscle activity in the subjects in the MBT shoe group versus the subjects in the New Balance shoe group. Again these results were consistent with the muscle activation benefits as promoted by the makers of MBT shoes.  

Wearing MBT shoes while walking caused an increase in ankle joint dorsiflexion (dorsiflexion of the ankle happens when you move your foot towards your leg) from initial heel contact through to midstance (midstance is the time when your swinging leg is even to your weight bearing foot and leg). Increased ankle dorsiflexion at contact to midstance makes your calf muscle stretch more while walking as compared to subjects wearing the New Balance shoe.

In 2009 researchers at Stanford University conducted a study examining what happened when individuals ran in MBT shoes versus New Balance 658 running shoes.  They found running in MBT footwear led to a greater amount of ankle dorsiflexion from initial heel contact through to midstance.  If you have tight calf muscles the use of MBT footwear while walking or running may cause strain on the tendo Achilles leading to tendinitis.

These increases in muscular activity that have been reported in these studies have led to the “Toning or Physiological” footwear category. A number of shoe companies have developed their own Toning or Physiological footwear to capitalize on the popularity of MBT footwear.  Until research has been conducted on these other “Toning and Physiological” shoe brands you can not apply the MBT research findings to these other shoe brands.

In my next blog, I will outline the lower leg and foot problems that can be relieved by wearing MBT footwear and the lower leg and foot problems that will be aggravated if you wear MBT footwear.

www.footcarewhitby.ca

www.footcarepeterborough.ca

Is your heel pain making you miserable?

The alarm clock radio has just rang and your day is about to begin. You dread your first step out of bed because it is going to be painful but you have perfected a method to keep as much weight off of your painful heel.  You realize the pain will get a little better as the day goes on but you also know that when you get home and sit down but have to get up again its going to be painful!  Does this sound familiar?

If you are reading my blog,  you may already know that you may have plantar fasciitis or heel spur syndrome.  Heel pain occurs because the plantar fascia pulls away from its attachment under the heel bone.  This pulling away occurs with every step you take while walking.  The plantar fascia has role in keeping your foot stable as you lift you heel off the ground while walking. The plantar fascia helps to resist your foot from bending.
To give you an idea of what I am describing, I want you to take your hand and place it with your palm down on top of a table.  Slowly lift the palm of your hand off the table.  The more you lift your palm, the more you will pivot on the tips of your fingers.  Now bend you hand, you will feel a tightening in the palm of your hand.  You have just stretched your palmar fascia.  When you bend your hand this is simulating what your foot is doing when you lift your heel off the ground and the weight is on your forefoot.  This is the time you cause damage to your heel causing pain.
This is a common problem for anyone in their 40" and 50's. There can be many factors which can lead to the "perfect storm" of heel pain.  Over the years, we all gain a little weight,  we don't exercise enough, we work on concrete floors covered with tile or carpet and we continue to use old and worn out footwear.  Sometimes heel pain can occur because we start a new activity that places a lot of bending stresses on the foot that can lead to a painful heel.
In Canada during the springtime we all want to be outside after a long winter.   Warmer weather brings more activity which unfortunately can lead to heel pain.  During this time of the year, we recieve many calls concerning heel pain. There can be many causes of heel pain, but the bottom line is you want  your heel pain to go away.
Your family and friends will most likely have advice on out to get rid of your heel pain, sometimes their advice is good and sometimes it is bad.  If your heel pain has lasted for more than 2 weeks and the intensity of the pain is getting worse you should immediately  seek professional help from a chiropodist/podiatrist or your family doctor.  The longer your heel pain is left untreated, the greater the chance it can become chronic.  The longer you have heel pain the more likely  you will start to change the way you walk leading other problems.  In the worse case scenario, you can develop heel pain in the other heel because you have compensated by putting more weigh on the non painful heel.  Another compensation is developing  a tight calf muscle because you don't want to put any weight on your painful heel.
I routinely see patients with heel pain who have waited longer than 4 to 6 months before they seek treatment or they have followed bad advice.  If you have chronic heel pain it may require a longer duration of  time and a more comprehensive approach to resolve your heel pain.   If your heel pain is not chronic there is usually an easy solution for your heel pain.
If you have heel pain do not let it become chronic and get treatment at the earliest possible date.
www.heelpainwhitby.ca
www.heelpainpeterborough.ca