"Rocker Bottom" shoes... Are they just a passing fad?

There are a variety of these types of "toner" or "rocker bottom" shoes available on the market today.  From Skecher's Shape-Ups to Reebok's EasyTone, my patients often ask me if these shoes are worth trying.

Skecher's Shape-Ups

Several of my patients have shared with me their personal journey with the "toner" shoes.  From the 80 year old lady who struggled to use them, only to be saved from an inevitable fall by the use of her walker, to the Cracker Barrel waitress who is "certain" that she only continues to work because of these "incredible new shoes".  

With such a variety of opinions and experiences, I believe that any clinician recommending the purchase of "rocker bottom" shoes needs to consider the following...

"Normal gait biomechanics"are definately altered with these shoes.  A few foot conditions may benefit from the short term use of these shoes.  The "rocker bottom" does effectively offload the forefoot, which may help with forefoot pain related to capsulitis or Morton's neuroma.  The shoe may also provide a stretch of the plantar fascia that may help to alleviate the symptoms of plantar fasciitis.

"Rocker Bottom" shoes can lead to instability and falls.  According to the Consumer Reports health report there were more reports of injuries with these types of shoes then any other in 2010.  Here is an example of a Skecher's lawsuit over the Shape-Up shoes causing stress fractures.

"Rocker Bottom" shoes have not proven to provide the health benefits that they have advertised.  In fact there is currently a Skecher's class action lawsuit over unfounded claims of health benefits.

In conclusion, I have choosen not to recommend "rocker bottom" shoes for my patients.  What will you decide?

Performing a Nail Surgery

The spring and summer months bring flowers blooming, family picnics and a flare up of those pesky ingrown toenails.  With the renewed commitment to exercise after taking the winter season off, you can plan on the incidence of complications and infections related to ingrown toenails increasing.   The question is how to appropriately and effectively manage this very painful problem.

For a quick primer on Onychocryptosis click HERE!

One of the first questions is whether it is best to perform a simple slant back procedure, partial nail avulsion without chemical matrixectomy, partial nail matrixectomy or a total nail matrixectomy.

For a simple, first time ingrown toenail with paronychia you might consider doing a simple slant back procedure with a topical anesthetic spray and a small nail cutter.  Necessary instruments are listed below.

For nails that are chronically ingrown or damaged I would recommend considering a more permanent procedure. 

For diabetics that are poorly controlled or any patient with vascular compromise, I would caution the use of a chemical matrixectomy.  

As to the question of Sodium Hydroxide verses Phenol for chemical of choice, I choose Sodium Hydroxide.   I have used both chemicals in the past but have found that the tissue damage and irritation with Sodium Hydroxide is less then with Phenol.  This study published by the NIH comparing the Sodium Hydroxide and Phenol Matrixectomy showed significantly reduced healing times with Sodium Hydroxide use with comparable long term success rates.

Click HERE for Video of Partial Sodium Hydroxide Matrixectomy

Click HERE for Video of Post Op Nail Surgery Day 14

 Click Here for a Printable Post Op Nail Surgery Patient Instruction Sheet

Evaluating Gait and Recommending Athletic Shoes

What type of athletic shoe should I buy?  Is there really that much difference in the brands?  Why do manufacturers like New Balance, Brooks and Asics have such a variety of choices?

When considering an answer, it is important to be educated on a couple of things.  First, you need to understand the different components of an athletic shoe.   Please visit the "Anatomy of a Shoe" link provided by the American Academy of Podiatric Sports Medicine for an excellent explanation.

Next, you need to assess your patient's gait.  Do they have neutral pronation, overpronate or underpronate?  The following video links will help you become comfortable making this assessment.

 Click for Video explaining Neutral Pronation

Click for Video explaining Overpronation

Click for Video explaining Underpronation

Back to the original question ... what is the best athletic shoe?  When making suggestions to my patient's, I follow the recommendation list provided by the American Academy of Podiatric Sports Medicine.

Personally, I have worn Brooks tennis shoes for the past few years and really like them.  Brooks has a wonderful interactive "Shoe Advisor" section to help you choose the perfect style for your unique needs!

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