Effects of rocker-bottom shoes on the gait biomechanics of running and walking: A systematic review

Background: There is growing evidence demonstrating the effectiveness of rocker-bottom shoes regarding repetitive mechanical stress on the musculoskeletal system during locomotion. 

Research question: Is there any effect of rocker-bottom shoes on the lower extremity biomechanics during walking and running in healthy individuals? Methods: Databases including PubMed, Scopus, Web of Science, Embase, ProQuest, Cochrane, and CINAHL were searched from inception until March 2024. Twenty-six eligible studies that examined the effects of rocker-bottom shoes on gait parameters were included. The modified Downs & Black index was used to assess the methodological quality of the included studies. 

Results: Seventeen studies with rocker-bottom profiles at forefoot-only and nine studies with rearfoot-to-forefoot profiles were identified. Both forefoot-only (toe apex position between 30 % and 50 % and toe spring 30–50 mm/ toe rocker angle 7–30°) and rearfoot-to-forefoot (heel apex position between 18 % and 40 %, heel spring 20–40 mm, heel rocker angle 7–15°) rocker-bottom shoes were effective in redistributing plantar pressure from rearfoot to midfoot and forefoot regions. They also reduced peak dorsiflexion, peak plantar flexor moment, sagittal ankle ROM, and peak knee flexion compared to non-rocker shoes. 

Significance: Although rocker-bottom shoes appear effective in alleviating overuse injury via offloading forefoot plantar pressure and improving sagittal plane ankle kinematics and kinetics, caution should be taken regarding design specifications, particularly mass, thickness, and material properties of the rocker-bottom shoes.