Shoe Soles: Stiff Rocker Bottom Sole versus Flexible Sole “Barefoot”

There are many things to consider when selecting shoes, including comfort, injury and energy expenditure.

Arnie Davis a Certified Pedorthotist has coined the term shoes with rocker bottom soles are the proverbial “aspirin” for chronic foot problems. A rocker sole shoe is recommended to help manage a number of painful injuries including: low back pain; knee pain arthritis; ankle pain arthritis; heel pain; big toe pain; diabetic ulcers on the foot; and recovery from foot surgery (ankle and big toe fusion).

The analogy of the shoe sole to aspirin provides an opportunity to explain and compare options related to the stiffness and shape of the sole of shoes.  A contrast to the stiff rocker sole shoe is a flexible flat sole shoe or barefoot like.







One of the reasons to recommend aspirin is for pain relief.  Both a stiff rocker sole shoe and a flat flexible sole barefoot like shoe have been purported to provide pain relief.

Aspirin has side effects the most common is gastrointestinal disturbance. The common side effect of a rocker sole shoe is instability and increased risk of falling. The common side effect of barefoot is sharp objects hurt your feet?

Aspirin generally is used on a temporary basis, but in low dosage it is used on long term daily basis to help prevent blood clotting, heart attacks or strokes. Stiff rocker sole shoes can be used on short term basis to deal with acute musculoskeletal pain, but also maybe the best type of shoe sole to use on long term daily basis. Going barefoot can be done for just brief periods of time, or can be long term action.

The mechanism of aspirin is based on biochemistry. The mechanism of the sole of the shoe is based on biomechanics. Stiff rocker sole shoes act by inhibiting excessive joint motion, at the big toe and ankle joint.  It alters the joint forces lowering forces at big toe, ankle, and knee.  It prevents unwanted compensation for stiff big toe joints and impaired ankle joints.

The mechanism of barefoot is purported to increase sensory impute, strengthen the intrinsic muscles in the foot. Studies have demonstrated that barefoot or more flexible sole shoes can result in a decrease in impact forces compared to walking in shoes. Walking barefoot distributes the force and pressure over a wider area of the foot as compared to walking in shoes the force and pressure is concentrated into small area of the foot such as the heel or ball of the feet.

Stiff rocker sole shoe is a passive intervention; where as a flexible flat barefoot like shoe requires active involvement of muscles. If you have a chronic joint disease, joint deformity and are seeking pain relief a stiff rocker sole shoe is indicated. If you are healthy without acute injury and want to prevent pain, a flexible flat barefoot like shoe is indicated.

The stiffness or flexibility and shape of the sole of a shoe is something to consider in the management of lower extremity musculoskeletal pain syndromes.

Gait Deviations:

If you have musculoskeletal pain in lower extremity a gait analysis can determine if you demonstrate any of the following gait deviation which suggests a stiff rocker sole shoe maybe helpful:

  • insufficient big toe motion; insufficient ankle motion
  • heel comes off ground before opposite foot strike ground when walking
  • early supination
  • hyper-extension of knee during mid-stance
  • weak push off at toe off

A stiff rocker sole shoe is to aspirin, as a flexible flat sole barefoot like shoe is to healthy nutrition.

Damien Howell Physical Therapy – 804-647-9499 – Fax: 866-879-8591 At-Home, At Office, At Fitness Facility, I come to you, I do home visits, or Online