Influence of prefabricated orthopedic footwear with rocker soles on foot loading while walking: A comparative biomechanical investigation of three different types of footwear

Rocker-bottom footwear with increased midsole stiffness is commonly prescribed to reduce painful forefoot loading. However, its combined effects on dorsiflexion-related loading at the metatarsophalangeal joints and plantar pressure distribution during walking remain incompletely understood. Do prefabricated therapeutic footwear with rocker soles and midsole stiffening reduce dorsiflexion-related loading and alter plantar pressure distribution compared with standard footwear? Thirteen healthy adults walked on a treadmill under three conditions: their own shoes, a prefabricated orthopedic shoe, and a prefabricated therapeutic comfort shoe combining rocker geometry and increased midsole stiffness. Plantar pressure and dorsiflexion-related bending moments were recorded using in-shoe sensor systems. Peak plantar pressures and dorsiflexion moments during late stance were compared across conditions. Footwear condition significantly affected dorsiflexion moments at the first and fifth metatarsophalangeal regions (p <.001). The therapeutic rocker shoe reduced peak dorsiflexion moments by 25% at MTH1 and 22% at MTH5 compared with participants’ own shoes, while the orthopedic shoe showed smaller reductions. Plantar pressure distribution also changed significantly. The rocker shoe reduced forefoot and toe pressures (e.g., T1 −33%, MT2 −22%), accompanied by increased midfoot loading and reduced rearfoot pressure. Prefabricated stiff rocker footwear substantially reduced dorsiflexion-related loading at the metatarsophalangeal region and shifted plantar loading toward the midfoot. These biomechanical effects support the rationale for rocker-stiff footwear to offload the forefoot and may be clinically relevant for conditions requiring reduced metatarsophalangeal loading. • Rocker-stiff footwear significantly reduced MTP dorsiflexion moments in late stance. • Peak dorsiflexion moments decreased by 25% (MTH1) and 22% (MTH5). • Forefoot and toe plantar pressures were reduced by up to 33%. • Plantar loading was redistributed from the forefoot toward the midfoot. • Combined rocker geometry and midsole stiffness altered foot rollover mechanics.