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Monday, March 10, 2014

Monday's Image of the Week: Abnormal Heel Wear as a Sign of Gait Problems

As this patient walks, his right heel scuffs the ground terribly causing tripping and foot slap. This is a neurological problem related to his low back. It is seen primarily at the heel of his right shoe (on the left side of the image below). As a podiatrist, I am trained to look for clues in shoe inserts and shoe outer sole wear patterns. Usually the clues are more subtle. This patient was having major nerve problems in the right low back, and the nerves were not firing appropriately. 


  1. Hello Dr. Blake,

    Do you think a rocker bottom shoes will be of help in reducing the problems caused by increased impact on forefoot generated by foot slapping ?

    1. Daniel, Thank you so very much for the question. I would have to answer possibly yes and possibly no. Rocker bottom shoes are inherently unstable, allowing more motion going forward, and sometimes more pronation (inward motion). Foot Slap causes a violent forward motion of the foot on the leg (also an instability). Do these 2 instabilities cancel each other out? Rocker bottom shoes may ease the roll through the foot following heel strike over a traditional shoe in patients with foot slap. Unfortunately, if the foot slap is also associated with over pronation, the rockerbottom shoe may really add too much pronation. This should be easy to observe or feel when trying the shoes on in the store. Dr Rich Blake

  2. Dr. Blake,

    Thanks for your reply !
    A rocker type sole with a heel with lower hardness will be unstable and will allow more pronation in midstance [I'm thinking at MBT design]. But, I suppose that a more stiff [how much hardness ?] heel on a custom made rocker type sole will not encourage the pronation and will help with decreasing the deceleration of plantarflexion moment in the initial contact to midstance phases. These are only suppositions, this is why I ask your opinion !


Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.