Short communication In-shoe pressure distribution in ‘‘unstable’’ (MBT) shoes and flat-bottomed training shoes: A comparative study L. Stewart * , J.N.A. Gibson, C.E. Thomson Department of Orthopaedic Surgery, Royal Infirmary of Edinburgh, c/o Jennifer Hill, GU316, Chancellor’s Building, 49 Little France Crescent, Edinburgh EH16 4SB, United Kingdom Received 17 February 2006; received in revised form 9 June 2006; accepted 12 June 2006 Abstract Background: Footwear comfort in many clinical situations is dependent on the ability of the ‘shoe’ to redistribute plantar pressure. Offloading the metatarsal heads may be achieved by fitting an insole, but recently a new design of shoe with a curved under sole (Masai Barefoot Technology 1 or ‘‘MBT shoe’’) has been advocated. The aim of this study was to directly assess the effect of such shoes on gait pattern. Methods: Normal subjects were recruited and asked to walk sequentially in (a) flat-soled training shoes and (b) midfoot bearing shoes (MBT shoe). Mean and peak pressures in four anatomically defined areas of the foot, and the total area of sole contact were measured electronically by an in-shoe system (Pedar Ltd., UK). Principal results: Standing in the Masai shoes resulted in a 21% lesser peak pressure under the midfoot and an 11% lesser peak pressure under the heel in comparison to the figures found when patients wore their training shoes. There was a 76% compensatory increase in pressure under the toes. In essence there was a significant shift in pressure towards the front of the foot. # 2006 Elsevier B.V. All rights reserved. Keywords: Foot; Plantar pressure; Weight distribution; MBT shoes 1. Introduction Shoes receive the blame for many foot deformities and symptoms. Valgus deviation develops in some toddlers after they are introduced to shoes, and the higher prevalence of foot pathology in women is linked to their increased tendency to wear high-heeled and ill-fitting shoes. Focal increases in plantar pressure may also readily be linked to plantar ulceration, stress fractures, plantar fasciitis, heel spurs, and metatarsalgia [1,2]. Previous studies have found that changing shoe design can significantly alter the plantar pressure in specific regions of the foot. A rocker sole, used in patients with diabetic neuropathy, decreases the pressure under the medial and central forefoot and toes, but increases the pressure in the rest of the foot [3,4], whereas a high-heel relieves pressure under the hind foot [1,5]. The latter may be advantageous in patients with plantar fasciitis. The designers of the Masai Barefoot Technology shoe (MBT) have further developed the idea that footwear can have multiple effects on foot health and pathology. Based on observations of the Masai tribe who are not accustomed to wearing shoes, the MBT shoe is designed to recreate a natural uneven walking surface to reduce problems caused by today’s rigid soled shoes and hard ground. Amongst many other predicted benefits, the makers of MBT shoes claim that the shoe design with an unstable rounded sole (Fig. 1) distributes plantar pressure more equally and reduces the concentration of pressure on the heels. If these effects on pressure are found to be true, MBT shoes may offer an additional form of conservative management for a number of foot and lower limb pathologies. The aim of this study therefore, was to systematically assess the effect of the MBT shoe on plantar pressure. www.elsevier.com/locate/gaitpost Gait & Posture 25 (2007) 648–651 * Corresponding author. E-mail address: LauraLouiseStewart@hotmail.com (L. Stewart). 0966-6362/$ – see front matter # 2006 Elsevier B.V. All rights reserved. doi:10.1016/j.gaitpost.2006.06.012