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Skechers proposing $40 million to settle class action

According to Big Class Action, Skechers have proposed to settle the class action for $40 million.

A $40 million settlement has been proposed in a consumer fraud class action lawsuit pending against toning shoe manufacturer Skechers U.S.A.

Entitled Grabowski v. Skechers U.S.A., Inc., No. 3:12-cv-00204 (W.D. Ky.), the lawsuit concerns claims that Skechers violated certain state laws and consumer protection statutes in connection with the marketing and sale of its toning shoes. Skechers denies those allegations.

Internet Interest in Toning Shoes

I have just been looking at Google trends to see what interest there is in toning shoes. There has been a big decline in the number of people searching for ‘toning shoes’ at Google since a peak in December2011:

According to Google Adwords tools, there are 12 000 searches each month for ‘toning shoes’.

Spine kinematics and trunk muscle activity using unstable footwear

This study from researchers at the University of Salzburg in Austria that looked at spinal alignment and muscle activity of selected muscles in the back while standing in typical shoes and MBT shoes.

The main findings were:

Results showed that wearing unstable MBT shoes increased flexion at the mid-thoracic level (0.8°; P = 0.001) and led to greater mean velocities of angular displacement at the thoracolumbar (11.2%; P = 0.003) and at the lumbopelvic (10.8%; P = 0.02) regions, accompanied by more lumbar erector spinae activity (18.2%; P = 0.003).

Evaluation:
– this was done during standing and not walking
– it does confirm that there are changes in the low back, spine and muscle activity with the use of unstable or toning shoes

While adding to the body of knowledge on the biomechanical effects of toning shoes, more work is needed to determine the actual ‘clinical’ effects of those changes.

Toning Shoes for Children

This is certainly a controversial area. Skechers did target an advertising campaign in 2011 aimed at girls which did anger some parent groups and advertising industry groups. The shoes and their promotion were targeted at age 7 and up. The campaign used slim cartoon characters as a girl band and run on the Cartoon Network and Nickelodeon:

Skechers childrens toning shoes advert

There was a change.org petition asking Skechers to stop marketing the shoes:

The commercial in question features a band of thin girls singing about their shoes, and being followed around by surly looking boys dressed like ice cream, burgers, and other “junk” foods. Women have plenty of time to be targeted for their weight throughout their lives. By not only marketing a shoe line to young girls, but also not even having an equivalent for boys Skechers is sending a clear message to girls and women: you’re never too young to start hating your body.

Skechers responded:

This person’s concerns about Shape-ups for Girls are unfounded and way off base. The whole message behind Shape-ups is to get moving, get exercise, and get fit. This is the same messaging being used by the First Lady’s Let’s Move initiative, which is aimed specifically at children. Please look this site over and ask yourself whether the person who started the petition might voice the exact same concerns about the Let’s Move messaging for children.

Skechers are still producing the shoe.

Putting aside the above concerns about the marketing, what about the use of toning shoes in children?

I think that the predominant consensus among podiatry and health professional groups as well as industry commentators would be that if children wear shoes, then those shoes should not interfere with the normal motion and development of the foot. By that apparent consensus, then a toning shoe would appear to interfere with normal foot function, especially the windlass mechanism of the foot and run the risk of interfering with the normal development of the foot as a consequence. However, given that children do not wear shoes 24/7, it is not clear just how much of a problem that this would be. It is also not clear how much of an interference over what sort of time period is needed to really be a long term problem. There are lots of opinions, rhetoric and propaganda on this with very little science.

Children wearing toning shoes for short periods of time are possibly going to have some benefits in developing improved balance and co-ordination as they do use the muscles differently and the gait is altered. How can that be a problem? It must be helpful. That has to be balanced against the potential of interfering with normal development. It will have to be one of trade-offs.

Will they lead to a weakening of muscles? Unlikely, as most kids do spend a reasonable amount of time running around barefoot. Toning shoes do work some muscles harder, so that is not going to lead to a weakening either.

The alteration in gait that occurs in these shoes may be helpful in some children with some type’s neurological deficits. This is going to have to be a decision made in consultation with the clinician involved in treating the child and if this type of shoe would have a negative or positive effect on the particular gait of the individual.

My recommendations:
– Normal development of the foot should not be interfered with by the footwear
– The toning shoes are probably not going to do any harm provided they are used in moderation
– The shoes may even be helpful if worn for short periods
– They may be useful in certain gait patterns in certain neurological problems in children

Do Toning Shoes Interfere with the Windlass Mechanism of the Foot?

The windlass mechanism of the foot is an extremely important element in the normal functioning of the foot. It is the foots own natural arch supporting mechanism. The windlass mechanism consists of the plantar aponeurosis or plantar fascia. This powerful ligament attaches to the bottom of the heel bone and to the bases of the toes, so straddles the arch of the foot. During gait, when the heel comes off the ground, the toes flex, pulling on the plantar fascia and winding it around the metatarsal head (the ‘windlass’). This tightens the plantar fascia and supports the arch naturally. There are a number of different dysfunctions of the plantar fascia that can affect the windlass mechanism (see this).

windlassSource: http://en.wikipedia.org/wiki/File:PF-PlantarMove.jpg

What impact do toning shoes have on this windlass mechanism?
Quite frankly, they actually interfere with it. As most of the toning shoes use designs that incorporate a rocker bottom, the toes do not need to flex during gait, so the windlass mechanism is not ‘tightened’ up and the foot’s natural arch supporting mechanism is not engaged. In a lot of cases, this will not be absolute and there may well be some partial activation of the windlass mechanism. This will depend of the exact toning shoe used and the natural gait of the person using it, so it will be individual.

Is that a problem or not?
It might be or it might not be. It is going to depend on a lot of other factors. It is going to have to be one of trade-offs. For example, what are the benefits of wearing the shoe versus the negative of the windlass mechanism not working. It could well be that part of the ‘toning’ effect for the muscles being made to work harder comes as the muscles need to support the arch more as the windlass mechanism does not support it. There is certainly no research that has looked at the effect of the toning shoes on the windlass mechanism or the consequences of the potential interference with it.

However, those with problems of windlass dysfunction, may need to approach the use of toning shoes with caution as any worsening of their windlass mechanism function could potentially be problematic. More can be found on the problems of the windlass mechanism at Run Research Junkie.

Rocker Bottom Shoes and Falls Risk in Those With Diabetes

Those with diabetes mellitus have an increased risk for falls. This is mostly due to the development of peripheral neuropathy which reduces the sensory input from the plantar surface of the foot. This neuropathy also puts them at increased risk for complication such a plantar ulcers, often referred to as the diabetic foot. A number of different strategies are often used to reduce the pressures under the ball of the foot to reduce the risk of these complications. One of these methods is a rocker bottom shoe. This has been shown to reduce plantar pressures, but there is a risk it may increase the risk for falls due to the instability the rocker may create.

A study in Gait and Posture from researchers at East Carolina University used 20 healthy controls to investigate what rocker sole shoes did to parameters associated with the center of mass and center of pressure which are measure of postural stability. They concluded:

In young healthy adults, shoes with rocker bottom soles had a destabilizing effect to perturbed stance, thereby increasing the potential for imbalance. These results raise concerns that footwear with rocker bottom sole modifications to accommodate an insensate foot may increase the risk of falls.

Evaluation:
– the subjects were healthy adults and not people with diabetic neuropathy.
– its does point to a theoretical increase in instability in those who do have diabetic neuropathy.
– rocker sole shoes probably should be used with caution in those with diabetic foot complications, especially if they have other risk factors present for falls.

Skechers Lawsuit for Causing Bulging Disc

According to a press release from Wright & Schulte, LLC, they have filed a suit against Skechers:

alleging that his regular use of Skechers Shape-Ups resulted in five bulging discs in his lower back and his severe back injuries caused him to lose strength in his legs. Filed on December 15, 2012, this case (Case No. 3:12-cv-00838-TBR) names the defendants to be Skechers, U.S.A., Inc., Skechers, U.S.A., Inc., II and Skechers Fitness Group

According to court documents, the plaintiff purchased three pairs of Skechers Shape-Ups in 2009 and 2010 and after regularly wearing these Skechers toning shoes for two years, the plaintiff began experiencing severe lower back pain and decreasing strength in his legs allegedly due to Skechers toning shoes. Upon visiting a physician and undergoing an MRI, the plaintiff was informed that he had five bulging discs in his lower back and that his injuries would require surgery.

Court documents state that the fundamentally precarious rocker-bottom design of Skechers toning shoes caused the plaintiff’s injuries. They also allege that the manufacturers of these shoes did not perform any safety testing even when consumers had suffered from Skechers injuries and that the Skechers corporations never warned the public about the possibility of injuries associated with these toning shoes.

No comment was available from Skechers as they do not comment on litigation.

Does the case have merit? I guess it all depends what risk factors for “bulging disks” were present before they started wearing the Skechers Shape-Ups and how much they contributed to the problem (see the post on achilles tendon ruptures and toning shoes)

Toning shoes for plantar fasciitis?

A study published in Clinical Biomechanics (online Sept 2012) looked at pain levels in people aged 40-65 with plantar fasciitis. Using a visual analogue pain scale, they compared the use of foot orthotics to toning shoes to foot orthotics and toning shoes.

The pain scores on the VAS for the 3 conditions were:

Rocker shoes and foot orthotics:  9.7mm
Rocker shoes: 30.9
Foot Orthoses 29.5

So the rockers shoes combined with foot orthoses produced the best results and the authors concluded:

The findings indicate that a combined prescription of rocker sole shoes and custom-made foot orthoses had greater immediate therapeutic effects compared to when each treatment had been individually prescribed.

Evaluation:
– this is not a very commonly used intervention for treating plantar fasciitis
– this was an acute intervention and the participants were not followed over time
– the VAS is not the most validated measure for pain levels in plantar fascitis

For more on plantar fasciitis, see this post.and this essay. Run Junkie has one of the sensible approaches to it.

Do Toning Shoes Casue an Achilles Tendon Rupture?

A recent news report talks about litigation against Skechers from a male who claims that his Achilles tendon was ruptured from the use of their Shape Up toning shoes. The case has not been heard yet and there is no statement from Skechers.

Is the claim valid?

Toning shoes do alter the way you walk. They do alter the loads on different tissues, and yes they do make the calf muscles work harder, so they do place a greater load on the Achilles tendon. Much more is needed to rupture it though (more on Achilles ruptures), so to claim it is the cause is, in my opinion, a bit of a stretch. There must be a number of other risk factors present first and an Achilles tendon rupture is usually accompanied with simultaneous ankle dorsiflexion and knee extension. That will possibly be increased somewhat in toning shoes that have a rocker bottom. Generally a number of risk factors need to be in place for the rupture to happen, so the toning shoes can only be one of them.

As by way of analogy, there was the controversy when the Cox-2 inhibitor, Vioxx which was used as an anti-inflammatory agent was withdrawn from the market due to the increased risk for cardiovascular events. A number of people who had heart attacks or strokes while on this drug sued. Most of the cases failed, as they already had the risk factors for the heart attack or stroke (see this Wikipedia discussion) and Vioxx was not found to be the causative factor.

It will be interesting to see which way this Skechers case goes, or if it is just settled (which would be shame, as I would like to know which way the courts would rule!). Would they rule in favor of the litigant that the shoes caused the Achilles rupture or will they rule like in the Vioxx cases that other risk factors were already present?

The problem of illegal knock offs

Ever since MBT started the footwear category for the toning shoes, they have been plagued with the illegal reproduction of their shoes. Like any company they are constantly having to fight this on many fronts. One of these fronts is to try and get the websites that sell the illegal copies removed from the search engines. In order to maintain transparency, Google reports the number and some information on the copyright removal request that it gets and actions. Here is the details on the requests received from Masai Marketing and Trading AG for the MBT shoes. This give an indication of the extent of the problem.

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