The purpose of this study was to examine the effects on plantar pressure of the rocker bottom shoe, which is a frequently used intervention for the ulcerated diabetic foot. In-shoe pressure distribution was recorded during walking in a conventional extra-depth shoe which was then modified into a rocker bottom configuration with a 24° rocker, and the experiment was repeated. Peak pressures in the rocker shoe were reduced by ≈30% compared to the conventional shoe in the medial and central forefoot and in the toe regions, but pressures were elevated in the heel, the midfoot, and in the lateral forefoot regions. These experiments suggest that a correctly designed rocker bottom shoe may reduce the risk of ulceration in certain areas of the foot. However, since pressures in some regions can also be elevated by this type of footwear, attention to individual design is critical.
Get full access to this article
View all access options for this article.
References
1.
. BarrettJ.P.MooneyV.: Neuropathic and diabetic pressure lesions. Orthop. Clin. North America, 4(1):43–47, 1973.
2.
. BaumanJ.H.BrandP.W.: Measurement of pressure between foot and shoe. The Lancet, 23:629–632, 1963.
3.
. BaumanJ.H.GirlingJ.P.BrandP.W.: Plantar pressures and trophic ulceration: An evaluation of footwear. J. Bone Joint Surg., 45B(4):652–673, 1963.
4.
. BildD.E.SelbyJ.V.SinnockP.BrownerW.S.BravemanP.ShowstackJ.A.: Lower-extremity amputation in people with diabetes. Diabetes Care, 12(1):24–31, 1989.
5.
. BirkeJ.A.CornwallM.A.JacksonM.: Relationship between hallux limitus and ulceration of the great toe. J. Orthop. Sports Physical Ther., 10(5):172–176, 1988.
6.
. BirkeJ.A.SimsD.S.: Plantar sensory threshold in the ulcerative foot. Leprosy Reviews, 57:261–267, 1986.
7.
. BirkeJ.A.SimsD.S.BufordW.L.: Walking casts: effect of plantar foot pressures. J. Rehab. Res. Dev., 22(3):18–22, 1985.
8.
. BrandP.W.: Addendum to Chapter XXII. In Leprosy in Theory and Practice. CochraneR.G. (ed), Bristol, England: John Wright and Sons, 1959.
9.
. BrandP.W.: The diabetic foot. In: Diabetes Mellitus. Theory and Practise. EllenbergM.RifkinH. (eds), 3rd ed.Vol 2. New Hyde Park, N. Y.: Medical Examination Publishing; 1983, pp. 829–850.
10.
. CavanaghP.R.UlbrechtJ.S.: Pressure measurement in the diabetic foot. In: SammarcoJ.The Diabetic Foot. Philadelphia: W. B. Saunders, 1990.
11.
. ColemanW.C.: Footwear in a management program of injury prevention. In: The Diabetic Foot. LevinM.E.O'NealL.W. (eds.), 4th ed.St. Louis: C. V. Mosby, 1988, pp. 293–309.
12.
. ColemanW.C.: The relief of pressures using outer shoe sole modifications. In: Proceedings of the International Conference on Biomechanics and Clinical Kinesiology of the Hand and Foot. Mothirami-PatilK.SrinivasaH. (eds), Madras, India: Indian Institute of Technology, 1985, pp. 29–31.
13.
. ColemanW.C.BrandP.W.BirkeJ.A.: The total contact cast: a therapy for plantar ulceration on insensitive feet. J. Am. Podiatry Assoc., 74(11):584–552, 1984.
14.
. EdwardsC.A.: Orthopedic Shoe Technology for the Orthopedic Shoe Technician. Muncie, Indiana: Precision Printing Co., 1981, p. 246.
15.
. EnnaC.D.BrandP.W.ReedJ.K.WelchD.: Orthotic care of the denervated foot in Hansen's disease. Orthot. Prosthetics, 30(1):33–39, 1976.
16.
. HamptonG.H.: Therapeutic footwear for the insensitive foot. Physical Therapy, 59(1):23–29, 1979.
17.
. MarquartW.: Orthopaedishe Schuhe und Einlagen: Begriffsbestimmung. Orthopaedie; 1979, p. 8.
18.
. MilgramJ.E.JacobsonM.A.: Footgear: therapeutic modifications of the sole and heel. Orthop. Rev., VII(11):57–62, 1978.
19.
. NawoczenskiD.A.BirkeJ.A.ColemanW.C.: Effect of rocker sole design on plantar forefoot pressures. J. Am. Podiatric Med. Assoc., 78(9):455–460, 1988.
20.
. NicolK.HennigE.M.: Measurement of pressure distribution by means of a flexible large surface mat. In: Biomechanics VI-A. AsmussenE.JorgensonK., (eds.), Baltimore: University Park Press, 1978, pp. 374–380.
21.
. PollardJ.P.Le QuesneL.P.TappinJ.W.: Forces under the foot. J. Biomed. Engin.5:37–40, 1983.
22.
. PriceE.W.: Studies on plantar ulceration in leprosy. VI. The management of plantar ulcers. Leprosy Review, 31(3):159–171, 1960.
23.
. RossW.F.: Etiology and treatment of plantar ulcers. Leprosy Review, 31:25–40, 1960.
24.
. RossW.F.: Footwear and the prevention of ulcers in leprosy. Leprosy Review, 33:202–206, 1962.
25.
. SchaffP.HauserW.: Dynamische Druckverteilungsmessung mit flexiblen Messmatten - ein Innovatives Messverfahren in der Sportorthopaedie und Traumatologie. Sportverletzung-Sportschaden, 4:185–222, 1987.
26.
. SchaffP.KirschW.HauserW.MehnertH.: Eine Geraeteentwicklung zur Messung der Druckverteilung unter der Fussohle im Schuh und deren Anwendbarkeit in der Diabetologie. Akt. Endokrin. Stoffw., 7(3), 1986.
27.
. SimsD.S.BirkeJ.A.: Effect of rocker sole placement on plantar pressures (Abstract). In: Proceedings of the 20th Annual Meeting of the USPHS Professional Association. Atlanta, 1985, p. 53.
28.
. WardD.: Footwear in leprosy. Leprosy Review, 34:94–105, 1962.
