Optimisation of rocker sole footwear for prevention of first plantar ulcer: comparison of group‐optimised and individually‐selected footwear designs

Abstract

BackgroundAppropriate footwear for individuals with diabetes but no ulceration history could reduce the risk of first ulceration. However, individuals who deem themselves at low risk are unlikely to seek out bespoke footwear which is personalised. Therefore, our primary aim was to investigate whether group-optimised footwear designs, which could be prefabricated and delivered in a retail setting, could achieve appropriate pressure reduction, or whether footwear selection must be on a patient-by-patient basis. A second aim was to compare responses to footwear design between healthy participants and people with diabetes in order to understand the transferability of previous footwear research, performed in healthy populations.MethodsPlantar pressures were recorded from 102 individuals with diabetes, considered at low risk of ulceration. This cohort included 17 individuals with peripheral neuropathy. We also collected data from 66 healthy controls. Each participant walked in 8 rocker shoe designs (4 apex positions × 2 rocker angles). ANOVA analysis was then used to understand the effect of two design features and descriptive statistics used to identify the group-optimised design. Using 200 kPa as a target, this group-optimised design was then compared to the design identified as the best for each participant (using plantar pressure data).ResultsPeak plantar pressure increased significantly as apex position was moved distally and rocker angle reduced (p < 0.001). The group-optimised design incorporated an apex at 52% of shoe length, a 20° rocker angle and an apex angle of 95°. With this design 71–81% of peak pressures were below the 200 kPa threshold, both in the full cohort of individuals with diabetes and also in the neuropathic subgroup. Importantly, only small increases (<5%) in this proportion were observed when participants wore footwear which was individually selected. In terms of optimised footwear designs, healthy participants demonstrated the same response as participants with diabetes, despite having lower plantar pressures.ConclusionsThis is the first study demonstrating that a group-optimised, generic rocker shoe might perform almost as well as footwear selected on a patient by patient basis in a low risk patient group. This work provides a starting point for clinical evaluation of generic versus personalised pressure reducing footwear.

Footwear and insole design features for offloading the diabetic at risk foot—A systematic review and meta‐analyses

“…We excluded 28 of these articles based on irrelevant study population (n = 12), irrelevant study design (n = 4), irrelevant outcome/ intervention (n = 12) leaving 46 20‐65 included in the final review. As the initial search was undertaken in July 2016, updated searches were performed in December 2017 yielding 6918 articles, from which an additional three studies 66‐68 were included and November 2019 yielding 7821 articles from which a further five studies 69‐73 were included.…”

“…Fifty‐four studies met the inclusion criteria. Study designs included: n = 13 RCT’s, 23,25,31,38,42,49,55,56,61,62,70,73,77 n = 37 cohort studies, 20‐22,24,26‐30,32‐37,39‐41,43,45,47‐49,51‐54,57‐60,64,66‐68,71,72 n = 2 case‐control studies, 44,63 n = 1 nonintervention case series study 46 and n = 1 nonrandomized cross‐sectional over trial 65 . Four authors reported results of the same study in different papers 21,22,39,40,45,47,49,50 and therefore results from these studies were described, but only one set of each results was used within any meta‐analysis.…”

Evaluation of orthotic insoles for people with diabetes who are at‐risk of first ulceration

“…4), clinicians need to decide whether the hallux is a greater priority for pressure relief than metatarsal heads. Alternative insole designs or pressure-reducing footwear [40] may be more appropriate in these cases.…”

Prescription variables for the medical footwear

“…As a func# on of the placement of the rocker point rela# ve to the joint of interest, there are diff erent types: nega# ve heel, double or forefoot rocker. Modifying the angle rocker infl uences the value of the pressure under metatarso-phalangeal joints [38]. Standard types could be defi ned according to the joint of interest (ankle joint rocker, Lisfranc rocker, heel rocker, etc.).…”