Shoes for the Insensitive Foot: The Effect of a “Rocker Bottom” Shoe Modification on Plantar Pressure Distribution

Schaff, P.; Cavanagh, Peter R.

doi:10.1177/107110079001100303

Cited by 121 publications

(77 citation statements)

References 14 publications

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“…These may reduce the risk of ulceration by reducing peak plantar pressures (Schaff and Cavanagh 1990). In the design of orthopaedic shoes for the diabetic, an indication of the plantar pressure distribution needs to be obtained, so that an insole can be designed to reduce pressure in regions prone to ulceration.…”

Section: Methods Of Prevention and Treatment Of Diabetic Foot Complicmentioning

confidence: 99%

An in-shoe laser Doppler sensor for assessing plantar blood flow in the diabetic foot

Cobb¹,

Claremont²

2001

Medical Engineering & Physics

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An in-shoe laser Doppler sensor for assessing plantar blood flow in the diabetic foot. Jonathan Edwin CobbPlantar ulceration is a complication of the diabetic foot prevalent in adults with type 11 diabetes mellitus. Although neuropathy, microvascular disease and biornechanical factors are all implicated, the mechanism by which the tissue becomes pre-disposed to damage remains unclear. Recent theories suggest that the nutritional supply to the tissue is compromised, either by increased flow through the arteriovenous anastomoses ('capillary steal' theory) or through changes in the micro vascu I ature (haemodynamic hypothesis). Clinical data to support these ideas has been limited to assessment of the unclad foot under rest conditions. A limitation of previous studies has been the exclusion of static and dynamic tissue loading, despite extensive evidence that these biornechanical factors are essential in the development of plantar ulceration. The present study has overcome these problems by allowing assessment of plantar blood flow, in-shoe, during standing and walking.The system comprises a laser Doppler blood flux sensor operating at 780nm, load sensor, measurement shoe, instrumentation, and analysis software. In-vitro calibration was performed using standard techniques. An in-vivo study of a small group of diabetic subjects indicated differences in the blood flux response between diabetic neuropaths, diabetics with vascular complications and a control group. For example, following a loading period of 120s, relative increases in response from rest to peak were: Control (150% to 259%), Vascular (-70% to 242%), Neuropathic (109%-174%) and recovery times to 50% of the peak response were: Control (33s to 45s), Vascular (43s to >120s), Neuropathic (>120s). Dynamic re-perfusion rates (arbitrary units per millisecond) obtained for the swing phase of gait were: Control (6.1 a. u/ms to 7.9 a. u/ms), Vascular (4 a. u/ms to 6.2 a. u/ms), Neuropathic (2.3 a. u/ms to 4.5 a. u/ms).

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Section: Methods Of Prevention and Treatment Of Diabetic Foot Complicmentioning

confidence: 99%

An in-shoe laser Doppler sensor for assessing plantar blood flow in the diabetic foot

Cobb¹,

Claremont²

2001

Medical Engineering & Physics

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“…Schaff (Schaff, et al, 1990) found changes in forefoot peak pressures with a lateral shifting of high pressure areas. Significant changes were also seen in temporal parameters.…”

Section: Introductionmentioning

confidence: 99%

“…Specific shoe design is based on pressure measurements from a floor-reaction imprint; our group has previously demonstrated the effectiveness of this design in relieving midfoot pressures without exacerbating hindfoot or forefoot pressures (Brown, et al, 2004). Other investigations of plantar pressure changes secondary to such modified footwear are widely reported in the literature (Chesnin, et al, 2000;van Schie, et al, 2000;Fuller, et al, 2001;VanZant, et al, 2001), but investigations of changes in joint motion (kinematics) and joint loading (kinetics) are less common (Peterson, et al, 1985;Schaff, et al, 1990;Mueller, et al, 1995;Dingwell, et al, 1999;Xu, et al, 1999). The studies that do exist are generally limited to observational or quantitative two-dimensional analysis.…”

Section: Introductionmentioning

confidence: 99%

Biomechanics of the double rocker sole shoe: Gait kinematics and kinetics

Long

Sirota

Klein

et al. 2007

Journal of Biomechanics

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The use of footwear with contoured soles is common in treatment and care of patients with diabetes; these rocker sole shoes are designed to alleviate loading in key areas on the plantar surface of the foot, reducing pressure in key areas and alleviating pain and potential soft tissue damage. While investigations of pressure changes have been conducted, no quantitative study to date has addressed the three-dimensional kinematic and kinetic changes that result from using these shoes. Forty (40) subjects were tested wearing both unmodified and double rocker sole shoes, and the resulting motion patterns were compared to assess change caused by the rocker sole. Overall walking speed remained unchanged throughout testing; slightly increased flexion (<5°) was apparent at the hip, knee, and ankle during early and midstance. These results demonstrate the maintenance of gait function with minimal kinematic changes when using the rocker sole shoe. Investigations of multisegmental foot motion may reveal additional information about the contour effects; analysis of contour variations may also be warranted to investigate the possibility of controlling motion based on rocker sole parameters.

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“…Frequent assessment of risk factors (neuropathy, foot deformity, history of ulceration and angiopathy) is necessary for the early detection of patients at risk for developing foot disease and for preventing amputation. Better patient education about foot care and appropriate footwear are expected to prevent at least half of the amputations for diabetic foot disease (Assal et al, 1985;Edmonds et al, 1986;Schaff and Cavanagh, 1990;Barth et al, 1991;Thomson et al, 1991).…”

Section: Introductionmentioning

confidence: 99%

Evaluation of a screening and prevention programme for diabetic foot complications

Meijer

Links²,

Smit

et al. 2001

Prosthetics &Amp; Orthotics International

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Foot complications in diabetes can be decreased by preventive measures. The authors evaluated the current diabetic foot screening and prevention programme of the diabetes outpatient clinic of their university hospital, by assessing the presence of risk factors for the development of foot disorders and the preventive measures taken.Fifty (50) diabetic patients not known to have foot complications were selected at random. Risk factors and preventive measures were inventarised with the Coleman riskcategorization system and the Preventive Measures Scale, respectively.Sixty per cent (60%) of the patients were at risk of developing diabetic foot complications. The preventive measures were low in these patients. Patient knowledge was insufficient and behaviour even worse. Basal preventive shoe adaptations were absent in most patients at risk. No relation between risk category and the preventional status was found.Cross-sectional examination at a university outpatient clinic showed serious risk profiles for foot complications, which were not balanced by the application of generally accepted preventive measures. At the outpatient clinic, screening should be optimised.

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Shoes for the Insensitive Foot: The Effect of a “Rocker Bottom” Shoe Modification on Plantar Pressure Distribution

Cited by 121 publications

References 14 publications

An in-shoe laser Doppler sensor for assessing plantar blood flow in the diabetic foot

An in-shoe laser Doppler sensor for assessing plantar blood flow in the diabetic foot

Biomechanics of the double rocker sole shoe: Gait kinematics and kinetics

Evaluation of a screening and prevention programme for diabetic foot complications

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