The Influence of Shoe Design on Plantar Pressures in Neuropathic Feet

Abstract

OBJECTIVE -The aim of this study was to investigate the effect of shoe design on the plantar pressure dynamics of patients with diabetic neuropathy during walking.RESEARCH DESIGN AND METHODS -Three shoe design categories were tested. Total contact area and biomechanical variables in multiple areas under the foot were measured.RESULTS -Shoes with a rocker bottom principle reduced pressure 35-65% underneath the heel and the central metatarsal heads. Increased contact area did not result in significant pressure reductions underneath the forefoot. Pressure dynamics underneath the heel and medial forefoot (first metatarsal head and hallux) on average showed no significant differences among the different shoes with a cushioning insole.CONCLUSIONS -The most effective way to offload the forefoot of patients with neuropathic feet is through the use of the rocker sole principle. In general, the effect of an insole depends on the design characteristics of a shoe. Predicting the effect of therapeutic footwear on an individual scale, however, remains difficult. Therefore, in-shoe pressure measurements seem to be necessary to evaluate a therapeutic shoe prescription in certain individual cases. Diabetes Care 26:441-445, 2003B auman et al. (1) were among the first researchers who published their study on the relationship between high-pressure areas and plantar ulceration in the insensitive foot. They appreciated the effect of both a total contact cast and certain orthopedic shoes on the healing process of neuropathic ulcers. They investigated the effect of shoe sole design on plantar pressure reduction using small pressure sensors taped to specific areas underneath the sole of the foot.Using similar equipment 25 years later, Nawoczenski et al. (2) showed that certain pivotal and curved rocker bottom shoes were able to effectively reduce forefoot pressure in normal subjects. Many studies have followed since then (rev. in 3). However, despite all the pioneering work, different disciplines dealing with the neuropathic foot often still disagree about which therapeutic shoe modalities to prescribe. In the Netherlands, also, this is a continuing topic of dispute. Although some strongly propagate the use of custom made (orthopedic) shoes with a stiff sole and rocker bar to prevent recurrence of a neuropathic ulcer, others recommend the use of an extra depth shoe. It has been argued that these less heavy, more cosmetically attractive shoes would be at least as effective in preventing recurrence of neuropathic ulcers.According to Spencer, "There is a need to measure the effectiveness of the range of pressure relieving interventions for the prevention and treatment of diabetic foot ulcers as there is a small amount of poor quality research in this area" (3). The present study was performed to investigate the relation between shoe design and pressure reduction in the context of the above discussion. Three shoe design categories were tested. Total contact area and biomechanical variables in multiple areas under the foot were measured usin...

Biomechanics of Pressure Ulcer in Body Tissues Interacting with External Forces during Locomotion

“…Increase in heel height may shift the peak pressure region to the forefoot, such as to the first metatarsal and hallux regions (64). A rocker bottom outsole may reduce the forefoot pressure during walking (65).…”

The effectiveness of footwear and offloading interventions to prevent and heal foot ulcers and reduce plantar pressure in diabetes: a systematic review

“…These include a variety of prefabricated and custommade therapeutic footwear designs, hosiery (socks) and running shoes. Shoes with a rocker-bottom outsole were found to be effective in reducing forefoot peak pressures [91]. Footwear with some sort of molded insole also provided significant reductions in plantar pressure [88,89,[92][93][94][95][96][97][98][99][100][101][102].…”

Experimental Study on Different Characteristics of Plantar Pressure Distribution in Different Sports Shoes

“…Nawata et al analyzed the plantar pressure of 70 students during exercise [5]; Sacco et al analyzed the effects of different types of shoes on the leg muscles and plantar pressure [4]; Mika et al studied the influence of high heels on the spines and plantar arch of women during gait [6]; Nagel and Van et al studied how to modify the structure of shoes to reduce the pressure in forefoot [7][8]; De et al studied the changes in plantar pressure during running on bare foot and in shoes [9]; Henning et al studied the difference in plantar pressure in different kinds of sports shoes [10]. At the same time, some scholars also designed healthcare shoes that could help people lose weight, correct posture, reduce injuries during gait and lower plantar loads [11][12][13][14][15][16][17].…”