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La modificación del calzado y las ortesis de pie pueden desempeñar un papel importante en el tratamiento no quirúrgico de las afecciones del pie y tobillo. El calzado terapéutico se utiliza para el tratamiento de pacientes con diabetes, artrosis, afecciones neurológicas, lesiones traumáticas, deformaciones congénitas y lesiones deportivas. Estas modalidades mejoran el modo de andar y aumentan el grado de locomoción del enfermo. También se utilizan para tratar problemas agudos (como la fascitis plantar o la metatarsalgia) y como herramientas preventivas en pacientes con neuropatía diabética. La selección del calzado se basa fundamentalmente en el estado del enfermo, la forma y el tipo de pie y las actividades cotidianas del paciente. Las modificaciones consisten en refuerzos que proporcionan estabilidad, alzas para reducir las fuerzas de flexión; suelas en balancín para equilibrar el pie desde el apoyo con el talón hasta el despegue de los dedos; y el ahormado y rediseño del calzado para acomodarse a las deformidades. Los cuatro tipos principales de ortesis habituales son: adaptables, que proporcionan amortiguación y protección al pie; semirrígidas, que almohadillan y cubren el pie y le proporcionan soporte, control y redistribución del peso; rígidas, que proporcionan soporte al arco plantar; y prótesis parciales de pie, para las amputaciones parciales, que ayudan a proteger el pie. [ABSTRACT FROM AUTHOR]

Rocker sole shoes are commonly prescribed to diabetic patients with insensate feet. Recent passage of the therapeutic shoe bill has drawn an increased focus on prescription of rehabilitative footwear. The purpose of this work is to investigate the dynamics of lower extremity joints (hip, knee, and ankle) with the application of a toe-only rocker sole shoe under controlled laboratory conditions. Forty (40) normal adults volunteered for gait analysis using controlled baseline and prescription toe-only rocker sole shoes. Three-dimensional motion analysis techniques were used to acquire kinematic and kinetic data using a six camera Vicon 370 motion system and two AMTI force plates. While significant changes from baseline to toe-only rocker were noted in cadence (increased) and stride length (decreased), no significant change in walking speed was observed. The most significant kinematic changes with the application of the toe-only shoe occurred at the ankle and knee in the sagittal plane during stance. The most significant kinetic effects were observed in the hip and knee during swing phase. Changes in power were noted at all joints, mostly in terminal stance. These kinematic and kinetic changes, along with previously studied effects of pressure relief at the metatarsal heads, should aid medical professionals in prescribing prophylactic footwear. [ABSTRACT FROM AUTHOR]

Rocker soles are the most commonly prescribed shoe modification for treatment of diabetes-related foot problems. There is now significant published and ongoing research to justify their use and verify their efficacy. The purpose of this session is to explore the indications and applications for rocker soles in caring for patients with diabetes. Because of sensory neuropathy, the diabetic foot is at risk for ulceration. if these ulcers are left untreated and/or treated incorrectly can lead to osteomyelitis and ultimately amputation of the foot. Ulcers occur most often under areas of high pressure. Depth shoes with rocker soles are designed to relieve such high-pressure areas. Three commonly prescribed rockers are the toe-only, negative heel and double rocker sole. For this study, 40 healthy subjects were selected over 3 years. They were screened by a physician for foot deformities and questioned about their medical history as it relates to diabetes and/or neuropathies. Each was fitted for 2 pairs of shoes by a certified pedorthist. One would serve as the baseline shoe and the other would be modified weekly. The aforementioned 3 types of rockers were randomly assigned to each subject. A calibrated in-shoe pressure system was used to measure plantar pressures with sensors placed bilaterally under the hallux; heel; base of 5th metatarsal; and heads of the 1st, 2nd, between the 3rd and 4th, and the 5th metatarsal. Subjects began the study in their baseline shoes, then switched to the modified shoes and measured again after acclimating to the modifications. The goal of our study was to validate the pressure-reduction capabilities of a rocker compared to a baseline shoe. We found that the toe-only rocker significantly reduces forefoot pressures while increasing the weight-bearing load proximal to the metatarsal heads. The negative heel rocker sole also reduces forefoot pressures while increasing the weight-bearing load in the midfoot. However, because the negative heel rocker requires less material to be added to the shoe, patients felt more stable than in the toe-only rocker. The double rocker decreased both heel and forefoot pressures when compared to the baseline shoe. It also decreased midfoot pressure, although not significantly. Used correctly, rocker soles are valuable tools to help reduce plantar pressures and prevent foot ulcerations when caring for patients with diabetes. [ABSTRACT FROM AUTHOR]