Rocker Sole Research and Clinical Applications for Diabetes Patients.

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]