Effect of rocker shoe design features on forefoot plantar pressures in people with and without diabetes.

BACKGROUND: There is no consensus on the precise rocker shoe outsole design that will optimally reduce plantar pressure in people with diabetes. This study aimed to understand how peak plantar pressure is influenced by systematically varying three design features which characterise a curved rocker shoe: apex angle, apex position and rocker angle. METHODS: A total of 12 different rocker shoe designs, spanning a range of each of the three design features, were tested in 24 people with diabetes and 24 healthy participants. Each subject also wore a flexible control shoe. Peak plantar pressure, in four anatomical regions, was recorded for each of the 13 shoes during walking at a controlled speed. FINDINGS: There were a number of significant main effects for each of the three design features, however, the precise effect of each feature varied between the different regions. The results demonstrated maximum pressure reduction in the 2nd-4th metatarsal regions (39%) but that lower rocker angles (<20°) and anterior apex positions (>60% shoe length) should be avoided for this region. The effect of apex angle was most pronounced in the 1st metatarsophalangeal region with a clear decrease in pressure as the apex angle was increased to 100°. INTERPRETATION: We suggest that an outsole design with a 95° apex angle, apex position at 60% of shoe length and 20° rocker angle may achieve an optimal balance for offloading different regions of the forefoot. However, future studies incorporating additional design feature combinations, on high risk patients, are required to make definitive recommendations.

Fetal wastage in women with anti-Ro(SSA) antibody.

Retrospective obstetric histories were obtained in 50 anti-Ro(SSA) antibody positive women (aged 15-50 years) and 47 anti-nRNP antibody positive women of similar age range. Twenty (40%) anti-Ro(SSA) positive women and 33 (70%) anti-nRNP positive women fulfilled the revised ARA criteria for systemic lupus erythematosus (SLE). Thirty-four anti-Ro(SSA) positive women had a total of 84 pregnancies with a fetal loss of 28%; 29 anti-nRNP positive women had a total of 63 pregnancies with a fetal loss of 19%. Although the overall frequency of fetal wastage between the 2 groups was not significantly different, analysis of the subgroup of SLE patients demonstrated a significantly greater fetal wastage in black anti-Ro(SSA) positive women (15 of 21, 71%) compared with black anti-nRNP positive women (5 of 28, 18% p less than .001). No significant difference in fetal wastage was noted between either the white SLE or the non-SLE women in either antibody group. These data suggest that black SLE patients with anti-Ro(SSA) antibody may be at increased risk of fetal wastage.

Dyshidrotic eczema associated with piroxicam photosensitivity.

Piroxicam has been reported to cause photosensitivity in several patients. Two patients with an unusual variant involving a dyshidrotic eruption of the palms are described herein.