Biomechanical implications of the negative heel rocker sole shoe: gait kinematics and kinetics.

Rocker sole shoes are commonly prescribed to diabetic patients with insensate feet. Recent passage of the therapeutic shoe bill has drawn an increased focus to prescription 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 negative heel rocker sole shoe under controlled lab conditions. Forty normal adults volunteered for gait evaluations using controlled baseline and prescription negative heel 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. No significant change in walking speed or stride length was seen with the negative heel rocker shoe, although cadence was increased. The most significant kinematic changes with the application of the negative heel shoe occurred at the ankle in the sagittal plane with increased plantarflexion at terminal stance. Significant hip and knee changes were also noted with increased mid-stance hip extension and knee flexion. The most significant kinetic effects were seen in the transverse plane followed by changes in the sagittal and coronal planes. Changes in power were mostly noted in the sagittal plane. Other statistically significant changes in gait kinematics and kinetics were observed, although the magnitudes and durations were limited and as a result were not considered clinically significant. The study results indicated the negative heel rocker shoe significantly altered proximal joint metrics (hip and knee). The most significant distal joint alterations were seen in sagittal plane ankle kinetics. 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.

Biomechanics of the double rocker sole shoe: gait kinematics and kinetics.

This paper reports the kinematic and kinetic changes in gait with bilateral double rocker sole shoe modifications. Three-dimensional motion analysis techniques were used to evaluate gait characteristics (temporal-spatial, kinematic, and kinetic measures) of forty (40) subjects while wearing baseline and double rocker sole shoes. Walking speed was unchanged by the double rocker modification. Sagittal plane motions showed significant change at the pelvis, hip, knee, and ankle. (p = 0.01). The toe-only rocker consistently resulted in increase in posterior pelvic tilt (p =0.01). Kinetic changes were observed at the hip in the sagittal and transverse planes, and at the knee and ankle in the sagittal planes. Changes in pelvic tilt and hip rotation were hypothesized to result from feelings of imbalance during ambulation with the double rocker sole shoe.

Preventive foot care in people with diabetes.

A number of effective, low-cost strategies are available to identify and treat the person at risk for diabetic foot ulcers and lower-extremity amputation. These strategies must be more widely adopted by all diabetic care providers to maintain the integrity and function of the lower limb, and thus improve the quality of life for people with diabetes.

Prescription footwear for arthritis of the foot and ankle.

The Board Certified Pedorthist can be a valuable member of the team of healthcare professionals involved in the treatment of arthritis of the foot and ankle. In addition to providing prescription footwear, the pedorthist can assist in educating the patient, postoperative care, and long term monitoring of the patient's progress. The objectives in the pedorthic care of arthritis of the foot and ankle are to reduce shock and shear; to relieve excessive pressure from sensitive or painful areas; to accommodate, correct, and support deformities; and to control or limit painful motion of joints. Specific types of prescription footwear used to accomplish these objectives include shoes, external shoe modifications, and custom made foot orthoses.

Prescription insoles and footwear.

Current research emphasizes the importance of prevention in caring for the diabetic foot. Prescription footwear has been shown to be a significant factor in prevention of both ulcer recurrence and amputation. In addition, scientific evidence demonstrates the ability of insole materials to reduce shock and shear, the effectiveness of insoles in providing pressure relief, and the ability of rocker soles to relieve metatarsal pressure. This evidence, however, is limited and is often based on clinical investigation rather than on objective, quantitative measurements. Recent advances in biomechanical modeling and in-shoe pressure measurement should allow more objective data on a wider variety of prescription footwear to become available. The importance of prescription footwear as a preventive measure is nonetheless widely recognized. The knowledge and experience of pedorthists make them uniquely qualified to provide the needed shoes, modifications, and insoles for the long-term management of the diabetic foot.

Indications and prescriptions for orthoses in sports.

The use of orthoses, in conjunction with appropriate shoes and external shoe modifications, is an important part of the overall treatment program for foot and ankle injuries in sports. Prescription footwear can also be a significant factor in injury prevention. Similarly, the CPed is an important member of the team involved in treating and preventing foot and ankle injuries in sports. By providing footwear, patient education, and follow-up assistance, the CPed can make a valuable contribution to a comprehensive program of treatment and injury prevention.

The art and science of fitting shoes.

The two primary components of achieving proper shoe fit are shoe shape and shoe size. Shoe shape refers to the shape of both the sole and the upper. Proper fit is achieved when shoe shape is matched to foot shape. Shoe size is determined by arch length rather than overall foot length. The proper shoe size is the one that accommodates the first metatarsal joint in the widest part of the shoe. A set of seven guidelines for achieving proper shoe fit is offered. Properly fitting shoes are important in avoiding foot discomfort and deformity, and are absolutely essential in patients with arthritis, diabetes, and other foot disorders.