Abstract
We aimed to identify if any differences existed in spatiotemporal parameters during gait among different densities of rocker soles in patients with a history of neuropathic ulcerations and the differences in comfort between shoe conditions. This study was a cross-sectional study of 24 patients with diabetes and a history of neuropathic diabetic foot ulcers (DFUs). Spatiotemporal parameters (duration of stance phase (ms), stride length (cm), and step velocity (m/s)) were analyzed in barefoot, semirigid outsole, and rigid outsole footwear conditions. A dynamic pressure measurement system (Footscan® system, RSscan International, Olen, Belgium) was used to assess shoe conditions. We also analyzed differences in comfort between the shoe conditions using a visual analog scale. A Wilcoxon test for paired samples was used to assess gait differences. Result showed that a rigid outsole causes changes in the subphases of the stance phase (p < 0.001; Cohen d = 0.6) compared to a semirigid outsole. Stride length (p < 0.001; Cohen d = 0.66) and step velocity were significantly longer (p < 0.001; Cohen d = 2.03) with the use of rigid outsole footwear. A rigid rocker sole reduces the time of the stance phase, in addition to increasing the stride length and velocity of step in patients with a previous history of DFUs.
Highlights
Diabetic foot ulcers (DFUs) are one of the most common complication of diabetes mellitus [1], accounting for 20% of minor and major amputations due to diabetic foot ulcer (DFU)-induced infections [2]
Almost 50% of DFUs appear on the plantar surface of the forefoot [6], and diabetic polyneuropathy (DPN) plays a key role in their development, due to reduced proprioception of the patients and reduced range of motion of foot joints [7]
It has been hypothesized that a rigid rocker sole restricts the dorsiflexion of the toes, quickening the transition from the total contact phase of the foot to the push-off phase during gait in patients with diabetes mellitus (DM) and DPN [16]
Summary
Diabetic foot ulcers (DFUs) are one of the most common complication of diabetes mellitus [1], accounting for 20% of minor and major amputations due to DFU-induced infections [2]. Patients with an active DFU have a 2.5 times higher risk of death [3], and the mortality rate increases to 70% 5 years after undergoing an amputation [4]. Almost 50% of DFUs appear on the plantar surface of the forefoot [6], and diabetic polyneuropathy (DPN) plays a key role in their development, due to reduced proprioception of the patients and reduced range of motion of foot joints [7]. The combination of DPN, a history of DFUs, and minor amputations significantly increases the risk of reulceration to 40% in the first year after ulcer healing [1]. A rigid rocker sole effectively reduces the rate of plantar reulceration [12]
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