The Influence of Shoe Design on Plantar Pressures in Neuropathic Feet

• Published in: Diabetes care Vol. 26; no. 2; pp. 441 - 445
• Main Authors: PRAET, Stephan F. E, LOUWERENS, Jan-Willem K
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01-02-2003
• Subjects: Aged; Associated diseases and complications; Biological and medical sciences; Care and treatment; Diabetes; Diabetes. Impaired glucose tolerance; Diabetic foot; Diabetic Neuropathies - physiopathology; Diabetics; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Equipment Design; Feet; Female; Foot; Foot - physiopathology; Health aspects; Humans; Medical sciences; Middle Aged; Pain Measurement; Pressure; Product design; Shoes; Shoes & boots; Ulcers; Walking; Endocrinopathy; Human; Nervous system diseases; Diabetes mellitus; Shoe; Peripheral neuropathy; Pressure; Design; Walking; Plantar; Orthopedics; Adult; Female; Peripheral nerve disease; Elderly; Comparative study
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/diacare.26.2.441

The Influence of Shoe Design on Plantar Pressures in Neuropathic Feet
Stephan F.E. Praet , MD, MSC 1 2 and
Jan-Willem K. Louwerens , MD, PHD 1 3
1 University Medical Center Utrecht, Orthopaedic Surgery, Utrecht, The Netherlands
2 Maxima Medical Center, Sports Medicine, Veldhoven, the Netherlands
3 St. Maartens Clinic, Orthopaedic Surgery, Nijmegen, The Netherlands
Abstract
OBJECTIVE —The aim of this study was to investigate the effect of shoe design on the plantar pressure dynamics of patients with diabetic
neuropathy during walking.
RESEARCH DESIGN AND METHODS —Three shoe design categories were tested. Total contact area and biomechanical variables in multiple areas under the foot
were measured.
RESULTS —Shoes with a rocker bottom principle reduced pressure 35–65% underneath the heel and the central metatarsal heads. Increased
contact area did not result in significant pressure reductions underneath the forefoot. Pressure dynamics underneath the heel
and medial forefoot (first metatarsal head and hallux) on average showed no significant differences among the different shoes
with a cushioning insole.
CONCLUSIONS —The most effective way to offload the forefoot of patients with neuropathic feet is through the use of the rocker sole principle.
In general, the effect of an insole depends on the design characteristics of a shoe. Predicting the effect of therapeutic
footwear on an individual scale, however, remains difficult. Therefore, in-shoe pressure measurements seem to be necessary
to evaluate a therapeutic shoe prescription in certain individual cases.
EVA, ethyl vinyl acetate
VAS, visual analog scale
Footnotes
Address correspondence and reprint requests to Dr. Stephan F.E. Praet, Maxima Medical Center, Department of Sports Medicine,
P.O. Box 7777, 5500 MB Veldhoven, The Netherlands. E-mail: spraet{at}sjz.nl .
Received for publication 22 February 2002 and accepted in revised form 1 November 2002.
S.F.E.P. has received consulting fees and research grants from RSscan International.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
DIABETES CARE