[The Heibronnen roll-off shoe. An improved forefoot strain reducing orthosis using biomechanical principles]

To reduce the strain on the middle and forefoot in postoperative and posttraumatic care, we developed a new shoe. It is applied as part of treatment following skeletal or soft tissue surgery in this region and in treatment of the diabetic foot (types I and II). Pedographically, we found the vertex of the roll-off process located at the base of the fifth metatarsal bone, meaning that the foot starts to roll-off at this point while walking. The movement was recorded by a pedobarograph bearing full weight and with the use of one crutch in comparison to the roll-off process in a regular shoe. Results show a reduction of the plantar strain on the forefoot of 70% and of 62% on the Chopart joint while bearing full weight. The use of (forearm-) crutches reduces strain further. The new design of the sole enables the (podiatric) patient to stand and walk in a well-balanced fashion. Since immobilisation of the calf is avoided and muscular function is increased, the risk of thromboembolic complications can be minimized. Four different sizes of the "Strain Minimizing Shoe", including seven modular insoles are available, providing a wide range of individually adapted shoe applications for the patient's foot.