Shoes for the insensitive foot: the effect of a "rocker bottom" shoe modification on plantar pressure distribution

The purpose of this study was to examine the effects on plantar pressure of the rocker bottom shoe, which is a frequently used intervention for the ulcerated diabetic foot. In-shoe pressure distribution was recorded during walking in a conventional extra-depth shoe which was then modified into a rocker bottom configuration with a 24 degrees rocker, and the experiment was repeated. Peak pressures in the rocker shoe were reduce by approximately 30% compared to the conventional shoe in the medial and central forefoot and in the toe regions, but pressures were elevated in the heel, the midfoot, and in the lateral forefoot regions. These experiments suggest that a correctly designed rocker bottom show may reduce the risk of ulceration in certain areas of the foot. However, since pressures in some regions can also be elevated by this type of footwear, attention to individual design is critical.