Chapman J D, Preece S, Braunstein B, Höhne A, Nester C J, Brueggemann P, Hutchins S
University of Salford, UK.
Clin Biomech (Bristol). 2013 Jul;28(6):679-85. doi: 10.1016/j.clinbiomech.2013.05.005. Epub 2013 Jun 2.
There is no consensus on the precise rocker shoe outsole design that will optimally reduce plantar pressure in people with diabetes. This study aimed to understand how peak plantar pressure is influenced by systematically varying three design features which characterise a curved rocker shoe: apex angle, apex position and rocker angle.
A total of 12 different rocker shoe designs, spanning a range of each of the three design features, were tested in 24 people with diabetes and 24 healthy participants. Each subject also wore a flexible control shoe. Peak plantar pressure, in four anatomical regions, was recorded for each of the 13 shoes during walking at a controlled speed.
There were a number of significant main effects for each of the three design features, however, the precise effect of each feature varied between the different regions. The results demonstrated maximum pressure reduction in the 2nd-4th metatarsal regions (39%) but that lower rocker angles (<20°) and anterior apex positions (>60% shoe length) should be avoided for this region. The effect of apex angle was most pronounced in the 1st metatarsophalangeal region with a clear decrease in pressure as the apex angle was increased to 100°.
We suggest that an outsole design with a 95° apex angle, apex position at 60% of shoe length and 20° rocker angle may achieve an optimal balance for offloading different regions of the forefoot. However, future studies incorporating additional design feature combinations, on high risk patients, are required to make definitive recommendations.
对于能最佳降低糖尿病患者足底压力的精确摇椅式鞋底设计尚无共识。本研究旨在了解通过系统改变表征弯曲摇椅式鞋底的三个设计特征：顶角角度、顶角位置和摇椅角度，峰值足底压力会受到怎样的影响。
对24名糖尿病患者和24名健康参与者测试了总共12种不同的摇椅式鞋底设计，涵盖了这三个设计特征的每个范围。每个受试者还穿着一双柔性对照鞋。在以受控速度行走期间，记录了13双鞋中每双鞋在四个解剖区域的峰值足底压力。
这三个设计特征中的每个都有许多显著的主效应，然而，每个特征的精确效应在不同区域之间有所不同。结果表明，第2 - 4跖骨区域压力降低最大（39%），但该区域应避免较低的摇椅角度（<20°）和靠前的顶角位置（>鞋长的60%）。顶角角度的影响在第1跖趾关节区域最为明显，随着顶角角度增加到100°，压力明显降低。
我们建议，一种顶角角度为95°、顶角位置在鞋长60%处且摇椅角度为20°的鞋底设计可能实现前脚不同区域卸载的最佳平衡。然而，需要对高风险患者进行纳入更多设计特征组合的未来研究，以给出明确建议。
