Bus Sicco A, Maas Josina C, Otterman Nicoline M
Human Performance Laboratory, Department of Rehabilitation, Academic Medical Centre, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
Human Performance Laboratory, Department of Rehabilitation, Academic Medical Centre, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
Clin Biomech (Bristol). 2017 Dec;50:21-26. doi: 10.1016/j.clinbiomech.2017.10.003. Epub 2017 Oct 2.
A forefoot-offloading shoes has a negative-heel rocker outsole and is used to treat diabetic plantar forefoot ulcers, but its mechanisms of action and their association with offloading and gait stability are not sufficiently clear.
Ten neuropathic diabetic patients were tested in a forefoot-offloading shoe and subsequently in a control shoe with no specific offloading construction, both worn on the right foot (control shoe on left), while walking at 1.2m/s. 3D-instrumented gait analysis and simultaneous in-shoe plantar pressure measurements were used to explain the shoe's offloading efficacy and to define centre-of-pressure profiles and left-to-right symmetry in ankle joint dynamics (0-1, 1:maximum symmetry), as indicators for gait stability.
Compared to the control shoe, peak forefoot pressures, vertical ground reaction force, plantar flexion angle, and ankle joint moment, all in terminal stance, and the proximal-to-distal centre-of-pressure trajectory were significantly reduced in the forefoot-offloading shoe (P<0.01). Peak ankle joint power was 51% lower in the forefoot-offloading shoe compared to the control shoe: 1.61 (0.35) versus 3.30 (0.84) W/kg (mean (SD), P<0.001), and was significantly associated with forefoot peak pressure (R=0.72, P<0.001). Left-to-right symmetry in the forefoot-offloading shoe was 0.39 for peak ankle joint power.
By virtue to their negative-heel rocker-outsole design, forefoot-offloading shoes significantly alter a neuropathic diabetic patient's gait towards a reduced push-off power that explains the shoe's offloading efficacy. However, gait symmetry and stability are compromised, and may be factors in the low perceived walking discomfort and limited use of these shoes in clinical practice. Shoe modifications (e.g. less negative heel, a more cushioning insole) may resolve this trade-off between efficacy and usability.
一种前足减压鞋具有负跟摇椅式鞋底，用于治疗糖尿病足底前足溃疡，但其作用机制以及它们与减压和步态稳定性的关联尚不完全清楚。
10名神经性糖尿病患者分别穿着前足减压鞋和无特定减压结构的对照鞋（右脚穿前足减压鞋，左脚穿对照鞋），以1.2m/s的速度行走时接受测试。采用三维步态分析仪器和鞋内足底压力同步测量，以解释鞋子的减压效果，并确定压力中心分布以及踝关节动力学中的左右对称性（0 - 1，1表示最大对称性），作为步态稳定性指标。
与对照鞋相比，前足减压鞋在终末支撑期的前足峰值压力、垂直地面反作用力、跖屈角度、踝关节力矩以及近端到远端的压力中心轨迹均显著降低（P<0.01）。与对照鞋相比，前足减压鞋的踝关节峰值功率低51%：分别为1.61（0.35）W/kg和3.30（0.84）W/kg（均值（标准差），P<0.001），且与前足峰值压力显著相关（R = 0.72，P<0.001）。前足减压鞋的踝关节峰值功率左右对称性为0.39。
由于其负跟摇椅式鞋底设计，前足减压鞋显著改变神经性糖尿病患者的步态，使蹬离功率降低，这解释了鞋子的减压效果。然而，步态对称性和稳定性受到影响，这可能是临床实践中患者感觉行走不适程度低以及此类鞋子使用受限的原因。对鞋子进行改进（如减小负跟程度、增加鞋垫缓冲）可能解决疗效与实用性之间的这种权衡。
