title: The influence of shoe design on plantar pressures in neuropathic feet.
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.
  
  
  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.
authors.affiliation: University Medical Center Utrecht, Orthopaedic Surgery, The Netherlands. spraet@sjz.nl
authors.forename: Stephan F E
authors.initials: SF
authors.lastname: Praet
authors.forename: Jan-Willem K
authors.initials: JW
authors.lastname: Louwerens
mesh_terms: D000368:Aged; D003929:Diabetic Neuropathies / Q000503:physiopathology*; D004867:Equipment Design; D005260:Female; D005528:Foot / Q000503:physiopathology*; D006801:Humans; D008875:Middle Aged; D010147:Pain Measurement; D011312:Pressure; D012775:Shoes; D016138:Walking