title: Forefoot plantar pressure reduction of off-the-shelf rocker bottom provisional footwear.
abstract: BACKGROUND
  Increased plantar pressures have been shown to be a risk factor in ulceration of the neuropathic foot. Prescriptive footwear is a common medical treatment, yet evidence regarding the efficacy of these prescriptions is underdeveloped. The purpose of this study is to determine the off-loading properties of four provisional shoes; a rocker sole compared to a flat sole shoe with and without the addition of a 1.25 cm plastizote insert.
  
  
  METHODS
  Fifteen subjects with peripheral neuropathy and a normal longitudinal arch were recruited to compare four types of provisional (post-operative) footwear. Plantar surface foot pressures were measured while wearing a rocker sole shoe or a flat stiff sole shoe. Both shoes were worn with and without a 1.25 cm plastizote insert. Peak plantar pressures were recorded for the hallux, metatarsal heads (1-5), midfoot, and heel.
  
  
  RESULTS
  The rocker sole shoe with plastizote had the best off-loading properties. While wearing this footwear, mean peak plantar pressure was 2.8 kg/cm(2) (range: 1.7 to 4.5 kg/cm(2), 50% mean reduction from flat sole shoe without plastizote) and 1.9 kg/cm(2) (range: 0.7 to 3.6 kg/cm(2), 35% mean reduction) at the five metatarsal heads and hallux, respectively.
  
  
  CONCLUSIONS
  For patients with a normal longitudinal arch and forefeet, either at risk of developing an ulcer or are healing a forefoot ulcer, a provisional shoe with a rocker sole and plastizote insole provides plantar pressure reduction of the forefoot. However, when results were analyzed for the subjects individually the amount of off-loading varied.
authors.affiliation: Department of Orthopedic Surgery, Division of Orthopedic Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Kavros
authors.forename: Meegan G
authors.initials: MG
authors.lastname: Van Straaten
authors.forename: Krista A
authors.initials: KA
authors.lastname: Coleman Wood
authors.forename: Kenton R
authors.initials: KR
authors.lastname: Kaufman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005528:Foot / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010523:Peripheral Nervous System Diseases / Q000150:complications / Q000503:physiopathology* / Q000517:prevention & control*; D011312:Pressure; D003668:Pressure Ulcer / Q000209:etiology / Q000503:physiopathology* / Q000517:prevention & control*; D012775:Shoes; D016138:Walking