what-when-how
In Depth Tutorials and Information
Many variations in the design have been tested: the angle of the toe
spring, the site where the angle starts, and combinations of toe spring
with negative heel. Some variations have reached consumers directly,
such as the Masai Barefoot Technology style footwear that has a distinc-
tive rocker sole.
Forefoot pressure reduction varies according to the insole, precise
footwear design features and patient group, but should be in the region
of 20 per cent (though some report much higher reductions). Many advo-
cate use of plantar pressure data to inform the design and evaluation of
rocker footwear prior to patients using it routinely. This is because subtle
changes in the angle and site of the toe spring, in the context of the
particular patient's foot anatomy and function, may influence the foot-
wear's effectiveness. Wearers may experience some minor changes in
kinematics of the ankle, knee and hip to accommodate the changes in
how load is transferred forwards under the foot, but these should not
cause concern unless there are pre-existing pathologies at these joints.
As well as use in the foot of a person at risk of ulceration, rocker soles
are also used in cases where there is a need to reduce toe flexion (due
to pain), or where toe flexion is absent (due to, for example, prior injury
or surgical fixation). 'Rocker profile soles are the most commonly used
external shoe modification. A recent review of the literature by Hutchins
et al (2009) into the biomechanics and clinical efficacy of footwear adapted
with rocker profiles found that although they do reduce forefoot plantar
pressures, the definitive profile shape has not been defined. Further to
this they recommend that further research is warranted into the effects
of rocker profiles on individual joints of the foot and the manner in which
they effect lower limb muscle activity and gait patterns. A recent and as
yet unpublished study by the lead author (Hutchins et al 2009) has inves-
tigated the use of rocker profile footwear in cases of intermittent claudica-
tion, with reports of improved pain-free walking distances. This seems
logical if the profiles alter ankle moments and subsequently alter the activ-
ity of calf musculature, but again requires further investigation.'
Sole plates
These are often used in combination with a rocker sole and/or orthoses
but can be used on their own to provide a completely rigid shoe. They
are usually made from steel. An alternative is to extend the shank of the
shoe. The purpose is to prevent normal foot function and relieve pain.
Heel raise or elevation
The purpose of the compensatory raise is in the management of true or
apparent shortening of the lower limb. It is achieved by increasing the
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