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Slide 2 Trent Salkavich, B App Sc (Pod) Joshua Burns PhD, B App Sc (Pod) Hons Lindy Begg, Dip Pod Caleb Wegener, B App Sc (Pod) Hons Effect of forefoot rocker sole angle on plantar pressure distribution Slide 3 Definition: Forefoot Rocker Sole Shoe Pressure relieving intervention for the forefoot prevent ulceration and re-ulceration. Contoured platform that controls joint motion by rocking the foot from heel strike through toe-off in the sagittal plane Walking is achieved by the contour of the rocker bottom forcing the foot to rock or tip forward when body weight passes over the fulcrum of the shoe. Slide 4 The Forefoot Rocker Sole The forefoot rocker sole reduces plantar pressure in the insensate forefoot during gait (Wei-Li et al, 2004) however the relationship between rocker gradient and plantar pressures remains unclear. Slide 5 Case Study Aim To assess the effect of different forefoot rockers on peak plantar pressures in a patient with a history of forefoot ulceration Slide 6 Case Study Medical Hx 56 year old female School teacher Insulin Dependent Diabetes Mellitus 1985 BMI: 27.5 Hyperlipidemia Palpable bilateral dorsalis pedis and tibialis posterior pulses PPG - R130, L 178 Sensory neuropathy Presented with osteomyelitic ulcer L 1 st MPJ, causal pathway- untreated callous Present 10 weeks until healed Foot type Cavoid, Foot Posture Index; R -7, L -6 Plantarflexed 1 st MPJs bilaterally Increased 1 st MPJ stiffness bilaterally Mild hallux abducto valgus bilaterally Slide 7 Methods 4 different conditions were measured : 1.15 , flexible sole, without Thanner 2.15, flexible sole with Thanner 3.15, rigid sole, with Thanner 4.17, rigid sole, with Thanner Plantar foot pressures were measured using Novel Pedar System whilst the patient walked 2 lengths of a 10 metre flat walkway. Peak plantar pressures were measured Measurements were taken consecutively Slide 8 Test 1: 15 , flexible sole, without Thanner Conditions Original prescribed footwear 7 weeks old Standard 15 rocker flexible sole No moulded accomodative orthoses (Thanner) Slide 9 Test 1: 15 0, flexible sole, without Thanner Slide 10 Test 2, 15, flexible, Thanner Conditions Standard shoe 15 rocker Flexible sole Thanner Slide 11 Test 2 -15, Flexible, Thanner Slide 12 Test 3 15, rigid, Thanner Conditions Rigid sole 15 rocker Thanner Slide 13 Test 3 - 15, rigid, Thanner Slide 14 Test 4 - 17, rigid, Thanner Conditions 17 rocker Rigid sole Thanner Slide 15 Test 4 - 17, rigid, Thanner Slide 16 Pressure Results CONDITION PRESSURE kPa Flexible, 15 Rigid, 15Rigid, 17 Slide 17 Results A 2 increase in forefoot rocker gradient from 15 - 17 lead to a 26% reduction in forefoot plantar pressure. Slide 18 Discussion Additional forefoot rocker angle can assist to significantly reduce peak plantar pressures and should be considered when prescribing footwear. Standard orthopaedic rocker shoe has a 15 forefoot rocker gradient. This case study sets a basis for further research involving rocker gradient and forefoot pressure reduction. Slide 19 Acknowledgements Pierre Marrion Footwear That Fits Pty Ltd Dr Josh Burns Ms Lindy Begg Caleb Wegner Slide 20