Effect of offloading footwear on postural stability and walking in healthy and diabetics with peripheral neuropathy

There is a direct relationship between reduction in pressure to the wound area and healing potential. A common practice in conservative care for diabetic foot ulceration is offloading the wound area through footwear. However, recent literature suggests general offloading footwear reduce activity levels of patients due to decreased postural stability and reduced walking speeds. Hence, the current study investigates two basic offloaders, negative-heel and rocker-bottom shoes, and their effects on gait and balance through innovative body worn sensors.

Postural stability assessments through center of mass (COM) sway area were performed on 18 healthy and 9 diabetic peripheral neuropathy (DPN) subjects. Walking assessments were performed for 40 feet at habitual speed in randomized order using the three footwear types. Gait and balance parameters were evaluated with repeated measures ANOVA at alpha value of 0.05.

In the eyes open and eyes closed tasks, offloading footwear impacted postural stability (p=0.00, ANOVA) in healthy subjects. Rocker-bottom shoes suggest to have increased COM sway area by 65% during eyes open and 86% during eyes closed compared to standard-shoes, especially in the anterior-posterior direction. Negative-heel shoes increased sway by 10% but surprisingly improved postural stability in healthy by 20% during the eyes closed setting. Offloading footwear, especially rocker bottom shoes, seem to negatively affect static balance and dynamic walking. This ongoing study requires additional recrutiment and analyses to ascertain the effects of offloading footwear in DPN patients.