142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

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

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014 : 11:10 AM - 11:30 AM

Rashid Ahmed, BS , Dr. William M. Scholl College of Podiatric Medicine, Rosalind Franklin University of Medicine & Science, North Chicago, IL
John Rother, BS , Rosalind Franklin University of Medicine & Science, North Chicago, IL
Sai Yalla, PhD , Department of Podiatric Surgery and Applied Biomechanics, Dr. William M. Scholl College of Podiatric Medicine, North Chicago, IL
Karen Stevens, PT, DPT, MS, OCS , Department of Physical Therapy, Rosalind Franklin University of Medicine & Science, North Chicago, IL
Adam Fleischer, DPM, MPH, FACFAS , Department of Podiatric Medicine and Radiology, Dr. William M. Scholl College of Podiatric Medicine, North Chicago, IL
Robert Joseph, DPM, PhD, FACFAS , Chairman, Department of Podiatric Medicine & Radiology, Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University, North Chicago, IL
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.

Learning Areas:

Public health or related research

Learning Objectives:
Identify that one of the primary methods in foot ulceration treatment is offloading, however their impact on postural stability could play a vital role in noncompliance, thereby inhibiting wound closure. Discussing that offloading footwear, specifically rocker-bottom shoes, show significant increase in COM sway, thereby compromising postural stability. Evaluating the impact of offloading footwear helps better identify fall risk in DPN patients.

Keyword(s): Diabetes, Risk Factors/Assesment

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: As a student researcher, I learned how to use the equipment, I collected the data with the help of my co-authors, and I analyzed the data.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.