Optimization of rocker sole footwear
the 1st MTP region or the hallux region (Table 1),
showing that the effect of varying apex position was
the same irrespective of rocker angle. However, in the
2-4th MTH region, increasing apex position angle
from 62% to 67% lead to an increase in pressure with
the 15° but not the 20° rocker angle (Fig. 2h, Table
1). Nevertheless, at the more proximal apex positions
(when there was lowest pressures), the effect of
changing apex position was consistent across the two
rocker angles (Fig. 2h).
The apex position at 52% of shoe length was found to
minimize peak pressures for the largest proportion of
individuals for both rocker angles (Table 2). The one
exception was in the hallux region with a 15° rocker
angle in which the 57% apex was shown to be optimal.
designs produced 30% and 37% reductions in peak
pressure (for the RA = 15° and 20° respectively, Fig. 3).
Given the consistency of the 52% apex position, this
was selected as the group-optimized design for all
anatomical regions and both rocker angles. Peak
pressures were significantly higher in the control shoe
compared to the group-optimized designs (Fig. 3, p <
0.001). This difference was most pronounced for the
2-4th MTH region, for which the two group-optimized
There were only small differences in performance,
between the group-optimized and personalized
footwear, within the context of the 200 kPa threshold.
For example, with a RA = 15°, the proportion of
individuals with pressures <200 kPa was only 4–6%
larger with the group-optimized design, compared
to the personalized design. Similar trends were
observed with the 20° rocker angle, however,
interestingly, there was no increase in the proportion
of participants beneath the 200 kPa threshold in
the 2-4th MTH region (Table 3) with personalized
footwear. Nevertheless, there was up to 12% increase
in the proportion of individuals under the 200 kPa
threshold when the group-optimized 15° rocker angle
was compared to the group-optimized 20° rocker angle
design (Table 3). Table 3 also illustrates the proportion
of individuals with diabetes and peripheral neuropathy
under the 200 kPa threshold. These data follow
similar trends to those of the full cohort of people with
diabetes, despite the fact that peak pressures (across all
the eight rocker shoe designs) were between 6 and 9
kPa higher in the neuropathic (n = 17) compared to
the nonneuropathic group (n = 85).
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