Off-loading 減壓- Rocker shoes

游朝慶 醫師

   Rocker shoes弧形底鞋是使用最多的糖尿病鞋之一^1,2，其可能有許多名字，如rocker sole shoe, rocker bottom shoe , round bottom shoes, round/ed sole shoes等，這種鞋子已被證明可有效降低足底壓力³，甚至當搭配矯正特製鞋墊時，其可降低足底蹠骨頭(MTH)壓力高達30-50%^4-6。其形狀就是鞋底在蹠骨頭處往上以一個角度翹起削薄，其鞋底是硬的，故在行走時，可限制蹠骨頭關節彎曲，以充份分散前足的壓力^６，最近有研究建議⁷apex angle角度在 ９５度，前足底翹起角度(Rocker angle)在２０度，鞋底沒有翹起的比例(apex position)為全鞋的６０％時，可以給足底壓力帶來最好的減壓效果，apex是最凸點的意思，apex position, Rocker angle及apex angle的定義請參考下面圖示。

   以形狀而言，至少有下圖六種不同的弧形底鞋A, Mild. B, Heel-to-toe. C, Toe only. D, Severe angle. E, Negative heel. F, Double。

1.Janisse DJ. Prescription insoles and footwear. Clin Podiatr Med Surg 1995;12(1):41–61.

2.Pedorthic Footwear Association. Introduction to Pedorthics. Columbia, Md.; 1998.

3.Brown D, Wertsch JJ, Harris GF, et al. Effect of rocker soles on plantar pressures. Arch Phys Med Rehabil 2004;85(1):81-86.

4. Nawoczenski DA, Birke JA, Coleman WC. Effect of rocker sole design on plantar forefoot pressures. J Am Podiatr Med Assoc 1988;78;(9):455-460.

5. Schaff PS, Cavanagh PR. Shoes for the insensitive foot: the effect of a “rocker bottom” shoe modification on plantar pressure distribution. Foot Ankle 1990;11(3):129-140.

6. Delzell E. The role of rocker soles in reducing ulcer risk. Lower Ext Rev. 2011.  Available at http://www.lowerextremityreview.com/article/the-role-of-rocker-soles-in-... .

Chapman JD, Preece S, Braunstein B, Effect of rocker shoe design features on forefoot plantar pressures in people with and without diabetes Clin Biomech (Bristol, Avon). 2013 Jul;28(6):679-85. doi: 10.1016/j.clinbiomech.2013.05.005. Epub 2013 Jun 2.