The immediate effect of the rocker sole on postural stability in diabetic patients with neuropathy

The effect of rocker soles on improvement of foot plantar pressure distribution is well documented. Rockers are commonly prescribed for diabetic patients with neuropathy in order to offloading the particular area of the foot sole thereby decreasing the chance of the foot ulcers. On the other hand, these patients may experience balance problems because of the somatosensory defects due to peripheral neuropathy. There is an evidence of postural destabilizing effect of rocker soles in healthy adults. The purpose of the current study was to investigate the postural responses to the rocker sole in diabetic patients with neuropathy. Seventeen diabetic patients with neuropathy participated in this study. Canvas shoes were modified by addition of toe only rocker soles made of EVA (Ethyl Vinyl Acetate). The motor control test was conducted by the use of Neurocom system to evaluate postural stability with and without rocker sole. The Center of force displacement, response latency and response strength were measured. No significant difference was observed between the toe only rocker sole and without it in center of force displacement and response latency of the patients (P› 0.05). The results also indicated a significant increase in the response strength of patients by the rocker shoe, only in medium perturbations (P‹ 0.05). The results of this study demonstrated that the postural stability of diabetic patients with neuropathy in response to the toe only rocker shoe is the same as the shoe without any rocker profiles. However, rocker shoes increase the need for generating active force during the automatic postural response of these patients which may indicate a training effect on diabetic patients with neuropathy.