This article will provide objective evidence about the effect of rocker outsole on postural balance in diabetic patients. In prescription of rocker outsole to prevent plantar ulceration of diabetic foot, immediate postural destabilising is not a concern.

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Aims/Introduction Neuropathy is a common complication of diabetes that reduces balance by disrupting vision, and the sensory and vestibular systems. This is important in older adults who are more at risk of falling. Studies show that improving the sensory mechanisms through insoles can improve balance in people with balance disorders. As textured insoles have recently been considered for improving balance disorders, this study aimed to investigate the immediate effect of textured insoles on the balance of patients with diabetic neuropathy. Materials and Methods A total of 17 patients with diabetic neuropathy participated in this quasi‐experimental study. The studied variables were the general balance index, posterior–anterior balance index and medial‐lateral balance index, which were measured in three conditions: (i) soft textured insoles; (ii) hard textured insoles; and (iii) without textured insoles. A Biodex balance device was used for this purpose. Results In the general balance index, there was a significant difference between all the studied conditions. In the posterior–anterior balance index, there was a significant difference between without textured insole and hard textured insoles, and also soft and hard textured insoles. In the medial‐lateral balance index, there was a significant difference between the hard textured insoles and without textured insoles, and also soft and hard textured insoles (P < 0.05). Conclusions Wearing textured insoles can increase the balance in patients with diabetic neuropathy. This can be due to its effect on the sensory feedback of the soles, improving the proprioception and tactile sensors that are the main sources of balance.

Rocker outsole shoes are commonly prescribed to diabetic patients to redistribute peak plantar pressures at high risk areas such as forefoot thereby decreasing risks of plantar ulceration. However, there are evidences of postural destabilizing effect of the rocker outsole shoes. Patients with diabetes, particularly those suffering from neuropathy, are at a higher risk of falling. Then, beside primary role of rocker outsole in offloading, it is essential to explore the effect of the rocker outsole on postural stability of these patients. The smaller base of support (BOS) of the rocker outsoles due to their specific geometry has been previously mentioned as a threat to postural stability. Margin of stability (MOS) appeared to be an appropriate method for measuring postural stability during walking by considering the dynamicity of BOS in its equation. MOS is defined as the distance between the velocity adjusted position of the centre of mass (COM) and the boundaries of the BOS which constantly changes during walking. Then, this study proposes how we can use MOS concept to investigate the impact of the rocker outsoles on dynamic stability. In this study the kinematic data from a single subject with diabetic neuropathy was used to explain the efficiency of the methodology. Conclusive results are expected after carrying out systematic tests using a statistically representative sample size.

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