Those with diabetes mellitus have a significantly increased risk for falls. This is  due to the development of the sensory neuropathy which reduces the sensory input the foot which is important for balance. This lack of sensation is also important in the development of a lot of foot complications. A number of techniques are used to reduce the pressures under the ball of the foot to treat these problems and also reduce the risk of these complications. One of these methods is a rocker bottom shoe.  These are similar to the toning shoes that are promoted to ‘tone up’ when wearing them (they don’t actually do that!). They have, however, been shown to reduce plantar pressures so could be helpful in diabetes, however that needs to be in the context of balance issues that may occur due to the instability design of the toning or rockerbottom shoes.

A recent study in Gait and Posture from researchers at East Carolina University studied twenty non-diabetic healthy controls to investigate what the rocker sole shoes did to balance and postural stability. They concluded that:

In young healthy adults, shoes with rocker bottom soles had a destabilizing effect to perturbed stance, thereby increasing the potential for imbalance. These results raise concerns that footwear with rocker bottom sole modifications to accommodate an insensate foot may increase the risk of falls.

This does suggest that there are potential problems in using the toning or rocker shoes may have a negative impact on balance. If the person with diabetes has other risk factors for falls, then it may be advisable not to use them.

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Ultrasound diagnosis of peripheral neuropathy

by admin on November 26, 2012

The December issue of Diabetes Care has an intriguing paper on the use of diagnostic ultrasound of the tibial nerve in those with diabetes to detect diabetic peripheral neuropathy. Ultrasound is cheaper than nerve conduction studies. The cross sectionals study looked at those who had been diagnosed with diabetic neuropathy. They all had an enlarged nerve on ultrasound. This makes the potential for ultrasound to detect peripheral neuropathy.


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