There has been much discussion recently in a host of publications about the role of pressure and shear in the treatment and prevention of foot ulcers. Emily Delzell’s article, The role of rocker soles in reducing ulcer risk (Lower Extremity Review, August 2011) shares findings from a recent study, suggesting that rocker soles effectively reduce peak plantar pressures in patients at risk for diabetic foot ulceration.

Delzell reported findings from earlier studies, suggesting that rocker soles reduce pressure under the forefoot, and specifically under the metatarsal heads, by 30-50%, although it is unknown what amount of pressure reduction in footwear is necessary to truly help heal and ultimately prevent foot ulcers.

Not discussed in the article, is the role of shear forces in the genesis of skin trauma. Increasingly, shear is being discussed at healthcare conferences, and through special interest groups, such as the National Pressure Ulcer Advisory Panel (NPUAP). The shortcoming of shear, at the present time, is the inability to accurately measure shear forces underneath the foot. Still, the prevention and treatment of foot ulcers should include consideration of shear stresses, particularly under bony prominences where shear can be especially damaging.

Complementary to rocker shoes, total contact casts, and other pressure offloading devices, friction and shear interface materials, including ShearBan, provide additional margin of safety from skin breakdown. When applied directly to footwear or orthopedic devices, opposite a troublesome hot spot, blister or foot ulcer, ShearBan has proven effective at helping to heal existing skin trauma, while preventing future occurrences.

Continue reading, The role of rocker soles in reducing ulcer risk.