Ramsey SD, Newton K, Blough D, et al: Incidence, outcomes, and cost of foot ulcers in patients with diabetes. .Diabetes Care 22::382. ,1999. .
Frykberg RG, Armstrong DG, Giurini J, et al: Diabetic foot disorders; a clinical practice guideline. .J Foot Ankle Surg 39 (suppl 5)::S1. ,2000. .
Frykberg RG, Habershaw GM, Chrzan JS: “Epidemiology of the Diabetic Foot: Ulcerations and Amputations,” in Clinical Management of Diabetic Neuropathy, ed by A Veves, p 273, Humana Press, Totowa, NJ, 1998..
Adler AI, Boyko EJ, Ahroni J, et al: Lower-extremity amputation in diabetes: the independent effects of peripheral vascular disease, sensory neuropathy, and foot ulcers. .Diabetes Care 22::1029. ,1999. .
Mayfield JA, Reiber GE, Sanders LJ, et al: Preventive foot care in people with diabetes. .Diabetes Care 21::2161. ,1998. .
Pecoraro RE, Reiber GE, Burgess EM: Pathways to diabetic limb amputation: basis for prevention. .Diabetes Care 13::513. ,1990. .
Larsson J, Agardh CD, Apelqvist J, et al: Long-term prognosis after healed amputation in patients with diabetes. .Clin Orthop 350::149. ,1998. .
American Diabetes Association: Consensus Development Conference on diabetic foot wound care. .Diabetes Care 22::1354. ,1999. .
Reiber GE, Boyko EJ, Smith DG: “Lower Extremity Foot Ulcers and Amputations in Diabetes,” in Diabetes in America, 2nd Ed, ed by MI Harris, C Cowie, MP Stern, p 409, National Institutes of Health, Bethesda, MD, 1995..
Veves A, Murray HJ, Young MJ, et al: The risk of foot ulceration in diabetic patients with high foot pressure: a prospective study. .Diabetologia 35::660. ,1992. .
Schoenhaus HD, Wernick E, Cohen R: “Biomechanics of the Diabetic Foot,” in The High Risk Foot in Diabetes Mellitus, ed by RG Frykberg, p 125, Churchill Livingstone, New York, 1991..
Caputo GM, Cavanagh PR, Ulbrecht JS, et al: Assessment and management of foot disease in patients with diabetes. .N Engl J Med 331::854. ,1994. .
Cavanagh PR, Ulbrecht JS, Caputo GM: “The Biomechanics of the Foot in Diabetes Mellitus,” in Levin and O’Neal’s The Diabetic Foot, 6th Ed, ed by JH Bowker, MA Pfeifer, p 125, Mosby, St Louis, 2001..
International Working Group on the Diabetic Foot: International Consensus on the Diabetic Foot. Amsterdam, The Netherlands, 1999..
Kennedy L, Baynes JW: Non-enzymatic glycosylation and the chronic complications of diabetes: an overview. .Diabetologia 26::93. ,1984. .
Birke JA, Franks BD, Foto JG: First ray joint limitation, pressure, and ulceration of the first metatarsal head in diabetes mellitus. .Foot Ankle Int 16::277. ,1995. .
Fernando DJ, Masson EA, Veves A, et al: Relationship of limited joint mobility to abnormal foot pressures and diabetic foot ulceration. .Diabetes Care 14::8. ,1991. .
Reiber GE, Vileikyte L, Boyko EJ, et al: Causal pathways for incident lower-extremity ulcers in patients with diabetes from two settings. .Diabetes Care 22::157. ,1999. .
Murray HJ, Young MJ, Hollis S, et al: The association between callus formation, high pressures and neuropathy in diabetic foot ulceration. .Diabet Med 13::979. ,1996. .
Lavery LA, Armstrong DG, Vela SA, et al: Practical criteria for screening patients at high risk for diabetic foot ulceration. .Arch Intern Med 158::157. ,1998. .
Frykberg RG, Lavery L, Pham H, et al: Role of neuropathy and high foot pressures in diabetic foot ulceration. .Diabetes Care 21::1714. ,1998. .
Pham H, Armstrong DG, Harvey C, et al: Screening techniques to identify people at high risk for diabetic foot ulceration: a prospective multicenter trial. .Diabetes Care 23::606. ,2000. .
Kastenbauer T, Sauseng S, Sokol G, et al: A prospective study of predictors for foot ulceration in type 2 diabetes. .JAPMA 91::343. ,2001. .
Frykberg RG: Diabetic foot ulcers: current concepts. .J Foot Ankle Surg 37::440. ,1998. .
Cavanagh PR, Ulbrecht JS, Caputo GM: New developments in the biomechanics of the diabetic foot. .Diabetes Metab Res Rev 16 (suppl 1)::S6. ,2000. .
Caravagi C, Faglia E, De Giglio R, et al: Effectiveness and safety of a nonremovable fiberglass off-bearing cast versus a therapeutic shoe in the treatment of neuropathic foot ulcers: a randomized study. .Diabetes Care 23::1746. ,2000. .
Armstrong DG, Nguyen HC, Lavery LA, et al: Off-loading the diabetic foot wound: a randomized clinical trial. .Diabetes Care 24::1019. ,2001. .
Frykberg RG: Offloading properties of a new rocker insole (abstract):. Diabetes 47 (suppl 1)::A168. ,1998. .
Pitei DL, Edmonds ME: Foot pressure measurements. .Wounds 12 (suppl 6)::19B. ,2000. .
Lawless MW, Reveal GT, Laughlin RT: Foot pressures during gait: a comparison of techniques for reducing pressure points. .Foot Ankle Int 22::594. ,2001. .
Reiber GE, Pecoraro RE, Koepsell TD: Risk factors for amputation in patients with diabetes mellitus: a case control study. .Ann Intern Med 117::97. ,1992. .
Vela SA, Lavery LA, Armstrong DG, et al: The effect of increased weight on peak pressures: implications for obesity and diabetic foot pathology. .J Foot Ankle Surg 37::416. ,1998. .
Veves A, Sarnow MR, Giurini JM, et al: Differences in joint mobility and foot pressures between black and white diabetic patients. .Diabet Med 12::585. ,1995. .
Multiple offloading modalities are currently used in the management of diabetic plantar foot ulcerations. A relatively new device, the Rocker Insole, was tested for its ability to relieve plantar forefoot pressures when inserted into a surgical boot as compared to a patient’s customary footwear and the surgical boot alone. The Rocker Insole significantly reduced forefoot pressures by 48% when worn inside the surgical boot. Mean peak pressures unexpectedly increased 12% when the surgical boot was worn alone. This preliminary investigation suggests that when worn in conjunction with a surgical boot, the Rocker Insole can effectively offload plantar forefoot pressures and may be useful in the management of plantar metatarsal ulcerations. (J Am Podiatr Med Assoc 92(1): 48-53, 2002)