Kinematic analysis of postural reactions to a posterior translation in rocker bottom shoes in younger and older adults

- Older adults were unable to withstand faster perturbations without stepping.
- Differences between age groups likely due to difference in speed of perturbation.
- Both age groups displayed kinematic differences when wearing rocker bottom shoes.
- Rocker bottom shoes may lead to increased instability to posterior perturbations.

Shoes with rocker bottom soles are utilized by persons with diabetic peripheral neuropathy to reduce plantar pressures during gait. The risk of falls increases with age and is compounded by diabetic neuropathy. The purpose of this study was to analyze how rocker bottom shoes affect posture control of older adults (50-75 years old) and younger adults (20-35 years old) in response to posterior slide perturbations. The postural response to a posterior platform translation was normalized among subjects by applying the below threshold stepping velocity (BTSV) for each subject. The BTSV was the fastest velocity of platform translation that did not cause a stepping response while wearing the rocker bottom shoes. Joint excursion, time to first response, response time, and variability of mean peak joint angles were analyzed at the ankle, knee, hip, trunk, and head in the sagittal plane. The statistical analysis was a 2-factor mixed repeated measures design to determine interactions between and within shoe types and age groups. While wearing rocker bottom shoes, both age groups exhibited increased joint excursion, differences in time to initial response, and longer response time. The older group demonstrated decreased joint excursion and increased time to initial response compared to the younger group, as well as a significantly slower mean BTSV. These findings support the conclusion that in healthy older adults and in populations at risk for falls, the use of rocker bottom or other unstable shoes may increase the potential of falls when confronted with a standing perturbation such as a forceful slip or trip.