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Ramadhan GT, Haris F, Jan YK, Liau BY, Chang WT, Tai CC, Lung CW. Effect of different inner pressures of air insoles and walking durations on plantar pressure time integral. Sci Rep 2024; 14:19272. [PMID: 39164374 PMCID: PMC11336220 DOI: 10.1038/s41598-024-70312-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 08/14/2024] [Indexed: 08/22/2024] Open
Abstract
Air insoles have provided insights for reducing the risk of diabetic foot ulcers (DFU). The pressure time integral (PTI) is an effective assessment that considers the time effect in various physical activities. We investigated the interactions between three different insole inner pressures (80, 160, and 240 mmHg) and two walking durations (10 and 20 min). The big toe (T1), first metatarsal head (M1), and second metatarsal head (M2) were investigated in 13 healthy participants. One-way analysis of variance (ANOVA) showed that the effects of each insole inner pressure significantly differed (P < 0.05) with a 10 min walking duration. The PTI values resulting from 80 mmHg in M2 (38.4 ± 3.8, P = 0.002) and 160 mmHg in M1 (44.3 ± 4.3, P = 0.027) were lower than those from 240 mmHg. Additionally, the paired t test showed that the effects of each walking duration were also considerably different at 160 mmHg. The PTI at 10 min was lower than that at 20 min in M1 (44.31 ± 4.31, P = 0.015) and M2 (47.14 ± 5.27, P = 0.047). Thus, we suggest that walking with a pressure of 160 mmHg for 10 min has a lower risk of DFU.
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Affiliation(s)
- Gilang Titah Ramadhan
- Department of Computer Science and Information Engineering, Asia University, Taichung, 413305, Taiwan
| | - Fahni Haris
- School of Nursing, Universitas Muhammadiyah Yogyakarta, Yogyakarta, 55183, Indonesia
| | - Yih-Kuen Jan
- Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, 61820, USA
| | - Ben-Yi Liau
- Department of Automatic Control Engineering, Feng Chia University, Taichung, 407102, Taiwan
| | - Wen-Thong Chang
- Department of Computer Science and Information Engineering, Asia University, Taichung, 413305, Taiwan
| | - Chien-Cheng Tai
- School of Public Health, Taipei Medical University, New Taipei City, 235603, Taiwan
| | - Chi-Wen Lung
- Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, 61820, USA.
- Department of Creative Product Design, Asia University, Taichung, 413305, Taiwan.
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Ren Y, Wang H, Song X, Wu Y, Lyu Y, Zeng W. Advancements in diabetic foot insoles: a comprehensive review of design, manufacturing, and performance evaluation. Front Bioeng Biotechnol 2024; 12:1394758. [PMID: 39076210 PMCID: PMC11284111 DOI: 10.3389/fbioe.2024.1394758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 05/24/2024] [Indexed: 07/31/2024] Open
Abstract
The escalating prevalence of diabetes has accentuated the significance of addressing the associated diabetic foot problem as a major public health concern. Effectively offloading plantar pressure stands out as a crucial factor in preventing diabetic foot complications. This review comprehensively examines the design, manufacturing, and evaluation strategies employed in the development of diabetic foot insoles. Furthermore, it offers innovative insights and guidance for enhancing their performance and facilitating clinical applications. Insoles designed with total contact customization, utilizing softer and highly absorbent materials, as well as incorporating elliptical porous structures or triply periodic minimal surface structures, prove to be more adept at preventing diabetic foot complications. Fused Deposition Modeling is commonly employed for manufacturing; however, due to limitations in printing complex structures, Selective Laser Sintering is recommended for intricate insole designs. Preceding clinical implementation, in silico and in vitro testing methodologies play a crucial role in thoroughly evaluating the pressure-offloading efficacy of these insoles. Future research directions include advancing inverse design through machine learning, exploring topology optimization for lightweight solutions, integrating flexible sensor configurations, and innovating new skin-like materials tailored for diabetic foot insoles. These endeavors aim to further propel the development and effectiveness of diabetic foot management strategies. Future research avenues should explore inverse design methodologies based on machine learning, topology optimization for lightweight structures, the integration of flexible sensors, and the development of novel skin-like materials specifically tailored for diabetic foot insoles. Advancements in these areas hold promise for further enhancing the effectiveness and applicability of diabetic foot prevention measures.
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Affiliation(s)
- Yuanfei Ren
- The First Department of Hand and Foot Surgery, Central Hospital of Dalian University of Technology, Dalian, China
| | - Hao Wang
- Department of Engineering Mechanics, School of Mechanics and Aerospace Engineering, Dalian University of Technology, Dalian, China
| | - Xiaoshuang Song
- Department of Engineering Mechanics, School of Mechanics and Aerospace Engineering, Dalian University of Technology, Dalian, China
| | - Yanli Wu
- Department of Engineering Mechanics, School of Mechanics and Aerospace Engineering, Dalian University of Technology, Dalian, China
| | - Yongtao Lyu
- Department of Engineering Mechanics, School of Mechanics and Aerospace Engineering, Dalian University of Technology, Dalian, China
- DUT-BSU Joint Institute, Dalian University of Technology, Dalian, China
| | - Wei Zeng
- Department of Mechanical Engineering, New York Institute of Technology, New York, NY, United States
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Aman A, Bhunia M, Mukhopadhyay S, Gupta R. Machine learning assisted classification between diabetic polyneuropathy and healthy subjects using plantar pressure and temperature data: a feasibility study. Comput Methods Biomech Biomed Engin 2024:1-12. [PMID: 38826026 DOI: 10.1080/10255842.2024.2359041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 05/10/2024] [Indexed: 06/04/2024]
Abstract
Automated and early detection of diabetics with polyneuropathy in an ambulatory health monitoring setup may reduce the major risk factors for diabetic patients. Increased and localized plantar pressure associated with impaired pain and temperature is a combination of developing foot ulcers in subjects with polyneuropathy. Although many interesting research works have been reported in this area, most of them emphasize on signal acquisition process and plantar pressure distribution in the foot region. In this work, a machine learning assisted low complexity technique was developed using plantar pressure and temperature signals which will classify between diabetic polyneuropathy and healthy subjects. Principal component analysis (PCA) and maximum relevance minimum redundancy (mRMR) methods were used for feature extraction and selection respectively followed by k-NN classifier for binary classification. The proposed technique was evaluated with 100 min of publicly available annotated data from 43 subjects and provides blind test accuracy, sensitivity, precision, F1-score, and area under curve (AUC) of 99.58%, 99.50%, 99.44%, 99.47% and 99.56% respectively. A low resource hardware implementation in ARM v6 controller required an average memory usage of 81.2 kB and latency of 1.31 s to process 9 s pressure and temperature data collected from 16 sensor channels for each of the foot region.
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Affiliation(s)
- Ayush Aman
- Institute of Radio Physics and Electronics, University of Calcutta, Kolkata, India
| | - Mousam Bhunia
- Institute of Radio Physics and Electronics, University of Calcutta, Kolkata, India
| | - Sumitra Mukhopadhyay
- Institute of Radio Physics and Electronics, University of Calcutta, Kolkata, India
| | - Rajarshi Gupta
- Electrical Engineering, Department of Applied Physics, University of Calcutta, Kolkata, India
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Haris F, Jan YK, Liau BY, Hsieh CW, Shen WC, Tai CC, Shih YH, Lung CW. Plantar pressure gradient and pressure gradient angle are affected by inner pressure of air insole. Front Bioeng Biotechnol 2024; 12:1353888. [PMID: 38529404 PMCID: PMC10961410 DOI: 10.3389/fbioe.2024.1353888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/21/2024] [Indexed: 03/27/2024] Open
Abstract
Clinically, air insoles may be applied to shoes to decrease plantar pressure gradient (PPG) and increase plantar gradient angle (PGA) to reduce foot ulcers. PPG and PGA may cause skin breakdown. The effects of different inner pressures of inflatable air insoles on dynamic PPG and PGA distributions are largely unknown in non-diabetics and people with diabetes. This study aimed to explore the impact of varying inner air insole pressures on PPG and PGA to establish early mitigation strategies for people at risk of foot ulcers. A repeated measures study design, including three air insoles (80 mmHg, 160 mmHg, and 240 mmHg) and two walking durations (10 and 20 min) for a total of six walking protocols, was tested on 13 healthy participants (height, 165.8 ± 8.4 cm; age, 27.0 ± 7.3 years; and weight, 56.0 ± 7.9 kg, BMI: 20.3 ± 1.7 kg/m^2) over three consecutive weeks. PPG, a measurement of the spatial variation in plantar pressure around the peak plantar pressure (PPP) and PGA, a variation in the gradient direction values at the three plantar regions, big toe (T1), first metatarsal head (M1), and second metatarsal head (M2), were calculated. This study indicated that PPG was lower at 80 mmHg air insoles after 20 min of walking in the M1 region (p = 0.010). The PGA in the M2 increased at an air insole of 80 mmHg compared to 240 mmHg (p = 0.015). Compared to 20 min, the 10 min walking duration at 240 mmHg of air insole had the lowest PPG in the M1 (p = 0.015) and M2 (p = 0.034) regions. The 80 mmHg air insole significantly lowered the PPG compared to a 160 mmHg and 240 mmHg air insole. Moreover, the 80 mmHg air insole significantly decreased PPP and increased PGA compared to the 160 mmHg and 240 mmHg air insole. A shorter walking period (10 min) significantly lowered PPG. The findings of this study suggest that people with a higher risk of foot ulcers should wear softer air insoles to have a lower PPG, as well as an increased PGA.
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Affiliation(s)
- Fahni Haris
- Department of Healthcare Administration, Asia University, Taichung, Taiwan
- School of Nursing, Universitas Muhammadiyah Yogyakarta, Yogyakarta, Indonesia
| | - Yih-Kuen Jan
- Rehabilitation Engineering Lab, University of Illinois at Urbana-Champaign, Champaign, IL, United States
| | - Ben-Yi Liau
- Department of Automatic Control Engineering, Feng Chia University, Taichung, Taiwan
| | - Chang-Wei Hsieh
- Department of Computer Science and Information Engineering, Asia University, Taichung, Taiwan
| | - Wei-Cheng Shen
- Department of Digital Media Design, Asia University, Taichung, Taiwan
| | - Chien-Cheng Tai
- International Ph.D. Program for Cell Therapy and Regeneration Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yin-Hwa Shih
- Department of Healthcare Administration, Asia University, Taichung, Taiwan
| | - Chi-Wen Lung
- Rehabilitation Engineering Lab, University of Illinois at Urbana-Champaign, Champaign, IL, United States
- Department of Creative Product Design, Asia University, Taichung, Taiwan
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Design and Preliminary Validation of Individual Customized Insole for Adults with Flexible Flatfeet Based on the Plantar Pressure Redistribution. SENSORS 2021; 21:s21051780. [PMID: 33806449 PMCID: PMC7961547 DOI: 10.3390/s21051780] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/27/2021] [Accepted: 03/01/2021] [Indexed: 12/14/2022]
Abstract
Flatfoot is a common musculoskeletal deformity. One of the most effective treatments is to wear individually customized plantar pressure-based insoles to help users change the abnormally distributed pressure on the pelma. However, most previous studies were divided only into several plantar areas without detailed plantar characteristic analysis. In this study, a new insole is designed which redistributes pressure following the analysis of characteristic points of plantar pressure, and practical evaluation during walking of subjects while wearing the insole. In total, 10 subjects with flexible flatfeet have participated in the performance of gait experiments by wearing flat insoles, orthotic insoles, and plantar pressure redistribution insoles (PPRI). The results showed that the stance time of PPRI was significantly lower than that of the flat insoles under slow gait. PPRI in the second to third metatarsal and medial heel area showed better unloading capabilities than orthotic insoles. In the metatarsal and heel area, the PPRI also had its advantage in percentage of contact area compared to flat insole and orthotic insole. The results prove that PPRI improves the plantar pressure distribution and gait efficiency of adults with flexible flatfeet, and can be applied into clinical application.
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