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van Netten JJ, Raspovic A, Lavery LA, Monteiro-Soares M, Paton J, Rasmussen A, Sacco ICN, Bus SA. Prevention of foot ulcers in persons with diabetes at risk of ulceration: A systematic review and meta-analysis. Diabetes Metab Res Rev 2024; 40:e3652. [PMID: 37243880 DOI: 10.1002/dmrr.3652] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/17/2023] [Indexed: 05/29/2023]
Abstract
AIMS Prevention of foot ulcers in persons with diabetes is important to help reduce the substantial burden on both individual and health resources. A comprehensive analysis of reported interventions is needed to better inform healthcare professionals about effective prevention. The aim of this systematic review and meta-analysis is to assess the effectiveness of interventions to prevent foot ulcers in persons with diabetes who are at risk thereof. MATERIALS AND METHODS We searched the available scientific literature in PubMed, EMBASE, CINAHL, Cochrane databases and trial registries for original research studies on preventative interventions. Both controlled and non-controlled studies were eligible for selection. Two independent reviewers assessed risk of bias of controlled studies and extracted data. A meta-analysis (using Mantel-Haenszel's statistical method and random effect models) was done when >1 RCT was available that met our criteria. Evidence statements, including the certainty of evidence, were formulated according to GRADE. RESULTS From the 19,349 records screened, 40 controlled studies (of which 33 were Randomised Controlled Trials [RCTs]) and 103 non-controlled studies were included. We found moderate certainty evidence that temperature monitoring (5 RCTs; risk ratio [RR]: 0.51; 95% CI: 0.31-0.84) and pressure-optimised therapeutic footwear or insoles (2 RCTs; RR: 0.62; 95% CI: 0.26-1.47) likely reduce the risk of plantar foot ulcer recurrence in people with diabetes at high risk. Further, we found low certainty evidence that structured education (5 RCTs; RR: 0.66; 95% CI: 0.37-1.19), therapeutic footwear (3 RCTs; RR: 0.53; 95% CI: 0.24-1.17), flexor tenotomy (1 RCT, 7 non-controlled studies, no meta-analysis), and integrated care (3 RCTs; RR: 0.78; 95% CI: 0.58-1.06) may reduce the risk of foot ulceration in people with diabetes at risk for foot ulceration. CONCLUSIONS Various interventions for persons with diabetes at risk for foot ulceration with evidence of effectiveness are available, including temperature monitoring (pressure-optimised) therapeutic footwear, structured education, flexor tenotomy, and integrated foot care. With hardly any new intervention studies published in recent years, more effort to produce high-quality RCTs is urgently needed to further improve the evidence base. This is especially relevant for educational and psychological interventions, for integrated care approaches for persons at high risk of ulceration, and for interventions specifically targeting persons at low-to-moderate risk of ulceration.
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Affiliation(s)
- Jaap J van Netten
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Program Rehabilitation, Amsterdam, The Netherlands
| | - Anita Raspovic
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Lawrence A Lavery
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Matilde Monteiro-Soares
- Portuguese Red Cross School of Health - Lisbon, Lisbon, Portugal
- MEDCIDS - Departamento de Medicina da Comunidade Informação e Decisão em Saúde, Faculty of Medicine, University of Porto, Porto, Portugal
- RISE@CINTESIS, Faculty of Medicine, Oporto University, Porto, Portugal
| | - Joanne Paton
- School of Health Professions, Faculty of Health, University of Plymouth, Plymouth, UK
| | | | - Isabel C N Sacco
- Physical Therapy, Speech and Occupational Therapy Department, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Sicco A Bus
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Program Rehabilitation, Amsterdam, The Netherlands
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Fastier-Wooller JW, Lyons N, Vu TH, Pizzolato C, Rybachuk M, Itoh T, Dao DV, Maharaj J, Dau VT. Flexible Iron-On Sensor Embedded in Smart Sock for Gait Event Detection. ACS APPLIED MATERIALS & INTERFACES 2024; 16:1638-1649. [PMID: 38110238 DOI: 10.1021/acsami.3c11805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
Portable and wearable electronics for biomechanical data collection have become a growing part of everyday life. As smart technology improves and integrates into our lives, some devices remain ineffective, expensive, or difficult to access. We propose a washable iron-on textile pressure sensor for biometric data acquisition. Biometric data, such as human gait, are a powerful tool for the monitoring and diagnosis of ambulance and physical activity. To demonstrate this, our washable iron-on device is embedded into a sock and compared to gold standard force plate data. Biomechanical testing showed that our embedded sensor displayed a high aptitude for gait event detection, successfully identifying over 96% of heel strike and toe-off gait events. Our device demonstrates excellent attributes for further investigations into low-cost, washable, and highly versatile iron-on textiles for specialized biometric analysis.
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Affiliation(s)
- Jarred W Fastier-Wooller
- School of Engineering and Built Environment, Griffith University, Gold Coast 4222, QLD, Australia
- Department of Precision Engineering, The University of Tokyo, Hongo, Tokyo 113-8656, Japan
| | - Nathan Lyons
- Queensland College of Art, Griffith University, Gold Coast 4215, QLD, Australia
- Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast 4215, QLD, Australia
| | - Trung-Hieu Vu
- School of Engineering and Built Environment, Griffith University, Gold Coast 4222, QLD, Australia
| | - Claudio Pizzolato
- Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast 4215, QLD, Australia
- School of Health Sciences and Social Work, Griffith University, Gold Coast 4215, QLD, Australia
| | - Maksym Rybachuk
- School of Engineering and Built Environment, Griffith University, Nathan 4111, QLD, Australia
- Centre for Quantum Dynamics and Australian Attosecond Science Facility, Griffith University, Nathan 4111, QLD, Australia
| | - Toshihiro Itoh
- Department of Precision Engineering, The University of Tokyo, Hongo, Tokyo 113-8656, Japan
| | - Dzung Viet Dao
- School of Engineering and Built Environment, Griffith University, Gold Coast 4222, QLD, Australia
- Queensland Micro- and Nanotechnology Centre, Griffith University, Nathan 4111, QLD, Australia
| | - Jayishni Maharaj
- Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast 4215, QLD, Australia
- School of Health Sciences and Social Work, Griffith University, Gold Coast 4215, QLD, Australia
| | - Van Thanh Dau
- School of Engineering and Built Environment, Griffith University, Gold Coast 4222, QLD, Australia
- Centre of Catalysis and Clean Energy, Griffith University, Science Road, Gold Coast 4222, QLD, Australia
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3
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Walker KJ, Przestrzelski BT, Kaluf B, Driggers NH, Ballard WD, Pruett TC, Hoeffner SL, DesJardins JD. Novel 3D-printed foot orthoses with variable hardness: A comfort comparison to traditional orthoses. Med Eng Phys 2023; 115:103978. [PMID: 37120178 DOI: 10.1016/j.medengphy.2023.103978] [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: 06/21/2022] [Revised: 03/12/2023] [Accepted: 04/06/2023] [Indexed: 05/01/2023]
Abstract
Custom foot orthoses are used to treat a variety of foot pathologies. However, orthotic production requires significant hands-on fabrication time and expertise to produce orthoses that are both comfortable and effective. This paper introduces a novel 3D printed orthosis and fabrication method that utilizes custom architectures to produce variable-hardness regions. These novel orthoses are compared to traditionally fabricated orthoses during a 2-week user comfort study. Twenty (n = 20) male volunteers underwent orthotic fitting for both traditional and 3D-printed foot orthoses prior to engaging in treadmill walking trials and 2 weeks of wear. Each participant undertook a regional comfort, acceptance, and comparison analysis of the orthoses at three time points throughout the study (0, 1, and 2 weeks). Both the 3D-printed and the traditionally fabricated foot orthoses demonstrated statistically significant increases in comfort when compared to the factory fabricated shoe insert. Additionally, the two orthosis groups were not significantly different from each other in comfort rankings both regionally and overall at any time point. The similar comfort achieved by the 3D-printed orthosis to the traditionally fabricated orthosis after 7 days and 14 days emphasizes the potential of the future use of the more reproducible and adaptable 3D-printed orthosis manufacturing methodology.
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Affiliation(s)
- Kyle J Walker
- Clemson University, Department of Bioengineering, 301 Rhodes Hall, Clemson, SC 29634, United States
| | - Breanne T Przestrzelski
- Clemson University, Department of Bioengineering, 301 Rhodes Hall, Clemson, SC 29634, United States
| | - Brian Kaluf
- Ottobock North America, 3820 Great Lakes Dr, Salt Lake City, UT 84120, United States
| | - Nikki H Driggers
- Carolina Orthotics & Prosthetics - Ottobock Care, 1455 Harden Street Extension, Columbia, SC 29201, United States
| | - W Daniel Ballard
- Upstate Pedorthic Services, 24 Parkway Commons Way, Greer, SC 29650, United States
| | - Timothy C Pruett
- Clemson University, Department of Bioengineering, 301 Rhodes Hall, Clemson, SC 29634, United States
| | - Steve L Hoeffner
- Clemson University, Department of Bioengineering, 301 Rhodes Hall, Clemson, SC 29634, United States
| | - John D DesJardins
- Clemson University, Department of Bioengineering, 301 Rhodes Hall, Clemson, SC 29634, United States.
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4
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Graded stiffness offloading insoles better redistribute heel plantar pressure to protect the diabetic neuropathic foot. Gait Posture 2023; 101:28-34. [PMID: 36706604 DOI: 10.1016/j.gaitpost.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 01/09/2023] [Accepted: 01/18/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND Diabetic heel ulceration is a common, detrimental, and costly complication of diabetes. This study investigates a novel "graded-stiffness" offloading method, which consists of a heel support with increasing levels of stiffness materials to better redistribute plantar pressure for heel ulcer prevention and treatment. RESEARCH QUESTION Is the novel "graded-stiffness" solution better able to redistribute heel pressure and reduce focal stress concentration areas of the heel? METHODS Twenty healthy young men walked with four, 3D-printed, insole configurations. The configurations included the "graded-stiffness" insoles with and without an offloading hole under the heel tissue at risk for ulcerations and two conventional offloading supports of flat insoles with no offloading and simple holed offloading insoles. In-shoe plantar pressure was measured using the Pedar-X system. Peak pressure and pressure dose were measured at three heel regions: offloaded region, perimeter of offloaded region, and periphery region. RESULTS The simple offloading configuration reduced pressure at the offloaded region; however, pressure at the perimeter of the offloading region significantly increased. With respect to ANOVA, the "graded-stiffness" offloading configurations were more effective than existing tested solutions in reducing and redistributing heel peak pressure and pressure dose, considering all heel regions. SIGNIFICANCE The "graded-stiffness" offloading solution demonstrated a novel flexible and customized solution that can be manufactured on-demand through a precise selection of the graded-stiffness offloading location and material properties to fit the shape and size of the ulcer. This study is a follow-up in-vivo pilot study, in a healthy population group, to our previous computation modeling work that reported the efficiency of the "graded-stiffness" configuration, and which emphasizes its potential for streamlining and optimizing the prevention and treatment of diabetic heel ulcers.
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Hu X, Tang J, Cai W, Sun Z, Zhao Z, Qu X. Characteristics of foot plantar pressure during turning in young male adults. Gait Posture 2023; 101:1-7. [PMID: 36696820 DOI: 10.1016/j.gaitpost.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/27/2022] [Accepted: 01/08/2023] [Indexed: 01/11/2023]
Abstract
BACKGROUND Turning gait is considered as a challenging motor task. However, only few existing studies reported turning biomechanics from the aspect of foot plantar pressure. RESEARCH QUESTION This study aimed to investigate turning biomechanics by studying foot plantar pressure characteristics METHODS: Twelve young male participants were involved in this experimental study. They were instructed to perform turning tasks with different turning angles (i.e., 30°, 60°, and 90°). Foot plantar pressure was quantified by the force time integral (FTI) underneath seven plantar sub-areas. Analysis was carried out for different turning strategies (spin turns versus step turns), separately. RESULTS The results showed that for small-angle spin turns, plantar pressure patterns changed at the early stage of the approaching step, suggesting a preparatory action for the increased lower limb range of motion in the transverse plane during turning; for step turns, an imbalance weight bearing mechanism was adopted when making large-angle turns to compensate for the centripetal force during turning. SIGNIFICANCE The findings provide improved knowledge about turning biomechanics. They have practical implications for motion planning of lower-limb assistive devices for those with difficulties in turning.
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Affiliation(s)
- Xinyao Hu
- Institute of Human Factors and Ergonomics, College of Mechatronics and Control Engineering, Shenzhen University, China
| | - Junpeng Tang
- Institute of Human Factors and Ergonomics, College of Mechatronics and Control Engineering, Shenzhen University, China
| | - Wenfei Cai
- Department of Sports, Shenzhen University, China
| | - Zhenglong Sun
- School of Science and Engineering, Chinese University of Hong Kong (Shenzhen), Shenzhen, China
| | - Zhong Zhao
- Institute of Human Factors and Ergonomics, College of Mechatronics and Control Engineering, Shenzhen University, China
| | - Xingda Qu
- Institute of Human Factors and Ergonomics, College of Mechatronics and Control Engineering, Shenzhen University, China.
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Ning K, Yick KL, Yu A, Yip J. Effects of textile-fabricated insole on foot skin temperature and humidity for enhancing footwear thermal comfort. APPLIED ERGONOMICS 2022; 104:103803. [PMID: 35635942 DOI: 10.1016/j.apergo.2022.103803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 06/15/2023]
Abstract
Traditional insole materials which trap heat and moisture inside footwear cause discomfort to the wearer. Here, a novel textile-fabricated insole material with a 3D structure that offers good porosity and breathability for improving the footwear microclimate is proposed. Changes in foot skin temperature and humidity when wearing the textile-fabricated insole throughout treadmill walking are collected from 21 female subjects (age: 25.5 ± 4.5) and compared with traditional and 3D printed insoles. Subjective assessment of their perceived thermal comfort with various insole conditions is also conducted. In comparison to polyurethane, 3D printed thermoplastic polyurethane and leather insoles, textile-fabricated insoles show no significant changes in foot skin temperature. Nevertheless, a significant reduction of the relative humidity of the skin of the sole (3.21%) and heel (24.41%) is found. The findings are a valuable reference for the fabrication of insoles with higher wear comfort.
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Affiliation(s)
- Karolyn Ning
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hong Kong
| | - Kit-Lun Yick
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hong Kong.
| | - Annie Yu
- Department of Advanced Fibro Science, Kyoto Institute of Technology, Japan
| | - Joanne Yip
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hong Kong
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7
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Shi QQ, Li PL, Yick KL, Li NW, Jiao J. Effects of contoured insoles with different materials on plantar pressure offloading in diabetic elderly during gait. Sci Rep 2022; 12:15395. [PMID: 36100637 PMCID: PMC9470545 DOI: 10.1038/s41598-022-19814-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/05/2022] [Indexed: 01/22/2023] Open
Abstract
To investigate the effect of contoured insoles constructed of different insole materials, including Nora Lunalastik EVA, Nora Lunalight A fresh, Pe-Lite, and PORON Medical 4708 with Langer Biomechanics longitudinal PPT arch pads on offloading plantar pressure on the foot of the elderly with Type 1 or 2 diabetes during gait. Twenty-two elderly with Type 1 or 2 diabetes participated in the study. Their plantar pressure was measured by using an insole measurement system, while the participants walked 10 m in their bare feet or used each experimental insole in random order. The plantar surface was divided into four specific regions including the toes, forefoot, midfoot, and rearfoot. The mean peak pressure (MPP) and pressure-time integral (PTI) of ten steps with or without wearing one of the four insoles were analyzed on the dominant foot and the four specific plantar regions. After completion of the activities, the participants scored each insole from 1 (the least comfortable) to 10 (the most comfortable). The analysis of variance (ANOVA) factor of the insoles had significant effects on the MPP (P < 0.001) and PTI (P = 0.004) in the dominant foot during gait. Pairwise comparison results showed that the MPP and PTI in the dominant foot were significantly lower (P < 0.001) with PORON Medical 4708 than barefoot, Nora Lunalight A fresh, and Pe-Lite. Additionally, the insole materials had a significant effect for the forefoot (P < 0.001) and rearfoot (P < 0.001) in terms of the MPP and PTI compared with the barefoot condition during gait. Regardless of the plantar region, the MPP and PTI values were the lowest when PORON Medical 4708 was used as the insole material among four insole materials. Meanwhile, a significantly lower MPP and PTI can be found in the forefoot and rearfoot with the use of the four experimental insoles when compared with barefoot. The soft insole materials (i.e., PORON medical 4708 and Nora Lunalastik EVA) had a better performance than the rigid insole materials (i.e., Nora Lunalight A fresh, and Pe-Lite) on plantar pressure offloading for diabetic elderly.
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Affiliation(s)
- Qiu Qiong Shi
- School of Fashion and Textiles, The Hong Kong Polytechnic University, Hong Kong, China
| | - Pui Ling Li
- Laboratory for Artificial Intelligence in Design, Hong Kong, China
| | - Kit-Lun Yick
- School of Fashion and Textiles, The Hong Kong Polytechnic University, Hong Kong, China.
- Laboratory for Artificial Intelligence in Design, Hong Kong, China.
| | - Nga-Wun Li
- Laboratory for Artificial Intelligence in Design, Hong Kong, China
| | - Jiao Jiao
- Dr. Stephen Hui Research Centre for Physical Recreation and Wellness, Hong Kong Baptist University, Hong Kong, China
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A novel graded-stiffness footwear device for heel ulcer prevention and treatment: a finite element-based study. Biomech Model Mechanobiol 2022; 21:1703-1712. [PMID: 35908097 DOI: 10.1007/s10237-022-01614-0] [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: 01/04/2022] [Accepted: 07/08/2022] [Indexed: 11/02/2022]
Abstract
Diabetic heel ulceration is a serious, destructive, and costly complication of diabetes. In this study, a novel "graded-stiffness" offloading method was proposed. This method consists of heel support with multi-increasing levels of stiffness materials, to prevent and treat heel ulcers. A three-dimensional finite element model of the heel was used to evaluate the novel "graded-stiffness" orthotic device compared to two existing solutions: (1) an insole with a hole under the active ulcer and (2) an insole with a hole filled with a soft material (elastic modulus of 15 kPa). Volumetric exposure evaluation of internal tissues to stress was performed at two volume-of-interests: (1) the area of the heel soft tissues typically at high risk for ulceration, and (2) the soft tissues surrounding the high-risk area. The models predict that the "graded-stiffness" offloading solution is more effective than existing solutions in distributing and reducing heel internal loads, considering both volume-of-interests. Comparing different material gradient combinations for the offloading support reveals considerable variation of the heel stress distribution. In clinical practice, the "graded-stiffness" technological solution enables to form an adaptable and flexible system that can be customized to a specific patient, through adequate selection of the offloading materials, to fit the shape and size of the ulcer. This solution can be made as an off-the-shelf product or alternatively, be manufactured by-demand using 3D printing tools. The proposed novel practical offloading solution has the potential for streamlining and optimizing the prevention and treatment of diabetic heel ulcers.
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Effects of Custom-Made Insole Materials on Frictional Stress and Contact Pressure in Diabetic Foot with Neuropathy: Results from a Finite Element Analysis. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11083412] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Offloading plantar pressure in a diabetic foot with neuropathy is challenging in conventional clinical practice. Custom-made insole (CMI) materials play an important role in plantar pressure reduction, but the assessment is costly and time-consuming. Finite element analysis (FEA) can provide an efficient evaluation of different insoles on the plantar pressure distribution. This study investigated the effect of CMI materials and their combinations on plantar pressure reduction for the diabetic foot with neuropathy using FEA. The study was conducted by constructing a three-dimensional foot model along with CMI to study the peak contact pressure between the foot and CMI. The softer material (E = 5 MPa) resulted in a better reduction of peak contact pressure compared with the stiffer material (E = 11 MPa). The plantar pressure was well redistributed with softer material compared with the stiffer material and its combination. In addition, the single softer material resulted in reduced frictional stress under the first metatarsal head compared with the stiffer material and the combination of materials. The softer material and its combination have a beneficial effect on plantar pressure reduction and redistribution for a diabetic foot with neuropathy. This study provided an effective approach for CMI material selection using FEA.
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10
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Collings R, Freeman J, Latour JM, Paton J. Footwear and insole design features for offloading the diabetic at risk foot-A systematic review and meta-analyses. Endocrinol Diabetes Metab 2021; 4:e00132. [PMID: 33532602 PMCID: PMC7831212 DOI: 10.1002/edm2.132] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/10/2020] [Accepted: 03/14/2020] [Indexed: 12/25/2022] Open
Abstract
The aim of this systematic review was to identify the best footwear and insole design features for offloading the plantar surface of the foot to prevent foot ulceration in people with diabetic peripheral neuropathy. We searched multiple databases for published and unpublished studies reporting offloading footwear and insoles for people with diabetic neuropathy and nonulcerated feet. Primary outcome was foot ulcer incidence; other outcome measures considered were any standardized kinetic or kinematic measure indicating loading or offloading the plantar foot. Fifty-four studies, including randomized controlled studies, cohort studies, case-series, and a case-controlled and cross-sectional study were included. Three meta-analyses were conducted and random-effects modelling found peak plantar pressure reduction of arch profile (37 kPa (MD, -37.5; 95% CI, -72.29 to -3.61; P < .03), metatarsal addition (35.96 kPa (MD, -35.96; 95% CI, -57.33 to -14.60; P < .001) and pressure informed design 75.4 kPa (MD, -75.4 kPa; 95% CI, -127.4 to -23.44 kPa; P < .004).The remaining data were presented in a narrative form due to heterogeneity. This review highlights the difficulty in differentiating the effect of different insole and footwear features in offloading the neuropathic diabetic foot. However, arch profiles, metatarsal additions and apertures are effective in reducing plantar pressure. The use of pressure analysis to enhance the effectiveness of the design of footwear and insoles, particularly through modification, is recommended.
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Affiliation(s)
- Richard Collings
- School of Health ProfessionsFaculty of Health: Medicine, Dentistry and Human SciencesUniversity of PlymouthPlymouthUK
- Department of Podiatry, Torbay and South DevonNHS Foundation TrustPlymouthUK
| | - Jennifer Freeman
- School of Health ProfessionsFaculty of Health: Medicine, Dentistry and Human SciencesUniversity of PlymouthPlymouthUK
| | - Jos M. Latour
- School of Nursing and MidwiferyFaculty of Health: Medicine, Dentistry and Human SciencesUniversity of PlymouthPlymouthUK
| | - Joanne Paton
- School of Health ProfessionsFaculty of Health: Medicine, Dentistry and Human SciencesUniversity of PlymouthPlymouthUK
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Rogerio FRPG, Guedes DP. Reprodutibilidade e concordância entre diferentes protocolos de baropodometria dinâmica durante a marcha: um estudo preliminar. FISIOTERAPIA E PESQUISA 2020. [DOI: 10.1590/1809-2950/17018227042020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO A identificação da pressão plantar durante a marcha é utilizada por clínicos e investigadores para verificar sobrecarga na estrutura podal. Neste particular, diferentes protocolos têm sido empregados para essa finalidade. O objetivo do estudo foi verificar a reprodutibilidade e a concordância de protocolos abreviados de marcha para identificar a pressão plantar dinâmica em jovens assintomáticos. Quinze voluntários foram submetidos aos protocolos abreviados one-step e three-step e ao protocolo padrão midgait em três momentos: inicial, dia seguinte e após sete dias. Para cada uma das oito máscaras podais, foram consideradas as medidas de pico de pressão plantar e integral pressão/tempo. A reprodutibilidade foi analisada mediante Anova one-way e coeficiente de correlação intraclasse, enquanto a concordância entre os protocolos foi verificada através de teste t pareado, correlação momento-produto de Pearson e plotagem de Bland-Altman. Os resultados apontaram que o protocolo three-step apresentou mais elevada reprodutibilidade em ambas as medidas de pressão plantar dinâmica. Quanto à concordância entre os protocolos, apesar de os abreviados demonstrarem tendência em subestimar as medidas produzidas pelo protocolo padrão midgait, na maioria das máscaras podais não foram identificadas diferenças estatísticas entre os escores médios. Ainda, por intermédio da técnica de Bland-Altman, constatou-se substancial capacidade de concordância entre as medidas identificadas pelos protocolos one-step, three-step e midgait. Concluindo, os protocolos abreviados devem ser selecionados de acordo com a medida de interesse da pressão plantar e a máscara podal a ser analisada, surgindo evidências de reprodutibilidade e concordância mais favoráveis para o uso do protocolo three-step.
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12
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Uddin KZ, Youssef G, Trkov M, Seyyedhosseinzadeh H, Koohbor B. Gradient optimization of multi-layered density-graded foam laminates for footwear material design. J Biomech 2020; 109:109950. [PMID: 32807338 DOI: 10.1016/j.jbiomech.2020.109950] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 07/03/2020] [Accepted: 07/08/2020] [Indexed: 10/23/2022]
Abstract
Several sports-related injuries and orthopedic treatments need the necessity of corrective shoes that can assuage the excessive pressure on sensitive locations of the foot. In the present work, we study the mechanical and energy absorption characteristics of density-graded foams designed for shoe midsoles. The stress-strain responses of polyurea foams with relative densities (nominal density of foam divided by the density of water) of 0.095, 0.23, and 0.35 are obtained experimentally and used as input to a semi-analytical model. Using this model, three-layered foam laminates with various gradients are designed and characterized in terms of their weight, strength, and energy absorption properties. We show that, in comparison with monolithic foams, significant improvement in strength and energy absorption performance can be achieved through density gradation. Our findings also suggest that there is not a single gradient that offers a superior combination of strength, energy absorption, and weight. Rather, an optimal gradient depends on the plantar location and pressure. Depending on the magnitude of the local plantar pressure, density gradients that lead to the highest specific energy absorption are identified for normal walking and running conditions.
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Affiliation(s)
- Kazi Zahir Uddin
- Department of Mechanical Engineering, Rowan University, 201 Mullica Hill Road, Glassboro, NJ 08028, USA
| | - George Youssef
- Experimental Mechanics Laboratory, Department of Mechanical Engineering, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, USA
| | - Mitja Trkov
- Department of Mechanical Engineering, Rowan University, 201 Mullica Hill Road, Glassboro, NJ 08028, USA
| | - Hamid Seyyedhosseinzadeh
- Orthopedic Research Group, School of Osteopathic Medicine, Rowan University, 201 S. Broadway, Camden, NJ 08103, USA
| | - Behrad Koohbor
- Department of Mechanical Engineering, Rowan University, 201 Mullica Hill Road, Glassboro, NJ 08028, USA.
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