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Yang XG, Peng Z, Liu X, Liu XL, Lu S. A narrative review of the measurement methods for biomechanical properties of plantar soft tissue in patients with diabetic foot. Front Endocrinol (Lausanne) 2024; 15:1332032. [PMID: 39135623 PMCID: PMC11317276 DOI: 10.3389/fendo.2024.1332032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 07/08/2024] [Indexed: 08/15/2024] Open
Abstract
This article provides an overview of the development history and advantages and disadvantages of measurement methods for soft tissue properties of the plantar foot. The measurement of soft tissue properties is essential for understanding the biomechanical characteristics and function of the foot, as well as for designing and evaluating orthotic devices and footwear. Various methods have been developed to measure the properties of plantar soft tissues, including ultrasound imaging, indentation testing, magnetic resonance elastography, and shear wave elastography. Each method has its own strengths and limitations, and choosing the most appropriate method depends on the specific research or clinical objectives. This review aims to assist researchers and clinicians in selecting the most suitable measurement method for their specific needs.
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Affiliation(s)
- Xiong-gang Yang
- Department of Orthopedics, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
- The Key Laboratory of Digital Orthopedics of Yunnan Province, Kunming, Yunnan, China
| | - Zhi Peng
- Department of Orthopedics, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Xiang Liu
- Department of Orthopedics, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Xiao-liang Liu
- Department of Orthopedics, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Sheng Lu
- Department of Orthopedics, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
- The Key Laboratory of Digital Orthopedics of Yunnan Province, Kunming, Yunnan, China
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Huang R, Ning X, Wu L, Zhu J, Tang L, Ma X. An exploratory in-situ dynamic mechanical analysis on the shearing stress-strain mechanism of human plantar soft tissue. Sci Rep 2024; 14:11953. [PMID: 38796594 PMCID: PMC11128022 DOI: 10.1038/s41598-024-62713-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 05/21/2024] [Indexed: 05/28/2024] Open
Abstract
A DMA (dynamic mechanical analysis)-like device based on the principle of classical viscoelasticity testing is invented to investigate the in-situ/in-vivo shear-bearing mechanism of plantar soft tissue. Forty-three volunteers were recruited for the shear-strain test in the longitudinal and transverse directions at five anatomical spots on the plantar surface. Several encouraging observations indicated significant variances among different spots and individuals, implying that the outer forefoot surrounding the second, fifth metatarsal head is a more intensive shear-bearing region on the plantar surface compared to the inner forefoot under the first metatarsal head, and drawing the hypothesis of a significant effect of BMI on the shear-bearing property. The speculations agree with our expectations and other previous research. The feasibility and practical value of this novel approach are substantiated, and these intriguing discoveries provide foundational underpinnings for further in-depth investigations.
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Affiliation(s)
- Ran Huang
- Academy for Engineering and Technology, Fudan University, Shanghai, 200433, China.
- Yiwu Research Institute of Fudan University, Yiwu, 322000, Zhejiang, China.
- Center for Innovation and Entrepreneurship, Taizhou Institute of Zhejiang University, Taizhou, 318000, Zhejiang, China.
| | - Xinyi Ning
- Academy for Engineering and Technology, Fudan University, Shanghai, 200433, China
| | - Longyan Wu
- Academy for Engineering and Technology, Fudan University, Shanghai, 200433, China
| | - Jun Zhu
- Yiwu Research Institute of Fudan University, Yiwu, 322000, Zhejiang, China
| | - Lisheng Tang
- Center for Innovation and Entrepreneurship, Taizhou Institute of Zhejiang University, Taizhou, 318000, Zhejiang, China.
| | - Xin Ma
- Academy for Engineering and Technology, Fudan University, Shanghai, 200433, China.
- Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, 200233, China.
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3
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Wu L, Huang R, Tang L, Ning X, Zhu J, Ma X. A novel in-situ dynamic mechanical analysis for human plantar soft tissue: The device design, definition of characteristics, test protocol, and preliminary results. Heliyon 2024; 10:e29986. [PMID: 38707476 PMCID: PMC11068617 DOI: 10.1016/j.heliyon.2024.e29986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 05/07/2024] Open
Abstract
The in-situ mechanical characterization of elastomers is not highly regarded due to the existence of a well-established set of sample-based standard tests for research and industry. However, there are certain situations or materials, like biological soft tissue, where an in-situ approach is necessary due to the impossibility of sampling from a living body. We have developed a dynamic mechanical analysis (DMA)-like device to approach in-vivo and in-situ multidimensional stress-strain properties of human plantar soft tissues. This work elucidates the operational mechanism of the novel measurement, with the definition of a new set of moduli, test standardization and protocol. Exploratory results of a volunteer's living plantar, silica rubber samples are presented with well preciseness and consistence as expected.
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Affiliation(s)
- Longyan Wu
- Academy for Engineering and Technology, Fudan University, Shanghai, 200433, China
| | - Ran Huang
- Academy for Engineering and Technology, Fudan University, Shanghai, 200433, China
- Yiwu Research Institute of Fudan University, Yiwu, Zhejiang, 322000, China
- Center for Innovation and Entrepreneurship, Taizhou Institute of Zhejiang University, Taizhou, Zhejiang, 318000, China
| | - Lisheng Tang
- Center for Innovation and Entrepreneurship, Taizhou Institute of Zhejiang University, Taizhou, Zhejiang, 318000, China
| | - Xinyi Ning
- Academy for Engineering and Technology, Fudan University, Shanghai, 200433, China
| | - Jun Zhu
- Yiwu Research Institute of Fudan University, Yiwu, Zhejiang, 322000, China
| | - Xin Ma
- Academy for Engineering and Technology, Fudan University, Shanghai, 200433, China
- Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, 200233, China
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4
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Crossland SR, Sairally F, Edwards J, Culmer P, Brockett CL. Mechanical characteristics of diabetic and non-diabetic plantar skin. J Mech Behav Biomed Mater 2024; 150:106279. [PMID: 38007990 DOI: 10.1016/j.jmbbm.2023.106279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/28/2023] [Accepted: 11/23/2023] [Indexed: 11/28/2023]
Abstract
Diabetic foot ulceration is linked to high amputation and mortality rates, with the substantial associated annual spend on the at-risk diabetic foot reflecting the intensive time and labour involved in treatment. Assessing plantar interactions and developing improved understanding of the formation pathways of diabetic ulceration is important to orthotic interventions and patient outcomes. Plantar skin surrogates which emulate the mechanical and tribological characteristics can help improve physical models of ulceration, reduce reliance on cadaveric use and inform more complex computational modelling approaches. The information available from existing studies to characterise plantar skin is limited, typically featuring ex-vivo representations of skin and subcutaneous tissue combined and given focus to shear studies with time dependency. The aim of this study is to improve understanding of plantar tissue mechanics by assessing the mechanical characteristics of plantar skin in two groups; (1) non-diabetic and (2) diabetic donors without the subcutaneous tissue attachment of previous work in this field. Digital image correlation was used to assess inherent skin pre-tension of the plantar rearfoot prior to dissection. Young's modulus, storage and loss moduli were tested for using tensile stress-strain failure analysis and tensile and compressive dynamic mechanical analysis, which was conducted on excised plantar rearfoot donor specimens for both disease state cohorts at frequencies reflecting those achieved in activities of daily living. Plantar skin thickness for donor specimens were comparable to values obtained using ultrasound acquired in vivo values. Median tensile storage and loss moduli, along with Young's modulus, was higher in the diabetic cohort. With a mean Young's modulus of 0.83 ± 0.49 MPa and 1.33 ± 0.43 MPa for non-diabetic and diabetic specimens respectively. Compressive studies showed consistency between cohorts for median storage and loss moduli. The outcomes from this study show mechanical characteristics of plantar skin without the involvement of subcuteanous tissues under reflective daily achieved loading regimes, showing differences in the non-diabetic and diabetic specimens trialled to support improved understanding of plantar tissue response under tribological interactions.
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Affiliation(s)
- Sarah R Crossland
- Department of Mechanical Engineering, University of Leeds, Leeds, UK.
| | | | - Jen Edwards
- Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | - Peter Culmer
- Department of Mechanical Engineering, University of Leeds, Leeds, UK
| | - Claire L Brockett
- Insigneo Institute for in silico Medicine, University of Sheffield, Sheffield, UK
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Pettenuzzo S, Belluzzi E, Pozzuoli A, Macchi V, Porzionato A, Boscolo-Berto R, Ruggieri P, Berardo A, Carniel EL, Fontanella CG. Mechanical Behaviour of Plantar Adipose Tissue: From Experimental Tests to Constitutive Analysis. Bioengineering (Basel) 2023; 11:42. [PMID: 38247919 PMCID: PMC10813593 DOI: 10.3390/bioengineering11010042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 12/22/2023] [Accepted: 12/28/2023] [Indexed: 01/23/2024] Open
Abstract
Plantar adipose tissue is a connective tissue whose structural configuration changes according to the foot region (rare or forefoot) and is related to its mechanical role, providing a damping system able to adsorb foot impact and bear the body weight. Considering this, the present work aims at fully describing the plantar adipose tissue's behaviour and developing a proper constitutive formulation. Unconfined compression tests and indentation tests have been performed on samples harvested from human donors and cadavers. Experimental results provided the initial/final elastic modulus for each specimen and assessed the non-linear and time-dependent behaviour of the tissue. The different foot regions were investigated, and the main differences were observed when comparing the elastic moduli, especially the final elastic ones. It resulted in a higher level for the medial region (89 ± 77 MPa) compared to the others (from 51 ± 29 MPa for the heel pad to 11 ± 7 for the metatarsal). Finally, results have been used to define a visco-hyperelastic constitutive model, whose hyperelastic component, which describes tissue non-linear behaviour, was described using an Ogden formulation. The identified and validated tissue constitutive parameters could serve, in the early future, for the computational model of the healthy foot.
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Affiliation(s)
- Sofia Pettenuzzo
- Department of Civil, Environmental and Architectural Engineering, University of Padova, 35131 Padova, Italy; (S.P.); (A.B.)
| | - Elisa Belluzzi
- Musculoskeletal Pathology and Oncology Laboratory, Department of Surgery, Oncology and Gastroenterology, University of Padova (DiSCOG), Via Giustiniani 3, 35128 Padova, Italy; (E.B.); (A.P.)
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology (DiSCOG), University of Padova, Via Giustiniani 3, 35128 Padova, Italy;
- Centre for Mechanics of Biological Materials, University of Padova, 35131 Padova, Italy; (V.M.); (A.P.); (R.B.-B.); (E.L.C.)
| | - Assunta Pozzuoli
- Musculoskeletal Pathology and Oncology Laboratory, Department of Surgery, Oncology and Gastroenterology, University of Padova (DiSCOG), Via Giustiniani 3, 35128 Padova, Italy; (E.B.); (A.P.)
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology (DiSCOG), University of Padova, Via Giustiniani 3, 35128 Padova, Italy;
- Centre for Mechanics of Biological Materials, University of Padova, 35131 Padova, Italy; (V.M.); (A.P.); (R.B.-B.); (E.L.C.)
| | - Veronica Macchi
- Centre for Mechanics of Biological Materials, University of Padova, 35131 Padova, Italy; (V.M.); (A.P.); (R.B.-B.); (E.L.C.)
- Department of Neuroscience, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy
- Veneto Region Reference Center for the Preservation and Use of Gifted Bodies, Veneto Region, 35100 Padua, Italy
| | - Andrea Porzionato
- Centre for Mechanics of Biological Materials, University of Padova, 35131 Padova, Italy; (V.M.); (A.P.); (R.B.-B.); (E.L.C.)
- Department of Neuroscience, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy
- Veneto Region Reference Center for the Preservation and Use of Gifted Bodies, Veneto Region, 35100 Padua, Italy
| | - Rafael Boscolo-Berto
- Centre for Mechanics of Biological Materials, University of Padova, 35131 Padova, Italy; (V.M.); (A.P.); (R.B.-B.); (E.L.C.)
- Department of Neuroscience, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy
- Veneto Region Reference Center for the Preservation and Use of Gifted Bodies, Veneto Region, 35100 Padua, Italy
| | - Pietro Ruggieri
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology (DiSCOG), University of Padova, Via Giustiniani 3, 35128 Padova, Italy;
- Centre for Mechanics of Biological Materials, University of Padova, 35131 Padova, Italy; (V.M.); (A.P.); (R.B.-B.); (E.L.C.)
| | - Alice Berardo
- Department of Civil, Environmental and Architectural Engineering, University of Padova, 35131 Padova, Italy; (S.P.); (A.B.)
- Centre for Mechanics of Biological Materials, University of Padova, 35131 Padova, Italy; (V.M.); (A.P.); (R.B.-B.); (E.L.C.)
- Department of Biomedical Sciences, University of Padova, 35131 Padova, Italy
| | - Emanuele Luigi Carniel
- Centre for Mechanics of Biological Materials, University of Padova, 35131 Padova, Italy; (V.M.); (A.P.); (R.B.-B.); (E.L.C.)
- Department of Industrial Engineering, University of Padova, 35131 Padova, Italy
| | - Chiara Giulia Fontanella
- Centre for Mechanics of Biological Materials, University of Padova, 35131 Padova, Italy; (V.M.); (A.P.); (R.B.-B.); (E.L.C.)
- Department of Industrial Engineering, University of Padova, 35131 Padova, Italy
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Fu Y, Pu H, Huang Q, Qiu P, Zhao D, Cheng Y. Application of 3D Printing Insole by Hemodynamics in Older Patients with Critical Limb Ischemia: Protocol for a Randomized Clinical Trial. Int J Gen Med 2023; 16:5241-5246. [PMID: 38021061 PMCID: PMC10644844 DOI: 10.2147/ijgm.s429768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Critical limb ischemia (CLI) is a severe condition characterized by inadequate blood flow to the lower extremities, often leading to tissue damage and amputation. CLI is characterized by microcirculatory dysfunction, muscle tissue necrosis, and inflammation. Patients may suffer from the traumatic pain and the increase of plantar pressure, and foot care for patients with CLI has become the "last mile" to improve their life quality. Traditional shoe insoles often lack individual customization, failing to address the unique anatomical needs and hemodynamic characteristics of patients. The study aims to investigate the effects of this innovative intervention on improving the clinical outcomes, and quality of life in CLI patients. Methods and Analysis This Critical Limb Ischemia Hemodynamic Insole Study is a randomized controlled study performed to explore the effect of a 3D printing insole on foot care of CLI patients. This study recruitment began on November 1, 2021. Patients with CLI confirmed by clinical symptoms and imaging were recruited as the research objects. Participants will be randomly assigned to either the experimental group, which will receive 3D-printed insoles customized based on their hemodynamics, or the control group, which will receive traditionally manufactured insoles. Both groups were followed up for up to 24 months after surgery, including claudication distance, claudication time, pain score, rehospitalization, etc. Trial Registration Number ChiCTR2100051857.
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Affiliation(s)
- Yan Fu
- Department of Nursing, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Hongji Pu
- Department of Vascular Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Qun Huang
- Department of Vascular Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Peng Qiu
- Department of Vascular Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Deyin Zhao
- Second Ward of General Surgery, Suzhou Hospital of Anhui Medical University (Suzhou Municipal Hospital of Anhui Province), Anhui, People’s Republic of China
| | - Yong Cheng
- Department of Nursing, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
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Brady LM, Rombokas E, Wang YN, Shofer JB, Ledoux WR. The effect of diabetes and tissue depth on adipose chamber size and plantar soft tissue features. Foot (Edinb) 2023; 56:101989. [PMID: 36905794 PMCID: PMC10450093 DOI: 10.1016/j.foot.2023.101989] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 02/19/2023] [Accepted: 02/23/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND Plantar ulceration is a serious complication of diabetes. However, the mechanism of injury initiating ulceration remains unclear. The unique structure of the plantar soft tissue includes superficial and deep layers of adipocytes contained in septal chambers, however, the size of these chambers has not been quantified in diabetic or non-diabetic tissue. Computer-aided methods can be leveraged to guide microstructural measurements and differences with disease status. METHODS Adipose chambers in whole slide images of diabetic and non-diabetic plantar soft tissue were segmented with a pre-trained U-Net and area, perimeter, and minimum and maximum diameter of adipose chambers were measured. Whole slide images were classified as diabetic or non-diabetic using the Axial-DeepLab network, and the attention layer was overlaid on the input image for interpretation. RESULTS Non-diabetic deep chambers were 90 %, 41 %, 34 %, and 39 % larger in area (26,954 ± 2428 µm2 vs 14,157 ± 1153 µm2), maximum (277 ± 13 µm vs 197 ± 8 µm) and minimum (140 ± 6 µm vs 104 ± 4 µm) diameter, and perimeter (405 ± 19 µm vs 291 ± 12 µm), respectively, than the superficial (p < 0.001). However, there was no significant difference in these parameters in diabetic specimens (area 18,695 ± 2576 µm2 vs 16627 ± 130 µm2, maximum diameter 221 ± 16 µm vs 210 ± 14 µm, minimum diameter 121 ± 8 µm vs 114 ± 7 µm, perimeter 341 ± 24 µm vs 320 ± 21 µm). Between diabetic and non-diabetic chambers, only the maximum diameter of the deep chambers differed (221 ± 16 µm vs 277 ± 13 µm). The attention network achieved 82 % accuracy on validation, but the attention resolution was too coarse to identify meaningful additional measurements. CONCLUSIONS Adipose chamber size differences may provide a basis for plantar soft tissue mechanical changes with diabetes. Attention networks are promising tools for classification, but additional care is required when designing networks for identifying novel features. DATA AVAILABILITY All images, analysis code, data, and/or other resources required to replicate this work are available from the corresponding author upon reasonable request.
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Affiliation(s)
- Lynda M Brady
- VA RR& D Center for Limb Loss and MoBility, Seattle, WA 98108, USA; Department of Mechanical Engineering, University of Washington, Seattle, WA 98195, USA
| | - Eric Rombokas
- Department of Mechanical Engineering, University of Washington, Seattle, WA 98195, USA
| | - Yak-Nam Wang
- VA RR& D Center for Limb Loss and MoBility, Seattle, WA 98108, USA; Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, WA 98195, USA
| | - Jane B Shofer
- VA RR& D Center for Limb Loss and MoBility, Seattle, WA 98108, USA
| | - William R Ledoux
- VA RR& D Center for Limb Loss and MoBility, Seattle, WA 98108, USA; Department of Mechanical Engineering, University of Washington, Seattle, WA 98195, USA; Department of Orthopaedics & Sports Medicine, University of Washington, Seattle, WA 98195, USA.
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Jones AD, Crossland SR, Nixon JE, Siddle HJ, Russell DA, Culmer PR. STrain Analysis and Mapping of the Plantar Surface (STAMPS): A novel technique of plantar load analysis during gait. Proc Inst Mech Eng H 2023; 237:841-854. [PMID: 37353979 DOI: 10.1177/09544119231181797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023]
Abstract
Diabetic foot ulceration is driven by peripheral neuropathy, resulting in abnormal foot biomechanics and elevated plantar load. Plantar load comprises normal pressure and tangential shear stress. Currently, there are no in-shoe devices measuring both components of plantar load. The STAMPS (STrain Analysis and Mapping of the Plantar Surface) system was developed to address this and utilises digital image correlation (DIC) to determine the strain sustained by a plastically deformable insole, providing an assessment of plantar load at the foot-surface interface during gait. STAMPS was developed as a multi-layered insole, comprising a deformable mid-layer, onto which a stochastic speckle pattern film is applied. A custom-built imaging platform is used to obtain high resolution pre- and post-walking images. Images are imported into commercially available DIC software (GOM Correlate, 2020) to obtain pointwise strain data. The strain and displacement data are exported and post-processed with custom analysis routines (MATLAB, Mathworks Inc.), to obtain the resultant global and regional peak strain (SMAG), antero-posterior strain (SAP) and medio-lateral strain (SML). To validate the core technique an experimental test process used a Universal Mechanical Tester (UMT) system (UMT TriboLab, Bruker) to apply controlled vertical and tangential load regimes to the proposed multi-layer insole. A pilot study was then conducted to assess the efficacy of using the STAMPS system to measure in-shoe plantar strain in three healthy participants. Each participant walked 10 steps on the STAMPS insole using a standardised shoe. They also walked 10 m in the same shoe using a plantar pressure measurement insole (Novel Pedar®) to record peak plantar pressure (PPP) as a gold-standard comparator. The results of the experimental validation tests show that with increased normal force, at a constant shear distance, SMAG increased in a linear fashion. Furthermore, they showed that with increased shear distance, at a constant force, SMAG increased. The results of the pilot study found participant 1 demonstrated greatest SMAG in the region toes 3-5 (15.31%). The highest mean SMAG for participant 2 was at the hallux (29.31%). Participant 3 exhibited highest strain in the regions of the first and second metatarsal heads (58.85% and 41.62% respectively). Increased PPP was strongly associated with increased SMAG with a Spearman's correlation coefficient 0.673 (p < 0.0001). This study has demonstrated the efficacy of a novel method to assess plantar load across the plantar surface of the foot. Experimental testing validated the sensitivity of the method to both normal pressure and tangential shear stress. This technique was successfully incorporated into the STAMPS insole to reliably measure and quantify the cumulative degree of strain sustained by a plastically deformable insole during a period of gait, which can be used to infer plantar loading patterns. Future work will explore how these measures relate to different pathologies, such as regions at risk of diabetic foot ulceration.
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Affiliation(s)
- Alexander D Jones
- Leeds Vascular Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Sarah R Crossland
- Leeds School of Mechanical Engineering, University of Leeds, Leeds, UK
| | - Jane E Nixon
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Heidi J Siddle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - David A Russell
- Leeds Vascular Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Peter R Culmer
- Leeds School of Mechanical Engineering, University of Leeds, Leeds, UK
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9
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Hudak YF, Li JS, Cullum S, Strzelecki BM, Richburg C, Kaufman GE, Abrahamson D, Heckman JT, Ripley B, Telfer S, Ledoux WR, Muir BC, Aubin PM. A novel workflow to fabricate a patient-specific 3D printed accommodative foot orthosis with personalized latticed metamaterial. Med Eng Phys 2022; 104:103802. [PMID: 35641072 PMCID: PMC9210925 DOI: 10.1016/j.medengphy.2022.103802] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 03/09/2022] [Accepted: 04/12/2022] [Indexed: 12/19/2022]
Abstract
Patients with diabetes mellitus are at elevated risk for secondary complications that result in lower extremity amputations. Standard of care to prevent these complications involves prescribing custom accommodative insoles that use inefficient and outdated fabrication processes including milling and hand carving. A new thrust of custom 3D printed insoles has shown promise in producing corrective insoles but has not explored accommodative diabetic insoles. Our novel contribution is a metamaterial design application that allows the insole stiffness to vary regionally following patient-specific plantar pressure measurements. We presented a novel workflow to fabricate custom 3D printed elastomeric insoles, a testing method to evaluate the durability, shear stiffness, and compressive stiffness of insole material samples, and a case study to demonstrate how the novel 3D printed insoles performed clinically. Our 3D printed insoles results showed a matched or improved durability, a reduced shear stiffness, and a reduction in plantar pressure in clinical case study compared to standard of care insoles.
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Affiliation(s)
- Yuri F Hudak
- VA RR&D Center for Limb Loss and MoBility (CLiMB), VA Puget Sound Health Care System, Seattle, WA, United States; Department of Mechanical Engineering, University of Washington, Seattle, WA, United States
| | - Jing-Sheng Li
- VA RR&D Center for Limb Loss and MoBility (CLiMB), VA Puget Sound Health Care System, Seattle, WA, United States; Department of Mechanical Engineering, University of Washington, Seattle, WA, United States
| | - Scott Cullum
- VA RR&D Center for Limb Loss and MoBility (CLiMB), VA Puget Sound Health Care System, Seattle, WA, United States; Department of Mechanical Engineering, University of Washington, Seattle, WA, United States
| | - Brian M Strzelecki
- VA RR&D Center for Limb Loss and MoBility (CLiMB), VA Puget Sound Health Care System, Seattle, WA, United States
| | - Chris Richburg
- VA RR&D Center for Limb Loss and MoBility (CLiMB), VA Puget Sound Health Care System, Seattle, WA, United States
| | - G Eli Kaufman
- VA RR&D Center for Limb Loss and MoBility (CLiMB), VA Puget Sound Health Care System, Seattle, WA, United States
| | - Daniel Abrahamson
- VA RR&D Center for Limb Loss and MoBility (CLiMB), VA Puget Sound Health Care System, Seattle, WA, United States
| | - Jeffrey T Heckman
- James A. Haley Veterans' Hospital & Clinics, Tampa, FL, United States; Department of Rehabilitation Medicine, University of South Florida, Tampa, FL, United States
| | - Beth Ripley
- Department of Radiology, VA Puget Sound Health Care System, Seattle, WA ,United States
| | - Scott Telfer
- Department of Orthopedics and Sports Medicine, University of Washington, Seattle, WA, United States
| | - William R Ledoux
- VA RR&D Center for Limb Loss and MoBility (CLiMB), VA Puget Sound Health Care System, Seattle, WA, United States; Department of Mechanical Engineering, University of Washington, Seattle, WA, United States; Department of Orthopedics and Sports Medicine, University of Washington, Seattle, WA, United States
| | - Brittney C Muir
- VA RR&D Center for Limb Loss and MoBility (CLiMB), VA Puget Sound Health Care System, Seattle, WA, United States; Department of Mechanical Engineering, University of Washington, Seattle, WA, United States.
| | - Patrick M Aubin
- VA RR&D Center for Limb Loss and MoBility (CLiMB), VA Puget Sound Health Care System, Seattle, WA, United States; Department of Mechanical Engineering, University of Washington, Seattle, WA, United States
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