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Brady LM, Wukelic C, Ledoux WR. A method for automated masking and plantar pressure analysis using segmented computed tomography scans. Gait Posture 2024; 111:92-98. [PMID: 38657477 PMCID: PMC11127777 DOI: 10.1016/j.gaitpost.2024.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 03/26/2024] [Accepted: 04/12/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Plantar pressure, a common gait and foot biomechanics measurement, is typically analyzed using proprietary commercial software packages. Regional plantar pressure analysis is often reported in terms of underlying bony geometry, and recent advances in image processing and accessibility have made computed tomography, radiographs, magnetic resonance imaging, or other imaging methods more popular for incorporating bone analyses in biomechanics. RESEARCH QUESTION Can a computed tomography-based regional mask provide comparable regional analysis to commercial plantar pressure software and can the increased flexibility of an in-house method obtain additional insight from common measurements? METHODS A plantar pressure analysis method was developed based on bony geometry from computed tomography scans to calculate peak pressure, pressure time integral incorporating sub-peak values, force time integral, pressure gradient, and pressure gradient angle. Static and dynamic plantar pressure were acquired for 4 subjects (male, 65 ± 2.4 years). Plantar pressure variables were calculated using commercial and computed tomography-based systems. RESULTS Dynamic peak pressure, pressure time integral, and force-time integral computed using the bone-based software was 5 % (9kPa), 7 % (0.3kPa-s) and 13 % (0.3 N-s) different than the commercial software on average. Region masks of the metatarsals and toes differed between commercial and computed tomography-based software due to subject-specific bone geometry and toe shape. Pressure time integral values incorporating sub-peak pressure were higher and demonstrated higher relative hindfoot values compared to those without. Removing step-on frames to static pressure analysis decreased forefoot pressures. Regional maps of peak pressure and maximum pressure gradient demonstrate different peak locations. SIGNIFICANCE Computed tomography-based regional masks are comparable to commercial masks. Inclusion of static step-on frames and sub-peak pressures may change regional plantar pressure patterns. Differences in location of maximum pressure gradient and peak pressure may be useful for assessing subject specific injury risk.
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Affiliation(s)
- Lynda M Brady
- VA RR& D Center for Limb Loss and MoBility (CLiMB), Seattle, WA 98108, USA; Department of Mechanical Engineering, University of Washington, Seattle, WA 98195, USA
| | - Corey Wukelic
- VA RR& D Center for Limb Loss and MoBility (CLiMB), Seattle, WA 98108, USA
| | - William R Ledoux
- VA RR& D Center for Limb Loss and MoBility (CLiMB), 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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Shen WC, Cheng HT, Jan YK, Liau BY, Hsieh CW, Bau JG, Tai CC, Lung CW. Effect of negative pressure therapy on the treatment response to scar thickness and viscoelasticity. Front Bioeng Biotechnol 2024; 12:1353418. [PMID: 38712331 PMCID: PMC11070486 DOI: 10.3389/fbioe.2024.1353418] [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: 12/10/2023] [Accepted: 03/12/2024] [Indexed: 05/08/2024] Open
Abstract
Patients with scars face a grave threat to their mental and physical health. Negative pressure has been used for scar therapy in medical care and provides a microenvironment conducive to scar healing while stimulating cell regeneration. Negative pressure may disrupt scar tissue regeneration when the pressure is too high or too low, so finding a suitable negative pressure is important. We hypothesized that different negative pressure magnitudes would affect scar tissue properties differently. This research aimed to provide practical recommendations for scar therapy. This study used three negative pressures (-105 mmHg, -125 mmHg, and -145 mmHg) to compare scar material properties. We measured scar tissue thickness and viscoelasticity with a motor-driven ultrasound indentation system. According to the results of this study, scar thickness is most effectively reduced at a negative pressure of -105 mmHg. In comparison, scar viscoelasticity continuously increases at a negative pressure of -125 mmHg. Negative pressure therapy can be recommended to scar care clinics based on the results of this study.
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Affiliation(s)
- Wei-Cheng Shen
- Department of Creative Product Design, Asia University, Taichung, Taiwan
| | - Hsu-Tang Cheng
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Asia University Hospital, Asia University College of Medical and Health Science, Taichung, Taiwan
- Department of Food Nutrition and Health Biotechnology, Asia University, Taichung, Taiwan
| | - Yih-Kuen Jan
- Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Ben-Yi Liau
- Department of Automatic Control Engineering, Feng Chia University, Taichung, Taiwan
| | - Chang-Wei Hsieh
- Department of Electrical Engineering, National Dong Hwa University, Hualien, Taiwan
| | - Jian-Guo Bau
- Department of Agricultural Technology, National Formosa University, Yunlin, Taiwan
| | - Chien-Cheng Tai
- School of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Chi-Wen Lung
- Department of Creative Product Design, Asia University, Taichung, Taiwan
- Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, United States
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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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Jan YK, Lin CF, Liao F, Singh NB. Editorial: Nonlinear dynamics and complex patterns in the human musculoskeletal system and movement. Front Bioeng Biotechnol 2023; 11:1339376. [PMID: 38162178 PMCID: PMC10756663 DOI: 10.3389/fbioe.2023.1339376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 12/08/2023] [Indexed: 01/03/2024] Open
Affiliation(s)
- Yih-Kuen Jan
- Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, United States
| | - Cheng-Feng Lin
- Department of Physical Therapy, National Cheng Kung University, Tainan, Taiwan
| | - Fuyuan Liao
- Department of Biomedical Engineering, Xi’an Technological University, Xi’an, China
| | - Navrag B. Singh
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Singapore-ETH Centre, Future Health Technologies Program, CREATE Campus, Singapore, Singapore
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Zhang X, Teng Z, Geng X, Ma X, Chen WM. A fluoroscopic imaging-guided computational analyses to inform internal tissue loads within fat pad of the diabetic foot during gait. J Biomech 2023; 157:111744. [PMID: 37535986 DOI: 10.1016/j.jbiomech.2023.111744] [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: 02/04/2023] [Revised: 07/25/2023] [Accepted: 07/28/2023] [Indexed: 08/05/2023]
Abstract
To accurately predict internal tissue loads for early diagnostics of diabetic foot ulcerations, a novel data-driven computational analysis was conducted. A dedicated dual fluoroscopic system was combined with a pressure mat to simultaneously characterize foot motions and soft tissue's material properties during gait. Finite element (FE) models of the heel pad of a diabetic patient were constructed with 3D trajectories of the calcaneus applied as boundary conditions to simulate gait events. The tensile and compressive stresses occurring in the plantar tissue were computed. Predictions of the layered tissue FE model with anatomically-accurate heel pad structures (i.e., fat and skin) were compared with those of the traditional lumped tissue (i.e., homogeneous) models. The influence of different material properties (patient-specific versus generic) on internal tissue stresses was also investigated. The results showed the peak tensile stresses in the layered tissue model were predominantly found in the skin and distributed towards the circumferential regions of the heel, while peak compressive stresses in the fat tissue-bone interface were up to 51.4% lower than those seen in the lumped models. Performing FE analyses at four different phases of walking revealed that ignorance of layered tissue structures resulted in an unphysiological increase of peak-to-peak value of stress fluctuation in the fat and skin tissue components. Thus, to produce more clinical-relevant predictions, foot FE models are suggested to include layered tissue structures of the plantar tissue for an improved estimation of internal stresses in the diabetic foot in gait.
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Affiliation(s)
- Xingyu Zhang
- Institute of Biomedical Engineering and Technology, Academy for Engineering and Technology, Fudan University, 220 Handan Road, Shanghai, China
| | - Zhaolin Teng
- Department of Orthopaedics, Huashan Hospital affiliated to Fudan University, 12 Middle Wulumuqi Road, Shanghai, China
| | - Xiang Geng
- Department of Orthopaedics, Huashan Hospital affiliated to Fudan University, 12 Middle Wulumuqi Road, Shanghai, China
| | - Xin Ma
- Department of Orthopaedics, Huashan Hospital affiliated to Fudan University, 12 Middle Wulumuqi Road, Shanghai, China
| | - Wen-Ming Chen
- Institute of Biomedical Engineering and Technology, Academy for Engineering and Technology, Fudan University, 220 Handan Road, Shanghai, China.
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Pirri C, Biz C, Pirri N, Macchi V, Porzionato A, De Caro R, Ruggieri P, Stecco C. Crural and Plantar Fasciae Changes in Chronic Charcot Diabetic Foot: A Cross-Sectional Ultrasound Imaging Study-An Evidence of Fascial Continuity. J Clin Med 2023; 12:4664. [PMID: 37510779 PMCID: PMC10380358 DOI: 10.3390/jcm12144664] [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: 06/13/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
Crural fascia (CF) and plantar fascia (PF) are biomechanically crucial in the gait and in the proprioception, particularly in the propulsion phase of the foot during the gait cycle and in the dissipation of forces during weight-bearing activities. Recent studies have revealed an association between increases in PF thickness and diabetes. The purpose of this study was to measure and compare by ultrasound (US) imaging the thickness of the CF and PF at different regions/levels in chronic Charcot diabetic foot patients (group 1) and in healthy volunteers (group 2). A cross-sectional study was performed using US imaging to measure the CF with Pirri et al.'s protocol and PF with a new protocol in a sample of 31 subjects (15 patients and 16 healthy participants). The findings for CF and PF revealed statistically significant differences in the poster region of CF (Post 1: group 1 vs. group 2: p = 0.03; Post 2: group 1 vs. group 2: p = 0.03) and in PF at two different levels (PF level 1: group 1 vs. group 2: p < 0.0001; PF level 2: group 1 vs. group 2: p < 0.0001). These findings suggest that chronic Charcot diabetic foot patients have CF and PF thicker compared to healthy volunteers. The US examination suggests that fascial thicknesses behavior in these patients points out altered fascial remodeling due to diabetes pathology and biomechanical changes.
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Affiliation(s)
- Carmelo Pirri
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padua, Italy
| | - Carlo Biz
- Department of Orthopedics and Orthopedic Oncology, University of Padova, 35128 Padova, Italy
| | - Nina Pirri
- Department of Medicine-DIMED, School of Radiology, Radiology Institute, University of Padova, 35121 Padova, Italy
| | - Veronica Macchi
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padua, Italy
| | - Andrea Porzionato
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padua, Italy
| | - Raffaele De Caro
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padua, Italy
| | - Pietro Ruggieri
- Department of Orthopedics and Orthopedic Oncology, University of Padova, 35128 Padova, Italy
| | - Carla Stecco
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padua, Italy
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Li Y, Mo PC, Lin CF, Pauly S, Kundal N, Hernandez ME, Jan YK. Using near-infrared spectroscopy to investigate the effects of pressures and durations of cupping therapy on muscle blood volume and oxygenation. JOURNAL OF BIOPHOTONICS 2023:e202200342. [PMID: 37002817 DOI: 10.1002/jbio.202200342] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 03/04/2023] [Accepted: 03/28/2023] [Indexed: 06/19/2023]
Abstract
Cupping therapy has been widely used to manage musculoskeletal impairment. However, the effects of pressure and duration of cupping therapy on the hemodynamic activity of the muscle have not been investigated. A 2 × 2 repeated measures factorial design was used to examine the main effect and interaction of pressure (-225 and -300 mmHg) and duration (5 and 10 min) on biceps muscle blood flow using near-infrared spectroscopy in 18 participants. The results showed that a significant interaction is between pressure and duration on deoxy-hemoglobin (p = 0.045). A significant main effect of pressure is on oxyhemoglobin (p = 0.005) and a significant main effect of duration is on oxyhemoglobin (p = 0.005). Cupping therapy at -300 mmHg for 10 min results in a higher oxyhemoglobin (6.75 ± 2.08 μM) and deoxy-hemoglobin (1.71 ± 0.78 μM) compared to other three combinations. Our study provides first evidence that the pressure and duration factors of cupping therapy can significantly affect muscle blood volume and oxygenation.
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Affiliation(s)
- Yameng Li
- Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
- College of Physical Education and Sports, Beijing Normal University, Beijing, China
| | - Pu-Chun Mo
- Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Cheng-Feng Lin
- Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
- Department of Physical Therapy, National Cheng Kung University, Tainan, Taiwan
| | - Serah Pauly
- Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Nikeeta Kundal
- Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Manuel E Hernandez
- Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Yih-Kuen Jan
- Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
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Yan Y, Ou J, Shi H, Sun C, Shen L, Song Z, Shu L, Chen Z. Plantar pressure and falling risk in older individuals: a cross-sectional study. J Foot Ankle Res 2023; 16:14. [PMID: 36941642 PMCID: PMC10029259 DOI: 10.1186/s13047-023-00612-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/02/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Falls are commonplace among elderly people. It is urgent to prevent falls. Previous studies have confirmed that there is a difference in plantar pressure between falls and non-falls in elderly people, but the relationship between fall risk and foot pressure has not been studied. In this study, the differences in dynamic plantar pressure between elderly people with high and low fall risk were preliminarily discussed, and the characteristic parameters of plantar pressure were determined. METHODS Twenty four high-fall-risk elderly individuals (HR) and 24 low-fall-risk elderly individuals (LR) were selected using the Berg Balance Scale 40 score. They wore wearable foot pressure devices to walk along a 20-m-long corridor. The peak pressure (PP), pressure time integral (PTI), pressure gradient (maximum pressure gradient (MaxPG), minimum pressure gradient (MinPG), full width at half maximum (FWHM)) and average pressure (AP) of their feet were measured for inter-group and intra-group analysis. RESULTS The foot pressure difference comparing the high fall risk with low fall risk groups was manifested in PP and MaxPG, concentrated in the midfoot and heel (p < 0.05), while the only time parameter, FWHM, was manifested in the whole foot (p < 0.05). The differences between the left and right foot were reflected in all parameters. The differences between the left and right foot in LR were mainly reflected in the heel (p < 0.05), while it in the HR was mainly reflected in the forefoot (p < 0.05). CONCLUSIONS The differences comparing the high fall risk with low fall risk groups were mostly reflected in the midfoot and heel. The HR may have been more cautious when landing. In the intra-group comparison, the difference between the right and left foot of the LR was mainly reflected during heel striking, while it was mainly reflected during pedalling in the HR. The sensitivity of PP, PTI and AP was lower and the newly introduced pressure gradient could better reflect the difference in foot pressure between the two groups. The pressure gradient can be used as a new foot pressure parameter in scientific research.
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Affiliation(s)
- Yifeng Yan
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jianlin Ou
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Hanxue Shi
- School of Future Technology, South China University of Technology, Guangzhou, China
| | - Chenming Sun
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Longbin Shen
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Zhen Song
- School of Future Technology, South China University of Technology, Guangzhou, China
- School of Microelectronics, South China University of Technology, Guangzhou, China
| | - Lin Shu
- School of Future Technology, South China University of Technology, Guangzhou, China.
- Institute of Modern Industrial Technology of SCUT in Zhongshan, Zhongshan, China.
- Pazhou Lab, Guangzhou, China.
| | - Zhuoming Chen
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, China.
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Wu FL, Lung CW, Wang WTJ, Elliott J, Jain S, Jan YK. Effects of Walking Speeds and Durations on Peak Plantar Pressures. J Am Podiatr Med Assoc 2022; 112:20-043. [PMID: 36525323 DOI: 10.7547/20-043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Walking at various speeds and durations may result in different peak plantar pressure (PPP). However, there is no study comparing the effect of walking speeds and durations on PPP. The purpose of this study was to explore whether different walking speeds and durations significantly change PPP and establish a normal response in healthy people. METHODS An in-shoe plantar pressure system was used to measure PPP under the first toe, first metatarsal, second metatarsal, and heel regions in 12 healthy, young people. All participants performed six walking trials at three speeds (3, 6, and 9 km/h) and for two durations (10 and 20 min). The 3 × 2 two-way analysis of variance was used to examine the main effects of speeds and durations and their interaction. RESULTS The results showed that walking speeds significantly affected PPP and that walking duration did not. No interaction between the walking speed and duration was observed. Peak plantar pressure values under the first toe and the first metatarsal head were significantly higher (P < .05) at 9 km/h (509.1 ± 314.2 kPa and 591.4 ± 302.4 kPa, respectively) than at 3 km/h (275.4 ± 168.7 kPa and 369.4 ± 205.4 kPa, respectively) after 10-min walking. CONCLUSIONS People at risk for foot ulcers may use slow and brisk walking for exercise to reduce PPP, thus reducing risk for foot ulcers. Our study demonstrated that slow running at 9 km/h significantly increases PPP.
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Affiliation(s)
- Fu-Lien Wu
- *Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL
| | - Chi-Wen Lung
- *Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL.,†Department of Creative Product Design, Asia University, Taichung, Taiwan
| | - Wendy Tzyy-Jiuan Wang
- ‡Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan
| | - Jeannette Elliott
- §Disability Resources and Educational Services, University of Illinois at Urbana-Champaign, Champaign, IL
| | - Sanjiv Jain
- ‖Department Physical Medicine and Rehabilitation, Carle Foundation Hospital, Urbana, IL
| | - Yih-Kuen Jan
- *Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL.,¶Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, People's Republic of China
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Li Y, Mo PC, Jain S, Elliott J, Bleakney A, Lyu S, Jan YK. Effect of durations and pressures of cupping therapy on muscle stiffness of triceps. Front Bioeng Biotechnol 2022; 10:996589. [PMID: 36466351 PMCID: PMC9712727 DOI: 10.3389/fbioe.2022.996589] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 11/02/2022] [Indexed: 10/14/2023] Open
Abstract
Cupping therapy has been used for the alleviation of muscle soreness in athletes. However, clinical studies of cupping therapy show conflicting results. Lack of standardized guidelines of the dose-response relationship of cupping therapy, such as appropriate cupping duration and negative pressure, limits the adoption of cupping therapy in clinical practice. The objectives of this study were to investigate the effect of various pressures and durations of cupping therapy on reducing muscle stiffness. The 2 × 2 factorial design with the repeated measures and counterbalanced design was used to test four cupping protocols, including two negative pressures at -225 and -300 mmHg and two durations at 5 and 10 min, in 12 healthy young people. B-mode and elastographic ultrasound was used to assess muscle stiffness of the triceps before and after cupping therapy. The region of interest of elastographic image was divided into the superficial and deep layers for assessing the effect of cupping therapy on stiffness of various depths of the triceps. Normalized stiffness was calculated as a ratio of pre-cupping stiffness divided by post-cupping stiffness of each participant. The two-way analysis of variance (ANOVA) was used to examine the main effects of the pressure and duration factors and the interaction effect between the pressure and duration factors. The results showed that there were no interactions between the pressure and duration factors (overall layer p = 0.149, superficial layer p = 0.632, and deep layer p = 0.491). The main effects of duration of the overall, superficial and deep layers were p = 0.538, p = 0.097 and p = 0.018, respectively. The results showed that 10-min cupping at -300 mmHg is more effective on reducing stiffness of the deep layer of the triceps compared to 5-min cupping (p = 0.031). This study provides the first evidence that the dose of cupping therapy could significantly affect changes of triceps stiffness and the deep layer of the muscle is more sensitive to cupping therapy compared to the superficial and overall layers.
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Affiliation(s)
- Yameng Li
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, United States
- College of Physical Education and Sports, Beijing Normal University, Beijing, China
| | - Pu-Chun Mo
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Sanjiv Jain
- Department of Physical Medicine and Rehabilitation, Carle Foundation Hospital, Urbana, IL, United States
| | - Jeannette Elliott
- Disability Resources and Educational Services, University of Illinois at Urbana-Champaign, Champaign, IL, United States
| | - Adam Bleakney
- Disability Resources and Educational Services, University of Illinois at Urbana-Champaign, Champaign, IL, United States
| | - Shaojun Lyu
- College of Physical Education and Sports, Beijing Normal University, Beijing, China
| | - Yih-Kuen Jan
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, United States
- Disability Resources and Educational Services, University of Illinois at Urbana-Champaign, Champaign, IL, United States
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Lung CW, Mo PC, Cao C, Zhang K, Wu FL, Liau BY, Jan YK. Effects of walking speeds and durations on the plantar pressure gradient and pressure gradient angle. BMC Musculoskelet Disord 2022; 23:823. [PMID: 36042445 PMCID: PMC9426236 DOI: 10.1186/s12891-022-05771-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/25/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Walking exercise has been demonstrated to improve health in people with diabetes. However, it is largely unknown the influences of various walking intensities such as walking speeds and durations on dynamic plantar pressure distributions in non-diabetics and diabetics. Traditional methods ignoring time-series changes of plantar pressure patterns may not fully capture the effect of walking intensities on plantar tissues. The purpose of this study was to investigate the effect of various walking intensities on the dynamic plantar pressure distributions. In this study, we introduced the peak pressure gradient (PPG) and its dynamic patterns defined as the pressure gradient angle (PGA) to quantify dynamic changes of plantar pressure distributions during walking at various intensities. METHODS Twelve healthy participants (5 males and 7 females) were recruited in this study. The demographic data were: age, 27.1 ± 5.8 years; height, 1.7 ± 0.1 m; and weight, 63.5 ± 13.5 kg (mean ± standard deviation). An insole plantar pressure measurement system was used to measure plantar pressures during walking at three walking speeds (slow walking 1.8 mph, brisk walking 3.6 mph, and slow running 5.4 mph) for two durations (10 and 20 min). The gradient at a location is defined as the unique vector field in the two-dimensional Cartesian coordinate system with a Euclidean metric. PGA was calculated by quantifying the directional variation of the instantaneous peak gradient vector during stance phase of walking. PPG and PGA were calculated in the plantar regions of the first toe, first metatarsal head, second metatarsal head, and heel at higher risk for foot ulcers. Two-way ANOVA with Fisher's post-hoc analysis was used to examine the speed and duration factors on PPG and PGA. RESULTS The results showed that the walking speeds significantly affect PPG (P < 0.05) and PGA (P < 0.05), and the walking durations does not. No interaction between the walking duration and speed was observed. PPG in the first toe region after 5.4 mph for either 10 or 20 min was significantly higher than 1.8 mph. Meanwhile, after 3.6 mph for 20 min, PPG in the heel region was significantly higher than 1.8 mph. Results also indicate that PGA in the forefoot region after 3.6 mph for 20 min was significantly narrower than 1.8 mph. CONCLUSIONS Our findings indicate that people may walk at a slow speed at 1.8 mph for reducing PPG and preventing PGA concentrated over a small area compared to brisk walking at 3.6 mph and slow running at 5.4 mph.
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Affiliation(s)
- Chi-Wen Lung
- grid.35403.310000 0004 1936 9991Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL USA ,grid.252470.60000 0000 9263 9645Department of Creative Product Design, Asia University, Taichung, Taiwan
| | - Pu-Chun Mo
- grid.35403.310000 0004 1936 9991Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL USA
| | - Chunmei Cao
- grid.12527.330000 0001 0662 3178Division of Sports Science and Physical Education, Tsinghua University, Beijing, China
| | - Keying Zhang
- grid.12527.330000 0001 0662 3178Division of Sports Science and Physical Education, Tsinghua University, Beijing, China
| | - Fu-Lien Wu
- grid.35403.310000 0004 1936 9991Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL USA
| | - Ben-Yi Liau
- grid.411432.10000 0004 1770 3722Department of Biomedical Engineering, Hungkuang University, Taichung, Taiwan
| | - Yih-Kuen Jan
- grid.35403.310000 0004 1936 9991Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL USA
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12
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Guan Y, Bai M, Li Q, Li W, Liu G, Liu C, Chen Y, Lin Y, Hui Y, Wei R. A plantar wearable pressure sensor based on hybrid lead zirconate-titanate/microfibrillated cellulose piezoelectric composite films for human health monitoring. LAB ON A CHIP 2022; 22:2376-2391. [PMID: 35635092 DOI: 10.1039/d2lc00051b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Flexible and wearable electronic sensors hold great promise for improving the quality of life, especially in the field of healthcare monitoring, owing to their low cost, flexibility, high electromechanical coupling performance, high sensitivity, and biocompatibility. To achieve high piezoelectric performance similar to that of rigid materials while satisfying the flexible requirements for wearable sensors, we propose novel hybrid films based on lead zirconate titanate powder and microfibrillated cellulose (PZT/MFC) for plantar pressure measurements. The flexible films made using the polarization process are tested. It was found that the maximum piezoelectric coefficient was 31 pC N-1 and the maximum tensile force of the flexible films was 26 N. A wide range of bending angles between 15° and 180° proves the flexibility capability of the films. In addition, the charge density shows a proportional relation with the applied mechanical force, and it could sense stress of 1 kPa. Finally, plantar pressure sensors are arranged and packaged with a film array followed by connection with the detection module. Then, the pressure curves of each point on the plantar are obtained. Through analysis of the curve, several parameters of human body motions that are important in the rehabilitation of diabetic patients and the detection of sports injury can be performed, including stride frequency, length and speed. Overall, the proposed PZT/MFC wearable plantar pressure sensor has broad application prospects in the field of sports injury detection and medical rehabilitation training.
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Affiliation(s)
- Yanfang Guan
- School of Electromechanical Engineering, Henan University of Technology, Zhengzhou 450001, China.
- National Engineering Laboratory/Key Laboratory of Henan Province, Henan University of Technology, Zhengzhou 450001, China
| | - Mingyang Bai
- School of Electromechanical Engineering, Henan University of Technology, Zhengzhou 450001, China.
| | - Qiuliang Li
- School of Electromechanical Engineering, Henan University of Technology, Zhengzhou 450001, China.
| | - Wujie Li
- School of Electromechanical Engineering, Henan University of Technology, Zhengzhou 450001, China.
| | - Guangyu Liu
- School of Electromechanical Engineering, Henan University of Technology, Zhengzhou 450001, China.
| | - Chunbo Liu
- School of Electromechanical Engineering, Henan University of Technology, Zhengzhou 450001, China.
| | - Yu Chen
- School of Mechanical Engineering, Chengdu University, Chengdu, 610106, China
| | - Yang Lin
- Department of Mechanical, Industrial & Systems Engineering, University of Rhode Island, Kingston 02881, USA
| | - Yanbo Hui
- School of Electromechanical Engineering, Henan University of Technology, Zhengzhou 450001, China.
| | - Ronghan Wei
- Advanced Intelligent Manufacturing, Nano Opto-mechatronics & Biomedical Engineering Lab, Zhengzhou University, Zhengzhou 450001, China
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13
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Leung MSH, Yick KL, Sun Y, Chow L, Ng SP. 3D printed auxetic heel pads for patients with diabetic mellitus. Comput Biol Med 2022; 146:105582. [PMID: 35588678 DOI: 10.1016/j.compbiomed.2022.105582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/29/2022] [Accepted: 04/30/2022] [Indexed: 11/03/2022]
Abstract
More than 422 million people worldwide suffered from diabetes mellitus (DM) in 2021. Diabetic foot is one the most critical complications resultant of DM. Foot ulceration and infection are frequently arisen, which are associated with changes in the mechanical properties of the plantar soft tissues, peripheral arterial disease, and sensory neuropathy. Diabetic insoles are currently the mainstay in reducing the risk of foot ulcers by reducing the magnitude of the pressure on the plantar Here, we propose a novel pressure relieving heel pad based on a circular auxetic re-entrant honeycomb structure by using three-dimensional (3D) printing technology to minimize the pressure on the heel, thus reducing the occurrence of foot ulcers. Finite element models (FEMs) are developed to evaluate the structural changes of the developed circular auxetic structure upon exertion of compressive forces. Moreover, the effects of the internal angle of the re-entrant structure on the peak contact force and the mean pressure acting on the heel as well as the contact area between the heel and the pads are investigated through a finite element analysis (FEA). Based on the result from the validated FEMs, the proposed heel pad with an auxetic structure demonstrates a distinct reduction in the peak contact force (∼10%) and the mean pressure (∼14%) in comparison to a conventional diabetic insole (PU foam). The characterized result of the designed circular auxetic structure not only provides new insights into diabetic foot protection, but also the design and development of various impact resistance products.
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Affiliation(s)
- Matthew Sin-Hang Leung
- The Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China; Laboratory for Artificial Intelligence in Design, Hong Kong Science Park, New Territories, Hong Kong, China
| | - Kit-Lun Yick
- The Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China; Laboratory for Artificial Intelligence in Design, Hong Kong Science Park, New Territories, Hong Kong, China.
| | - Yue Sun
- School of Fashion Design & Engineering, Zhejiang Sci-Tech University, Hangzhou City, Zhejiang Province, China
| | - Lung Chow
- The Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
| | - Sun-Pui Ng
- Hong Kong Community College, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
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14
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Jan YK, Major MJ, Pu F, Sonenblum SE. Editorial: Soft Tissue Biomechanics in Wound Healing and Prevention. Front Bioeng Biotechnol 2022; 10:897860. [PMID: 35449596 PMCID: PMC9017806 DOI: 10.3389/fbioe.2022.897860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 03/18/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Yih-Kuen Jan
- Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, United States
- *Correspondence: Yih-Kuen Jan,
| | - Matthew J. Major
- Departments of Physical Medicine and Rehabilitation and Biomedical Engineering, Northwestern University, Chicago, IL, United States
- Jesse Brown VA Medical Center, Chicago, IL, United States
| | - Fang Pu
- Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Sharon Eve Sonenblum
- Rehabilitation Engineering and Applied Research Laboratory, The George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, United States
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15
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Duan Y, Ren W, Liu W, Li J, Pu F, Jan YK. Relationship Between Plantar Tissue Hardness and Plantar Pressure Distributions in People With Diabetic Peripheral Neuropathy. Front Bioeng Biotechnol 2022; 10:836018. [PMID: 35445007 PMCID: PMC9013892 DOI: 10.3389/fbioe.2022.836018] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/14/2022] [Indexed: 12/29/2022] Open
Abstract
Objective: People with diabetic peripheral neuropathy (DPN) are usually accompanied with increased plantar pressure. Such high plantar loading during daily activities may cause changes in the biomechanical properties of plantar soft tissue, whose viability is critical to the development of foot ulcers. This study aimed to investigate the relationship between plantar tissue hardness and plantar pressure in people with and without DPN, and preliminarily explore the influence of plantar loading patterns on the plantar pressure and tissue hardness. Methods: The study was conducted on 14 people with DPN and 14 diabetic people without DPN. The Shore durometer and MatScan System were used to measure the plantar tissue hardness and plantar pressure, respectively. The plantar loading level was evaluated by the duration of daily weight-bearing activity and was used to group diabetic participants with and without DPN into two subgroups (lower loading group and higher loading group). Results: The plantar tissue hardness was significantly correlated with static peak plantar pressure (PPP, p < 0.05) and dynamic pressure-time integral (PTI, p < 0.05) in the forefoot region in people with DPN. Results of variance analysis showed a significant interaction effect between peripheral neuropathy and plantar loading on tissue hardness (p < 0.05), but not plantar pressure. For people with DPN, significant differences in tissue hardness between the higher loading group and lower loading group were observed in the forefoot, midfoot and hindfoot regions. In the higher loading group, people with DPN had significantly greater tissue hardness than that in people without DPN in the toes, forefoot, midfoot and hindfoot regions (p < 0.05). Conclusions: There is a significant correlation between tissue hardness and PPP, and between tissue hardness and PTI in people with DPN. Plantar loading associated with daily activities plays a significant role on the plantar tissue hardness in people with DPN. The findings of this study contribute to further understand the relationship between increased plantar tissue hardness and high plantar pressure in people with diabetic peripheral neuropathy.
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Affiliation(s)
- Yijie Duan
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Weiyan Ren
- Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs, National Research Center for Rehabilitation Technical Aids, Beijing, China
| | - Wei Liu
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Jianchao Li
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Fang Pu
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
- *Correspondence: Fang Pu, ; Yih-Kuen Jan,
| | - Yih-Kuen Jan
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, United States
- *Correspondence: Fang Pu, ; Yih-Kuen Jan,
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16
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Chester D, Lee V, Wagner P, Nordberg M, Fisher MB, Brown AC. Elucidating the combinatorial effect of substrate stiffness and surface viscoelasticity on cellular phenotype. J Biomed Mater Res A 2022; 110:1224-1237. [PMID: 35107204 PMCID: PMC9305170 DOI: 10.1002/jbm.a.37367] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/24/2021] [Accepted: 01/21/2022] [Indexed: 12/03/2022]
Abstract
Cells maintain tensional homeostasis by monitoring the mechanics of their microenvironment. In order to understand this mechanotransduction phenomenon, hydrogel materials have been developed with either controllable linear elastic or viscoelastic properties. Native biological tissues, and biomaterials used for medical purposes, often have complex mechanical properties. However, due to the difficulty in completely decoupling the elastic and viscous components of hydrogel materials, the effect of complex composite materials on cellular responses has largely gone unreported. Here, we characterize a novel composite hydrogel system capable of decoupling and individually controlling both the bulk stiffness and surface viscoelasticity of the material by combining polyacrylamide (PA) gels with microgel thin films. By taking advantage of the high degree of control over stiffness offered by PA gels and viscoelasticity, in terms of surface loss tangent, of microgel thin films, it is possible to study the influence that bulk substrate stiffness and surface loss tangent have on complex fibroblast responses, including cellular and nuclear morphology and gene expression. This material system provides a facile method for investigating cellular responses to complex material mechanics with great precision and allows for a greater understanding of cellular mechanotransduction mechanisms than previously possible through current model material platforms.
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Affiliation(s)
- Daniel Chester
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, North Carolina, USA.,Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina, USA
| | - Veronica Lee
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, North Carolina, USA
| | - Paul Wagner
- Department of Materials Science and Engineering, North Carolina State University, Raleigh, North Carolina, USA
| | - Matthew Nordberg
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, North Carolina, USA
| | - Matthew B Fisher
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, North Carolina, USA.,Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina, USA
| | - Ashley C Brown
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, North Carolina, USA.,Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina, USA
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17
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Ren W, Duan Y, Jan YK, Ye W, Li J, Liu W, Liu H, Guo J, Pu F, Fan Y. Effect of Exercise Volume on Plantar Microcirculation and Tissue Hardness in People With Type 2 Diabetes. Front Bioeng Biotechnol 2021; 9:732628. [PMID: 34900954 PMCID: PMC8660562 DOI: 10.3389/fbioe.2021.732628] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 11/11/2021] [Indexed: 01/22/2023] Open
Abstract
Objective: Exercise has been reported to be beneficial for people with type 2 diabetes (T2DM), but exercise, especially weight-bearing exercise, may increase the risk of diabetic foot ulcers (DFUs). This study aimed to explore the associations between different volumes of weight-bearing physical activities and plantar microcirculation and tissue hardness in people with T2DM. Methods: 130 elderly people with T2DM were enrolled for this cross-sectional study. They were classified into the high exercise volume group and the low exercise volume group based on their weekly energy expenditure (metabolic equivalents per week) in the past year. Weekly energy expenditure was calculated using the International Physical Activity Questionnaire and the Compendium of Physical Activities. The plantar oxygen saturation (SO2) and soft tissue hardness of each participant’s right foot were measured. Results: A total of 80 participants completed the trial. The average exercise energy expenditure of the high exercise volume group and the low exercise volume group were significantly different (p < 0.05). The results showed that the SO2 of the high exercise volume group (67.25 ± 6.12%) was significantly higher than the low exercise volume group (63.75 ± 8.02%, p < 0.05). The plantar tissue hardness of the high exercise volume group was lower than the low exercise volume group in the big toe, midfoot and hindfoot regions (p < 0.05). Conclusion: This study demonstrates that higher volumes of exercise are associated with better plantar microcirculation and lower plantar tissue hardness in people with T2DM. The findings of this study indicate that weight-bearing exercise may not increase risk of developing diabetic foot ulcers.
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Affiliation(s)
- Weiyan Ren
- Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs, National Research Center for Rehabilitation Technical Aids, Beijing, China
| | - Yijie Duan
- Key Laboratory for Biomechanics and Mechanobiology of Chinese Education Ministry, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Yih-Kuen Jan
- Key Laboratory for Biomechanics and Mechanobiology of Chinese Education Ministry, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China.,Rehabilitation Engineering Laboratory, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, United States
| | - Wenqiang Ye
- Key Laboratory for Biomechanics and Mechanobiology of Chinese Education Ministry, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Jianchao Li
- Key Laboratory for Biomechanics and Mechanobiology of Chinese Education Ministry, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Wei Liu
- Key Laboratory for Biomechanics and Mechanobiology of Chinese Education Ministry, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Hongmei Liu
- Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs, National Research Center for Rehabilitation Technical Aids, Beijing, China.,Key Laboratory for Biomechanics and Mechanobiology of Chinese Education Ministry, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Junchao Guo
- Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs, National Research Center for Rehabilitation Technical Aids, Beijing, China
| | - Fang Pu
- Key Laboratory for Biomechanics and Mechanobiology of Chinese Education Ministry, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Yubo Fan
- Key Laboratory for Biomechanics and Mechanobiology of Chinese Education Ministry, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China.,School of Engineering Medicine, Beihang University, Beijing, China
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18
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Estimation of Various Walking Intensities Based on Wearable Plantar Pressure Sensors Using Artificial Neural Networks. SENSORS 2021; 21:s21196513. [PMID: 34640838 PMCID: PMC8512589 DOI: 10.3390/s21196513] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 09/25/2021] [Accepted: 09/26/2021] [Indexed: 11/16/2022]
Abstract
Walking has been demonstrated to improve health in people with diabetes and peripheral arterial disease. However, continuous walking can produce repeated stress on the plantar foot and cause a high risk of foot ulcers. In addition, a higher walking intensity (i.e., including different speeds and durations) will increase the risk. Therefore, quantifying the walking intensity is essential for rehabilitation interventions to indicate suitable walking exercise. This study proposed a machine learning model to classify the walking speed and duration using plantar region pressure images. A wearable plantar pressure measurement system was used to measure plantar pressures during walking. An Artificial Neural Network (ANN) was adopted to develop a model for walking intensity classification using different plantar region pressure images, including the first toe (T1), the first metatarsal head (M1), the second metatarsal head (M2), and the heel (HL). The classification consisted of three walking speeds (i.e., slow at 0.8 m/s, moderate at 1.6 m/s, and fast at 2.4 m/s) and two walking durations (i.e., 10 min and 20 min). Of the 12 participants, 10 participants (720 images) were randomly selected to train the classification model, and 2 participants (144 images) were utilized to evaluate the model performance. Experimental evaluation indicated that the ANN model effectively classified different walking speeds and durations based on the plantar region pressure images. Each plantar region pressure image (i.e., T1, M1, M2, and HL) generates different accuracies of the classification model. Higher performance was achieved when classifying walking speeds (0.8 m/s, 1.6 m/s, and 2.4 m/s) and 10 min walking duration in the T1 region, evidenced by an F1-score of 0.94. The dataset T1 could be an essential variable in machine learning to classify the walking intensity at different speeds and durations.
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19
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Lung CW, Liau BY, Peters JA, He L, Townsend R, Jan YK. Effects of various walking intensities on leg muscle fatigue and plantar pressure distributions. BMC Musculoskelet Disord 2021; 22:831. [PMID: 34579699 PMCID: PMC8477480 DOI: 10.1186/s12891-021-04705-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 09/04/2021] [Indexed: 01/14/2023] Open
Abstract
Background Physical activity may benefit health and reduce risk for chronic complications in normal and people with diabetes and peripheral vascular diseases. However, it is unclear whether leg muscle fatigue after weight-bearing physical activities, such as brisk walking, may increase risk for plantar tissue injury. In the literature, there is no evidence on the effect of muscle fatigue on plantar pressure after various walking intensities. The objectives of this study were to investigate the effects of various walking intensities on leg muscle fatigue and plantar pressure patterns. Methods A 3 × 2 factorial design, including 3 walking speeds (1.8 (slow and normal walking), 3.6 (brisk walking), and 5.4 (slow running) mph) and 2 walking durations (10 and 20 min) for a total of 6 walking intensities, was tested in 12 healthy participants in 3 consecutive weeks. The median frequency and complexity of electromyographic (EMG) signals of tibialis anterior (TA) and gastrocnemius medialis (GM) were used to quantify muscle fatigue. Fourier transform was used to compute the median frequency and multiscale entropy was used to calculate complexity of EMG signals. Peak plantar pressure (PPP) values at the 4 plantar regions (big toe, first metatarsal head, second metatarsal head, and heel) were calculated. Results Two-way ANOVA showed that the walking speed (at 1.8, 3.6, 5.4 mph) significantly affected leg muscle fatigue, and the duration factor (at 10 and 20 min) did not. The one-way ANOVA showed that there were four significant pairwise differences of the median frequency of TA, including walking speed of 1.8 and 3.6 mph (185.7 ± 6.1 vs. 164.9 ± 3.0 Hz, P = 0.006) and 1.8 and 5.4 mph (185.7 ± 6.1 vs. 164.5 ± 5.5 Hz, P = 0.006) for the 10-min duration; and walking speed of 1.8 and 3.6 mph (180.0 ± 5.9 vs. 163.1 ± 4.4 Hz, P = 0.024) and 1.8 and 5.4 mph (180.0 ± 5.9 vs. 162.8 ± 4.9 Hz, P = 0.023) for the 20-min duration. The complexity of TA showed a similar trend with the median frequency of TA. The median frequency of TA has a significant negative correlation with PPP on the big toe ( r = -0.954, P = 0.003) and the first metatarsal head ( r = -0.896, P = 0.016). Conclusions This study demonstrated that brisk walking and slow running speeds (3.6 and 5.4 mph) cause an increase in muscle fatigue of TA compared to slow walking speed (1.8 mph); and the increased muscle fatigue is significantly related to a higher PPP.
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Affiliation(s)
- 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, 41354, Taiwan
| | - Ben-Yi Liau
- Department of Biomedical Engineering, Hungkuang University, Taichung, 433304, Taiwan
| | - Joseph A Peters
- Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, 61820, USA
| | - Li He
- College of Physical Education and Sports, Beijing Normal University, Beijing, 100875, China
| | - Runnell Townsend
- Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, 61820, USA
| | - Yih-Kuen Jan
- Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, 61820, USA.
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20
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Using Elastographic Ultrasound to Assess the Effect of Cupping Size of Cupping Therapy on Stiffness of Triceps Muscle. Am J Phys Med Rehabil 2021; 100:694-699. [PMID: 33065576 DOI: 10.1097/phm.0000000000001625] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Cupping therapy may reduce muscle stiffness for managing fatigue. However, there is no scientific evidence showing changes of muscle stiffness after cupping therapy. Furthermore, it is unclear whether the cup size of cupping therapy affects the change of muscle stiffness. The objective of this study was to compare the effect of cup size of cupping therapy on muscle stiffness. DESIGN A repeated measures design with a counterbalanced design was used to test three cup sizes (45, 40, and 35 mm in inner diameter) in 12 healthy participants. Strain elastography was used to measure stiffness of the triceps before and after cupping therapy at 300 mm Hg for 5 mins. Strain elastogram was converted to the grayscale for the quantification of stiffness. RESULTS The overall stiffness of triceps significantly reduced after cupping therapy with the 45-mm (106.2 ± 7.7, P < 0.05) and 40-mm (109.6 ± 7.1, P < 0.05) cups, but not the 35-mm cup (115.5 ± 10.3, nonsignificant) compared with before cupping (115.8 ± 13.5). The stiffness of superficial layer did not show significantly difference in all three sizes of cup. The stiffness of deep layer significantly reduced after the cupping therapy with the 45- and 40-mm cups. CONCLUSIONS This is the first study demonstrating that cupping therapy significantly reduced muscle stiffness, especially at the deep layer.
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Duan Y, Ren W, Xu L, Ye W, Jan YK, Pu F. The effects of different accumulated pressure-time integral stimuli on plantar blood flow in people with diabetes mellitus. BMC Musculoskelet Disord 2021; 22:554. [PMID: 34144680 PMCID: PMC8214278 DOI: 10.1186/s12891-021-04437-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/03/2021] [Indexed: 01/13/2023] Open
Abstract
Background Exercise, especially weight-bearing exercise (e.g. walking), may affect plantar tissue viability due to prolonged repetitive high vertical and high shear pressure stimulus on the plantar tissue, and further induce development of diabetic foot ulcers (DFUs). This study aimed to investigate the effects of different accumulated pressure-time integral (APTI) stimuli induced by walking on plantar skin blood flow (SBF) responses in people with diabetes mellitus (DM). Methods A repeated measures design was used in this study. Two walking protocols (low APTI (73,000 kPa·s) and high APTI (73,000 × 1.5 kPa·s)) were randomly assigned to ten people with DM and twenty people without DM. The ratio of SBF measured by laser Doppler flowmetry after walking to that before (normalized SBF) was used to express the SBF responses. Results After low APTI, plantar SBF of people with DM showed a similar response to people without DM (P = 0.91). However, after high APTI, people with DM had a significantly lower plantar SBF compared to people without DM (P < 0.05). In people with DM, plantar SBF in the first 2 min after both APTI stimuli significantly decreased compared to plantar SBF before walking (P < 0.05). Conclusions People with DM had a normal SBF response after low APTI walking but had an impaired SBF response after high APTI walking, which suggests that they should avoid weight-bearing physical activity with intensity more than 73,000 kPa·s and should rest for more than 2 min after weight-bearing physical activity to allow a full vasodilatory response to reduce risk of DFUs.
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Affiliation(s)
- Yijie Duan
- Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, People's Republic of China
| | - Weiyan Ren
- Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs, National Research Center for Rehabilitation Technical Aids, Beijing, People's Republic of China
| | - Liqiang Xu
- Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, People's Republic of China
| | - Wenqiang Ye
- Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, People's Republic of China
| | - Yih-Kuen Jan
- Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, People's Republic of China. .,Rehabilitation Engineering Laboratory, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA.
| | - Fang Pu
- Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, People's Republic of China.
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An Investigation of Regional Plantar Soft Tissue Hardness and Its Potential Correlation with Plantar Pressure Distribution in Healthy Adults. Appl Bionics Biomech 2021; 2021:5566036. [PMID: 34239603 PMCID: PMC8241530 DOI: 10.1155/2021/5566036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/29/2021] [Indexed: 12/03/2022] Open
Abstract
Background The plantar soft tissue plays a critical role in absorbing shocks and attenuating excessive stresses during walking. Plantar soft tissue property and plantar pressure are critical information for footwear design and clinical assessment. The aim of this study was to investigate the relationship between plantar soft tissue hardness and plantar pressure during walking. Methods 59 healthy volunteers (27 males and 32 females, aged 20 to 82) participated in this study. The plantar surface was divided into five regions: lateral rearfoot, medial rearfoot, lateral midfoot, lateral forefoot, and medial forefoot, and the plantar tissue hardness was tested using Shore durometer in each region. Average dynamic pressures in each region were analyzed for the five regions corresponding to the hardness tests. The relationship between hardness and average dynamic pressure was analyzed in each region. Results The average hardness of the plantar soft tissue in the above five regions is as follows: lateral rearfoot (34.49 ± 6.77), medial rearfoot (34.47 ± 6.64), lateral midfoot (27.95 ± 6.13), lateral forefoot (29.72 ± 5.47), and medial forefoot (28.58 ± 4.41). Differences of hardness were observed between age groups, and hardness of plantar soft tissues in forefoot regions increased with age (P < 0.05). A negative relationship was found between plantar soft tissue hardness and pressure reduction at lateral rearfoot, medial rearfoot, and lateral midfoot (P < 0.05). Conclusion The hardness of plantar soft tissues changes with age in healthy individuals, and there is a trend of increasing hardness of the plantar soft tissue with age. The plantar soft tissue hardness increases with plantar pressure.
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Khor BYC, Woodburn J, Newcombe L, Barn R. Plantar soft tissues and Achilles tendon thickness and stiffness in people with diabetes: a systematic review. J Foot Ankle Res 2021; 14:35. [PMID: 33910602 PMCID: PMC8080343 DOI: 10.1186/s13047-021-00475-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/15/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Diabetes mellitus is associated with changes in soft tissue structure and function. However, the directionality of this change and the extent to which either tissue thickness or stiffness contributes to the pathogenesis of diabetes-related foot ulcerations is unclear. Hence, this systematic review aims to summarise the existing evidence for soft tissue structural differences in the feet of people with and without diabetes. METHODS In compliance with MOOSE and PRISMA guidelines, AMED, CINAHL, MEDLINE, ProQuest Health & Medical Collection, ProQuest Nursing & Allied Health Database, and Web of Science electronic databases were systematically searched for studies published from database inception until 1st October 2020 [Prospero CRD42020166614]. Reference lists of included studies were further screened. Methodological quality was appraised using a modified critical appraisal tool for quantitative studies developed by McMaster University. RESULTS A total of 35 non-randomised observational studies were suitable for inclusion. Within these, 20 studies evaluated plantar tissue thickness, 19 studies evaluated plantar tissue stiffness, 9 studies evaluated Achilles tendon thickness and 5 studies evaluated Achilles tendon stiffness outcomes. No significant differences in plantar tissue thickness were found between people with and without diabetes in 55% of studies (11/20), while significantly increased plantar tissue stiffness was found in people with diabetes in 47% of studies (9/19). Significantly increased Achilles tendon thickness was found in people with diabetes in 44% of studies (4/9), while no significant differences in Achilles tendon stiffness were found between people with and without diabetes in 60% of studies (3/5). CONCLUSIONS This systematic review found some evidence of soft tissue structural differences between people with and without diabetes. However, uncertainty remains whether these differences independently contribute to diabetes-related foot ulcerations. The heterogeneity of methodological approaches made it difficult to compare across studies and methodological quality was generally inadequate. High-quality studies using standardised and validated assessment techniques in well-defined populations are required to determine more fully the role of structural tissue properties in the pathogenesis of diabetes-related foot ulcerations.
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Affiliation(s)
- Benedictine Yen Chen Khor
- Department of Podiatry and Radiography, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, G4 0BA, Scotland, UK.
| | - James Woodburn
- Department of Podiatry and Radiography, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, G4 0BA, Scotland, UK
- School of Health Sciences and Social Work, Griffith University, Queensland, Australia
| | - Lisa Newcombe
- Department of Podiatry and Radiography, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, G4 0BA, Scotland, UK
| | - Ruth Barn
- Department of Podiatry and Radiography, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, G4 0BA, Scotland, UK
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Jones P, Davies MJ, Khunti K, Fong DTP, Webb D. In-shoe pressure thresholds for people with diabetes and neuropathy at risk of ulceration: A systematic review. J Diabetes Complications 2021; 35:107815. [PMID: 33280984 DOI: 10.1016/j.jdiacomp.2020.107815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/19/2020] [Accepted: 11/18/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION In-shoe pressure thresholds play an increasingly important role in the prevention of diabetes-related foot ulceration (DFU). The evidence of their effectiveness, methodological consistency and scope for refinement are the subject of this review. METHODS 1107 records were identified (after duplicate removal) based on a search of five databases for studies which applied a specific in-shoe pressure threshold to reduce the risk of ulceration. 37 full text studies were assessed for eligibility of which 21 were included. RESULTS Five in-shoe pressure thresholds were identified, which are employed to reduce the risk of diabetes-related foot ulceration: a mean peak pressure threshold of 200 kPa used in conjunction with a 25% baseline reduction target; a sustained pressure threshold of 35 mm Hg, a threshold matrix based on risk, shoe size and foot region, and a 40-80% baseline pressure reduction target. The effectiveness of the latter two thresholds have not been assessed yet and the evidence for the effectiveness of the other in-shoe pressure thresholds is limited, based only on two RCTs and two cohort studies. CONCLUSIONS The heterogeneity of current measures precludes meta-analysis and further research and methodological standardisation is required to facilitate ready comparison and the further development of these pressure thresholds.
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Affiliation(s)
- Petra Jones
- Leicester Diabetes Centre, Leicester General Hospital, University Hospitals of Leicester, UK; Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK.
| | - Melanie J Davies
- Leicester Diabetes Centre, Leicester General Hospital, University Hospitals of Leicester, UK; Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK; NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Kamlesh Khunti
- Leicester Diabetes Centre, Leicester General Hospital, University Hospitals of Leicester, UK; Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Daniel T P Fong
- School of Sport, Exercise and Health Sciences, Loughborough University, UK
| | - David Webb
- Leicester Diabetes Centre, Leicester General Hospital, University Hospitals of Leicester, UK; Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
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Using Bidimensional Multiscale Entropy Analysis of Ultrasound Images to Assess the Effect of Various Walking Intensities on Plantar Soft Tissues. ENTROPY 2021; 23:e23030264. [PMID: 33668190 PMCID: PMC7995977 DOI: 10.3390/e23030264] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/18/2021] [Accepted: 02/20/2021] [Indexed: 02/07/2023]
Abstract
Walking performance is usually assessed by linear analysis of walking outcome measures. However, human movements consist of both linear and nonlinear complexity components. The purpose of this study was to use bidimensional multiscale entropy analysis of ultrasound images to evaluate the effects of various walking intensities on plantar soft tissues. Twelve participants were recruited to perform six walking protocols, consisting of three speeds (slow at 1.8 mph, moderate at 3.6 mph, and fast at 5.4 mph) for two durations (10 and 20 min). A B-mode ultrasound was used to assess plantar soft tissues before and after six walking protocols. Bidimensional multiscale entropy (MSE2D) and the Complexity Index (CI) were used to quantify the changes in irregularity of the ultrasound images of the plantar soft tissues. The results showed that the CI of ultrasound images after 20 min walking increased when compared to before walking (CI4: 0.39 vs. 0.35; CI5: 0.48 vs. 0.43, p < 0.05). When comparing 20 and 10 min walking protocols at 3.6 mph, the CI was higher after 20 min walking than after 10 min walking (CI4: 0.39 vs. 0.36, p < 0.05; and CI5: 0.48 vs. 0.44, p < 0.05). This is the first study to use bidimensional multiscale entropy analysis of ultrasound images to assess plantar soft tissues after various walking intensities.
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White S, McCullough MBA, Akangah PM. The Structural Effects of Diabetes on Soft Tissues: A Systematic Review. Crit Rev Biomed Eng 2021; 49:11-27. [PMID: 35993948 DOI: 10.1615/critrevbiomedeng.2022043200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Hyperglycemia, which is associated with diabetes, increases the production of advanced glycation end products. Advanced glycation end products lead to the structural degradation of soft tissues. The structural degradation of diabetic soft tissues has been investigated in humans, rodents, and canines. Therefore, the objective of this review is to unify the various contributions to diabetes research through the mechanical properties and geometric characteristics of soft tissues. A systematic review was performed and identified the effects of diabetes on mechanical and geometric properties of soft tissues via experimental testing or in vivo - driven finite element analysis. The literature concludes that diabetes contributes to major structural changes in soft tissues but does not cause the same structural changes in all soft tissues (e.g., diabetic tendons are weaker and diabetic plantar tissues are tougher). Diabetes stiffens and toughens soft tissues, thus altering viscoelastic behavior (e.g., poor strain and stress response). However, diabetes management routines can prevent or minimize the effects of diabetes on the mechanical and geometric properties of soft tissues. Unification of the structural effects of diabetes on soft tissues will contribute to the pathophysiology of diabetes.
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Affiliation(s)
- Shunafrica White
- Department of Mechanical Engineering, North Carolina Agricultural and Technical State University
| | - Matthew B A McCullough
- Department of Chemical, Biological, and Bioengineering at North Carolina Agricultural and Technical State University
| | - Paul M Akangah
- Department of Mechanical Engineering, North Carolina Agricultural and Technical State University
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27
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Using Elastographic Ultrasound to Assess Plantar Tissue Stiffness after Walking at Different Speeds and Durations. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10217498] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Exercise has been demonstrated to improve health in people with diabetes. However, exercise may increase risk for foot ulcers because of increased plantar pressure during most weight-bearing physical activities. To date, there is no study investigating the effect of various walking speeds and durations (i.e., the most common form of exercise in daily living) on the plantar foot. The objective of this study was to investigate the effect of various walking intensities on plantar tissue stiffness. A 3 × 2 factorial design, including three walking speeds (1.8, 3.6 and 5.4 mph) and two durations (10 and 20 min), was tested in 12 healthy participants. B-mode and elastographic ultrasound images were measured from the first metatarsal head to quantify plantar tissue stiffness after walking. Two-way ANOVA was used to examine the results. Our results showed that the walking speed factor caused a significant main effect of planar stiffness of the superficial layers (p = 0.007 and 0.003, respectively). However, the walking duration factor did not significantly affect the plantar stiffness. There was no interaction between the speed and duration factors on plantar tissue stiffness. Regarding the walking speed effect, there was a significant difference in the plantar stiffness between 1.8 and 3.6 mph (56.8 ± 0.8% vs. 53.6 ± 0.9%, p = 0.017) under 20 min walking duration. This finding is significant because moderate-to-fast walking speed (3.6 mph) can decrease plantar stiffness compared to slow walking speed (1.8 mph). This study suggests people at risk for foot ulcers walk at a preferred or fast speed (3.6 mph) rather than walk slowly (1.8 mph).
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28
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Emerging technologies for the prevention and management of diabetic foot ulcers. J Tissue Viability 2020; 29:61-68. [DOI: 10.1016/j.jtv.2020.03.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/27/2019] [Accepted: 03/14/2020] [Indexed: 12/14/2022]
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29
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Wu FL, Wang WT, Liao F, Liu Y, Li J, Jan YK. Microvascular Control Mechanism of the Plantar Foot in Response to Different Walking Speeds and Durations: Implication for the Prevention of Foot Ulcers. INT J LOW EXTR WOUND 2020; 20:327-336. [PMID: 32326799 DOI: 10.1177/1534734620915360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Physical activity has been recommended by the American Diabetes Association (ADA) as a preventive intervention of diabetes complications. However, there is no study investigating how microvascular control mechanism respond to different walking intensities in people with and without diabetes. The purpose of this study was to assess microvascular control mechanism of the plantar foot in response to various walking speeds and durations in 12 healthy people using spectral analysis of skin blood flow (SBF) oscillations. A 3×2 factorial design, including 3 speeds (3, 6, and 9 km/h) and 2 durations (10 and 20 minutes), was used in this study. Plantar SBF was measured using laser Doppler flowmetry over the first metatarsal head. Borg Rating of Perceived Exertion (RPE) scale and heart rate maximum were used to assess the walking intensity. Wavelet analysis was used to quantify regulations of metabolic (0.0095-0.02 Hz), neurogenic (0.02-0.05 Hz), myogenic (0.05-0.15 Hz), respiratory (0.15-0.4 Hz), and cardiac (0.4-2 Hz) controls. For 10-minute walking, walking at 9 km/h significantly increased the ratio of wavelet amplitudes of metabolic, neurogenic, myogenic, respiratory, and cardiac mechanisms compared with 3 km/h (P < .05). For 20-minute walking, walking at 6 km/h significantly increased the ratio of wavelet amplitudes of metabolic, myogenic, respiratory, and cardiac compared with 3 km/h (P < .05). RPE showed a significant interaction between the speed and duration factors (P < .01). This is the first study demonstrating that different walking speeds and durations caused different plantar microvascular regulations.
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Affiliation(s)
- Fu-Lien Wu
- University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | | | - Fuyuan Liao
- Xi'an Technological University, Xi'an, Shaanxi, China
| | - Yang Liu
- University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Jiacong Li
- University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Yih-Kuen Jan
- University of Illinois at Urbana-Champaign, Champaign, IL, USA.,Beihang University, Beijing, China
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30
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Zhu T, Wang Y, Yang J, Liao F, Wang S, Jan YK. Wavelet-based analysis of plantar skin blood flow response to different frequencies of local vibration. Physiol Meas 2020; 41:025004. [DOI: 10.1088/1361-6579/ab6e56] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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31
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Effects of walking speeds and durations on plantar skin blood flow responses. Microvasc Res 2020; 128:103936. [DOI: 10.1016/j.mvr.2019.103936] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/09/2019] [Accepted: 10/11/2019] [Indexed: 12/11/2022]
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Geng X, Shi J, Chen W, Ma X, Wang X, Zhang C, Chen L. Impact of first metatarsal shortening on forefoot loading pattern: a finite element model study. BMC Musculoskelet Disord 2019; 20:625. [PMID: 31881881 PMCID: PMC6933751 DOI: 10.1186/s12891-019-2973-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 11/26/2019] [Indexed: 11/11/2022] Open
Abstract
Backgrounds There has long been a consensus that shortening of the first metatarsal during hallux valgus reconstruction could lead to postoperative transfer metatarsalgia. However, appropriate shortening is sometimes beneficial for correcting severe deformities or relieving stiff joints. This study is to investigate, from the biomechanical perspective, whether and how much shortening of the first metatarsal could be allowed. Methods A finite element model of the human foot simulating the push-off phase of the gait was established. Progressive shortening of the first metatarsal from 2 to 8 mm at an increment of 2 mm were sequentially applied to the model, and the corresponding changes in forefoot loading pattern during push-off phase, especially the loading ratio at the central rays, was calculated. The effect of depressing the first metatarsal head was also investigated. Results With increasing shortening level of the first metatarsal, the plantar pressure of the first ray decreased, while that of the lateral rays continued to rise. When the shortening reaches 6 mm, the load ratio of the central rays exceeds a critical threshold of 55%, which was considered risky; but it could still be manipulated to normal if the distal end of the first metatarsal displaced to the plantar side by 3 mm. Conclusions During the first metatarsal osteotomy, a maximum of 6 mm shortening length is considered to be within the safe range. Whenever a higher level of shortening is necessary, pushing down the distal metatarsal segment could be a compensatory procedure to maintain normal plantar force distributions.
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Affiliation(s)
- Xiang Geng
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Rd., Jing'an District, Shanghai, China
| | - Jiaqi Shi
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Rd., Jing'an District, Shanghai, China
| | - Wenming Chen
- Academy for Engineering & Technology, Fudan University, Shanghai, China.,School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Xin Ma
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Rd., Jing'an District, Shanghai, China.
| | - Xu Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Rd., Jing'an District, Shanghai, China
| | - Chao Zhang
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Rd., Jing'an District, Shanghai, China
| | - Li Chen
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Rd., Jing'an District, Shanghai, China
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Effect of Exercise on Risk Factors of Diabetic Foot Ulcers: A Systematic Review and Meta-Analysis. Am J Phys Med Rehabil 2019; 98:103-116. [PMID: 30020090 DOI: 10.1097/phm.0000000000001002] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The objectives of this study were to examine the effectiveness of different types of exercise on risk factors of diabetic foot ulcers, including glycated hemoglobin, peripheral arterial disease, and diabetic peripheral neuropathy, in people with type 2 diabetes mellitus. PubMed, Web of Science, Cochrane Library, Scopus, and CINAHL were searched from inception to January 2018 for relevant articles. Eligible studies were randomized controlled trials that examined effects of exercise on the selected risk factors. Twenty randomized controlled trials with 1357 participants were included in the meta-analyses. The differences in postintervention values of glycated hemoglobin and ankle brachial index between exercise and control groups were synthesized, yielding mean differences of -0.45% (P < 0.00001) and 0.03 (P = 0.002), respectively; the differences in within-group changes in glycated hemoglobin were synthesized, yielding mean differences of -0.19% (P = 0.1), -0.25% (P = 0.0006), and -0.64% (P = 0.006) for aerobic versus resistance, combined versus aerobic, and combined versus resistance exercise, respectively. Exercise has a significant effect on reducing glycated hemoglobin, whereas combined exercise is more effective compared with aerobic or resistance exercise alone. Exercise also improves ankle brachial index. However, evidence regarding the association between exercise and peripheral neuropathy and risks of diabetic foot ulcers in people with type 2 diabetes mellitus remains insufficient.
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Liu C, Liu L, Liu G, Tian S, Bai J, Yu K, Tian D. Repair of thumb defect by using the toenail flap: biomechanical analysis of donor foot-a retrospective cohort study. J Orthop Surg Res 2019; 14:287. [PMID: 31477182 PMCID: PMC6721015 DOI: 10.1186/s13018-019-1330-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 08/19/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The thumb accounts for 50% of the total hand function. This study reports the functional outcomes and complications of people with traumatic thumb amputations who underwent toe-to-thumb reconstruction. METHODS From January 2013 to January 2018, 29 patients with second-degree thumb defect underwent thumb reconstruction with distal phalangeal braided toenail flap. The footscan foot pressure gait analysis system was used to measure the index changes of the same foot before and after 1, 3 and 6 months. The contact area, peak pressure, impulse value, contact time of each gait phase, centre of gravity coordinate and foot balance were analysed statistically. RESULTS Twenty-nine cases of thumb reconstruction recovered well. After following up for 6-15 months, the appearance of the reconstructed thumb was close to normal, and the sensation was restored to S3+. The two-point discrimination was 6-8 mm, and the function of the thumb was good. The function of the donor foot was well restored, and no skin ulceration, pain and claudication were noted during walking. Compared with that before the operation, the biomechanical indices of the donor foot were basically restored to normal 6 months after the operation. Only the stress and impulse values of the third metatarsal head were significantly increased, forming a stress concentration area centred on the third metatarsal head. CONCLUSIONS This study confirmed that the toenail flap with distal phalangeal bone restored the second-degree thumb defect without destroying the main functional structure of the sole. The biomechanical indices of the donor foot were basically restored to normal 6 months after the operation. Only the stress concentration area centred on the third metatarsal head, and the pain on the forefoot was induced after the operation. Discomfort, callus formation, metatarsal fasciitis, etc., can lead to fatigue fracture of the third metatarsal bone in severe cases, which requires further follow-up and observation. TRIAL REGISTRATION Clinicaltrials.gov , NCT03879941; registered on 10 March 2019, retrospectively.
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Affiliation(s)
- Chunjie Liu
- Department of Orthopedics, Tangshan Workers Hospital, Tangshan, 063000, Hebei, People's Republic of China
| | - Lei Liu
- Department of Orthopedics, Changping District Hospital, Beijing, 102200, People's Republic of China
| | - Guoli Liu
- Department of Orthopedics, The Second Hospital Of Tangshan, Tangshan, 063000, Hebei, People's Republic of China
| | - Siyu Tian
- Department of Hand Surgery, The Third Affiliated Hospital Of Hebei Medical University, Shijiazhuang, 050017, Hebei, People's Republic of China
| | - Jiangbo Bai
- Department of Hand Surgery, The Third Affiliated Hospital Of Hebei Medical University, Shijiazhuang, 050017, Hebei, People's Republic of China
| | - Kunlun Yu
- Department of Hand Surgery, The Third Affiliated Hospital Of Hebei Medical University, Shijiazhuang, 050017, Hebei, People's Republic of China
| | - Dehu Tian
- Department of Hand Surgery, The Third Affiliated Hospital Of Hebei Medical University, Shijiazhuang, 050017, Hebei, People's Republic of China.
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Zhang R, Ling L, Han D, Wang H, Yu G, Jiang L, Li D, Chang Z. FEM analysis in excellent cushion characteristic of ostrich (Struthio camelus) toe pads. PLoS One 2019; 14:e0216141. [PMID: 31116736 PMCID: PMC6530833 DOI: 10.1371/journal.pone.0216141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 04/15/2019] [Indexed: 11/18/2022] Open
Abstract
African ostrich (Struthio camelus) is the largest and fastest extent bipedal animal. The ostrich mainly relies on the 3rd toe to support the entire body under high-speed motion. The short and severe impact concentrated on the limited area would produce tremendous momentary internal stress and strain, which may contribute to the phalanges disloaction, soft tissue damage and the like. The vibration and excessive negative acceleration caused by the ground reaction force also affect the stability of the touching process. Therefore, ostrich toe pads are required to have excellent cushion characteristics. However, current studies often explains the cushion properties by analyzing the macro-microscopic structure of the pad organism, and there is a paucity of research on its biomechanical behaviour. Consequently, from the perspective of multi-layer structure and biomaterial assembly, this study aims to explain the biomechanical characteristics of the ostrich toe pads by FEM (Finite Element Method) analysis. Based on results, we deem that the ostrich toe pad could absorb energy and reduce vibration effectively. Firstly, the multi-layer structure of the pads make the stress and strain decay from outside to inside. Secondly, the minimal response frequency of the pad is 164.22 Hz, making it effectively avoid resonance phenomenon. Finally, the composite material model has the best performance in decreasing the negative acceleration peak value, the impact force peak value and the maximal equivalent stress value at velocities of 0.669 m/s and 1.339 m/s. These results help to further understand the buffer mechanism of the ostrich toe pad, and also have important inter-species reference value for the pathogenesis of human foot soft tissue injury.
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Affiliation(s)
- Rui Zhang
- Key Laboratory of Bionic Engineering, Ministry of Education, Jilin University, Changchun, PR China
- * E-mail: (RZ); (ZC)
| | - Lei Ling
- Key Laboratory of Bionic Engineering, Ministry of Education, Jilin University, Changchun, PR China
| | - Dianlei Han
- Key Laboratory of Bionic Engineering, Ministry of Education, Jilin University, Changchun, PR China
| | - Haitao Wang
- Key Laboratory of Bionic Engineering, Ministry of Education, Jilin University, Changchun, PR China
| | - Guolong Yu
- Key Laboratory of Bionic Engineering, Ministry of Education, Jilin University, Changchun, PR China
| | - Lei Jiang
- China North Vehicle Research Institute, Beijing, PR China
| | - Dong Li
- Beijing Institute of Spacecraft Environment Engineering, Beijing, PR China
| | - Zhiyong Chang
- Key Laboratory of Bionic Engineering, Ministry of Education, Jilin University, Changchun, PR China
- * E-mail: (RZ); (ZC)
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Jan YK, Liao F, Cheing GL, Pu F, Ren W, Choi HM. Differences in skin blood flow oscillations between the plantar and dorsal foot in people with diabetes mellitus and peripheral neuropathy. Microvasc Res 2019; 122:45-51. [DOI: 10.1016/j.mvr.2018.11.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 11/07/2018] [Accepted: 11/07/2018] [Indexed: 12/11/2022]
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Pu F, Ren W, Fu H, Zheng X, Yang M, Jan YK, Fan Y. Plantar blood flow response to accumulated pressure stimulus in diabetic people with different peak plantar pressure: a non-randomized clinical trial. Med Biol Eng Comput 2018; 56:1127-1134. [PMID: 29748781 DOI: 10.1007/s11517-018-1836-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 04/21/2018] [Indexed: 11/27/2022]
Abstract
The aim of this study was to investigate the plantar blood flow response to the same accumulated pressure stimulus in diabetic patients with different peak plantar pressure (PPP), which is important for assessing the risk of diabetic foot ulcer. Eleven diabetic subjects with high PPP (PPP ≥ 207 kPa) and 8 diabetic subjects with low PPP (PPP < 207 kPa) were asked to walk naturally on a treadmill so as to induce an accumulated stimulus of 73,000 kPa·s on their first metatarsal head, which was monitored with a sensorized insole. Blood perfusion (BP) in the first metatarsal head was measured before and after walking. Results showed that blood flow after applying the same walking stimulus was significantly decreased in comparison to the basal BP before walking in both high PPP and low PPP groups (p < 0.05), but no significant differences were found between the two groups in terms of BP parameters and its percentage change (p > 0.05). Moreover, BP parameters were not significantly correlated to PPP and the pressure-time integral (PTI) of the subjects' gait (p > 0.05). This indicated that, besides PPP and PTI, the accumulated mechanical stimulus should be taken into consideration when assessing the risk of diabetic patients developing foot ulcers. Graphical abstract Plantar blood flow response to a walking stimulus.
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Affiliation(s)
- Fang Pu
- Key Laboratory of Rehabilitation Technical Aids of Ministry of Civil Affair, School of Biological Science and Medical Engineering, Beihang University, No.37 Xueyuan Road, Haidian District, Beijing, 100191, People's Republic of China
- State Key Laboratory of Virtual Reality Technology and Systems, Beihang University, Beijing, People's Republic of China
| | - Weiyan Ren
- Key Laboratory of Rehabilitation Technical Aids of Ministry of Civil Affair, School of Biological Science and Medical Engineering, Beihang University, No.37 Xueyuan Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Hongyuan Fu
- Key Laboratory of Rehabilitation Technical Aids of Ministry of Civil Affair, School of Biological Science and Medical Engineering, Beihang University, No.37 Xueyuan Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Xuan Zheng
- Key Laboratory of Rehabilitation Technical Aids of Ministry of Civil Affair, School of Biological Science and Medical Engineering, Beihang University, No.37 Xueyuan Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Min Yang
- Affiliated Hospital of National Research Center for Rehabilitation Technical Aids, Beijing, People's Republic of China
| | - Yih-Kuen Jan
- Rehabilitation Engineering Laboratory, Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, 1206 South Fourth Street, Champaign, IL, 61820, USA.
| | - Yubo Fan
- Key Laboratory of Rehabilitation Technical Aids of Ministry of Civil Affair, School of Biological Science and Medical Engineering, Beihang University, No.37 Xueyuan Road, Haidian District, Beijing, 100191, People's Republic of China.
- Affiliated Hospital of National Research Center for Rehabilitation Technical Aids, Beijing, People's Republic of China.
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Liao F, Jan YK. Nonlinear dynamics of skin blood flow response to mechanical and thermal stresses in the plantar foot of diabetics with peripheral neuropathy. Clin Hemorheol Microcirc 2018; 66:197-210. [PMID: 28482622 DOI: 10.3233/ch-160239] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Diabetic foot ulcers (DFU) are a major complication in diabetics. Impaired microvascular reactivity is a major contributor to the development of DFU and has been traditionally quantified by time-domain or frequency-domain measures of skin blood flow (SBF). These measures, however, are unable to characterize the changes of nonlinear dynamics of SBF associated with diabetes and peripheral neuropathy. OBJECTIVE The objective of this study was to investigate altered nonlinear dynamics of skin blood flow in the plantar foot of diabetics with peripheral neuropathy. METHODS 18 type 2 diabetics with peripheral neuropathy and 8 healthy controls were recruited. SBF at the first metatarsal head in response to a loading pressure of 300 mmHg and a local heating was measured using laser Doppler flowmetry. A sample entropy approach was used to quantify the degree of regularity of SBF. RESULTS Our results showed that the regularity degree of SBF in the diabetic foot underwent only small changes during post-occlusive reactive hyperemia and thermally induced biphasic response compared to non-diabetics. SBF of the diabetic foot has higher degree of irregularity during reactive hyperemia because of attenuated myogenic activity, and demonstrated higher regularity during the biphasic response largely due to significantly enhanced cardiac activities. CONCLUSIONS This study suggests that the regularity degree of SBF at the first metatarsal head could be used to assess impaired microvascular reactivity and thus may be used to assess the risk for DFU in diabetics with peripheralneuropathy.
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Affiliation(s)
- Fuyuan Liao
- Department of Biomedical Engineering, Xi'an Technological University, Xi'an, China
| | - Yih-Kuen Jan
- Department of Kinesiology and Community Health, Rehabilitation Engineering Lab, University of Illinois at Urbana-Champaign, Champaign, IL, USA.,Computational Science and Engineering Program, University of Illinois at Urbana-Champaign, Urbana, IL, USA
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Aerts W, Scarton A, De Groote F, Guiotto A, Sawacha Z, Cobelli C, Vander Sloten J, Jonkers I. Validation of plantar pressure simulations using finite and discrete element modelling in healthy and diabetic subjects. Comput Methods Biomech Biomed Engin 2017; 20:1442-1452. [PMID: 28895759 DOI: 10.1080/10255842.2017.1372428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Plantar pressure simulation driven by integrated 3D motion capture data, using both a finite element and a discrete element model, is compared for ten healthy and ten diabetic neuropathic subjects. The simulated peak pressure deviated on average between 16.7 and 34.2% from the measured peak pressure. The error in the position of the peak pressure was on average smaller than 4.2 cm. No method was more accurate than the other although statistical differences were found between them. Both techniques are thus complementary and useful tools to better understand the alteration of diabetic foot biomechanics during gait.
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Affiliation(s)
- W Aerts
- a Department of Mechanical Engineering, Biomechanics Section , KU Leuven , Leuven , Belgium
| | - A Scarton
- b Department of Information Engineering , University of Padova , Padova , Italy
| | - F De Groote
- c Department of Mechanical Engineering , PMA, KU Leuven , Leuven , Belgium
| | - A Guiotto
- b Department of Information Engineering , University of Padova , Padova , Italy
| | - Z Sawacha
- b Department of Information Engineering , University of Padova , Padova , Italy
| | - C Cobelli
- b Department of Information Engineering , University of Padova , Padova , Italy
| | - J Vander Sloten
- b Department of Information Engineering , University of Padova , Padova , Italy
| | - I Jonkers
- d Department of Kinesiology, Human Movement Biomechanics , KU Leuven , Leuven , Belgium
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Fernando ME, Crowther RG, Lazzarini PA, Yogakanthi S, Sangla KS, Buttner P, Jones R, Golledge J. Plantar pressures are elevated in people with longstanding diabetes-related foot ulcers during follow-up. PLoS One 2017; 12:e0181916. [PMID: 28859075 PMCID: PMC5578502 DOI: 10.1371/journal.pone.0181916] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 06/09/2017] [Indexed: 01/14/2023] Open
Abstract
Objective High plantar pressures are implicated in the development of diabetes-related foot ulcers. Whether plantar pressures remain high in patients with chronic diabetes-related foot ulcers over time is uncertain. The primary aim of this study was to compare plantar pressures at baseline and three and six months later in participants with chronic diabetes-related foot ulcers (cases) to participants without foot ulcers (controls). Methods Standardised protocols were used to measure mean peak plantar pressure and pressure-time integral at 10 plantar foot sites (the hallux, toes, metatarsals 1 to 5, mid-foot, medial heel and lateral heel) during barefoot walking. Measurements were performed at three study visits: baseline, three and six months. Linear mixed effects random-intercept models were utilised to assess whether plantar pressures differed between cases and controls after adjusting for age, sex, body mass index, neuropathy status and follow-up time. Standardised mean differences (Cohen’s d) were used to measure effect size. Results Twenty-one cases and 69 controls started the study and 16 cases and 63 controls completed the study. Cases had a higher mean peak plantar pressure at several foot sites including the toes (p = 0.005, Cohen’s d = 0.36) and mid-foot (p = 0.01, d = 0.36) and a higher pressure-time integral at the hallux (p<0.001, d = 0.42), metatarsal 1 (p = 0.02, d = 0.33) and mid-foot (p = 0.04, d = 0.64) compared to controls throughout follow-up. A reduction in pressure-time integral at multiple plantar sites over time was detected in all participants (p<0.05, respectively). Conclusions Plantar pressures assessed during gait are higher in diabetes patients with chronic foot ulcers than controls at several plantar sites throughout prolonged follow-up. Long term offloading is needed in diabetes patients with diabetes-related foot ulcers to facilitate ulcer healing.
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Affiliation(s)
- Malindu E. Fernando
- Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Australia
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
- Movement Analysis Laboratory, Sports and Exercise Science, James Cook University, Townsville, Australia
- Podiatry Service, Kirwan Community Health Campus, Townsville, Queensland, Australia
- * E-mail:
| | - Robert G. Crowther
- Movement Analysis Laboratory, Sports and Exercise Science, James Cook University, Townsville, Australia
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Peter A. Lazzarini
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Queensland Health, Brisbane, Australia
| | - Saiumaeswar Yogakanthi
- Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Australia
| | - Kunwarjit S. Sangla
- Department of Diabetes and Endocrinology, The Townsville Hospital, Townsville, Queensland, Australia
| | - Petra Buttner
- Centre for Chronic Disease Prevention, James Cook University, Cairns, Queensland, Australia
| | - Rhondda Jones
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia
| | - Jonathan Golledge
- Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Australia
- Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Queensland, Australia
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Ledoux WR, Pai S, Shofer JB, Wang YN. The association between mechanical and biochemical/histological characteristics in diabetic and non-diabetic plantar soft tissue. J Biomech 2016; 49:3328-3333. [PMID: 27623704 PMCID: PMC5074896 DOI: 10.1016/j.jbiomech.2016.08.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 08/17/2016] [Accepted: 08/18/2016] [Indexed: 01/18/2023]
Abstract
Diabetes, and the subsequent complication of lower limb ulcers leading to potential amputation, remains an important health care problem in United States, even with declining amputation rates. It has been well documented that diabetes can alter the mechanical properties (i.e., increased stiffness) of the plantar soft tissue, although this finding is not universal. Similarly, biochemical, and histological changes have been found in the plantar soft tissue, but, as with the mechanical changes, these findings are not consistent across all studies. Our group׳s work has demonstrated that diabetes increases plantar soft tissue modulus and increases elastic septal thickness. The purpose of the current study was to explore the association between mechanical, biochemical and histological properties. Using previously collected data, a linear mixed effects regression was conducted. The correlations were weak; of the 32 that were tested, only 3 (modulus to septal thickness when location was accounted for, energy loss to total collagen, and energy loss to collagen/elastin ratio) were statistically significant, none with an R2 greater than 0.10. The main differences in the means were increased tissue stiffness and increased septal wall thickness, both trends were supported in the literature. However, as the correlations were weak, it is likely that another unexamined biochemical factor (perhaps collagen crosslinking) is associated with the mechanical tissue changes.
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Affiliation(s)
- William R Ledoux
- VA RR&D Center of Excellence for Limb Loss Prevention and Prosthetic Engineering, Seattle, WA 98108, United States; Departments of Mechanical Engineering, University of Washington, Seattle, WA 98195, United States; Department of Orthopaedics & Sports Medicine, University of Washington, Seattle, WA 98195, United States.
| | - Shruti Pai
- VA RR&D Center of Excellence for Limb Loss Prevention and Prosthetic Engineering, Seattle, WA 98108, United States; Departments of Mechanical Engineering, University of Washington, Seattle, WA 98195, United States
| | - Jane B Shofer
- VA RR&D Center of Excellence for Limb Loss Prevention and Prosthetic Engineering, Seattle, WA 98108, United States
| | - Yak-Nam Wang
- VA RR&D Center of Excellence for Limb Loss Prevention and Prosthetic Engineering, Seattle, WA 98108, United States; Applied Physics Laboratory, University of Washington, Seattle, WA 98195, United States
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Lung CW, Hsiao-Wecksler ET, Burns S, Lin F, Jan YK. Quantifying Dynamic Changes in Plantar Pressure Gradient in Diabetics with Peripheral Neuropathy. Front Bioeng Biotechnol 2016; 4:54. [PMID: 27486576 PMCID: PMC4949238 DOI: 10.3389/fbioe.2016.00054] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 06/20/2016] [Indexed: 01/17/2023] Open
Abstract
Diabetic foot ulcers remain one of the most serious complications of diabetes. Peak plantar pressure (PPP) and peak pressure gradient (PPG) during walking have been shown to be associated with the development of diabetic foot ulcers. To gain further insight into the mechanical etiology of diabetic foot ulcers, examination of the pressure gradient angle (PGA) has been recently proposed. The PGA quantifies directional variation or orientation of the pressure gradient during walking and provides a measure of whether pressure gradient patterns are concentrated or dispersed along the plantar surface. We hypothesized that diabetics at risk of foot ulceration would have smaller PGA in key plantar regions, suggesting less movement of the pressure gradient over time. A total of 27 participants were studied, including 19 diabetics with peripheral neuropathy and 8 non-diabetic control subjects. A foot pressure measurement system was used to measure plantar pressures during walking. PPP, PPG, and PGA were calculated for four foot regions – first toe (T1), first metatarsal head (M1), second metatarsal head (M2), and heel (HL). Consistent with prior studies, PPP and PPG were significantly larger in the diabetic group compared with non-diabetic controls in the T1 and M1 regions, but not M2 or HL. For example, PPP was 165% (P = 0.02) and PPG was 214% (P < 0.001) larger in T1. PGA was found to be significantly smaller in the diabetic group in T1 (46%, P = 0.04), suggesting a more concentrated pressure gradient pattern under the toe. The proposed PGA may improve our understanding of the role of pressure gradient on the risk of diabetic foot ulcers.
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Affiliation(s)
- Chi-Wen Lung
- Rehabilitation Engineering Laboratory, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA; Department of Creative Product Design, Asia University, Taichung, Taiwan
| | - Elizabeth T Hsiao-Wecksler
- Department of Mechanical Science and Engineering, University of Illinois at Urbana-Champaign , Urbana, IL , USA
| | - Stephanie Burns
- Department of Physical Therapy, Langston University , Langston, OK , USA
| | - Fang Lin
- Center for Lower Extremity Ambulatory Research, Rosalind Franklin University , North Chicago, IL , USA
| | - Yih-Kuen Jan
- Rehabilitation Engineering Laboratory, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign , Champaign, IL , USA
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Lee B, Benyajati S, Woods JA, Jan YK. Effect of local cooling on pro-inflammatory cytokines and blood flow of the skin under surface pressure in rats: feasibility study. J Tissue Viability 2014; 23:69-77. [PMID: 24513091 DOI: 10.1016/j.jtv.2014.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 12/18/2013] [Accepted: 01/16/2014] [Indexed: 01/11/2023]
Abstract
The primary purpose of this feasibility study was to establish a correlation between pro-inflammatory cytokine accumulation and severity of tissue damage during local pressure with various temperatures. The secondary purpose was to compare skin blood flow patterns for assessing the efficacy of local cooling on reducing skin ischemia under surface pressure. Eight Sprague-Dawley rats were assigned to two protocols, including pressure with local cooling (Δt = -10 °C) and pressure with local heating (Δt = 10 °C). Pressure of 700 mmHg was applied to the right trochanter area of rats for 3 h. Skin perfusion quantified by laser Doppler flowmetry and TNF-∗ and IL-1β levels were measured. Our results showed that TNF-α concentrations were increased more significantly with local heating than with local cooling under pressure whereas IL-1β did not change. Our results support the notion that weight bearing soft tissue damage may be reduced through temperature modulation and that non-invasive perfusion measurements using laser Doppler flowmetry may be capable of assessing viability. Furthermore, these results show that perfusion response to loading pressure may be correlated with changes in local pro-inflammatory cytokines. These relationships may be relevant for the development of cooling technologies for reducing risk of pressure ulcers.
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Affiliation(s)
- Bernard Lee
- Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Siribhinya Benyajati
- Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Jeffrey A Woods
- Rehabilitation Engineering Laboratory, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Yih-Kuen Jan
- Rehabilitation Engineering Laboratory, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA.
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Jan YK, Shen S, Foreman RD, Ennis WJ. Skin blood flow response to locally applied mechanical and thermal stresses in the diabetic foot. Microvasc Res 2013; 89:40-6. [PMID: 23727385 DOI: 10.1016/j.mvr.2013.05.004] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 04/29/2013] [Accepted: 05/20/2013] [Indexed: 12/19/2022]
Abstract
Diabetic foot ulcers are one of the most common complications in diabetics, causing significant disabilities and decreasing the quality of life. Impaired microvascular reactivity contributes to the development of diabetic foot ulcers. However, underlying physiological mechanisms responsible for the impaired microvascular reactivity in response to extrinsic causative factors of foot ulcers such as mechanical and thermal stresses have not been well investigated. A total of 26 participants were recruited into this study, including 18 type 2 diabetics with peripheral neuropathy and 8 healthy controls. Laser Doppler flowmetry was used to measure skin blood flow at the first metatarsal head in response to a mechanical stress at 300mmHg and a fast thermal stress at 42°C. Wavelet analysis of skin blood flow oscillations was used to assess metabolic, neurogenic and myogenic controls. Our results indicated that diabetics have significantly decreased metabolic, neurogenic and myogenic responses to thermal stress, especially in the neurogenic and myogenic controls during the first vasodilatory response and in the metabolic control during the second vasodilatory response. Diabetics have a significantly decreased myogenic response to mechanical stress during reactive hyperemia. Our findings demonstrate that locally applied mechanical and thermal stresses can be used to assess microvascular reactivity and risk of diabetic foot ulcers.
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Affiliation(s)
- Yih-Kuen Jan
- Rehabilitation Research Laboratory, Department of Kinesiology and Community Health, University of Illinois at Urbana - Champaign, Champaign, IL, USA.
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