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Castro-Martins P, Marques A, Coelho L, Vaz M, Baptista JS. In-shoe plantar pressure measurement technologies for the diabetic foot: A systematic review. Heliyon 2024; 10:e29672. [PMID: 38699042 PMCID: PMC11064085 DOI: 10.1016/j.heliyon.2024.e29672] [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: 07/29/2023] [Revised: 04/11/2024] [Accepted: 04/12/2024] [Indexed: 05/05/2024] Open
Abstract
Introduction Loss of cutaneous protective sensation and high plantar pressures increase the risk for diabetic foot patients. Trauma and ulceration are imminent threats, making assessment and monitoring essential. This systematic review aims to identify systems and technologies for measuring in-shoe plantar pressures, focusing on the at-risk diabetic foot population. Methods A systematic search was conducted across four electronic databases (Scopus, Web of Science, PubMed, Oxford Journals) using PRISMA methodology, covering articles published in English from 1979 to 2024. Only studies addressing systems or sensors exclusively measuring plantar pressures inside the shoe were included. Results A total of 87 studies using commercially available devices and 45 articles proposing new systems or sensors were reviewed. The prevailing market offerings consist mainly of instrumented insoles. Emerging technologies under development often feature configurations with four, six or eight resistive sensors strategically placed within removable insoles. Despite some variability due to the inherent heterogeneity of human gait, these devices assess plantar pressure, although they present significant differences between them in measurement results. Individuals with diabetic foot conditions appears exhibit elevated plantar pressures, with reported peak pressures reaching approximately 1000 kPa. The results also showed significant differences between the diabetic and non-diabetic groups. Conclusion Instrumented insoles, particularly those incorporating resistive sensor technology, dominate the field. Systems employing eight sensors at critical locations represent a pragmatic approach, although market options extend to systems with up to 960 sensors. Differences between devices can be a critical factor in measurement and highlights the importance of individualized patient assessment using consistent measurement devices.
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Affiliation(s)
- Pedro Castro-Martins
- CIETI, ISEP, Polytechnic of Porto, Portugal
- Faculty of Engineering, University of Porto, Portugal
| | - Arcelina Marques
- CIETI, ISEP, Polytechnic of Porto, Portugal
- Institute for Science and Innovation in Mechanical and Industrial Engineering, Porto, Portugal
| | - Luís Coelho
- CIETI, ISEP, Polytechnic of Porto, Portugal
- INESC-TEC, Centre for Robotics in Industry and Intelligent Systems, Porto, Portugal
| | - Mário Vaz
- Faculty of Engineering, University of Porto, Portugal
- Institute for Science and Innovation in Mechanical and Industrial Engineering, Porto, Portugal
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Zhang Z, Dai Y, Xu Z, Grimaldi N, Wang J, Zhao M, Pang R, Sun Y, Gao S, Boyi H. Insole Systems for Disease Diagnosis and Rehabilitation: A Review. BIOSENSORS 2023; 13:833. [PMID: 37622919 PMCID: PMC10452488 DOI: 10.3390/bios13080833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 08/11/2023] [Accepted: 08/15/2023] [Indexed: 08/26/2023]
Abstract
Some chronic diseases, including Parkinson's disease (PD), diabetic foot, flat foot, stroke, elderly falling, and knee osteoarthritis (KOA), are related to orthopedic organs, nerves, and muscles. The interaction of these three parts will generate a comprehensive result: gait. Furthermore, the lesions in these regions can produce abnormal gait features. Therefore, monitoring the gait features can assist medical professionals in the diagnosis and analysis of these diseases. Nowadays, various insole systems based on different sensing techniques have been developed to monitor gait and aid in medical research. Hence, a detailed review of insole systems and their applications in disease management can greatly benefit researchers working in the field of medical engineering. This essay is composed of the following sections: the essay firstly provides an overview of the sensing mechanisms and parameters of typical insole systems based on different sensing techniques. Then this essay respectively discusses the three stages of gait parameters pre-processing, respectively: pressure reconstruction, feature extraction, and data normalization. Then, the relationship between gait features and pathogenic mechanisms is discussed, along with the introduction of insole systems that aid in medical research; Finally, the current challenges and future trends in the development of insole systems are discussed.
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Affiliation(s)
- Zhiyuan Zhang
- School of Instrumentation and Optoelectronic Engineering, Beihang University, Beijing 100191, China; (Z.Z.); (Y.D.); (Z.X.)
| | - Yanning Dai
- School of Instrumentation and Optoelectronic Engineering, Beihang University, Beijing 100191, China; (Z.Z.); (Y.D.); (Z.X.)
| | - Zhenyu Xu
- School of Instrumentation and Optoelectronic Engineering, Beihang University, Beijing 100191, China; (Z.Z.); (Y.D.); (Z.X.)
| | - Nicolas Grimaldi
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL 32611, USA;
| | - Jiamu Wang
- School of Transportation Science and Engineering, Beihang University, Beijing 100191, China;
| | - Mufan Zhao
- School of Artificial Intelligence, Beihang University, Beijing 100191, China;
| | - Ruilin Pang
- School of Automation Science and Electrical Engineering, Beihang University, Beijing 100191, China;
| | - Yueming Sun
- School of Electronics and Information Engineering, Beihang University, Beijing 100191, China;
| | - Shuo Gao
- School of Instrumentation and Optoelectronic Engineering, Beihang University, Beijing 100191, China; (Z.Z.); (Y.D.); (Z.X.)
| | - Hu Boyi
- School of Industrial and Systems Engineering, University of Florida, Gaineville, FL 32611, USA
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Comparison between Piezoelectric and Piezoresistive Wearable Gait Monitoring Techniques. MATERIALS 2022; 15:ma15144837. [PMID: 35888304 PMCID: PMC9321623 DOI: 10.3390/ma15144837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 07/05/2022] [Accepted: 07/06/2022] [Indexed: 12/04/2022]
Abstract
Insole plantar stress detection (PSD) techniques play an important role in gait monitoring. Among the various insole PSD methods, piezoelectric- and piezoresistive-based architectures are broadly used in medical scenes. Each year, a growing number of new research outcomes are reported. Hence, a deep understanding of these two kinds of insole PSD sensors and state-of-the-art work would strongly benefit the researchers in this highly interdisciplinary field. In this context, this review article is composed of the following aspects. First, the mechanisms of the two techniques and corresponding comparisons are explained and discussed. Second, advanced materials which could enhance the performance of current piezoelectric and piezoresistive insole prototypes are introduced. Third, suggestions for designing insole PSD prototypes/products for different diseases are offered. Last, the current challenge and potential future trends are provided.
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Grech J, Mizzi S, Falzon O. A Technical Review of Foot Temperature Measurement Systems. J Am Podiatr Med Assoc 2022; 112:21-065. [PMID: 35239503 DOI: 10.7547/21-065] [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: 02/03/2023]
Abstract
People suffering from diabetes are at risk of developing foot ulcerations which, if left untreated, could also lead to amputation. Monitoring of the foot temperature can help in the prevention of these foot complications, and various studies have shown that elevated temperatures may be indicative of ulceration. Over the years, there have been various devices that were designed for foot temperature monitoring, for both clinical and home use. The technologies used included infrared thermometry, liquid crystal thermography, infrared thermography, and a vast range of analogue and digital temperature sensors incorporated into different measurement platforms. All these systems are able to collect thermal data from the foot, with some being able to acquire data only when the foot is stationary and others being able to acquire data from the foot in motion, which can give more in-depth insight into any emerging problems. The aim of this review is to evaluate the available literature related to the technologies used in these systems, outlining the benefits of each and what further developments may be required to make the foot temperature analysis more effective.
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Affiliation(s)
- Josef Grech
- *Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Stephen Mizzi
- †Centre of Biomedical Cybernetics, University of Malta, Msida, Malta
| | - Owen Falzon
- ‡Faculty of Engineering, University of Malta, Msida, Malta. Dr. Falzon is now with Centre of Biomedical Cybernetics, University of Malta, Msida, Malta
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Footwear microclimate and its effects on the microbial community of the plantar skin. Sci Rep 2021; 11:20356. [PMID: 34645918 PMCID: PMC8514438 DOI: 10.1038/s41598-021-99865-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 09/28/2021] [Indexed: 01/04/2023] Open
Abstract
The association between the footwear microclimate and microbial community on the foot plantar skin was investigated by experiments with three participants. Novel methods were developed for measuring in-shoe temperature and humidity at five footwear regions, as well as the overall ventilation rate inside the footwear. Three types of footwear were tested including casual shoes, running shoes, and perforated shoes for pairwise comparison of footwear microclimate and corresponding microbial community on the skin. The major findings are as follows: (1) footwear types make a significant difference to in-shoe temperature at the instep region with the casual shoes sustaining the warmest of all types; (2) significant differences were observed in local internal absolute humidity between footwear types, with the casual shoes sustaining the highest level of humidity at most regions; (3) the perforated shoes provided the highest ventilation rate, followed by running and casual shoes, and the faster the gait, the larger the discrepancy in ventilation rate between footwear types; (4) the casual shoes seemed to provide the most favorable internal environment for bacterial growth at the distal plantar skin; and (5) the bacterial growth at the distal plantar skin showed a positive linear correlation with the in-shoe temperature and absolute humidity, and a negative linear correlation with the ventilation rate. The ventilation rate seemed to be a more reliable indicator of the bacterial growth. Above all, we can conclude that footwear microclimate varies in footwear types, which makes contributions to the bacterial growth on the foot plantar skin.
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Saliba Thorne C, Gatt A, DeRaffaele C, Bazena A, Formosa C. Digital foot health technology and diabetic foot monitoring: A systematic review. Diabetes Res Clin Pract 2021; 175:108783. [PMID: 33775686 DOI: 10.1016/j.diabres.2021.108783] [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: 06/09/2020] [Revised: 11/17/2020] [Accepted: 03/20/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND In diabetic foot ulceration, a correlation between pressure and skin temperature is suspected. The aim of this systematic review is to provide a more rigorous analysis of existing literature related to the various technologies used to read and measure both in-shoe plantar pressures, and in-shoe skin temperatures simultaneously. METHODS A systematic review of the literature related to the topic was searched in database sources such as Medline OVID, Cochrane Library, PubMed, CONAHL, PROSPERO, and Elsevier. Outcome measures of interest included validity, reliability and responsiveness of in-shoe temperature and/or pressure mapping device used, and characteristics and quantity of sensors used, anatomical landmarks and statistical analysis used to interpret the data. Quality of evidence and risk of bias was evaluated using the QUADAS-2. RESULTS Nineteen studies were identified and included in this review. The majority of studies used a small sample size (mean n = 17) and recruited healthy participants. All studies have shown excellent validity but only a few tested for the reliability of the device. None of the studies tested for responsiveness of the device. Quality assessment results scored high risk in view of 'patient selection', 'use of reference standard' and 'applicability', and low risk in view of 'use if index test' and 'flow and timing'. CONCLUSIONS The data outlined in this review confirms that further improvement, reliability testing and clinical validation of the developed systems is required despite the results of excellent performance in detecting changes of in-shoe skin temperature and pressure.
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Affiliation(s)
| | - Alfred Gatt
- Faculty of Health Sciences, University of Malta, Malta
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Smart wearable system for safety-related medical IoT application: case of epileptic patient working in industrial environment. HEALTH AND TECHNOLOGY 2019. [DOI: 10.1007/s12553-019-00335-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Portable System for Monitoring the Microclimate in the Footwear-Foot Interface. SENSORS 2016; 16:s16071059. [PMID: 27399718 PMCID: PMC4970106 DOI: 10.3390/s16071059] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 06/28/2016] [Accepted: 06/29/2016] [Indexed: 11/16/2022]
Abstract
A new, continuously-monitoring portable device that monitors the diabetic foot has shown to help in reduction of diabetic foot complications. Persons affected by diabetic foot have shown to be particularly sensitive in the plantar surface; this sensitivity coupled with certain ambient conditions may cause dry skin. This dry skin leads to the formation of fissures that may eventually result in a foot ulceration and subsequent hospitalization. This new device monitors the micro-climate temperature and humidity areas between the insole and sole of the footwear. The monitoring system consists of an array of ten sensors that take readings of relative humidity within the range of 100% ± 2% and temperature within the range of −40 °C to 123.8 ± 0.3 °C. Continuous data is collected using embedded C software and the recorded data is processed in Matlab. This allows for the display of data; the implementation of the iterative Gauss-Newton algorithm method was used to display an exponential response curve. Therefore, the aim of our system is to obtain feedback data and provide the critical information to various footwear manufacturers. The footwear manufactures will utilize this critical information to design and manufacture diabetic footwear that reduce the risk of ulcers in diabetic feet.
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Khusainov R, Azzi D, Achumba IE, Bersch SD. Real-time human ambulation, activity, and physiological monitoring: taxonomy of issues, techniques, applications, challenges and limitations. SENSORS (BASEL, SWITZERLAND) 2013; 13:12852-902. [PMID: 24072027 PMCID: PMC3859040 DOI: 10.3390/s131012852] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 09/02/2013] [Accepted: 09/10/2013] [Indexed: 01/06/2023]
Abstract
Automated methods of real-time, unobtrusive, human ambulation, activity, and wellness monitoring and data analysis using various algorithmic techniques have been subjects of intense research. The general aim is to devise effective means of addressing the demands of assisted living, rehabilitation, and clinical observation and assessment through sensor-based monitoring. The research studies have resulted in a large amount of literature. This paper presents a holistic articulation of the research studies and offers comprehensive insights along four main axes: distribution of existing studies; monitoring device framework and sensor types; data collection, processing and analysis; and applications, limitations and challenges. The aim is to present a systematic and most complete study of literature in the area in order to identify research gaps and prioritize future research directions.
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Affiliation(s)
- Rinat Khusainov
- School of Engineering, Faculty of Technology, University of Portsmouth, Anglesea Building, Anglesea Road, Portsmouth PO1 3DJ, UK; E-Mails: (R.K.); (D.A.); (S.D.B.)
| | - Djamel Azzi
- School of Engineering, Faculty of Technology, University of Portsmouth, Anglesea Building, Anglesea Road, Portsmouth PO1 3DJ, UK; E-Mails: (R.K.); (D.A.); (S.D.B.)
| | - Ifeyinwa E. Achumba
- School of Engineering, Faculty of Technology, University of Portsmouth, Anglesea Building, Anglesea Road, Portsmouth PO1 3DJ, UK; E-Mails: (R.K.); (D.A.); (S.D.B.)
| | - Sebastian D. Bersch
- School of Engineering, Faculty of Technology, University of Portsmouth, Anglesea Building, Anglesea Road, Portsmouth PO1 3DJ, UK; E-Mails: (R.K.); (D.A.); (S.D.B.)
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North K, Kubiak EN, Hitchcock RW. Sensor packaging design for continuous underfoot load monitoring. Biomed Microdevices 2011; 14:217-24. [PMID: 22009581 DOI: 10.1007/s10544-011-9599-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Kylee North
- Department of Biomedical Engineering, University of Utah, 72 S. Central Campus Dr., Rm 2646, Salt Lake City, UT 84112, USA
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12
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Descatoire A, Thévenon A, Moretto P. Baropodometric information return device for foot unloading. Med Eng Phys 2009; 31:607-13. [DOI: 10.1016/j.medengphy.2008.12.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Revised: 12/08/2008] [Accepted: 12/21/2008] [Indexed: 11/28/2022]
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Bamberg SJM, Benbasat AY, Scarborough DM, Krebs DE, Paradiso JA. Gait analysis using a shoe-integrated wireless sensor system. ACTA ACUST UNITED AC 2008; 12:413-23. [PMID: 18632321 DOI: 10.1109/titb.2007.899493] [Citation(s) in RCA: 220] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
We describe a wireless wearable system that was developed to provide quantitative gait analysis outside the confines of the traditional motion laboratory. The sensor suite includes three orthogonal accelerometers, three orthogonal gyroscopes, four force sensors, two bidirectional bend sensors, two dynamic pressure sensors, as well as electric field height sensors. The "GaitShoe" was built to be worn in any shoe, without interfering with gait and was designed to collect data unobtrusively, in any environment, and over long periods. The calibrated sensor outputs were analyzed and validated with results obtained simultaneously from the Massachusetts General Hospital, Biomotion Laboratory. The GaitShoe proved highly capable of detecting heel-strike and toe-off, as well as estimating foot orientation and position, inter alia.
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Rokkam M, Chatni MR, ul Haque A, De Carlo AR, Robinson BF, Irazoqui PP, Porterfield DM. High-density data acquisition system and signal preprocessor for interfacing with microelectromechanical system-based biosensor arrays. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2007; 78:044303. [PMID: 17477683 DOI: 10.1063/1.2722420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Microelectromechanical system (MEMS) development has become an active area for research in over the last decade. This area has advanced rapidly in recent years due to the potential ability of MEMS devices to perform complex functions in a smaller area. There is also the prospect to develop devices that can (1) be easily manufactured, (2) offer low power consumption, and (3) reduce waste. Especially in the BioMEMS area these advantages are important in terms of applied devices for biosensing, clinical diagnostics, physiological sensing, flow cytometry, and other lab-on-a-chip applications. However, one major obstacle that has been overlooked is the interface of these microdevices with the macroworld. This is critical to enable applications and development of the technology, as currently testing and analysis of data from these devices is mostly limited to generic microprobe stations. New advancements in BioMEMS have to occur in concert with the development of data acquisition systems and signal preprocessors to fully appreciate and test these developing technologies. In this work, we present the development of a cost effective, high throughput data acquisition system (Bio-HD DAQ) and a signal preprocessor for a MEMS-based cell electrophysiology lab-on-a-Chip (CEL-C) device. The signal preprocessor consists of a printed circuit board mounted with the CEL-C device and a 64-channel filter/amplifier circuit array. The data acquisition system includes a high-density crosspoint switching matrix that connects the signal preprocessor to a 16-channel, 18 bit, and 625 kSs DAQ card. Multimodule custom software designed on LABVIEW 7.0 is used to control the DAQ system. While this version of the Bio-HD DAQ system and accompanying software are designed keeping in view the specific requirements of the CEL-C device, it is highly adaptable and, with minor modifications, can become a generic data acquisition system for MEMS development, testing, and application.
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Affiliation(s)
- M Rokkam
- Bindley Bioscience Center, Physiological Sensing Facility, Purdue University, West Lafayette, IN 47907, USA
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Maluf KS, Morley RE, Richter EJ, Klaesner JW, Mueller MJ. Foot pressures during level walking are strongly associated with pressures during other ambulatory activities in subjects with diabetic neuropathy. Arch Phys Med Rehabil 2004; 85:253-60. [PMID: 14966710 DOI: 10.1016/j.apmr.2003.06.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the relationship between foot pressures measured during level walking and other types of ambulatory activity in subjects with diabetes mellitus (DM) and peripheral neuropathy (PN). DESIGN Descriptive survey with repeated measures. SETTING University medical center. PARTICIPANTS Convenience sample of 16 ambulatory subjects with DM and PN. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Peak pressure and pressure-time integral (PTI) at the heel, great toe, first metatarsal head (MT1), and third metatarsal head (MT3) during level walking, ramp climbing, stair climbing, and turning at a self-selected speed. RESULTS Peak pressure and PTI during level walking correlated highly with pressures during ramp climbing (r range,.85-.97) and turning (r range,.75-.96) at all regions examined and with pressures during stair climbing at MT1 and MT3 (r range,.84-.91). Correlations between pressures during level walking and stair climbing were moderate at the great toe (r range,.46-.57) and poor at the heel (r range, -.12 to -.06). With few exceptions, pressures during ramp climbing, stair climbing, and turning were less than (P<.008) or equal to pressures during level walking. We found no activity-related differences in peak pressure or PTI independent of the effects of preferred walking speed. CONCLUSIONS Results support the clinical evaluation of peak pressure during level walking as an efficient method to screen for maximum levels of stress on the foot as patients with DM and PN perform their daily activities.
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Affiliation(s)
- Katrina S Maluf
- Department of Kinesiology and Applied Physiology, University of Colorado, Boulder, CO, USA
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Maluf KS, Mueller MJ. Novel Award 2002. Comparison of physical activity and cumulative plantar tissue stress among subjects with and without diabetes mellitus and a history of recurrent plantar ulcers. Clin Biomech (Bristol, Avon) 2003; 18:567-75. [PMID: 12880704 DOI: 10.1016/s0268-0033(03)00118-9] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To compare the amount of weight-bearing activity and estimates of cumulative plantar tissue stress between subjects with and without diabetes mellitus and a history of recurrent plantar ulcers. DESIGN Cross-sectional study with matched groups. BACKGROUND Weight-bearing activity among individuals with diabetes is likely to influence the amount of mechanical trauma accumulated by plantar tissues, yet activity levels have not been accounted for in previous measurements of plantar tissue stress or predictions of plantar tissue injury. METHODS Study groups included subjects with diabetes mellitus and peripheral neuropathy, either with or without a history of recurrent plantar ulcers, and non-diabetic control subjects (n=10 per group). Pressure on the plantar foot was assessed as subjects walked at their preferred speed in the shoes they reported wearing most often each day. Physical activity was monitored over seven consecutive days using an accelerometer. The product of mean daily strides and forefoot pressure-time integral was used to estimate daily cumulative stress on the plantar forefoot. RESULTS Subjects with diabetes and a history of recurrent plantar ulcers were 46% less active than subjects without diabetes (mean (SD)=2727 (1345) versus 5037 (2624) strides/day, P=0.04), and accumulated 41% less daily stress on the forefoot than non-diabetic and diabetic control subjects without a history of plantar ulcers (mean (SD)= 210 (134) versus 354 (118) and 354 (148) MPas/day respectively, P=0.03). CONCLUSIONS Subjects with diabetes and a history a previous ulcers may be susceptible to plantar tissue injury even at relatively low levels of cumulative tissue stress. RELEVANCE Changes in weight-bearing activity following plantar tissue injury in patients with diabetes may influence plantar tissue adaptation and the risk of ulcer recurrence.
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Affiliation(s)
- K S Maluf
- Washington University School of Medicine, Program in Physical Therapy, 4444 Forest Park Blvd, Campus Box 8502, Saint Louis, MO 63108-2212, USA
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de Groot IJM, Zohar OE, Haspels R, van Keeken H, Otten E. CAREN (computer assisted rehabilitation environment): a novel way to improve shoe efficacy. Prosthet Orthot Int 2003; 27:158-62. [PMID: 14571947 DOI: 10.1080/03093640308726673] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A new technical system, CAREN (computer assisted rehabilitation environment), is described, which makes it possible to do a total body movement analysis in a virtual environment. The virtual environment is reproducible and as close to natural environment as possible. In a case study it proved possible with this system to test different shoes and get insight in the movement problems. The importance of whole body analysis is demonstrated in this case study. The adjustments made in the shoes could be tested for their efficacy.
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Affiliation(s)
- I J M de Groot
- Rehabilitation Center De Trappenberg, Huizen, The Netherlands
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