Tri-axial plantar pressure sensor: design, calibration and characterization

Measuring Plantar Tissue Stress in People With Diabetic Peripheral Neuropathy: A Critical Concept in Diabetic Foot Management

Excessive stress on plantar tissue over time is one of the leading causes of diabetic foot ulcers among people with diabetic peripheral neuropathy. Plantar tissue stress (PTS) is a concept that attempts to integrate several well-known mechanical factors into one measure, including plantar pressure, shear stress, daily weight-bearing activity, and time spent in prescribed offloading interventions (adherence). Despite international diabetic foot guidelines recommending the measure of each of these individual mechanical factors in people with neuropathy, only recently has technology enabled their combined measurement to determine PTS. In this article we review the concept of PTS, the mechanical factors involved, and the findings of pivotal articles reporting measures of PTS in people with neuropathy. We also discuss key existing gaps in this field, including the lack of standards to measure and report PTS, a lack of practical solutions to measure shear stress, and the lack of PTS thresholds that may indicate benefit or detriment to people with neuropathy. To address some of these gaps, we propose recommended clinical and research standards for measuring and reporting PTS in people with neuropathy. Last, we forecast future clinical, research, and technological advancements that may use PTS to highlight the importance of this critical concept in the prevention and management of diabetic foot ulcers.

Design of a Tri-Axial Force Measurement Transducer for Plantar Force Measurements

Transducers for spatial plantar force measurements have numerous applications in biomechanics, rehabilitation medicine, and gait analysis. In this work, the design of a novel, tri-axial transducer for plantar force measurements was presented. The proposed design could resolve both the normal and the shear forces applied at the foot's sole. The novelty of the design consisted in using a rotating bump to translate the external loads into axial compressive forces which could be measured effectively by conventional pressure sensors. For the prototype presented, multilayer polydimethylsiloxane (PDMS) thin-film capacitive stacks were manufactured and used as sensing units, although in principle the design could be extended to various types of sensors. A quasi-static analytic solution to describe the behavior of the transducer was also derived and used to optimize the design. To characterize the performance of the transducer, a 3 cm diameter, 1 cm tall prototype was manufactured and tested under various combination of shear and normal loading scenarios. The tests confirmed the ability of the transducer to generate strong capacitive signals and measure both the magnitude and direction of the normal and shear loads in the dynamic range of interest.

Gait Shear and Plantar Pressure Monitoring: A Non-Invasive OFS Based Solution for e-Health Architectures

In an era of unprecedented progress in sensing technology and communication, health services are now able to closely monitor patients and elderly citizens without jeopardizing their daily routines through health applications on their mobile devices in what is known as e-Health. Within this field, we propose an optical fiber sensor (OFS) based system for the simultaneous monitoring of shear and plantar pressure during gait movement. These parameters are considered to be two key factors in gait analysis that can help in the early diagnosis of multiple anomalies, such as diabetic foot ulcerations or in physical rehabilitation scenarios. The proposed solution is a biaxial OFS based on two in-line fiber Bragg gratings (FBGs), which were inscribed in the same optical fiber and placed individually in two adjacent cavities, forming a small sensing cell. Such design presents a more compact and resilient solution with higher accuracy when compared to the existing electronic systems. The implementation of the proposed elements into an insole is also described, showcasing the compactness of the sensing cells, which can easily be integrated into a non-invasive mobile e-Health solution for continuous remote gait monitoring of patients and elder citizens. The reported results show that the proposed system outperforms existing solutions, in the sense that it is able to dynamically discriminate shear and plantar pressure during gait.

Plantar shear stress measurements - A review

BACKGROUND

Mechanical stress at the plantar surface has two components, pressure acting normal to the surface and shear stress acting tangential to the surface. Typically only pressure is measured and reported. However, plantar shear stress also plays a major role, especially in diabetic ulceration.

METHODS

During the last few decades, a variety of methods have been developed for the measurement of plantar shear stress. This paper reviews the technologies used in plantar shear stress measurements.

FINDINGS

Several technologies have been used, e.g. magneto-resistors, strain gauges, optical methods, piezoelectric materials and capacitive sensors. Examples of plantar shear stress values measured with the developed devices are also collected here and the relationship between sensor characteristics and the measured plantar shear stress distribution is discussed.

INTERPRETATION

Even with the limitations of current plantar shear stress measurement technologies, they can provide useful information on the plantar stress distribution.