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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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Matijevich E, Minty E, Bray E, Bachus C, Hajizadeh M, Liden B. A Multi-Faceted Digital Health Solution for Monitoring and Managing Diabetic Foot Ulcer Risk: A Case Series. SENSORS (BASEL, SWITZERLAND) 2024; 24:2675. [PMID: 38732781 PMCID: PMC11085305 DOI: 10.3390/s24092675] [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: 02/23/2024] [Revised: 04/12/2024] [Accepted: 04/19/2024] [Indexed: 05/13/2024]
Abstract
INTRODUCTION Diabetic foot ulcers (DFU) are a devastating complication of diabetes. There are numerous challenges with preventing diabetic foot complications and barriers to achieving the care processes suggested in established foot care guidelines. Multi-faceted digital health solutions, which combine multimodal sensing, patient-facing biofeedback, and remote patient monitoring (RPM), show promise in improving our ability to understand, prevent, and manage DFUs. METHODS Patients with a history of diabetic plantar foot ulcers were enrolled in a prospective cohort study and equipped with custom sensory insoles to track plantar pressure, plantar temperature, step count, and adherence data. Sensory insole data enabled patient-facing biofeedback to cue active plantar offloading in response to sustained high plantar pressures, and RPM assessments in response to data trends of concern in plantar pressure, plantar temperature, or sensory insole adherence. Three non-consecutive case participants that ultimately presented with pre-ulcerative lesions (a callus and/or erythematous area on the plantar surface of the foot) during the study were selected for this case series. RESULTS Across three illustrative patients, continuous plantar pressure monitoring demonstrated promise for empowering both the patient and provider with information for data-driven management of pressure offloading treatments. CONCLUSION Multi-faceted digital health solutions can naturally enable and reinforce the integrative foot care guidelines. Multi-modal sensing across multiple physiologic domains supports the monitoring of foot health at various stages along the DFU pathogenesis pathway. Furthermore, digital health solutions equipped with remote patient monitoring unlock new opportunities for personalizing treatments, providing periodic self-care reinforcement, and encouraging patient engagement-key tools for improving patient adherence to their diabetic foot care plan.
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Affiliation(s)
| | - Evan Minty
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Emily Bray
- Orpyx Medical Technologies, Inc., Calgary, AB T2G 1M8, Canada
| | - Courtney Bachus
- Orpyx Medical Technologies, Inc., Calgary, AB T2G 1M8, Canada
| | | | - Brock Liden
- Cutting Edge Research LLC, Circleville, OH 43113, USA
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Lockhart M, Dinneen SF, O'Keeffe DT. Plantar pressure measurement in diabetic foot disease: A scoping review. J Diabetes Investig 2024. [PMID: 38634342 DOI: 10.1111/jdi.14215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 03/27/2024] [Accepted: 03/29/2024] [Indexed: 04/19/2024] Open
Abstract
AIMS/INTRODUCTION Patients with a healed diabetic foot ulcer (DFU) have a 40% risk of ulcer recurrence within a year. New and effective measures to prevent DFU recurrence are essential. We aimed to highlight emerging trends and future research opportunities in the use of plantar pressure measurement to prevent DFU recurrence. MATERIALS AND METHODS Our scoping review protocol was drafted using the Preferred Reporting Items for Systematic Reviews and Meta-analysis - Scoping Review protocol. Peer-reviewed, English-language papers were included that addressed both plantar pressure measurement and diabetic foot disease, either as primary studies that have advanced the field or as review papers that provide summaries and/or opinion on the field as a whole, as well as specific papers that provide guidelines for future research and advancement in the field. RESULTS A total of 24 eligible publications were identified in a literature search using PubMed. A further 36 eligible studies were included after searching the references sections of these publications, leaving a total of 60 publications included in this scoping review. CONCLUSIONS Plantar pressure measurement can and will play a major role in the prevention of DFU. There is already a strong, albeit limited, evidence base in place to prove its benefit in reducing DFU recurrence. More research is required in larger populations, using remote monitoring in real-world settings, and with improved technology.
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Affiliation(s)
- Michael Lockhart
- Center for Endocrinology, Diabetes and Metabolism, Galway University Hospitals, Galway, Ireland
- Health Innovation via Engineering (HIVE) Laboratory, Lambe Institute, University of Galway, Galway, Ireland
| | - Sean F Dinneen
- Center for Endocrinology, Diabetes and Metabolism, Galway University Hospitals, Galway, Ireland
- School of Medicine, University of Galway, Galway, Ireland
| | - Derek T O'Keeffe
- Center for Endocrinology, Diabetes and Metabolism, Galway University Hospitals, Galway, Ireland
- Health Innovation via Engineering (HIVE) Laboratory, Lambe Institute, University of Galway, Galway, Ireland
- School of Medicine, University of Galway, Galway, Ireland
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Castro-Martins P, Marques A, Coelho L, Vaz M, Costa JT. Plantar pressure thresholds as a strategy to prevent diabetic foot ulcers: A systematic review. Heliyon 2024; 10:e26161. [PMID: 38390156 PMCID: PMC10882031 DOI: 10.1016/j.heliyon.2024.e26161] [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: 05/30/2023] [Revised: 11/22/2023] [Accepted: 02/08/2024] [Indexed: 02/24/2024] Open
Abstract
Background The development of ulcers in the plantar region of the diabetic foot originates mainly from sites subjected to high pressure. The monitoring of these events using maximum allowable pressure thresholds is a fundamental procedure in the prevention of ulceration and its recurrence. Objective The aim of this review was to identify data in the literature that reveal an objective threshold of plantar pressure in the diabetic foot, where pressure is classified as promoting ulceration. The aim is not to determine the best and only pressure threshold for ulceration, but rather to clarify the threshold values most used in clinical practice and research, also considering the devices used and possible applications for offloading plantar pressure. Design A systematic review. Methods The search was performed in three electronic databases, by the PRISMA methodology, for studies that used a pressure threshold to minimize the risk of ulceration in the diabetic foot. The selected studies were subjected to eligibility criteria. Results Twenty-six studies were included in this review. Seven thresholds were identified, five of which are intended for the inside of the shoe: a threshold of average peak pressure of 200 kPa; 25 % and 40-80 % reduction from initial baseline pressure; 32-35 mm Hg for a capillary perfusion pressure; and a matrix of thresholds based on patient risk, shoe size and foot region. Two other thresholds are intended for the barefoot, 450 and 750 kPa. The threshold of 200 kPa of pressure inside the shoe is the most agreed upon among the studies. Regarding the prevention of ulceration and its recurrence, the efficacy of the proposed threshold matrix and the threshold of reducing baseline pressure by 40-80 % has not yet been evaluated, and the evidence for the remaining thresholds still needs further studies. Conclusions Some heterogeneity was found in the studies, especially regarding the measurement systems used, the number of regions of interest and the number of steps to be considered for the threshold. Even so, this review reveals the way forward to obtain a threshold indicative of an effective steppingstone in the prevention of diabetic foot ulcer.
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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
| | - José Torres Costa
- Faculty of Engineering, University of Porto, Portugal
- Faculty of Medicine, University of Porto, Portugal
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Phuenpathom W, Panyakaew P, Vateekul P, Surangsrirat D, Bhidayasiri R. Residual effects of combined vibratory and plantar stimulation while seated influences plantar pressure and spatiotemporal gait measures in individuals with Parkinson's disease exhibiting freezing of gait. Front Aging Neurosci 2024; 15:1280324. [PMID: 38264550 PMCID: PMC10803580 DOI: 10.3389/fnagi.2023.1280324] [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: 08/20/2023] [Accepted: 12/27/2023] [Indexed: 01/25/2024] Open
Abstract
Introduction Combined plantar pressure and vibratory stimulation has been shown to decrease freezing of gait (FOG) episodes and improve spatiotemporal gait parameters compared to single stimulation in Parkinson's disease (PD) patients with FOG. However, the effect of combined plantar stimulations on plantar pressure analysis has never been explored. Methods Forty PD patients with frequent FOG were allocated to either FOG shoes embedded with a 100 Hz vibratory stimulation at the Achilles tendons and a soft thickened silicone pad at the hallux and sole, or sham shoes with a non-working vibratory motor and a flat non-pressure silicone pad (20 patients per arm) while seated for 96 s. The objective gait and plantar pressure analysis were measured immediately after the stimulation. Outcomes included the normalized percentage of changes in percent FOG (%FOG) and plantar pressure in the heel-strike and push-off phase that were compared between pre- and post-stimulations. Results The FOG shoes group showed significantly decreased %FOG (81.5 ± 28.9% vs. 6.8 ± 22.1%, p < 0.001), plantar pressure in the heel-strike (47.8 ± 43.7% vs. 4.3 ± 9.8%, p < 0.001), plantar pressure in the push-off (57.7 ± 59.6% vs. 6.2 ± 11.6%, p < 0.001), force time integral (FTI) (40.9 ± 32.5% vs. 6.6 ± 17.3%, p < 0.001), and decreased heel contact time (19.3 ± 12.3% vs. 22.7 ± 32.5%, p < 0.001) when compared to the sham group. There was a strong negative correlation between %FOG and peak plantar pressure (r = -0.440, p = 0.005), plantar pressure in the heel-strike (r = -0.847, p < 0.001). Conclusion Our study demonstrated that the FOG shoe could decrease FOG episodes by improving the heel-strike pressure, toe push-off and normalized heel-to-toe plantar pressure, suggesting that modification inputs from the peripheral sensory systems might significant improvement in FOG in PD.
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Affiliation(s)
- Warongporn Phuenpathom
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Pattamon Panyakaew
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Peerapon Vateekul
- Department of Computer Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand
| | - Decho Surangsrirat
- Assistive Technology and Medical Devices Research Center, National Science and Technology Development Agency, Pathum Thani, Thailand
| | - Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- The Academy of Science, The Royal Society of Thailand, Bangkok, Thailand
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Lazarus J, Cioroianu I, Ehrhardt B, Gurevich D, Kreusser L, Metcalfe B, Nishtala P, Preatoni E, Sharp TH. Data-driven digital health technologies in the remote clinical care of diabetic foot ulcers: a scoping review. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2023; 4:1212182. [PMID: 37727285 PMCID: PMC10505804 DOI: 10.3389/fcdhc.2023.1212182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/31/2023] [Indexed: 09/21/2023]
Abstract
Background The availability and effectiveness of Digital Health Technologies (DHTs) to support clinicians, empower patients, and generate economic savings for national healthcare systems are growing rapidly. Of particular promise is the capacity of DHTs to autonomously facilitate remote monitoring and treatment. Diabetic Foot Ulcers (DFUs) are characterised by high rates of infection, amputation, mortality, and healthcare costs. With clinical outcomes contingent on activities that can be readily monitored, DFUs present a promising focus for the application of remote DHTs. Objective This scoping review has been conducted as a first step toward ascertaining fthe data-related challenges and opportunities for the development of more comprehensive, integrated, and individualised sense/act DHTs. We review the latest developments in the application of DHTs to the remote care of DFUs. We cover the types of DHTs in development and their features, technological readiness, and scope of clinical testing. Eligibility criteria Only peer-reviewed original experimental and observational studies, case series and qualitative studies were included in literature searches. All reviews and manuscripts presenting pre-trial prototype technologies were excluded. Methods An initial search of three databases (Web of Science, MEDLINE, and Scopus) generated 1,925 English-language papers for screening. 388 papers were assessed as eligible for full-text screening by the review team. 81 manuscripts were found to meet the eligibility criteria. Results Only 19% of studies incorporated multiple DHTs. We categorised 56% of studies as 'Treatment-Manual', i.e. studies involving technologies aimed at treatment requiring manual data generation, and 26% as 'Prevention-Autonomous', i.e. studies of technologies generating data autonomously through wearable sensors aimed at ulcer prevention through patient behavioural change. Only 10% of studies involved more ambitious 'Treatment-Autonomous' interventions. We found that studies generally reported high levels of patient adherence and satisfaction. Conclusions Our findings point to a major potential role for DHTs in remote personalised medical management of DFUs. However, larger studies are required to assess their impact. Here, we see opportunities for developing much larger, more comprehensive, and integrated monitoring and decision support systems with the potential to address the disease in a more complete context by capturing and integrating data from multiple sources from subjective and objective measurements.
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Affiliation(s)
- Joel Lazarus
- Department of Social and Policy Studies, University of Bath, Bath, United Kingdom
| | - Iulia Cioroianu
- Department of Politics, Languages and International Studies, Faculty of Humanities and Social Sciences, University of Bath, Bath, United Kingdom
| | - Beate Ehrhardt
- Institute for Mathematical Innovation, Languages and International Studies, Faculty of Humanities and Social Sciences, University of Bath, Bath, United Kingdom
| | - David Gurevich
- Department of Life Sciences, University of Bath, Bath, United Kingdom
| | - Lisa Kreusser
- Department of Mathematical Sciences, Faculty of Science, University of Bath, Bath, United Kingdom
| | - Benjamin Metcalfe
- Department of Electronic and Electrical Engineering, Faculty of Science, University of Bath, Bath, United Kingdom
| | - Prasad Nishtala
- Department of Life Sciences, Faculty of Engineering and Design, University of Bath, Bath, United Kingdom
| | - Ezio Preatoni
- Department for Health, Faculty of Humanities and Social Sciences, University of Bath, Bath, United Kingdom
| | - Tamsin H. Sharp
- Department of Psychology, Faculty of Humanities and Social Sciences, University of Bath, Bath, United Kingdom
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Abou Ghaida H, Poffo L, Le Page R, Goujon JM. Effect of Sensor Size, Number and Position under the Foot to Measure the Center of Pressure (CoP) Displacement and Total Center of Pressure (CoPT) Using an Anatomical Foot Model. SENSORS (BASEL, SWITZERLAND) 2023; 23:4848. [PMID: 37430761 DOI: 10.3390/s23104848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/07/2023] [Accepted: 05/15/2023] [Indexed: 07/12/2023]
Abstract
Ambulatory instrumented insoles are widely used in real-time monitoring of the plantar pressure in order to calculate balance indicators such as Center of Pressure (CoP) or Pressure Maps. Such insoles include many pressure sensors; the required number and surface area of the sensors used are usually determined experimentally. Additionally, they follow the common plantar pressure zones, and the quality of measurement is usually strongly related to the number of sensors. In this paper, we experimentally investigate the robustness of an anatomical foot model, combined with a specific learning algorithm, to measure the static displacement of the center of pressure (CoP) and the center of total pressure (CoPT), as a function of the number, size, and position of sensors. Application of our algorithm to the pressure maps of nine healthy subjects shows that only three sensors per foot, with an area of about 1.5 × 1.5 cm2, are needed to give a good approximation of the CoP during quiet standing when placed on the main pressure areas.
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Affiliation(s)
- Hussein Abou Ghaida
- Univ Rennes, CNRS, Institut FOTON-UMR 6082, 6 rue de Kerampont CS 80518, F-22305 Lannion, France
| | - Luiz Poffo
- Univ Rennes, CNRS, Institut FOTON-UMR 6082, 6 rue de Kerampont CS 80518, F-22305 Lannion, France
| | - Ronan Le Page
- Univ Rennes, CNRS, Institut FOTON-UMR 6082, 6 rue de Kerampont CS 80518, F-22305 Lannion, France
| | - Jean-Marc Goujon
- Univ Rennes, CNRS, Institut FOTON-UMR 6082, 6 rue de Kerampont CS 80518, F-22305 Lannion, France
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Gavrilović M, Popović DB. A principal component analysis (PCA) based assessment of the gait performance. BIOMED ENG-BIOMED TE 2021; 66:449-457. [PMID: 34243223 DOI: 10.1515/bmt-2020-0307] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 06/23/2021] [Indexed: 11/15/2022]
Abstract
The gait assessment is instrumental for evaluating the efficiency of rehabilitation of persons with a motor impairment of the lower extremities. The protocol for quantifying the gait performance needs to be simple and easy to implement; therefore, a wearable system and user-friendly computer program are preferable. We used the Gait Master (instrumented insoles) with the industrial quality ground reaction forces (GRF) sensors and 6D inertial measurement units (IMU). WiFi transmitted 10 signals from the GRF sensors and 12 signals from the accelerometers and gyroscopes to the host computer. The clinician was following in real-time the acquired data to be assured that the WiFi operated correctly. We developed a method that uses principal component analysis (PCA) to provide a clinician with easy to interpret cyclograms showing the difference between the recorded and healthy-like gait performance. The cyclograms formed by the first two principal components in the PCA space show the step-to-step reproducibility. We suggest that a cyclogram and its orientation to the coordinate system PC1 vs. PC2 allow a simple assessment of the gait. We show results for six healthy persons and five patients with hemiplegia.
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Affiliation(s)
- Marija Gavrilović
- Faculty of Electrical Engineering, University of Belgrade, Bulevar Kralja Aleksandra 73, 11000 Belgrade, Serbia
| | - Dejan B Popović
- Serbian Academy of Sciences and Arts (SASA), Belgrade, Serbia.,Aalborg University, Aalborg, Denmark
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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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De Pascali C, Francioso L, Giampetruzzi L, Rescio G, Signore MA, Leone A, Siciliano P. Modeling, Fabrication and Integration of Wearable Smart Sensors in a Monitoring Platform for Diabetic Patients. SENSORS (BASEL, SWITZERLAND) 2021; 21:1847. [PMID: 33800949 PMCID: PMC7962045 DOI: 10.3390/s21051847] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/26/2021] [Accepted: 03/02/2021] [Indexed: 12/13/2022]
Abstract
The monitoring of some parameters, such as pressure loads, temperature, and glucose level in sweat on the plantar surface, is one of the most promising approaches for evaluating the health state of the diabetic foot and for preventing the onset of inflammatory events later degenerating in ulcerative lesions. This work presents the results of sensors microfabrication, experimental characterization and FEA-based thermal analysis of a 3D foot-insole model, aimed to advance in the development of a fully custom smart multisensory hardware-software monitoring platform for the diabetic foot. In this system, the simultaneous detection of temperature-, pressure- and sweat-based glucose level by means of full custom microfabricated sensors distributed on eight reading points of a smart insole will be possible, and the unit for data acquisition and wireless transmission will be fully integrated into the platform. Finite element analysis simulations, based on an accurate bioheat transfer model of the metabolic response of the foot tissue, demonstrated that subcutaneous inflamed lesions located up to the muscle layer, and ischemic damage located not below the reticular/fat layer, can be successfully detected. The microfabrication processes and preliminary results of functional characterization of flexible piezoelectric pressure sensors and glucose sensors are presented. Full custom pressure sensors generate an electric charge in the range 0-20 pC, proportional to the applied load in the range 0-4 N, with a figure of merit of 4.7 ± 1 GPa. The disposable glucose sensors exhibit a 0-6 mM (0-108 mg/dL) glucose concentration optimized linear response (for sweat-sensing), with a LOD of 3.27 µM (0.058 mg/dL) and a sensitivity of 21 µA/mM cm2 in the PBS solution. The technical prerequisites and experimental sensing performances were assessed, as preliminary step before future integration into a second prototype, based on a full custom smart insole with enhanced sensing functionalities.
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Affiliation(s)
| | - Luca Francioso
- National Research Council of Italy, Institute for Microelectronics and Microsystems (CNR-IMM), 95121 Lecce, Italy; (C.D.P.); (G.R.); (M.A.S.); (A.L.); (P.S.)
| | - Lucia Giampetruzzi
- National Research Council of Italy, Institute for Microelectronics and Microsystems (CNR-IMM), 95121 Lecce, Italy; (C.D.P.); (G.R.); (M.A.S.); (A.L.); (P.S.)
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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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Walsh L, Muaremi A, Stanton T, Blauth M, Clay I, Schieker M, Laurent D. Quantifying Functional Difference in Centre of Pressure Post Achilles Tendon Rupture using Sensor Insoles. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:3155-3158. [PMID: 31946557 DOI: 10.1109/embc.2019.8857174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Significant advances are being made to instrument and more objectively quantify gait and mobility assessment, treatment and rehabilitation. Wearable, inertial, optical and location-based technologies are proposed as scalable soutions, suited to both clinic and home-based settings, that can provide clinically meaningful insights into gait and mobility. In this paper, sensorised insoles are shown to provide the means to measure where pressure is distributed through each foot for each step, while it is in contact with the ground. Through profiling the points through which pressure is applied over each step and comparing changes between the affected and healthy limbs, insights into biomechanical foot dysfunction are shown for a patient population which may inform assessment, treatment and rehabilitation. This paper proposes a series of sensor-agnostic metrics derived from sensorised insoles to quantify foot mobility over a series of steps in a patient population. Differences in these metrics are shown between the affected and unaffected foot in a cohort of patients 8 weeks post Achilles tendon rupture.
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Moulaei K, Malek M, Sheikhtaheri A. Monitoring of external predisposing factors for Diabetic Foot: A literature review and physicians' perspectives. Med J Islam Repub Iran 2019; 33:159. [PMID: 32280665 PMCID: PMC7137813 DOI: 10.34171/mjiri.33.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Indexed: 11/11/2022] Open
Abstract
Background: Diabetic foot is one of the most important complications of diabetes caused by the existence of some destructive factors in different anatomical locations of feet. Management and monitoring of these factors are very important to decrease or avoid ulcerating lesions of the foot. The purpose of this study is to identify and introduce the predisposing factors and anatomical locations associated with these destructive factors. Methods: First, we conducted a comprehensive review of different databases to identify the factors and associated anatomical locations from the previous studies. Then, we designed a questionnaire and invited physicians and specialists to express their perspectives on these factors and locations. The data were analyzed using SPSS version 23. Frequency, percentage, mean and standard deviation of these variables were calculated. Results: Based on the literature review, four factors, including pressure, moisture and sweat, temperature, and acceleration were identified as factors destructive to the tissues of the diabetic foot and worsen ulcers. The view of specialists approved the results of the literature review. Besides, there was an insignificant difference between the results of the literature review and the specialists' view in terms of anatomical locations that need to be continuously monitored. Conclusion: Monitoring the pressure in heel, first metatarsal, and first metatarsal head; moisture and sweat under the fingers, hallux and heels as well as the temperature at the first metatarsal, first metatarsal head, and the third metatarsal head are important in preventing ulceration, destructing the foot tissue, and accelerating the treatment process.
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Affiliation(s)
- Khadijeh Moulaei
- School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Malek
- Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology and Metabolism, Iran University of medical sciences, Tehran, Iran
| | - Abbas Sheikhtaheri
- Health Management and Economics Research Center, Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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Gianino E, Miller C, Gilmore J. Smart Wound Dressings for Diabetic Chronic Wounds. Bioengineering (Basel) 2018; 5:E51. [PMID: 29949930 PMCID: PMC6163915 DOI: 10.3390/bioengineering5030051] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 06/13/2018] [Accepted: 06/19/2018] [Indexed: 12/31/2022] Open
Abstract
Given their severity and non-healing nature, diabetic chronic wounds are a significant concern to the 30.3 million Americans diagnosed with diabetes mellitus (2015). Peripheral arterial diseases, neuropathy, and infection contribute to the development of these wounds, which lead to an increased incidence of lower extremity amputations. Early recognition, debridement, offloading, and controlling infection are imperative for timely treatment. However, wound characterization and treatment are highly subjective and based largely on the experience of the treating clinician. Many wound dressings have been designed to address particular clinical presentations, but a prescriptive method is lacking for identifying the particular state of chronic, non-healing wounds. The authors suggest that recent developments in wound dressings and biosensing may allow for the quantitative, real-time representation of the wound environment, including exudate levels, pathogen concentrations, and tissue regeneration. Development of such sensing capability could enable more strategic, personalized care at the onset of ulceration and limit the infection leading to amputation. This review presents an overview of the pathophysiology of diabetic chronic wounds, a brief summary of biomaterial wound dressing treatment options, and biosensor development for biomarker sensing in the wound environment.
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Affiliation(s)
- Elizabeth Gianino
- Bioengineering Department, Clemson University, Clemson, SC 29632, USA.
| | - Craig Miller
- Bioengineering Department, Clemson University, Clemson, SC 29632, USA.
| | - Jordon Gilmore
- Bioengineering Department, Clemson University, Clemson, SC 29632, USA.
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Hegde N, Bries M, Melanson E, Sazonov E. One size fits all electronics for insole-based activity monitoring. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2017:3564-3567. [PMID: 29060668 DOI: 10.1109/embc.2017.8037627] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Footwear based wearable sensors are becoming prominent in many areas of monitoring health and wellness, such as gait and activity monitoring. In our previous research we introduced an insole based wearable system SmartStep, which is completely integrated in a socially acceptable package. From a manufacturing perspective, SmartStep's electronics had to be custom made for each shoe size, greatly complicating the manufacturing process. In this work we explore the possibility of making a universal electronics platform for SmartStep - SmartStep 3.0, which can be used in the most common insole sizes without modifications. A pilot human subject experiments were run to compare the accuracy between the one-size fits all (SmartStep 3.0) and custom size SmartStep 2.0. A total of ~10 hours of data was collected in the pilot study involving three participants performing different activities of daily living while wearing SmartStep 2.0 and SmartStep 3.0. Leave one out cross validation resulted in a 98.5% average accuracy from SmartStep 2.0, while SmartStep 3.0 resulted in 98.3% accuracy, suggesting that the SmartStep 3.0 can be as accurate as SmartStep 2.0, while fitting most common shoe sizes.
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Katanuma A, Itoi T, Baron TH, Yasuda I, Kin T, Yane K, Maguchi H, Yamazaki H, Sano I, Minami R, Manabu SY, Ikarashi S, Osanai M, Takahashi K. Bench-top testing of suction forces generated through endoscopic ultrasound-guided aspiration needles. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2015; 22:379-85. [PMID: 25557010 DOI: 10.1002/jhbp.201] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Adequate needle size and tissue acquisition techniques for endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) need further elucidation. Moreover, the actual negative pressure and suction forces of FNA needles remain unknown. We evaluated the suction forces of 19-gauge, 22-gauge, and 25-gauge conventional FNA needles and side hole aspiration needles using conventional negative pressure and the slow pull technique. METHODS Using a manometer, we determined the mean (SD) negative pressure and suction force for needle gauge, aspiration volume, and aspiration technique. We also evaluated the time to reach the maximum negative pressure. RESULTS Suction force was comparatively higher in the 19-gauge needle when 50 ml of negative pressure was applied. Suction force using the slow pull method was very weak at 5% of pressure found with conventional methods. With the use of a 20-ml syringe, the time to reach the maximum negative pressure was 4 s in the 19-gauge needle, 11 s in the 22-gauge needle, and 80 s in the 25-gauge needle. CONCLUSIONS Bench-top testing showed that suction force increases with a larger gauge needle and larger aspiration volume. The slow pull method produces a very weak suction force. The time to reach the maximum negative pressure was longest in the 25-gauge needle.
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Affiliation(s)
- Akio Katanuma
- Center for Gastroenterology, Teine-Keijinkai Hospital, 1-40-1-12 Maeda, Teine-ku, Sapporo, 006-8555, Japan.
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Tan AM, Fuss FK, Weizman Y, Troynikov O. Development of a Smart Insole for Medical and Sports Purposes. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.proeng.2015.07.191] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Miller J, Armstrong DG. Offloading the diabetic and ischemic foot: solutions for the vascular specialist. Semin Vasc Surg 2014; 27:68-74. [PMID: 25812760 DOI: 10.1053/j.semvascsurg.2014.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
For generations, the use of techniques to defer skin pressure and protect the lower-extremity wound has been a cardinal goal to achieve therapeutic success and healing. Choosing the appropriate postoperative offloading device or shoe is often difficult, as it is challenging to merge optimal mechanical protection with clinical realities and patient needs. The gold standard for offloading remains the total contact cast, yet it receives minimal utilization in the clinical setting. Other devices have shown benefit, including the removable cast walker, instant total contact cast, and depth inlay shoes, for preventative measures. Ultimately, any plantar, lower-extremity wound must receive some form of external pressure reduction to reach acceptable rates of healing. Future technologies will aid these measures by providing body-worn constant monitoring systems and more effective offloading via patient-specific exoskeletons. This review is a supplemental update on the available wound offloading modalities based on logic-driven research regarding pressure relief across the diabetic neuropathic or impaired perfusion foot.
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Affiliation(s)
- John Miller
- Southern Arizona Limb Salvage Alliance (SALSA), Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - David G Armstrong
- Southern Arizona Limb Salvage Alliance (SALSA), Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona, USA.
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Miller JD, Salloum M, Button A, Giovinco NA, Armstrong DG. How Can I Maintain My Patient With Diabetes and History of Foot Ulcer in Remission? INT J LOW EXTR WOUND 2014; 13:371-7. [DOI: 10.1177/1534734614545874] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Patients with diabetes and previous history of ulceration occupy the highest category of risk for reulceration and amputation. Annual recurrence rates of diabetic ulcerations have been reported as high as 34%, 61%, and 70% at 1, 3, and 5 years, respectively, with studies reporting 20% to 58% recurrence rate within 1 year. As the ever growing epidemic of diabetes expands globally, this sequelae of diabetic complication will continue to require increasing resources from the healthcare community to effectively manage. Recent data suggest that removal of preventative podiatric care from statewide reimbursement systems lead to significant and sustained increases in hospital admission (37%), charges (38%), length of stay (23%), and severe aggregate outcomes including amputation, sepsis and death (49%). The addition of comorbidities such as peripheral artery disease, poor nutrition, and non-adherence to preventive therapies not only increase a patient’s likelihood for ulcer recurrence, but also cost of care and certainty of hospital admission. Currently, numerous efforts, guidelines, and industry generated products exist to prolong remission from ulceration; however, the clinical science for treating this patient population calls for much more effort. Despite this, data continue to suggest to demonstrate that appropriate follow-up care, shoe and insole modification, and patient education play a central role in reducing reulceration and amputation. Novel modalities for offloading and wearable sensor technologies offer the advantage of round-the-clock, patient specific and active response healthcare. These have the potential to detect, or even prevent, many wounds before they begin.
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Affiliation(s)
- John D. Miller
- Des Moines University College of Podiatric Medicine, Des Moines, IA, USA
| | | | - Alex Button
- Midwestern College of Podiatric Medicine, Glendale, AZ, USA
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Abstract
An article by Ferber and coauthors in Journal of Diabetes Science and Technology reported on the ability of a novel in-shoe plantar sensory replacement unit (PSRU) to provide alert-based feedback derived from analyzing plantar pressure (PP) threshold measurements in real time. The study aimed at comparing the PSRU device to a gold standard pressure-sensing device (GS-PSD) to determine the correlation between concurrent measures of PP during walking. Data were collected simultaneously from 10 participants who walked overground with both devices. The variable of interest was the number of recorded data points greater than 32 mmHg for each of the PSRU sensors and corresponding average recordings from the GS-PSD. Authors concluded that the PSRU provides analogous data to the GS-PSD. However, several aspects of the study should be considered when interpreting their clinical relevance.
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Affiliation(s)
- Zimi Sawacha
- Department of Information Engineering, University of Padova, Via Gradenigo 6b I, 35131 Padova, Italy.
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