A study of in-shoe plantar shear in patients with diabetic neuropathy

Lord, M.; Hosein, Riad B.M.

doi:10.1016/s0268-0033(99)00076-5

Cited by 74 publications

(72 citation statements)

References 16 publications

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“…Beside pressure, shear stresses acting on the plantar foot surface were also measured using biaxial or triaxial transducers discretely embedded in the insole (66)(67)(68). This allows monitoring of the shear stresses in two orthogonal directions dynamically.…”

Section: Stresses At the Plantar Foot / Insole Interfacementioning

confidence: 99%

Biomechanics of Pressure Ulcer in Body Tissues Interacting with External Forces during Locomotion

Mak

Zhang²,

Tam

2010

Annu. Rev. Biomed. Eng.

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Forces acting on the body via various external surfaces during locomotion are needed to support the body under gravity, control posture, and overcome inertia. Examples include the forces acting on the body via the seating surfaces during wheelchair propulsion, the forces acting on the plantar foot tissues via the insole during gait, and the forces acting on the residual limb tissues via the prosthetic socket during various movement activities.Excessive exposure to unwarranted stresses at the body support interfaces could lead to tissue breakdowns commonly known as pressure ulcers, presented often as deep tissue injuries around bony prominences and/or surface damages on the skin. In this paper, we review the literatures on how the involved tissues respond to epidermal loadings, taking into account both experimental and computational findings from in-vivo and in-vitro studies. In particular, related literatures on internal tissue deformation and stresses, microcirculatory responses, as well as histological, cellular and molecular observations are discussed.

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Section: Stresses At the Plantar Foot / Insole Interfacementioning

confidence: 99%

Biomechanics of Pressure Ulcer in Body Tissues Interacting with External Forces during Locomotion

Mak

Zhang²,

Tam

2010

Annu. Rev. Biomed. Eng.

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“…Shear combined with pressure has also been associated with ulcer incidences (15)(16)(17)(18)(19)(20)(21). Among plantar shear studies, Pollard and Le Quesne's work (15) indicated overlapping locations for peak pressure and shear.…”

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confidence: 99%

Peak Plantar Pressure and Shear Locations

et al. 2007

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“…Unlike foot pressure where a variety of computerized systems are available, there are currently only a few experimental devices that can measure foot shear in vivo. Early published work reported a 15% reduction in shear beneath the first metatarsal head when thin nylon hosiery was compared with barefoot values (15). Recent laboratory tests of the PFC sock showed that the material had, on average, a 30% significantly lower coefficient of friction than other sock fabrics such as acrylic, polyester, and cotton, a value which was sustained over 1,400 repetitive cycles (35).…”

Section: Methodsmentioning

confidence: 99%

“…These steps occurred approximately halfway through each set of readings to avoid acceleration at the start of the recording and deceleration at the end (15,26). Two graphs, the first plotting total contact area versus time and the second total contact pressure versus time, were generated using the standard software package supplied with the F-scan.…”

Section: Research Design Andmentioning

confidence: 99%

“…Unlike friction which may be said to occur only on the external surface of the foot, the term shear is restricted to the static situation, and it can act on both the contact surface and deeper within the tissues (14). To illustrate, as the foot (usually the heel) makes initial contact with the ground, friction between the foot and the ground generates a horizontal force that acts backwards against the foot (shear) which, when repeated, may cause either direct damage to the skin and deeper tissues such as blistering or indirect damage due to callus formation and restriction of blood flow (15).…”

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confidence: 99%

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Efficacy of Multilayered Hosiery in Reducing In-Shoe Plantar Foot Pressure in High-Risk Patients With Diabetes

2005

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OBJECTIVE -High plantar pressure is an acknowledged risk factor in the development of plantar ulcers in the diabetic neuropathic foot. This study examines the ability of preventive foot care (PFC) socks to reduce plantar foot pressures in a sample of high-risk patients with diabetes.RESEARCH DESIGN AND METHODS -Nineteen patients with established peripheral neuropathy attending a complications clinic of the Manchester Diabetes Centre were recruited to the study. Fifteen (78%) of the patients were male, 40 -80 years of age, and ulcer-free at the time of recruitment. In-shoe plantar pressure measurements were recorded using the F-Scan and compared PFC socks with ordinary supermarket socks. The analysis measured differences in maximum foot contact area and plantar pressure for the whole foot, forefoot, and peak plantar pressure areas. RESULTS-The results showed a significant increase in maximum foot contact area of 11 cm 2 (95% CI 7-11) when subjects wore the PFC socks (P Ͻ 0.01). This was accompanied by 5.4 kPa (3.5-7.3) or 9% reduction in total foot pressure (P Ͻ 0.01). Similar results were observed at the forefoot, which showed a 14.2% increase in contact area and a 10.2% reduction in peak forefoot pressure.CONCLUSIONS -These results suggest that the wearing of PFC socks increases the underfoot contact area and hence decreases plantar foot pressures. Further studies are required to determine whether the pressure and friction reductions achieved by this simple intervention would be effective in reducing the incidence of foot ulcers in high-risk patients. Diabetes Care 28:2001-2006, 2005T he personal and health care costs associated with diabetic foot ulcers are well recognized. It has been estimated that ϳ2% of the diabetic population will have an active foot ulcer (1) and a similar proportion will develop a new lesion each year (1,2). Many factors are associated with the development of foot ulcers including neuropathy, deformity, and trauma (3,4). It is also recognized that although neuropathy is a major contributory factor in the development of ulcers, the ulcer is usually preceded by unrecognized minor tissue damage, commonly from footwear (5). It is not surprising, therefore, that footwear is considered to be an important and modifiable risk factor for foot ulceration.The main stresses that act upon the feet are step shock, pressure, friction, and shear. These stresses often occur together to damage insensitive and delicate foot structures.Step shock is the impact force generated by the body, particularly as the foot makes initial contact with the ground. This impact force is thought to be associated with a variety of bone and soft tissue disorders affecting the foot as well as other structures in the body (6). Not only have high plantar pressures been implicated in the development of foot ulcers (7,8) but also the offloading of diabetic foot ulcers is now also considered to be an essential component of foot wound management (9 -11). Friction is the static or active force that acts on the skin and resists slid...

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A study of in-shoe plantar shear in patients with diabetic neuropathy

Cited by 74 publications

References 16 publications

Biomechanics of Pressure Ulcer in Body Tissues Interacting with External Forces during Locomotion

Biomechanics of Pressure Ulcer in Body Tissues Interacting with External Forces during Locomotion

Peak Plantar Pressure and Shear Locations

Efficacy of Multilayered Hosiery in Reducing In-Shoe Plantar Foot Pressure in High-Risk Patients With Diabetes

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