Biomechanics of the heel pad for type 2 diabetic patients

Hsu, Ta-Cheng; Lee, Ying-Shiung; Shau, Yio-Wha

doi:10.1016/s0268-0033(02)00018-9

Cited by 51 publications

(64 citation statements)

References 19 publications

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“…In the case of the present study the use of a metronome enabled 253 the realization of load/unload cycles with a variability of 14% in terms of deformation rate. The correlation between FBS and the heel-pad stiffness found in this study can be attributed to the 270 effect of hyperglycaemia and the role of glycation on the collagen fibrils within the septal wall of the 271 plantar soft tissue (Hsu et al, 2002). Through microscopic studies of the heel-pad fragmented and 272 distorted collagen fibrils were found in the heel-pad structure of people with diabetes as compared to 273 a parallel structure of collagen fibrils in the heel-pad of non-diabetic adults (Hsu et al, 2002).…”

Section: Discussion 223mentioning

confidence: 68%

“…(Piaggesi et al, 1999) and shows 78 higher energy dissipation ratios (i.e. the ratio of the energy-input over the energy-return after the end 79 of a load/unload cycle) (Hsu et al, 2007(Hsu et al, , 2002(Hsu et al, , 2000. On the other hand Erdemir et al (Erdemir et 80 al., 2006) studied the mechanical behaviour of heel-pad using a novel methodology which combined 81 in-vivo testing and finite element modelling to inverse engineer the tissue's material coefficients.…”

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confidence: 99%

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The relationship between the mechanical properties of heel-pad and common clinical measures associated with foot ulcers in patients with diabetes

Chatzistergos¹,

Naemi²,

Sundar³

et al. 2014

Journal of Diabetes and its Complications

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Section: Discussion 223mentioning

confidence: 68%

mentioning

confidence: 99%

The relationship between the mechanical properties of heel-pad and common clinical measures associated with foot ulcers in patients with diabetes

Chatzistergos¹,

Naemi²,

Sundar³

et al. 2014

Journal of Diabetes and its Complications

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“…We determined the force-deformation (F-D) characteristics at two locations (Figure 2), heel pad under calcaneus [32] and plantar foot center-defined as the intersection point between the line through the first metatarsal head point (P1) and lateral plantar arch point (P4) and the line through the fifth metatarsal head point (P2) and medial plantar arch point (P3) [21,29], respectively. We chose these two locations to represent a bony region that bears high load and a soft tissue region, which generally has low load; the extremes of tissue type and loading are captured by testing these two locations.…”

Section: Test On Footmentioning

confidence: 99%

“…The tests were performed on nondisabled subjects and more characterizations are necessary to generate data for the nondisabled and pathological populations [32]. A more serious issue exists with patients who are insensate, because the apparatus can increase risk of ulceration because they may not be able to sense and deactivate the probe like a healthy subject would.…”

Section: Limitations and Future Workmentioning

confidence: 99%

An indentation apparatus for evaluating discomfort and pain thresholds in conjunction with mechanical properties of foot tissue in vivo

Xiong

Goonetilleke²,

Witana³

et al. 2010

JRRD

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Abstract-The mechanical properties of human foot tissue in vivo as well as discomfort and pain thresholds are important for various applications. In this study, an apparatus for measuring the discomfort and pain thresholds and the mechanical properties of human tissues is presented. The apparatus employs a stepper motor that controls the indentation speed, as well as a load cell and potentiometer that determine the corresponding reaction force and tissue deformation (displacement), respectively. A LabVIEW program (LabVIEW 8, National Instruments Corporation; Austin, Texas) was developed to control the indentation via a data acquisition card. The apparatus can accommodate indentor displacements up to 35 mm and can impart forces up to 150 N at a controlled indentation speed in the range of 0 to 10 mm/s. Tests showed that the displacement measurement error is 0.17 mm in the nominal range (0.5% in the full scale) and the measurement error of force is 1.6 N in the nominal range (1.1% in the full scale). Experimental results indicate that the apparatus is reliable and flexible for measuring the mechanical properties of foot tissue in vivo in conjunction with pain and discomfort thresholds.

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“…There is an increasing awareness that pathological conditions such as plantar heel pain or diabetic foot are associated with changes in the mechanical behaviour of plantar soft tissue (Hsu et al, 2007(Hsu et al, , 2000(Hsu et al, , 2002Klaesner et al, 2002;Spears and Miller-Young, 2006;Zheng YP, Choi YK et al, 2000). Therefore, quantifying the mechanical properties of plantar soft tissue has been an exciting and evolving topic for the past few years.…”

Section: Introductionmentioning

confidence: 99%

A clinically applicable non-invasive method to quantitatively assess the visco-hyperelastic properties of human heel pad, implications for assessing the risk of mechanical trauma

Behforootan

Chatzistergos

Chockalingam

et al. 2017

Journal of the Mechanical Behavior of Biomedical Materials

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Cite this article as: Sara Behforootan, Panagiotis E. Chatzistergos, Nachiappan Chockalingam and Roozbeh Naemi, A clinically applicable non-invasive method to quantitatively assess the visco-hyperelastic properties of human heel pad with implications for assessing the risk of mechanical trauma, Journal of the Mechanical Behavior of Biomedical Materials, http://dx.doi.org/10.1016Materials, http://dx.doi.org/10. /j.jmbbm.2017 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Purpose: To develop a clinically viable non-invasive method of assessing the mechanical properties of the heel pad. Furthermore the effect of non-linear mechanical behaviour of the heel pad on its ability to uniformly distribute foot-ground contact loads in light of the effect of overloading is also investigated. Methods:An automated custom device for ultrasound indentation was developed along with custom algorithms for the automated subject specific modeling of heel pad. Non-time-dependent and time-dependent material properties were inverse engineered from results from quasistatic indentation and stress relaxation test respectively. The validity of the calculated coefficients was assessed for five healthy participants. The implications of altered mechanical properties on the heel pad's ability to uniformly distribute plantar loading were also investigated in a parametric analysis. Results:The subject specific heel pad models with coefficients calculated based on quasi-static indentation and stress relaxation were able to accurately simulate dynamic indentation.Average error in the predicted forces for maximum deformation was only 6.6 ± 4.0%. When the inverse engineered coefficients were used to simulate the first instance of heel strike the error in terms of peak plantar pressure was 27%. The parametric analysis indicated that the heel pad's ability to uniformly distribute plantar loads is influenced both by its overall deformability and by its stress/ strain behaviour. When overall deformability stays constant, changes in stress/strain behaviour leading to a more "linear" mechanical behaviour appear to improve the heel pad's ability to uniformly distribute plantar loading. Conclusions:The developed technique can accurately assess the visco-hyperelastic behaviour of heel pad. It was observed that specific change in stress-strain behaviour can enhance/weaken the heel pad's ability to uniformly distribute plantar loading that will increase/decrease the risk for overloading and trauma.

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Biomechanics of the heel pad for type 2 diabetic patients

Cited by 51 publications

References 19 publications

The relationship between the mechanical properties of heel-pad and common clinical measures associated with foot ulcers in patients with diabetes

The relationship between the mechanical properties of heel-pad and common clinical measures associated with foot ulcers in patients with diabetes

An indentation apparatus for evaluating discomfort and pain thresholds in conjunction with mechanical properties of foot tissue in vivo

A clinically applicable non-invasive method to quantitatively assess the visco-hyperelastic properties of human heel pad, implications for assessing the risk of mechanical trauma

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