Effective and clinically relevant optimisation of cushioning stiffness to maximise the offloading capacity of diabetic footwear

Chatzistergos, Panagiotis E.; Gatt, Alfred; Formosa, Cynthia; Sinclair, Jonathan K.; Chockalingam, Nachiappan

doi:10.1016/j.diabres.2023.110914

Cited by 8 publications

(4 citation statements)

References 40 publications

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“…The first-ever DFU incidence is also associated with a 250% increase in the 5-year risk of death [21,22]. Integrated care that combines frequent specialist screening with education and offloading interventions (eg, the use of therapeutic footwear or orthoses) is currently used to prevent recurrent DFU [11,23,24] and is likely to be effective also for the prevention of first-ever ulcers. However, their blanket use across all people with diabetes is practically impossible due to the sheer number of people at risk of their first-ever DFU [18,20,25].…”

Section: Introductionmentioning

confidence: 99%

Exploring the Pathways of Diabetes Foot Complications Treatment and Investigating Experiences From Frontline Health Care Professionals: Protocol for a Mixed Methods Study

Andrikopoulou,

Chatzistergos,

Chockalingam

2024

JMIR Res Protoc

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Background Diabetes affects more than 4.3 million individuals in the United Kingdom, with 19% to 34% developing diabetes-related foot ulceration (DFU) during their lifespan, which can lead to an amputation. In the United Kingdom, every week, approximately 169 people have an amputation due to diabetes. Preventing first-ever ulcers is the most effective strategy to reduce the occurrence of diabetes-related amputations, but research in this space is lacking. Objective This protocol seeks to document the experiences and perspectives of frontline health care professionals who work with people who have diabetes and diabetes-related foot problems. Special attention is given to their perceptions of barriers to effective care, their views about barriers to effective and inclusive engagement with people with diabetes, and their experience with the first-ever DFU. Another aspect of the study is the focus on whether clinical management is affected by data sharing, data availability, and interoperability issues. Methods This is a mixed methods explanatory protocol, which is sequential, and its purpose is to use the qualitative data to explain the initial quantitative data collected through a survey of frontline health care professionals. Data analysis of quantitative data will be completed first and then synthesized with the qualitative data analysis. Qualitative data will be analyzed using the framework method. This study will use joint displays to integrate the data. Ethical approval has been granted by the ethics committee of Staffordshire University. Results The quantitative data collection started in March 2023 and will close in May 2024. The qualitative interviews commenced in November 2023 with volunteer participants who initially completed the survey. Conclusions This study’s survey focuses on data interoperability and the interviews focus more on the perspectives and experiences of clinicians and their perceived barriers for the effective management of diabetes foot ulcers. Including a geographically relevant and diverse cohort of health care professionals that spans a wide range of roles and care settings involved in diabetes-related foot care is very important for the successful application of this protocol. Special care is given to advertise and promote participation as widely as possible. The qualitative part of this protocol is also limited to 30-40 interview participants, as it is not realistic to interview higher numbers, due to time and resource constraints. International Registered Report Identifier (IRRID) DERR1-10.2196/54852

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Section: Introductionmentioning

confidence: 99%

Exploring the Pathways of Diabetes Foot Complications Treatment and Investigating Experiences From Frontline Health Care Professionals: Protocol for a Mixed Methods Study

Andrikopoulou,

Chatzistergos,

Chockalingam

2024

JMIR Res Protoc

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“…To help prevent plantar foot ulcer recurrence, custom-made footwear is commonly prescribed to high-risk people with diabetes; this footwear mainly aims to reduce plantar peak pressure inside the shoe [ 8 ]. This can be achieved by specific design features of the shoe, including a rocker outsole, outsole stiffness, custom-made insole, and different insole elements, such as a metatarsal pad or bar and top cover [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ]. In-shoe plantar pressure measurement is a tool with which the pressure-relieving capacity of such custom-made footwear and design elements can be evaluated and is widely used in scientific research [ 5 , 20 , 21 , 22 , 23 ].…”

Section: Introductionmentioning

confidence: 99%

In-Shoe Pressure Measurements in Diabetic Footwear Practice: Success Rate and Facilitators of and Barriers to Implementation

Zwaferink,

Nollet,

Bus

2024

Sensors

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We aimed to assess the success rate and facilitators of and the barriers to the implementation of in-shoe plantar pressure measurements in footwear practice for people with diabetes at high risk of foot ulceration. Eleven Dutch footwear practices were partly supported in purchasing a pressure measurement system. Over a 2.5-year period, trained shoe technicians evaluated 1030 people with diabetes (range: 13 to 156 across practices). The implementation success and associated facilitators and barriers were evaluated quantitatively using completed measurement forms and pressure measurement data obtained during four monitoring sessions and qualitatively through semi-structured interviews with technicians. Across the 11 practices, the primary target group (people with diabetes and a healed plantar foot ulcer) represented 25–90% of all the patients measured. The results showed that three practices were successful, five moderately successful, and three not successful. The facilitators included support by the company management board, collaboration with a prescribing physician, measurement sessions separate from the outpatient clinic, and a (dedicated) shoe technician experiencing a learning effect. The barriers included investment costs, usability aspects, and limited awareness among shoe technicians. In-shoe plantar pressure measurements can be implemented to a moderate to large degree in diabetic footwear practice. The barriers to and facilitators of implementation are organizational, logistical, financial, or technical, and the barriers are modifiable, supporting future implementation.

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“…Chatzistergos et al (2020) explored this concept in the context of diabetic footwear to reduce plantar pressure during normal gait. In such applications, it is important to have the correct stiffness of cushioning material for any therapeutic effects (Chatzistergos et al, 2023). The work by Chatzistergos et al (2023) shows considerable potential of elastomeric materials fabricated with customised designed porosity for meeting clinical needs; however, there still remains an opportunity to better explore TPMS structures through FFF for cushioning applications.…”

Section: Introductionmentioning

confidence: 99%

“…(2020) explored this concept in the context of diabetic footwear to reduce plantar pressure during normal gait. In such applications, it is important to have the correct stiffness of cushioning material for any therapeutic effects (Chatzistergos et al. , 2023).…”

Section: Introductionmentioning

confidence: 99%

Mechanical evaluation of elastomeric thermoplastic polyurethane additively manufactured triply periodic minimal surface area lattice structures for adjustable cushioning properties

Claybrook,

Southee,

Mohammed

2024

RPJ

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Purpose Cushioning is a useful material property applicable for a range of applications from medical devices to personal protective equipment. The current ability to apply cushioning in a product context is limited by the appropriateness of available materials, with polyurethane foams being the current gold standard material. The purpose of this study is to investigate additively manufactured flexible printing of scaffold structures as an alternative. Design/methodology/approach In this study, this study investigates triply periodic minimal surface (TPMS) structures, including Gyroid, Diamond and Schwarz P formed in thermoplastic polyurethane (TPU), as a possible alternative. Each TPMS structure was fabricated using material extrusion additive manufacturing and evaluated to ASTM mechanical testing standard for polymers. This study focuses attention to TPMS structures fabricated for a fixed unit cell size of 10 mm and examine the compressive properties for changes in the scaffold porosity for samples fabricated in TPU with a shore hardness of 63A and 90A. Findings It was discovered that for increased porosity there was a measured reduction in the load required to deform the scaffold. Additionally, a complex relationship between the shore hardness and the stiffness of a structure. It was highlighted that through the adjustment of porosity, the compressive strength required to deform the scaffolds to a point of densification could be controlled and predicted with high repeatability. Originality/value The results indicate the ability to tailor the scaffold design parameters using both 63A and 90A TPU material, to mimic the loading properties of common polyurethane foams. The use of these structures indicates a next generation of tailored cushioning using additive manufacturing techniques by tailoring both geometry and porosity to loading and compressive strengths.

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Effective and clinically relevant optimisation of cushioning stiffness to maximise the offloading capacity of diabetic footwear

Cited by 8 publications

References 40 publications

Exploring the Pathways of Diabetes Foot Complications Treatment and Investigating Experiences From Frontline Health Care Professionals: Protocol for a Mixed Methods Study

Exploring the Pathways of Diabetes Foot Complications Treatment and Investigating Experiences From Frontline Health Care Professionals: Protocol for a Mixed Methods Study

In-Shoe Pressure Measurements in Diabetic Footwear Practice: Success Rate and Facilitators of and Barriers to Implementation

Mechanical evaluation of elastomeric thermoplastic polyurethane additively manufactured triply periodic minimal surface area lattice structures for adjustable cushioning properties

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