Plantar pressures in diabetic patients with foot ulcers which have remained healed

Owings, Tammy M.; Apelqvist, Jan; Stenström, Anders; Becker, Mary B.; Bus, Sicco A.; Kalpen, Axel; Ulbrecht, Jan S.; Cavanagh, Peter R.

doi:10.1111/j.1464-5491.2009.02835.x

Cited by 134 publications

(148 citation statements)

References 27 publications

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“…The repeatability across the whole insole (ICC) is consistent with those previously reported for Tekscan within-day (0.94) [12] and between-day for force magnitude using Pedar (0.84) and Tekscan (0.76) [1]. Tekscan displayed lower repeatability for peak pressure values across the whole insole (PP), suggesting caution when the efficacy of treatments is being evaluated.…”

Section: Regional Protocolsupporting

confidence: 84%

“…However, the corresponding values for the resistive systems exhibited high errors (mean error in peak pressure from 200-600 kPa Medilogic = 40.0±21.8% and Tekscan≈143.3±133.5%), which reduces their validity for peak pressure calculations compared to Pedar. A mean peak pressure of 207 kPa has been proposed as a potential threshold to reduce risk in the previously ulcerated foot affected by diabetes [12]. The mean pressure error was within the ranges previously reported of 1.9-12.1% for the Pedar system and 1.3-33.9% for Tekscan when applying pressures of 30-500 kPa over two seconds [5].…”

Section: Regional Protocolsupporting

confidence: 73%

“…The CA error ranged from a 92% underestimation to a 249% overestimation of area of the regional loading device (Figure 2 McPoil at the same pressure (16%) [1] and below pressure ranges that may be required for clinical screening [12]. However, the corresponding values for the resistive systems exhibited high errors (mean error in peak pressure from 200-600 kPa Medilogic = 40.0±21.8% and Tekscan≈143.3±133.5%), which reduces their validity for peak pressure calculations compared to Pedar.…”

Section: Regional Protocolmentioning

confidence: 99%

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Validity and repeatability of three in-shoe pressure measurement systems

2016

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In-shoe pressure measurement devices are used in research and clinic to quantify plantar foot pressures. Various devices are available, differing in size, sensor number and type; therefore accuracy and repeatability. Three devices (Medilogic, Tekscan and Pedar) were examined in a 2 day x 3 trial design, quantifying insole response to regional and whole insole loading. The whole insole protocol applied an even pressure (50-600 kPa) to the insole surface for 0-30 seconds in the Novel TruBlue TM device. The regional protocol utilised cylinders with contact surfaces of 3.14 and 15.9cm 2 to apply pressures of 50 and 200 kPa. The validity (% difference and Root Mean Square Error: RMSE) and repeatability (Intra-Class Correlation Coefficient: ICC) of the applied pressures (whole insole) and contact area (regional) were outcome variables. Validity of the Pedar system was highest (RMSE 2.6 kPa; difference 3.9%), with the Medilogic (RMSE 27.0 kPa; difference 13.4%) and Tekscan (RMSE 27.0 kPa; difference 5.9%) systems displaying reduced validity. The average and peak pressures demonstrated high between-day repeatability for all three systems and each insole size (ICC≥0.859). The regional protocol contact area % difference ranged from -97 to +249%, but the ICC demonstrated medium to high between-day repeatability (ICC≥0.797). Due to the varying responses of the systems, the choice of an appropriate pressure measurement device must be based on the loading characteristics and the outcome variables sought. Medilogic and Tekscan were most effective between 200-300 kPa; Pedar performed well across all pressures. Contact area was less precise, but relatively repeatable for all systems.3

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Section: Regional Protocolsupporting

confidence: 84%

Section: Regional Protocolsupporting

confidence: 73%

Section: Regional Protocolmentioning

confidence: 99%

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Validity and repeatability of three in-shoe pressure measurement systems

2016

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“…This is probably because patients do not only walk barefoot in daily life but also wear shoes, in which the biomechanical conditions are different. Peak plantar pressures while walking barefoot are generally much higher than while wearing protective footwear that patients often get prescribed after healing of a plantar foot ulcer (15). Therefore, adherence to wearing such footwear influences the cumulative amount of mechanical load on the foot and may be an important mediator in risk for ulcer recurrence.…”

mentioning

confidence: 99%

Risk Factors for Plantar Foot Ulcer Recurrence in Neuropathic Diabetic Patients

et al. 2014

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OBJECTIVERecurrence of plantar foot ulcers is a common and major problem in diabetes but not well understood. Foot biomechanics and patient behavior may be important. The aim was to identify risk factors for ulcer recurrence and to establish targets for ulcer prevention. RESEARCH DESIGN AND METHODSAs part of a footwear trial, 171 neuropathic diabetic patients with a recently healed plantar foot ulcer and custom-made footwear were followed for 18 months or until ulceration. Demographic data, disease-related parameters, presence of minor lesions, barefoot and in-shoe plantar peak pressures, footwear adherence, and daily stride count were entered in a multivariate multilevel logistic regression model of plantar foot ulcer recurrence. RESULTSA total of 71 patients had a recurrent ulcer. Significant independent predictors were presence of minor lesions (odds ratio 9.06 [95% CI 2.98-27.57]), day-to-day variation in stride count (0.93 [0.89-0.99 CONCLUSIONSThe presence of a minor lesion was clearly the strongest predictor, while recommended use of adequately offloading footwear was a strong protector against ulcer recurrence from unrecognized repetitive trauma. These outcomes define clear targets for diabetic foot screening and ulcer prevention.In patients with diabetes, foot ulcers are a serious risk for infection and amputation (1). The prevention of foot ulcers is important to avoid these devastating outcomes. Several studies have identified risk factors for diabetic foot ulceration, which include, among others, peripheral neuropathy, peripheral arterial disease, and foot deformity (2-7). The strongest predictors of ulceration are presence of peripheral neuropathy and a history of ulceration, which shows that ulcers often recurdup to 40% annually (8). Ulcer recurrence significantly increases long-term costs for diabetic foot care (9) and further increases risk for amputation and deterioration of

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“…Accurate prediction of stresses under the foot in barefoot and shod conditions provides insight into the biomechanics of normal and pathological feet and is especially useful in people with diabetes and peripheral neuropathy (Erdemir et al, 2005;Morag et al, 1997;Shaw et al, 1997;Cavanagh et al, 2000;Bus et al, 2008;Owings et al, 2009). Various experimental and computational methods have been previously developed to measure or estimate the contact pressure and shear stress patterns in the foot during gait Sacco et al, 2009;Rao et al, 2010;Maluf and Mueller, 2003;Yavuz et al, 2007;Yavuz et al, 2009).…”

Section: Introductionmentioning

confidence: 98%

Comparison of hexahedral and tetrahedral elements in finite element analysis of the foot and footwear

Tadepalli¹,

Erdemir

Cavanagh³

2011

Journal of Biomechanics

142

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Finite element analysis has been widely used in the field of foot and footwear biomechanics to determine plantar pressures as well as stresses and strains within soft tissue and footwear materials. When dealing with anatomical structures such as the foot, hexahedral mesh generation accounts for most of the model development time due to geometric complexities imposed by branching and embedded structures. Tetrahedral meshing, which can be more easily automated, has been the approach of choice to date in foot and footwear biomechanics. Here we use the nonlinear finite element program Abaqus (Simulia, Providence, RI) to examine the advantages and disadvantages of tetrahedral and hexahedral elements under compression and shear loading, material incompressibility, and frictional contact conditions, which are commonly seen in foot and footwear biomechanics. This study demonstrated that for a range of simulation conditions, hybrid hexahedral elements (Abaqus C3D8H) consistently performed well while hybrid linear tetrahedral elements (Abaqus C3D4H) performed poorly. On the other hand, enhanced quadratic tetrahedral elements with improved stress visualization (Abaqus C3D10I) performed as well as the hybrid hexahedral elements in terms of contact pressure and contact shear stress predictions. Although the enhanced quadratic tetrahedral element simulations were computationally expensive compared to hexahedral element simulations in both barefoot and footwear conditions, the enhanced quadratic tetrahedral element formulation seems to be very promising for foot and footwear applications as a result of decreased labor and expedited model development, all related to facilitated mesh generation.

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Plantar pressures in diabetic patients with foot ulcers which have remained healed

Cited by 134 publications

References 27 publications

Validity and repeatability of three in-shoe pressure measurement systems

Validity and repeatability of three in-shoe pressure measurement systems

Risk Factors for Plantar Foot Ulcer Recurrence in Neuropathic Diabetic Patients

Comparison of hexahedral and tetrahedral elements in finite element analysis of the foot and footwear

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