What Has Finite Element Analysis Taught Us about Diabetic Foot Disease and Its Management? A Systematic Review

Abstract

BackgroundOver the past two decades finite element (FE) analysis has become a popular tool for researchers seeking to simulate the biomechanics of the healthy and diabetic foot. The primary aims of these simulations have been to improve our understanding of the foot’s complicated mechanical loading in health and disease and to inform interventions designed to prevent plantar ulceration, a major complication of diabetes. This article provides a systematic review and summary of the findings from FE analysis-based computational simulations of the diabetic foot.MethodsA systematic literature search was carried out and 31 relevant articles were identified covering three primary themes: methodological aspects relevant to modelling the diabetic foot; investigations of the pathomechanics of the diabetic foot; and simulation-based design of interventions to reduce ulceration risk.ResultsMethodological studies illustrated appropriate use of FE analysis for simulation of foot mechanics, incorporating nonlinear tissue mechanics, contact and rigid body movements. FE studies of pathomechanics have provided estimates of internal soft tissue stresses, and suggest that such stresses may often be considerably larger than those measured at the plantar surface and are proportionally greater in the diabetic foot compared to controls. FE analysis allowed evaluation of insole performance and development of new insole designs, footwear and corrective surgery to effectively provide intervention strategies. The technique also presents the opportunity to simulate the effect of changes associated with the diabetic foot on non-mechanical factors such as blood supply to local tissues.DiscussionWhile significant advancement in diabetic foot research has been made possible by the use of FE analysis, translational utility of this powerful tool for routine clinical care at the patient level requires adoption of cost-effective (both in terms of labour and computation) and reliable approaches with clear clinical validity for decision making.

Viscoelasticity in Foot-Ground Interaction

“…Even though FE analyses have shed new light on plantar soft tissue biomechanics [35,45,79,[93][94][95][96][97], their actual contribution for the improvement of the diagnosis and treatment of the diabetic foot or other foot-related pathologies is limited [98]. This is mainly attributed to the difficulty of using FE analysis outside the research domain and particularly within the context of clinical practice [98].…”

“…This is mainly attributed to the difficulty of using FE analysis outside the research domain and particularly within the context of clinical practice [98]. Developing reliable subject-specific FE modelling techniques that are easy to use and not computationally demanding remains the key barrier for clinically applicable FE modelling.…”

Virtually optimized insoles for offloading the diabetic foot: A randomized crossover study

“…Advanced computational simulation methods such as finite element (FE) analysis have provided a number of insights into the biomechanical effects of diabetic foot disease (Telfer et al, 2014a).…”

Biomechanical Modeling of the Foot

“…Several reviews have already summarized a list of foot models over the past few years. Among them, that recently published by (Telfer et al, 2014) provides a comprehensive review on diabetic foot modelling and investigates several aspects such as the bone geometry, the internal constraints, the soft tissue material properties, the skin surface pressures and their spreading, and the interactions between the foot and the device around the foot. Another review, from (Wang et al, 2016), focuses on the shoe and the insole and aims at designing the most adapted device for a given foot.…”