Roser Mark C, Canavan Paul K, Najafi Bijan, Cooper Watchman Marcy, Vaishnav Kairavi, Armstrong David G
1 Results Group, LLC, Tolland, CT, USA.
2 University of Massachusetts Memorial Medical Center, Department of Rehabilitation, Worcester, MA, USA.
J Diabetes Sci Technol. 2017 Sep;11(5):874-882. doi: 10.1177/1932296817726349.
Infected diabetic foot ulcers are the leading cause of lower limb amputation. This study evaluated the ability of in-shoe exoskeletons to redirect forces outside of body and through an exoskeleton as an effective means of offloading plantar pressure, the major contributing factor of ulceration.
We compared pressure in the forefoot and hind-foot of participants (n = 5) shod with novel exoskeleton footwear. Plantar pressure readings were taken during a 6-m walk at participant's self-selected speed, and five strides were averaged. Results were taken with Achilles exotendon springs disengaged as a baseline, followed by measurements taken with the springs engaged.
When springs were engaged, all participants demonstrated a decrease in forefoot pressure, averaging a 22% reduction ( P < .050). Patient feedback was universally positive, preferring the exotendon springs to be engaged and active.
Offloading is standard of care for reducing harmful plantar pressure, which may lead to foot ulcers. However, current offloading modalities are limited and have issues. This proof-of-concept study proposed a novel offloading approach based on an exoskeleton solution. Results suggest that when the novel exoskeletons were deployed in footwear and exotendon springs engaged, force was successfully transferred from the lower leg through the exoskeleton-enabled shoe to ground, reducing load on the forefoot. The results need to be confirmed in a larger sample. Another study is warranted to examine the effectiveness of this offloading to prevent diabetic foot ulcer, while minimizing gait alteration in daily physical activities.
感染性糖尿病足溃疡是下肢截肢的主要原因。本研究评估了鞋内式外骨骼将身体外部的力通过外骨骼重新导向的能力，以此作为减轻足底压力的有效手段，足底压力是溃疡形成的主要促成因素。
我们比较了穿着新型外骨骼鞋具的参与者（n = 5）前足和后足的压力。在参与者以自我选择的速度进行6米步行过程中获取足底压力读数，并对五步的读数进行平均。以跟腱外肌腱弹簧 disengaged 作为基线获取结果，随后在弹簧 engaged 时进行测量。
当弹簧 engaged 时，所有参与者的前足压力均有所降低，平均降低22%（P <.050）。患者反馈普遍积极，更喜欢外肌腱弹簧处于 engaged 且起作用的状态。
减轻压力是减少有害足底压力（可能导致足部溃疡）的标准治疗方法。然而，目前的减压方式有限且存在问题。这项概念验证研究提出了一种基于外骨骼解决方案的新型减压方法。结果表明，当新型外骨骼应用于鞋具且外肌腱弹簧 engaged 时，力成功地从小腿通过外骨骼鞋传递到地面，减轻了前足的负荷。结果需要在更大样本中得到证实。有必要进行另一项研究来检验这种减压方法预防糖尿病足溃疡的有效性，同时在日常身体活动中尽量减少步态改变。
