Department of Prosthetics and Orthotics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
J Diabetes Sci Technol. 2023 Jan;17(1):99-106. doi: 10.1177/19322968221101632. Epub 2022 Jun 4.
Non-removable knee-high devices are the gold-standard offloading treatments to heal plantar diabetic foot ulcers (DFUs). These devices are underused in practice for a variety of reasons. Recommending these devices for all patients, regardless of their circumstances and preferences influencing their ability to tolerate the devices, does not seem a fruitful approach.
The aim of this article is to explore the potential implications of a more personalized approach to offloading DFUs and suggest avenues for future research and development.
Non-removable knee-high devices effectively heal plantar DFUs by reducing plantar pressure and shear at the DFU, reducing weight-bearing activity and enforcing high adherence. We propose that future offloading devices should be developed that aim to optimize these mechanisms according to each individual's needs. We suggest three different approaches may be developed to achieve such personalized offloading treatment. First, we suggest modular devices, where different mechanical features (rocker-bottom sole, knee-high cast walls/struts, etc.) can be added or removed from the device to accommodate different patients' needs and the evolving needs of the patient throughout the treatment period. Second, advanced manufacturing techniques and novel materials could be used to personalize the design of their devices, thereby improving common hindrances to their use, such as devices being heavy, bulky, and hot. Third, sensors could be used to provide real-time feedback to patients and clinicians on plantar pressures, shear, weight-bearing activity, and adherence.
By the use of these approaches, we could provide patients with personalized devices to optimize plantar tissue stress, thereby improving clinical outcomes.
不可移动的膝高装置是非糖尿病性足底溃疡（DFU）治疗的金标准减压治疗方法。由于各种原因，这些设备在实践中未得到充分利用。为所有患者推荐这些设备，而不考虑影响他们耐受设备能力的情况和偏好，似乎不是一个有效的方法。
本文旨在探讨更个性化的 DFU 减压方法的潜在影响，并为未来的研究和开发提出途径。
不可移动的膝高装置通过降低 DFU 处的足底压力和剪切力、减少负重活动和强制高贴合度，有效地治愈足底 DFU。我们建议未来的减压设备应根据每个人的需求来优化这些机制。我们提出了三种不同的方法来实现这种个性化的减压治疗。首先，我们建议使用模块化设备，其中可以添加或移除不同的机械特征（摇底鞋底、膝高铸壁/支柱等），以满足不同患者的需求和治疗期间患者需求的变化。其次，先进的制造技术和新型材料可以用于个性化设计他们的设备，从而改善其使用的常见障碍，例如设备重、体积大、热。第三，可以使用传感器为患者和临床医生提供有关足底压力、剪切力、负重活动和贴合度的实时反馈。
通过使用这些方法，我们可以为患者提供个性化的设备，以优化足底组织的压力，从而改善临床结果。
