Biorobotics and Biomechanics Lab (BRML), Faculty of Mechanical Engineering, Technion-Israel Institute of Technology, 32000 Haifa, Israel.
Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel.
Gait Posture. 2023 Mar;101:28-34. doi: 10.1016/j.gaitpost.2023.01.013. Epub 2023 Jan 24.
Diabetic heel ulceration is a common, detrimental, and costly complication of diabetes. This study investigates a novel "graded-stiffness" offloading method, which consists of a heel support with increasing levels of stiffness materials to better redistribute plantar pressure for heel ulcer prevention and treatment.
Is the novel "graded-stiffness" solution better able to redistribute heel pressure and reduce focal stress concentration areas of the heel?
Twenty healthy young men walked with four, 3D-printed, insole configurations. The configurations included the "graded-stiffness" insoles with and without an offloading hole under the heel tissue at risk for ulcerations and two conventional offloading supports of flat insoles with no offloading and simple holed offloading insoles. In-shoe plantar pressure was measured using the Pedar-X system. Peak pressure and pressure dose were measured at three heel regions: offloaded region, perimeter of offloaded region, and periphery region.
The simple offloading configuration reduced pressure at the offloaded region; however, pressure at the perimeter of the offloading region significantly increased. With respect to ANOVA, the "graded-stiffness" offloading configurations were more effective than existing tested solutions in reducing and redistributing heel peak pressure and pressure dose, considering all heel regions.
The "graded-stiffness" offloading solution demonstrated a novel flexible and customized solution that can be manufactured on-demand through a precise selection of the graded-stiffness offloading location and material properties to fit the shape and size of the ulcer. This study is a follow-up in-vivo pilot study, in a healthy population group, to our previous computation modeling work that reported the efficiency of the "graded-stiffness" configuration, and which emphasizes its potential for streamlining and optimizing the prevention and treatment of diabetic heel ulcers.
糖尿病性足跟溃疡是糖尿病常见的、有害的且昂贵的并发症。本研究调查了一种新型的“分级刚度”减压方法，该方法包括足跟支撑垫，其使用具有不同刚度的材料，以更好地重新分布足底压力，从而预防和治疗足跟溃疡。
新型“分级刚度”解决方案是否更能重新分配足跟压力并减少足跟的焦点应力集中区域？
二十名健康的年轻男性使用四种 3D 打印的鞋垫配置进行行走。这些配置包括具有和不具有足跟组织下减压孔的“分级刚度”鞋垫，以及两种传统的减压支撑，即无减压的平底鞋垫和简单减压孔的鞋垫。使用 Pedar-X 系统测量鞋内足底压力。在三个足跟区域测量峰值压力和压力剂量：减压区域、减压区域的周边和周边区域。
简单减压配置可降低减压区域的压力；然而，减压区域周边的压力显著增加。根据 ANOVA，与现有的测试解决方案相比，“分级刚度”减压配置在降低和重新分布足跟峰值压力和压力剂量方面更有效，考虑到所有足跟区域。
“分级刚度”减压解决方案展示了一种新颖的灵活和定制化解决方案，可以通过精确选择分级刚度减压位置和材料特性，按需制造，以适合溃疡的形状和大小。本研究是在健康人群中对我们之前的计算建模工作的后续体内初步研究，该研究报告了“分级刚度”配置的效率，并强调了其在简化和优化糖尿病性足跟溃疡的预防和治疗方面的潜力。
