Pressure relief and load redistribution by custom-made insoles in diabetic patients with neuropathy and foot deformity
Pressure relief and load redistribution by custom-made insoles in diabetic patients with neuropathy and foot deformity
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DOI：
10.1016/j.clinbiomech.2004.02.010
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发表时间：
2004-07-01
影响因子：
1.8
通讯作者：
Cavanagh, PR
中科院分区：
文献类型：
--
作者：
Bus, SA;Ulbrecht, JS;Cavanagh, PR
Objective.目的：研究定制鞋垫对神经病变糖尿病足畸形患者足底压力和负荷重分布的影响。Cross-sectional.Background.尽管糖尿病患者通常会服用定制鞋垫，但有关其机械作用的定量数据却很少。方法。在步行过程中，测量了20名患有足部畸形的神经病糖尿病受试者的足部区域鞋内峰值压力和力-时间积分，这些受试者穿着平坦或定制的鞋垫。对第一跖骨头溃疡风险升高的21只足进行了分析。使用一种新的载荷转移算法对定制鞋垫引起的载荷再分配进行了评估。定制鞋垫显着降低了峰值压力和力-时间积分在脚跟和第一跖骨头区域;压力和积分显着增加，在内侧中足区域相比，平坦的鞋垫。定制鞋垫成功地减少了7/21英尺的第一跖骨头的压力和积分，在另外7个中取得了中等成功，但在其余7个中失败了。从足跟外侧到中足内侧区域的负荷转移最大。定制鞋垫比平坦鞋垫在减轻第一跖骨头区域的负荷方面更有效，但个体之间存在相当大的差异。大多数卸载发生在脚跟（不是一个典型的风险区域）。负荷转移算法有效地分析定制鞋垫action.RelevanceBecause类似的鞋垫修改显然发挥不同的效果，在不同的患者，一个全面的评价，使用鞋内压力测量定制设计，理想情况下，应进行前分配鞋垫糖尿病患者的神经病变和足部畸形。(C)2004年由Elsevier Ltd.出版。
Objective. To study the effects of custom-made insoles on plantar pressures and load redistribution in neuropathic diabetic patients with foot deformity.Design. Cross-sectional.Background. Although custom-made insoles are commonly prescribed to diabetic patients, little quantitative data on their mechanical action exists.Methods. Regional in-shoe peak pressures and force-time integrals were measured during walking in the feet of 20 neuropathic diabetic subjects with foot deformity who wore flat or custom-made insoles. Twenty-one feet with elevated risk for ulceration at the first metatarsal head were analysed. Load redistribution resulting from custom-made insoles was assessed using a new load-transfer algorithm.Results. Custom-made insoles significantly reduced peak pressures and force-time integrals in the heel and first metatarsal head regions; pressures and integrals were significantly increased in the medial midfoot region compared with flat insoles. Custom-made insoles successfully reduced pressures in and integrals at the first metatarsal head in 7/21 feet, were moderately successful in another seven, but failed in the remaining seven. Load transfer was greatest from the lateral heel to the medial midfoot regions.Conclusions. Custom-made insoles were more effective than flat insoles in off-loading the first metatarsal head region, but with considerable variability between individuals. Most off-loading occurred in the heel (not a region typically at risk). The load transfer algorithm effectively analyses custom-made-insole action.RelevanceBecause similar insole modifications apparently exert different effects in different patients, a comprehensive evaluation of custom designs using in-shoe pressure measurement should ideally be conducted before dispensing insoles to diabetic patients with neuropathy and foot deformity. (C) 2004 Published by Elsevier Ltd.