Biomechanical Properties of the Foot Sole in Diabetic Mellitus Patients: A Preliminary Study to Understand Ulcer Formation
Biomechanical Properties of the Foot Sole in Diabetic Mellitus Patients: A Preliminary Study to Understand Ulcer Formation
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糖尿病患者足底的生物力学特性：了解溃疡形成的初步研究
DOI：
10.4018/ijbce.2014010101
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发表时间：
2014
期刊：
影响因子：
--
通讯作者：
R. Periyasamy
中科院分区：
文献类型：
--
作者：
V. Narayanamurthy;R. Poddar;R. Periyasamy
本文评估和量化了足底的生物力学特性，如保护感觉的丧失、足底的硬度和称为功率比(PR)的压力分布参数及其变化，这些特性对溃疡的形成有直接的影响。为了了解这些参数之间的相互作用及其在溃疡形成中的作用，我们开发了一个新的参数--PRS指数。2003年12月至2007年6月在糖尿病足诊所就诊的所有糖尿病患者都要接受标准的足部检查。本研究以652例糖尿病患者为研究对象，其中包括57例溃疡患者。生物力学性能包括保护性感觉丧失(LOPS)，用10gm Semmes Weinstein单丝(SWMF)测量。使用硬度计(ASTM-D2240标准)测试鞋底硬度或缺乏柔韧性。足底压力测量使用PedoPowerGraph(P)，它测量压力分布参数PR。还测量了影响足底溃疡形成的鞋垫硬度等足部磨损特性。对有胃溃疡病史的糖尿病患者，可客观测量上述重要参数并计算出PRS指标值。我们发现，单独的PR或STARK实体不能预测溃疡形成的风险。在这项研究中，我们发现有溃疡病史的糖尿病患者的新的PRS指数值与既往溃疡患者病史的PRS指数之间存在显著的相关性(即p<；0.05水平)。与无溃疡病史的糖尿病患者无明显相关性，这可能是由于糖尿病患者随机穿着不同程度的鞋所致。从病例研究中我们发现，如果患者穿着合适的20度后倾角的MCR鞋，足底的PRS指数值和其他生物力学参数可以被逆转。使用适当的鞋类表明，这些参数易于测量，从而防止溃疡的形成，如先前的研究所述。以前有几种方法用于预测糖尿病患者的溃疡。但在这项研究中，我们研究了新的指标PRS及其在预测溃疡中的作用。使用适当的鞋类将逆转肥大反应；这可以通过prs指数来量化。我们发现，使用20度岸边的MCR鞋适当地卸载压力，可以降低PRS指数。
This aricle evaluates and quantifies the biomechanical properties of the foot sole like – loss of protective sensation, hardness of the foot sole and pressure distribution parameter called Power ratio (PR) and its alterations, which have a direct effect on ulcer formation. A new parameter PRS Index is developed to understand the interplay between these parameters and its role in ulcer formation. All diabetic subjects attending the Diabetic foot clinic from Dec2003 to June 2007 undergo a standard foot examination. A total of 652 diabetic patients including 57 ulcer patients are taken for our study. The biomechanical properties include loss of protective sensation (LOPS) which is measured by 10 gm Semmes Weinstein Monofilament (SWMF). Hardness of the foot sole or absence of suppleness is tested using the Durometer (ASTM-D 2240 standards). Plantar pressure measurement is done using the PedoPowerGraph(p) which measures pressure distribution parameter PR. Foot wear properties like hardness of the insole affecting the formation of plantar ulcers was also measured. The above mentioned important parameters can be measured objectively and calculate PRS index value for diabetic with history of previous ulcer patients. We found a single entity of either the PR or shore independently cannot predict the risk for ulcer formation. In this study we found new PRS index value for diabetic with history of previous ulcer patients show significant correlation (i.e. p<0.05 level) between footwear shore and PRS index for history of previous ulcer patients. No significant correlation was shown for diabetic without history of previous ulcer patients and this may be due to diabetic patients are wearing footwear randomly with different degree Shore. From the case studies we found that the PRS index values and other biomechanical parameter of the foot sole can be reversed if the patients wear proper MCR footwear with 20 degree Shore. Use of appropriate footwear has shown that these easily measurable parameters and thus prevent ulcer formation as mentioned in the earlier studies. Several methods are used previously for predicting ulceration in DM patients. But in this study the new index PRS was studied and its role in predicting ulceration. Use of appropriate footwear will reverse the hypertrophic response; this can be quantified by the PRS index. We have found that there is decrease in PRS index by proper off loading the pressure using 20-degree shore MCR footwear.