Virtually optimized insoles for offloading the diabetic foot: A randomized crossover study
Virtually optimized insoles for offloading the diabetic foot: A randomized crossover study
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DOI：
10.1016/j.jbiomech.2017.06.028
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发表时间：
2017-07-26
影响因子：
2.4
通讯作者：
Cavanagh, P. R.
中科院分区：
文献类型：
--
作者：
Telfer, S.;Woodburn, J.;Cavanagh, P. R.
将足部功能的客观生物力学测量方法整合到鞋垫的设计过程中，已被证明为足底溃疡的风险个体提供了增强的足底组织保护。利用数值建模技术的虚拟模拟的使用提供了进一步优化这些设备的潜在方法。在有足部溃疡风险的患者群体中，我们的目标是比较通过数值模拟技术优化的鞋垫与基于形状的设备的压力卸载性能。20名患有糖尿病和高危足病的参与者参加了这项研究。三对个性化鞋垫：一对基于形状数据，随后通过直接铣削制造；两对基于形状、压力和超声数据的设计，经过基于有限元分析的虚拟优化程序。对于后一套鞋垫设计，一双是通过直接铣削制造的，另一双是通过3D打印制造的。对于脚底压力较高的前足区域，分析了鞋垫的卸载性能。在88%的感兴趣区域中，与基于形状的装置相比，使用几乎优化的鞋垫导致了较低的峰值足底压力。总体而言，与基于形状的鞋垫相比，经过虚拟优化的鞋垫显著降低了峰值压力，与基于形状的鞋垫相比，碾压鞋垫的峰值压力平均降低了41.3千帕(p<；0.001，95%CI[31.151.5])，印刷设备的峰值压力平均降低了40.5kpa(p<；0.001，95%CI[26.4，54.5])。将虚拟优化集成到鞋垫设计过程中，与标准的基于形状的设备相比，卸载性能得到了改进。(C)2017爱思唯尔有限公司。保留所有权利。
Integration of objective biomechanical measures of foot function into the design process for insoles has been shown to provide enhanced plantar tissue protection for individuals at-risk of plantar ulceration. The use of virtual simulations utilizing numerical modeling techniques offers a potential approach to further optimize these devices. In a patient population at-risk of foot ulceration, we aimed to compare the pressure offloading performance of insoles that were optimized via numerical simulation techniques against shape-based devices. Twenty participants with diabetes and at-risk feet were enrolled in this study. Three pairs of personalized insoles: one based on shape data and subsequently manufactured via direct milling; and two were based on a design derived from shape, pressure, and ultrasound data which underwent a finite element analysis-based virtual optimization procedure. For the latter set of insole designs, one pair was manufactured via direct milling, and a second pair was manufactured through 3D printing. The offloading performance of the insoles was analyzed for forefoot regions identified as having elevated plantar pressures. In 88% of the regions of interest, the use of virtually optimized insoles resulted in lower peak plantar pressures compared to the shape-based devices. Overall, the virtually optimized insoles significantly reduced peak pressures by a mean of 41.3 kPa (p < 0.001, 95% CI [31.1, 51.5]) for milled and 40.5 kPa (p < 0.001, 95% CI [26.4, 54.5]) for printed devices compared to shape-based insoles. The integration of virtual optimization into the insole design process resulted in improved offloading performance compared to standard, shape-based devices. (C) 2017 Elsevier Ltd. All rights reserved.