Evaluation of orthotic insoles for people with diabetes who are at-risk of first ulceration
Evaluation of orthotic insoles for people with diabetes who are at-risk of first ulceration
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DOI：
10.1186/s13047-019-0344-z
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发表时间：
2019-06-18
影响因子：
2.9
通讯作者：
Nester, Christopher J.
中科院分区：
文献类型：
--
作者：
Martinez-Santos, Ana;Preece, Stephen;Nester, Christopher J.
本研究的重点是缓解压力的矫形鞋垫，专为零售鞋类和糖尿病患者而设计，有第一前足溃疡的风险。研究设计与方法采用患者特定的足底形状设计了一种矫形鞋垫，根据足底压力数据来定制足底的位置和形状。当60名患有糖尿病和神经病变的人穿着9种不同的矫形鞋垫行走时，研究了前足足底压力的变化。结果与结论当跖骨棒前缘位于峰值压力的77%时，其压力下降最为频繁，其影响与EVA或Poron卸荷材料的选择无关。在扁平鞋垫中，61%的参与者有一个或多个跖头区，压力超过200Kpa，采用通用矫形器设计规则时减少到58%，使用9个受试者中最好的矫形器鞋垫时减少到51%。我们的结果证实，足底压力释放对矫形鞋垫的设计决定和个体患者的脚是敏感的。
ObjectiveThis study focussed on pressure relieving orthotic insoles designed for retail footwear and people with diabetes and at risk of first forefoot ulceration. The aim was to investigate whether the pressure relieving effects of a customised metatarsal bar and forefoot cushioning are sensitive to bar location and shape, and material choice.Research design and methodsPatient-specific foot shape was used to design an orthotic insole, with metatarsal bar location and shape customised according to plantar pressure data. Changes in forefoot plantar pressure were investigated when 60 people with diabetes and neuropathy walked in nine variants of the orthotic insole. These comprised three variations in proximal/distal location of the customised metatarsal bar and three different metatarsal head offloading materials.Results & conclusionsThe most frequent reductions in pressure occurred when the anterior edge of the metatarsal bar was placed at 77% of the peak pressure values, and its effects were independent of the choice of EVA or Poron offloading material. In the flat insole, 61% of participants had one or more metatarsal head areas with pressure above the 200KPa, reducing to 58% when adopting generic orthotic design rules and 51% when using the best orthotic insole of the nine tested. Our results confirm that plantar pressure relief is sensitive to orthotic insole design decisions and individual patient feet.