DESIGN CRITERIA FOR THERAPEUTIC FOOTWEAR IN DIABETES

描述：(改编自《调查者摘要》)截肢 糖尿病患者的患病仍然是一个主要的公共卫生问题。更多 在美国，每年有超过6.5万例糖尿病患者接受截肢手术 而且，尽管最近做出了努力，这一数字仍在增加。胃部溃疡 神经性足是截肢和治疗用鞋的主要先驱。 已被证明是预防溃疡的重要组成部分。不幸的是， 目前还没有全面的指导方针来帮助处方和 这种鞋的构造。调查人员认为，一项全面的 对给定的“有风险”的神经性足与 一种特定的治疗性鞋类干预措施不太可能只来自人类 试验性工作。基于令人鼓舞的试点结果，他们因此建议 在此应用程序中开发了ABAQUS中日益复杂的一系列 基于个体化高分辨率MRI的前足有限元模型 图像。模型将包括屈肌腱、足底的作用 筋膜、颧横韧带、前足主要关节和 脚部与地面或鞋类之间的滑动界面。一批 建议进行力学试验以确定材料特性和模型边界 条件。这些模型将使用唯一的身体模型和 通过测量步行人体的压力和足底组织厚度 研究对象。一旦在这些简单的条件下实现了准确的预测， 我们将研究一系列典型的鞋类改进。这些措施包括 不同厚度和硬度的鞋垫，局部缓解应力的“塞子”， 趾垫，以及前脚模压的鞋垫。这些结果将再次 根据身体和人体受试者的测量结果进行验证。这项工作应该是 在脚部的建模方面取得了显著的进步，并且应该提供。 详细了解鞋类干预措施的设计原则 这可以减少脚底前脚的压力

DESCRIPTION: (adapted from Investigator's abstract) Lower extremity amputation in people with diabetes continues to be a major public health problem. More than 65,000 amputations are performed annually on diabetic patients in the US and, despite recent efforts, this number is increasing. Ulceration in the neuropathic foot is a major precursor of amputation and therapeutic footwear has been shown to be an important component of ulcer prevention. Unfortunately, there are still no overall guidelines to help with the prescription and construction of such shoes. The investigators believe that a comprehensive understanding of the problem of matching a given "at risk" neuropathic foot to a given therapeutic footwear intervention is unlikely flow just from human experimental work. Based on encouraging pilot results, they therefore propose in this application to develop in ABAQUS a series of increasingly complex finite element models of the forefoot based upon individual high resolution MRI images. The models will include the action of the flexor tendons, the plantar fascia, the transverse tarsal ligament, the major joints of the forefoot and a sliding interface between the foot and the ground or the footwear. A number of mechanical tests are proposed to develop material properties and model boundary conditions. The models will be validated using both a unique cadaver model and by measurements of pressure and plantar tissue thickness in walking human subjects. Once accurate predictions are achieved under these simple conditions, a series of typical footwear modifications will be examined. These will include insoles of different thickness and stiffness, "plugs" for local stress relief, metatarsal pads, and insoles with a molded forefoot. These results will again be validated against cadaver and human subject measurements. This work should result in significant advances in the modeling of the foot, and should provide. a detailed understanding of the design principles for footwear interventions that can reduce plantar pressure under the forefoot