DESIGN CRITERIA FOR THERAPEUTIC FOOTWEAR IN DIABETES

描述：（改编自研究者摘要）下肢截肢 在糖尿病患者中仍然是一个主要的公共卫生问题。更 在美国，每年有超过65，000例糖尿病患者接受截肢手术， 尽管最近作出了努力，但这一数字仍在增加。溃疡在 神经病足是截肢和治疗鞋的主要先驱 已被证明是预防溃疡的重要组成部分。不幸的是， 仍然没有总体的指导方针来帮助处方， 这种鞋的结构。调查人员认为， 理解将给定的"有风险"的神经病足与 给定的治疗性鞋类干预不太可能仅仅从人 实验工作。基于令人鼓舞的试点结果，他们建议 在这个应用程序中，在ABAQUS中开发了一系列越来越复杂的 基于个体高分辨率MRI的前足有限元模型 图像.这些模型将包括屈肌腱的动作，足底 筋膜，跗横韧带，前足的主要关节和 脚和地面或鞋之间的滑动界面。一些 建议进行力学试验，以确定材料特性和模型边界 条件将使用独特的尸体模型和 通过测量行走中的人的压力和足底组织厚度， 科目一旦在这些简单的条件下实现了准确的预测， 一系列典型的鞋类修改将被检查。这些将包括 不同厚度和硬度的鞋垫，用于局部应力释放的"塞子"， 跖骨垫和具有模制前足的鞋垫。这些结果将再次 根据尸体和人类受试者测量进行验证。这项工作应 导致足部建模的显著进步，并且应该提供。 详细了解鞋类干预的设计原则 可以减少前脚掌的足底压力

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