Reducing Internal Stresses in Deformed Diabetic Feet

项目总结/摘要 脚是运动过程中身体与地面相互作用的主要物理手段。的 足部的形状或结构与内在组织特征相结合决定了足部之间的力 各种组织层（即，内部应力）。异常的内部压力被认为会导致糖尿病， 神经性溃疡本提案的成功完成将有助于更好地了解 由于糖尿病引起的足部畸形和组织特征的变化改变了这些应力。对于糖尿病患者 失去保护性感觉和足部畸形的人，高压力会导致溃疡 发展和潜在的截肢。人们普遍希望采取干预措施，减少这些压力。 然而，在技术上非常具有挑战性的是，测量内部组织变形以比较各种组织变形的程度。 治疗策略降低内部压力。因此，本研究的目的是开发一种患者- 特定的计算模型，以探索足部畸形和僵硬的糖尿病组织如何导致增加 内部应力，并量化保守和手术治疗方案如何调节这些 压力我们的具体目标是：[1]开发患者特定的计算足部模型， 足部状况的范围，包括：i）健康，ii）糖尿病性神经病，iii）具有爪状脚趾的糖尿病性神经病， 和iv）具有溃疡史的糖尿病性神经病;适当时，手术前和手术后和/或 还将模拟保守治疗方案。[2]为了探索这些疾病和治疗方法 增加或减少足部的内应力。[3]为了减少产生病人的时间- 特定计算脚模型。患者特异性计算足部模型将从高度 详细的CT扫描和专门的装载装置将用于量化软组织解剖和 MRI扫描的机械性能。两者都是保守的（即，鞋垫）和外科手术（即，校正 爪趾）治疗方案也将建模，以确定这些技术是否实际上由于较低的内部 压力这项研究的长期目标是增加计算足部模型的临床可用性。作为 这种先进的数学技术将用于减少创建患者特异性 模型这项研究与退伍军人事务部使命和退伍军人群体有关，退伍军人群体一般年龄较大， 糖尿病和足部并发症的发病率高于整个人群。

Project Summary/Abstract The foot is the primary physical means of interaction between the body and the ground during locomotion. The shape or structure of the foot combined with the intrinsic tissue characteristics dictates the forces between various tissue layers (i.e., internal stresses). Aberrant internal stresses are thought to cause diabetic, neuropathic ulceration. The successful completion of this proposal will provide a better understanding of how foot deformity and changes in tissue characteristics due to diabetes alter these stresses. For diabetic patients who have lost protective sensation and who may have misshapen feet, high stresses can lead to ulcer development and potentially amputation. Interventions that might reduce these stresses are widely desired. However, it is technically very challenging to measure internal tissue deformation to compare how various treatment strategies lower internal stresses. Therefore, the purpose of this study is to develop a patient- specific computational model to explore how foot deformity and stiffer diabetic tissues can lead to increased internal stresses, and to quantify how conservative and surgical treatment options can modulate these stresses. Our specific aims are: [1] To develop patient-specific computational foot models of subjects with a range of foot conditions, including: i) healthy, ii) diabetic neuropathic, iii) diabetic neuropathic with claw toes, and iv) diabetic neuropathic with a history of ulceration; where appropriate, both pre- and post-surgical and/or conservative treatment options will also be modeled. [2] To explore how these conditions and treatments increase or decrease the internal stress in the foot. [3] To reduce the time required to generate a patient- specific computational foot model. Patient-specific computational foot models will be generated from highly detailed CT scans, and specialized loading devices will be used to quantify soft tissue anatomical and mechanical properties from MRI scans. Both conservative (i.e., shoe inserts) and surgical (i.e., correction of clawed toes) treatment options will also be modeled to determined if these techniques due in fact lower internal stresses. A long-term goal of this research is to increase the clinical usability of computational foot models. As such, advanced mathematical techniques will be used to reduce the time needed to create the patient-specific models. This research is relevant to the VA mission and the veteran population, which is in general older and has higher incidences of diabetes and foot complications than the population as a whole.