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Design Criteria for Therapeutic Footware in Diabetes

糖尿病治疗鞋的设计标准

基本信息

批准号：
7619966
负责人：
PETER Robert CAVANAGH
金额：
$ 40.04万
依托单位：
UNIVERSITY OF WASHINGTON
依托单位国家：
美国
项目类别：
财政年份：
2000
资助国家：
美国
起止时间：
2000-09-10 至 2012-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7619966
关键词：
Accounting Affect Amputation Anecdotes Biomechanics Characteristics Complex Complications of Diabetes Mellitus Cost Savings Data Deformity Diabetes Mellitus Diabetic Foot Elements Ensure Etiology Failure Foot Ulcer Frequencies Grant Healed Health Care Costs Individual Intervention Lead Leg Ulcer Limb structure Lower Extremity Measurement Measures Mechanics Metatarsal bone structure Methods Minority Modeling Modification Neuropathy Patients Pattern Phase Primary Prevention Property Prophylactic treatment Psyche structure Public Health Quality of life Recurrence Rehabilitation therapy Research Project Grants Risk Secondary Prevention Secondary to Shoes Simulate Skin Stress Structure Techniques Therapeutic Thick Time Tissues Ulcer Ultrasonography United States Validation Variant base design diabetic patient experience foot healing high risk improved lifetime risk model development novel pressure prevent research study sensory neuropathy simulation skills success tool

项目摘要

DESCRIPTION (provided by applicant): Foot complications of diabetes adversely affect public health. Estimated lifetime risk of foot ulcers in diabetic patients is 25%; ulcers cause most of the 80,000 lower-extremity amputations in U.S. diabetic patients annually. Health-care costs total $11 billion per year, with minorities disproportionately affected. Skin ulceration in neuropathic diabetic feet arises from mechanical contact between the foot and shoe that such patients cannot feel. Unsurprisingly, the foot-shoe interface is a prime focus of study. However, design of therapeutic footwear for diabetic patients remains based on anecdote; pedorthists' skills are rarely informed by scientific data. We propose to build on our successfully applied finite element (FE) method to foot biomechanics (grant 5R01 HD037433). We will provide guidance for designing therapeutic insoles and explore techniques for patient-specific modeling. In Specific Aim 1, using 3D patient-specific FE models, we will define general principles for insole design to ensure plantar pressure relief in different foot types of those without significant deformity or abnormal focal pressure. To simulate structure/function, our novel optimization technique will help define a "loading state" for the model, allowing configuration change. In the validation phase, we will directly compare measured with predicted plantar pressures in flat vs. conforming insoles, multi-layers vs. single layers, varying insole thicknesses, and differing insole material properties available for primary prevention. In Specific Aim 2, we will examine the feasibility of modeling at-risk feet with single or multiple regions of elevated plantar pressure based on pressure measurements. We will develop patient-specific models obtained by "morphing" the FE meshes from Specific Aim 1, based on anthropometric data and tissue-thickness measurements derived from ultrasound. In Specific Aim 3, we will use models of multi-featured therapeutic insoles for at-risk feet (e.g., metatarsal pads, bars, altered arch supports, and variations in material depth under individual MTHs) that will be validated using in-shoe pressure1 measurements. These experiments and simulations should lead to (a) a set of general rules for therapeutic insole design and (b) a tool for patient-specific modeling in complex cases. If lower-extremity ulcers can be prevented before they lead to amputation, the U.S. will realize substantial cost savings in terms of patient quality of life and less need for lengthy rehabilitation, with its associated mental and physical suffering.

描述（由申请人提供）：糖尿病足部并发症对公众健康产生不利影响。糖尿病患者终生发生足部溃疡的风险估计为 25%；每年美国糖尿病患者有 80,000 例下肢截肢，其中大部分是由溃疡引起的。医疗保健费用每年总计 110 亿美元，其中少数族裔受到的影响尤为严重。神经性糖尿病足的皮肤溃疡是由于患者感觉不到的足部和鞋子之间的机械接触而引起的。毫不奇怪，脚与鞋的界面是研究的主要焦点。然而，针对糖尿病患者的治疗鞋的设计仍然基于轶事。足操者的技能很少有科学数据支持。我们建议以我们成功应用于足部生物力学的有限元 (FE) 方法为基础（授权 5R01 HD037433）。我们将为设计治疗鞋垫提供指导，并探索针对患者特定建模的技术。在具体目标 1 中，使用 3D 患者特定 FE 模型，我们将定义鞋垫设计的一般原则，以确保不同脚型（无明显畸形或异常局部压力的脚型）的足底压力缓解。为了模拟结构/功能，我们新颖的优化技术将帮助定义模型的“加载状态”，从而允许配置更改。在验证阶段，我们将直接比较平底鞋垫与适形鞋垫、多层鞋垫与单层鞋垫、不同鞋垫厚度以及可用于一级预防的不同鞋垫材料特性的测量值与预测足底压力。在具体目标 2 中，我们将研究基于压力测量对具有单个或多个足底压力升高区域的危险脚进行建模的可行性。我们将根据人体测量数据和超声得出的组织厚度测量数据，通过“变形”特定目标 1 中的有限元网格来开发患者特定模型。在具体目标 3 中，我们将使用针对高危足部的多功能治疗鞋垫模型（例如，跖骨垫、横梁、改变的足弓支撑以及个别 MTH 下材料深度的变化），并使用鞋内压力1测量进行验证。这些实验和模拟应该产生（a）一套治疗鞋垫设计的一般规则和（b）一种在复杂情况下针对患者进行建模的工具。如果下肢溃疡能够在导致截肢之前得到预防，美国将在患者生活质量方面节省大量成本，并减少长期康复及其相关的精神和身体痛苦。

项目成果

期刊论文数量（10）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Nonsurgical strategies for healing and preventing recurrence of diabetic foot ulcers.

DOI：
10.1016/j.fcl.2006.06.004
发表时间：
2006-12-01
期刊：
Foot and ankle clinics
影响因子：
1.5
作者：
Cavanagh, Peter R;Owings, Tammy M
通讯作者：
Owings, Tammy M

Clustering and classification of regional peak plantar pressures of diabetic feet.

DOI：
10.1016/j.jbiomech.2012.09.007
发表时间：
2013-01-04
期刊：
Journal of biomechanics
影响因子：
2.4
作者：
Bennetts CJ;Owings TM;Erdemir A;Botek G;Cavanagh PR
通讯作者：
Cavanagh PR

Simple finite element models for use in the design of therapeutic footwear.

用于治疗鞋设计的简单有限元模型。

DOI：
10.1016/j.jbiomech.2014.07.020
发表时间：
2014
期刊：
Journal of biomechanics
影响因子：
2.4
作者：
Spirka,ThomasA;Erdemir,Ahmet;EwersSpaulding,Susan;Yamane,Ann;Telfer,Scott;Cavanagh,PeterR
通讯作者：
Cavanagh,PeterR

Comparison of hexahedral and tetrahedral elements in finite element analysis of the foot and footwear.