Investigation of Plantar Shear Stresses in Diabetic Patients: Relevance to Foot U

糖尿病患者足底剪切应力的调查：与足 U 的相关性

• 批准号: 7882144
• 负责人: Metin Yavuz
• 金额: $ 14.64万
• 依托单位: OHIO COLLEGE OF PODIATRIC MEDICINE
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-08-01 至 2012-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7882144
• 关键词: Amputation; Area; Biomechanics; Bone callus; Characteristics; Complication; Custom; Data; Devices; Diabetic Foot; Diabetic Foot Ulcer; Diabetic Neuropathies; Diabetic ulcer; Diagnosis; Disease; Etiology; Face; Failure; Fatigue; Foot Ulcer; Frequencies; Gait; Healthcare; Healthcare Systems; Individual; Intervention; Investigation; Lead; Lesion; Lifting; Limb structure; Location; Low Prevalence; Lower Extremity; Masks; Measures; Mechanics; Neuropathy; Pathology; Pathway interactions; Patients; Peripheral Nervous System Diseases; Plantar Ulcers; Play; Prevalence; Prevention; Preventive; Prospective Studies; Receiver Operating Characteristics; Recording of previous events; Research; Risk; Role; Sampling; Savings; Sensitivity and Specificity; Site; Skin callus; Stress; Surface; Symptoms; Tissues; Ulcer; Ursidae Family; Wound Healing; cost; design; diabetic; diabetic patient; experience; foot; foot sole; human subject; interest; pressure; prevent; psychologic; public health relevance; shear stress; tool

DESCRIPTION (provided by applicant): Diabetic foot ulcers continue to burden US healthcare system with an annual cost of $11 billion and yearly amputation rates of 100,000. Unfortunately, the exact etiology of the problem remains to be resolved. Developing effective footwear and intervention strategies to prevent diabetic amputations requires a comprehensive understanding of the complication pathway. Diabetic foot lesions are known to have a biomechanical pathology that involves increased stresses acting under the foot. However, studies have shown that foot pressure alone is not a good predictor of ulcerations. This is due to the fact that ulcers might occur at pressure levels that are not considered harmful and locations that do not bear peak pressures. Preliminary studies suggest a relationship between diabetic foot ulcers and shear stress, the other mechanical component, which occur at the foot-ground interface. These studies demonstrated the importance of plantar shear by revealing elevated shear stresses in diabetic patients with respect to control subjects, while foot pressures remained the same. Studies by others have shown that frictional shear stresses are responsible for creating calluses, which are known to be strongly associated with the occurrence of diabetic foot lesions. The significance of shear stresses arises from the fact that they fundamentally act with twice the temporal frequency of pressure under the foot. It is hypothesized that diabetic foot wounds are associated with high frictional shear forces experienced on the plantar surface of the lower extremity. Unlike earlier preliminary studies, this study will investigate plantar shear stresses in a large sample of subjects classified under four groups and a location-wise relationship between foot lesions and frictional shear stresses. The first specific aim of this study is to investigate and compare peak shear stress values, which will be obtained by a custom-built device in a total of 153 subjects. These subjects will include; (a) diabetic neuropathic patients with an ulcer history, (b) diabetic neuropathic patients without previous ulcers, (c) diabetic control patients and (d) healthy individuals. The second specific aim will explore whether previous foot ulcers developed at peak shear locations, in patients with recently healed wounds. If the presence of such an association is confirmed, these data will provide invaluable information in the design of preventive approaches to lower the prevalence of diabetic foot wounds. Prevention of diabetic foot ulcers will lift not only the financial burden on the US healthcare, but also the physical and psychological burden on diabetic patients who are vulnerable to complication. PUBLIC HEALTH RELEVANCE: Although the exact etiology of the diabetic neuropathic foot ulcerations is still not known, it is thought that these lesions are directly related with increased frictional shear forces under the diabetic foot. If the hypotheses of this study are confirmed, then the US healthcare system will realize substantial savings by the effective design of preventive devices and approaches aiming at reducing the prevalence of diabetic foot ulcers. Furthermore, diabetic neuropathic patients, who have to face the risk of losing their limbs, will be provided with greater physical and psychological comfort.

描述（由申请人提供）：糖尿病足溃疡继续给美国医疗保健系统带来负担，每年花费110亿美元，每年截肢率为10万。不幸的是，问题的确切病因仍有待解决。开发有效的鞋类和干预策略，以防止糖尿病截肢需要全面了解并发症的途径。已知糖尿病足病变具有生物力学病理学，其涉及作用于足部下的应力增加。然而，研究表明，足部压力本身并不是溃疡的良好预测因素。这是因为溃疡可能发生在不被认为有害的压力水平和不承受峰值压力的位置。初步研究表明，糖尿病足溃疡和剪切应力之间的关系，另一个机械组件，发生在脚-地面界面。这些研究通过揭示糖尿病患者相对于对照受试者的剪切应力升高而足底压力保持不变来证明足底剪切的重要性。其他人的研究表明，摩擦剪切应力是产生老茧的原因，已知老茧与糖尿病足病变的发生密切相关。剪应力的重要性来自于这样一个事实，即它们基本上以脚下压力的时间频率的两倍作用。据推测，糖尿病足伤口与下肢足底表面上经历的高摩擦剪切力相关。与早期的初步研究不同，本研究将调查足底剪切应力在一个大样本的主题分为四组和位置明智的足部病变和摩擦剪切应力之间的关系。本研究的第一个具体目的是研究和比较峰值剪切应力值，该值将通过定制器械在总计153例受试者中获得。这些主题将包括：（a）具有溃疡病史的糖尿病神经病患者，（B）先前没有溃疡的糖尿病神经病患者，（c）糖尿病对照患者和（d）健康个体。第二个具体目标将探索在最近愈合伤口的患者中，先前的足部溃疡是否在峰值剪切位置发展。如果这种关联的存在得到证实，这些数据将为设计预防方法以降低糖尿病足伤口的患病率提供宝贵的信息。预防糖尿病足溃疡不仅可以减轻美国医疗保健的经济负担，还可以减轻易患并发症的糖尿病患者的身心负担。 公共卫生相关性：虽然糖尿病神经性足溃疡的确切病因尚不清楚，但认为这些病变与糖尿病足下摩擦剪切力增加直接相关。如果本研究的假设得到证实，那么美国医疗保健系统将通过有效设计旨在降低糖尿病足溃疡患病率的预防性器械和方法来实现大量节省。此外，糖尿病神经病患者面对失去肢体的风险，将获得更大的身心安慰。