Development of measurement techniques to identify and characterise diabetic foot ulceration and foot health conditions

糖尿病是一种全球普遍存在的疾病，其相关影响是软组织和神经功能的改变。这些变化导致脚底压力异常高的区域，从而增加了溃疡形成和其他足部健康状况的易感性。不到一半的糖尿病足溃疡（DFU）愈合，高达60%的人会发生感染，29-80%的人需要在五年内进行一定程度的下肢截肢。dfu会使人严重衰弱，并伴随相关的社会和经济压力，影响患者的生活质量和医疗服务。临床评估DFU的方法通常包括目视检查足底表面和泡沫铸造来确定足底拓扑结构，这两种方法都忽略了足底压力和动态运动。其他测量技术包括鞋内感应，它利用足底压力峰值来预测溃疡的风险并指导治疗。虽然研究发现峰值压力与溃疡形成之间存在一定的相关性，但足底剪切力已被确定为影响DFU形成的因素，除了在各自位置发现差异b[2]。因此，了解糖尿病患者足底表面表现出的剪切力可能是指导更好的预防和治疗程序的关键。目前的测量技术昂贵、耗时且忽略剪切载荷。这限制了它们在临床环境中的应用，以及在英国和全球资源匮乏地区的应用，在这些地区，dfu的相关挑战被放大了。为了解决这些限制，利兹大学的研究集中在测量技术的发展上，这些技术可用于表征赤脚和穿鞋条件下的剪切载荷[3,4]。特别是，一种方法是使用一种称为数字图像相关（DIC）的计算机图像分析技术来确定鞋垫在行走过程中是如何变形的，这是一种低成本的方法来测量足部负荷bb0。这项技术有可能提高我们对DFU形成的理解，以及如何制定预防措施，并有望在临床环境中应用。本研究将扩展这些方法，开发新的方法，将当前的2D （DIC）分析转换为能够从测量应变确定负载剖面的3D方法。这对进一步理解DFU的发展将是一个有价值的贡献。这项工作在低资源和高资源环境下都具有临床意义。该研究将与行业合作伙伴一起探索未来的翻译，以扩大影响和临床效益。目的：本项目旨在开发一种强大的和临床适当的方法，使用数字图像相关测量足底负荷，以表征足部健康状况。目的:1。三维DIC技术用于捕获穿鞋和不穿鞋足底应变曲线的发展改进材料和方法，使临床和低资源环境下的可靠交付成为可能。从实测应变数据确定载荷剖面的反方法的发展通过健康和临床人群（特别是糖尿病和银屑病关节炎患者）的研究评估测量方法开发机会，将研究成果转化为矫形器行业和临床实践。在文献中发表方法和研究数据集

Diabetes is a globally prevalent condition, with the associated affects being altered soft tissues and nerve function. These changes result in areas of abnormally high plantar pressures and thus increased susceptibility to ulcer formation and other foot health conditions. Fewer than half of diabetic foot ulcers (DFU) heal, with up to 60% developing an infection and 29-80% requiring some degree of lower extremity amputation within five years [1]. DFUs are significantly debilitating, with associated social and economic pressures that impact both patient quality of life and healthcare services. Clinical methods of assessment for DFU typically involve visual inspection of the plantar surface together with foam casting to determine plantar topology, both of which neglect plantar pressure and dynamic movement. Other measurement techniques include in-shoe sensing, which use peak plantar pressures to predict risk of ulceration and guide treatment. Although research has found some-what of a correlation between peak pressure and ulcer formation, plantar shear force has been identified as an influence in DFU formation, in addition to disparities found in their respective locations [2]. Therefore, understanding the shear forces exhibited in the plantar surfaces of diabetic patient's feet could be key to guide better preventative and treatment procedures. Current measurement techniques are expensive, time-consuming and neglect shear loads. This restricts their application in clinical settings as well as low-resource areas, both in the UK and globally, where the associated challenges of DFUs are amplified. To address these limitations, research at Leeds has focussed on the development of measurement techniques which can be used to characterise shear loads in barefoot and in-shoe conditions [3,4]. In particular, one approach uses a computer image analysis technique called Digital Image Correlation (DIC) to determine how an insole deforms during walking as a low-cost way to measure aspects of foot loading [5]. The technique has the potential to improve our understanding of DFU formation and how to develop preventative measures, with promise for translation into use within a clinical environment. This research will extend these approaches, developing novel approaches to transform the current 2D (DIC) analysis into a 3D method capable of determining load profiles from measured strain. This will be a valuable contribution to further understanding of DFU development. The work has clinical relevance in both low and high-resource settings. The research will link with industry partners to explore future translation to broaden impact and clinical benefit. Aim: This project aims to develop a robust and clinically appropriate approach to using Digital Image Correlation for the measurement of plantar loads to characterise foot health conditions. Objectives: 1. Development of 3D DIC techniques to capture shod and unshod plantar strain profiles 2. Refinement of materials and methods to enable robust delivery in clinical and low-resource settings 3. Development of inverse-methods to determine load profiles from measured strain data 4. Evaluation of measurement methods through studies in healthy and clinical populations (specifically those with diabetes and Psoriatic arthritis) 5. Develop opportunities to translate research to the orthotics industry and clinical practice 6. Publication of methods and study datasets in the literature